Systems redesign supports rational antidepressant use in everyday practice

Background: Antidepressant use has risen x3-5 in Western countries since the early 1990s, outstripping changes in depression incidence or prevalence. This represents a major public health challenge. Methods: Nationally-collected antidepressant data were used to assess the impact of "Doing Well", (DW) a novel depression care programme operating in Renfrewshire, Scotland. "Doing Well" implemented a model of ‘‘stepped collaborative care’’, practitioner education and significant service redesign. Prescribing was compared for three groups: "DW" (76,000 population; clinical and educational intervention), "DW neighbours’’ (101,000 population; educational interventions only), and Scotland (no specific intervention).] Results: A national rise in antidepressant prescriptions was stabilised for the "DW" group (graph). Antidepressant cost/item fell by 42% and 40% in both ‘‘DW’’ and ‘‘DW neighbours’’ groups but rose by 8% nationally. Conclusions: Access to clinical interventions are required to reduce antidepressant prescriptions, but cost savings may be made with educational interventions alone.