Discontinuation rates of antidepressant use by Dutch soldiers

Abstract

Introduction: Soldiers have a higher risk for developing psychiatric disorders that require treatment;often with antidepressants. However, antidepressants as well as the psychiatric disorder, may influence military readiness in several ways. In the general population, early discontinuation of antidepressant treatment is often seen. It is yetunknown whether this occurs to a similar extent in soldiers. The objective of this study was to evaluate discontinuationof antidepressant use by Dutch soldiers in the first 12 months after start and determinants thereof. Materials andMethods: Data were obtained from the military pharmacy. All Dutch soldiers who started using an antidepressantbetween 2000 and 2014 were included. Kaplan-Meier curves were constructed to estimate the discontinuation rateover time and the influence of each determinant on discontinuation rate was estimated using Cox regression. Results:About 25.9% of de 2479 starters had discontinued their antidepressant use after 1 month; after 3 and 6 months thisnumber increased to 52.7% and 70.3%, respectively. Early discontinuation was higher in soldiers who received theirfirst prescription from a neurologist or rehabilitation specialist (HR 1.85, 95% CI 1.55-2.21, HR 2.66 95% CI1.97-3.58) compared to soldiers with a first prescription from a general practitioner. In addition, early discontinuationwas lower in soldiers who were prescribed serotonin reuptake inhibitors and other antidepressants (HR 0.57, 95% CI0.51-0.60, HR 0.63, 95% CI 0.55-0.73) and in soldiers between 40 and 50 years of age (HR 0.79, 95% CI 0.70-0.89).Conclusion: More than half of the soldiers discontinued their prescribed antidepressant within 3 months and after 6months, only 30% were still on antidepressants.