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BACKGROUND: Antidepressant switching is often indicative of treatment dissatisfaction; however, data regarding patterns, associated factors and timing of switching in children and adolescents remain limited. OBJECTIVES: This study aimed to determine switching patterns of antidepressant use and predictors of switching in Australian children and adolescents. METHODS: A retrospective cohort study of children and adolescents aged 5-18 years who initiated antidepressants between 2014 and 2022 was conducted, using a 10% random sample of the national Pharmaceutical Benefits Scheme dispensing data. We determined the proportions of initiators who switched between antidepressants within 12 months of initiation. A Cox proportional hazards model was used to determine the risk of switching by patient characteristic factors, and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) were reported. RESULTS: We included 44,381 child and adolescent antidepressant initiators, the most commonly initiated antidepressant being fluoxetine. Approximately one in six children and adolescents aged 5-18 years at initiation (15.0%) switched to a different antidepressant within the first 12 months. Most switches were to selective serotonin reuptake inhibitors. Individuals with a commonwealth healthcare concession card were less likely to switch antidepressants within 12 months (aHR 0.91, 95% CI 0.86, 0.96). Females (aHR 1.24, 95% CI 1.17, 1.31), those starting with antidepressants other than fluoxetine and concurrent anxiolytic users were more likely to switch. CONCLUSIONS: Switching between antidepressants is a common practice among children and adolescents in Australia, with most switches occurring during the early phases of treatment and primarily to selective serotonin reuptake inhibitors. A better understanding of the reasons for switching is important for informing tailored management approaches and improving treatment outcomes.
Kassie et al. (Fri,) studied this question.