Social Inequalities in Early Antidepressant Discontinuation

OBJECTIVE: This study aimed to test for social disparities in early discontinuation of antidepressant treatment and to explore associations with type of drug and composition of prescriber's clientele. METHODS: The cohort was 14,518 Marseille residents (ages 18-64 years) covered by the National Health Insurance Fund who had a new episode of antidepressant treatment (specifically, no prescription claim in the six months before the index claim) prescribed by a private general practitioner in 2008 or 2009. Factors associated with early discontinuation (prescription filled or refilled fewer than four times in the six months after the index claim) were analyzed with multilevel models that were adjusted for patient morbidity and number of consultations with private general practitioners and psychiatrists. Sensitivity analyses were conducted with different definitions of new treatment and early discontinuation. RESULTS: Low income, type of antidepressant (tricyclics versus selective serotonin reuptake inhibitors), and prescribers' clientele composition (specifically, a high proportion of socioeconomically disadvantaged patients) were independently associated with an increased risk of early antidepressant discontinuation. A significant interaction was found between low income and gender. Low-income patients were more likely than other patients to receive tricyclic antidepressants. CONCLUSIONS: These results add further evidence of inequalities in care for major depression and suggest that women are at greater disadvantage than men. Educational programs for general practitioners should focus on the risks of antidepressant discontinuation among disadvantaged patients. Enhancing therapeutic education of low-income patients may improve their treatment adherence.