Work

A temporal network analysis of drug co-prescription during antidepressants and anxiolytics dispensing in the Netherlands from 2018 to 2022

Year: 2026

Type: article

Abstract: Drug prescription networks (DPNs) model the temporal dynamics of medication co-prescription within a population. Understanding these networks can provide insights into polypharmacy and prescribing behaviors. This study assesses the structural characteristics of temporal DPNs derived from daily co-prescriptions of antidepressants, anxiolytics, and other therapeutic drug classes. By analyzing these networks using eigenvector centrality, we identify influential medications and prescribing patterns. We utilized the IADB.nl database, including prescriptions from 128 Dutch pharmacies (2018–2022). A cohort of patients prescribed antidepressants/anxiolytics was extracted. Medications were classified using the Anatomical Therapeutic Chemical (ATC) system into 24 therapeutic classes. Time-varying DPNs were constructed as undirected graphs using symmetric daily dose-adjusted co-prescriptions. Eigenvector centrality ( c e ) quantified relative nodal importance. Weekly-aggregated data included number of dispensing ( n c ) and eigenvector centrality, which were decomposed using a singular-spectrum approach. Antidepressants ( c e : 0.09, n c : 28,993) and anxiolytics ( c e : 0.05, n c : 14,061) had high eigenvector centrality, demonstrating frequent co-prescription. Other ATC groups with high centrality included those for the alimentary tract and metabolism ( A01-A16 ), blood and blood-forming organs ( B01-B06 ), cardiovascular system ( C01-C10 ), respiratory system ( R01-R07 ), and analgesics ( N02 ). DPNs revealed key co-prescription patterns. High-centrality medications highlight potential targets for drug monitoring, such as identifying co-prescription trends that may warrant evaluation for safety, appropriateness, or policy oversight. This approach aids in identifying influential medications and refining prescribing oversight. • Multi-class co-prescription was over ten times more common than same-class use in both antidepressant and anxiolytic users. • Seven highly central drug classes link psychiatric medications with chronic disease treatments, indicating key roles in co-prescription networks. • Network analysis reveals prescribing hubs not detectable through traditional drug utilization methods. • Findings align with Dutch clinical guidelines promoting multi-class use in anxiety and monotherapy in depression management. • Co-prescription patterns reflect underlying multimorbidity, highlighting the complexity of psychiatric and chronic illness care.

Source: Global Epidemiology

DOI: 10.1016/j.gloepi.2026.100248

Authors: Aly Lamuri, Spyros Balafas, Eelko Hak, Jens H. Bos, Frederike Jörg, Talitha L. Feenstra

Institutions: University of Groningen, University of Indonesia, University Medical Center Groningen

Language: English

Topic: Pharmaceutical Practices and Patient Outcomes

Subfield: Geriatrics and Gerontology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,670