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I was taking a look around some of the data for antidepressants and was wondering why there are sometimes such drastic decreases in spending. Spending for Escit

I was taking a look around some of the data for antidepressants and was wondering why there are sometimes such drastic decreases in spending. Spending for Escitalopram dropped over 80% in a single month[1]. There are a few others that had sharp drops in spending. Just curious, do you know why? In any case, it would be really interesting to see how legislation, lobbying, and current events (relative) may have affected this data. [1]: https://openprescribing.net/chemical/0403030X0 https://openprescribing.net/chemical/0403030X0

snthd 11y ago
https://en.wikipedia.org/wiki/Escitalopram#History https://en.wikipedia.org/wiki/Escitalopram#History Maybe the patent expiring. (WP talks about a US patent and this is the UK, so it's a guess)
- WeaselNo7 11y ago
  I read that as 'the patient expiring', which I believe would also have an effect on drug use.
DanBC 11y ago
I'm not sure about escitalopram. Possibly the NICE guidance changed and people stopped or started prescribing it? It's mentioned here: https://www.nice.org.uk/advice/ktt8/chapter/evidence-context https://www.nice.org.uk/advice/ktt8/chapter/evidence-context (First choice is a good quality talking therapy, but meds may be useful) > The full guideline on depression concluded that antidepressants have largely equal efficacy and that choice should mainly depend on side‑effect profile, people's preference and previous experience of treatments, propensity to cause discontinuation symptoms, safety in overdose, interactions and cost. However, a generic SSRI is recommended as first‑choice because of its favourable risk–benefit ratio. Neither escitalopram nor any of the available 'dual action' antidepressants, such as venlafaxine and duloxetine, were judged to have any clinically important advantages over other antidepressants. Results from meta‑analyses (Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder, Gartlehner et al. 2011 and 2 Cochrane reviews: Cipriani et al. 2012, CD006534 and Cipriani et al. 2012, CD006533) have provided no evidence to depart from NICE guidance when selecting antidepressants for people with depression. And similarly here: http://cks.nice.org.uk/depression#!scenario http://cks.nice.org.uk/depression#!scenario > Citalopram and escitalopram have been found to prolong the QT interval and are now contraindicated in people who are already taking medication known to prolong the QT interval as there may be an additive effect [Lundbeck Ltd, 2011a; Lundbeck Ltd, 2011b; MHRA, 2011]. Caution is advised in people with congenital long QT interval or who have pre-existing QT interval prolongation as they have a higher risk than average of developing a ventricular arrhythmia including Torsade de Pointes. But it's interesting.

snthd 11y ago

https://en.wikipedia.org/wiki/Escitalopram#History https://en.wikipedia.org/wiki/Escitalopram#History Maybe the patent expiring. (WP talks about a US patent and this is the UK, so it's a guess)

WeaselNo7 11y ago
I read that as 'the patient expiring', which I believe would also have an effect on drug use.

DanBC 11y ago

I'm not sure about escitalopram. Possibly the NICE guidance changed and people stopped or started prescribing it? It's mentioned here: https://www.nice.org.uk/advice/ktt8/chapter/evidence-context https://www.nice.org.uk/advice/ktt8/chapter/evidence-context (First choice is a good quality talking therapy, but meds may be useful) > The full guideline on depression concluded that antidepressants have largely equal efficacy and that choice should mainly depend on side‑effect profile, people's preference and previous experience of treatments, propensity to cause discontinuation symptoms, safety in overdose, interactions and cost. However, a generic SSRI is recommended as first‑choice because of its favourable risk–benefit ratio. Neither escitalopram nor any of the available 'dual action' antidepressants, such as venlafaxine and duloxetine, were judged to have any clinically important advantages over other antidepressants. Results from meta‑analyses (Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder, Gartlehner et al. 2011 and 2 Cochrane reviews: Cipriani et al. 2012, CD006534 and Cipriani et al. 2012, CD006533) have provided no evidence to depart from NICE guidance when selecting antidepressants for people with depression. And similarly here: http://cks.nice.org.uk/depression#!scenario http://cks.nice.org.uk/depression#!scenario > Citalopram and escitalopram have been found to prolong the QT interval and are now contraindicated in people who are already taking medication known to prolong the QT interval as there may be an additive effect [Lundbeck Ltd, 2011a; Lundbeck Ltd, 2011b; MHRA, 2011]. Caution is advised in people with congenital long QT interval or who have pre-existing QT interval prolongation as they have a higher risk than average of developing a ventricular arrhythmia including Torsade de Pointes. But it's interesting.