No abstract

OBJECTIVES: Numerous antidepressant agents are available to treat geropsychiatric patients with depression. While most current agents are reasonably effective in ameliorating depressive symptomatology, less is known about the impact of these agents on concurrent maladaptive behaviors. This study examines change in sixteen such behaviors from admission to discharge to three‐month post‐discharge follow‐up in geropsychiatric patients (age 55 and older) with major depression (ICD‐9‐CM codes 296.20‐296.36) treated with fluoxetine (n = 292), mirtazapine (n = 288), sertraline (n = 744), or venlaxafine (n = 289). METHODS: Data were obtained from the CQI+SM Outcomes Measurement System, which tracked patients admitted to geropsychiatric inpatient programs in 111 general hospitals across 33 states between 1997–1999. Maladaptive behaviors were measured by the Psychogeriatric Dependency Rating Scale (PGDRS) (Wilkinson & Graham‐White, 1980) and a Medication Usage Questionnaire was used to track medications prescribed at admission, discharge, and follow‐up. One‐way Analyses of Variance and if significant, Tukey's pairwise comparisons were used to compare medication groups. RESULTS: At admission, patients exhibited mild to moderate evidence of maladaptive behaviors (Mean PGDRS overall score of 20 out of 48). Medication groups were indistinguishable on change scores in overall maladaptive behaviors from time of admission to discharge (average length of stay around 16 days), discharge to follow‐up, or admission to follow‐up. On average, patients showed a very modest improvement (1–2 points) on the PGDRS from admission to discharge, modest decline from discharge to follow‐up (0–2 points), and no change to modest improvement from admission to follow‐up (0–1 points). CONCLUSIONS: Antidepressant agents in this analysis were associated with modest improvement in maladaptive behavior as assessed by the PDGRS. New treatment modalities that improve maladaptive behavior along with depressive symptomatology in older patients would be beneficial. Further controlled studies are needed to better understand these findings.

OBJECTIVES: While most current antidepressant agents, such as SSRIs and dual action agents are reasonably effective in ameliorating depressive symptomatology in older patients, less is known about their impact on concurrent instrumental activities of daily living (IADL's). This study examines change in IADL's, such as the capacity to use the telephone, travel, shop, cook, do housework, handle money, or take medicine, from admission to three‐month post‐discharge follow‐up in geropsychiatric patients (age 55 and older) with major depression (ICD‐9‐CM codes 296.20‐296.36) treated with fluoxetine (n = 77), mirtazapine (n = 36), sertraline (n = 145), or venlaxafine (n = 56). METHODS: Data were obtained from the CQI+SM Outcomes Measurement System, which tracked patients admitted to geropsychiatric inpatient programs in 111 general hospitals across 33 states between 1997–1999. IADL's were measured by selected items from the Duke OARS Multidimensional Functional Assessment Questionnaire (Lawton & Brody, 1969). A Medication Usage Questionnaire was used to track medications prescribed. One‐way Analyses of Variance and if significant, Tukey's pairwise comparisons were used to compare medication groups. RESULTS: At admission, patients exhibited moderate to severe inability to independently carry out IADL's (Mean score of 14 to 15 out of 21). Medication groups were indistinguishable on change scores in overall IADL's from time of admission to follow‐up. On average, patients showed no change in their ability to carry out IADL's during this time period, despite an improvement in level of depression, as measured by the collateral version of the Geriatric Depression Scale (Nitcher, Burke, Roccaforte, & Wengel, 1993). CONCLUSIONS: Antidepressant agents in this analysis were associated with modest improvement in IADL's as assessed by the Duke OARS Multidemsional Functional Assessment in Older Adults. New treatment modalities that improve IADL's along with depressive symptomatology in older patients would be beneficial. Further controlled studies are needed to better understand these findings.

Newer antidepressants are often prescribed to geriatric patients with depression because older agents often have side effects that may be problematic in the elderly. Less well‐understood are the prescribing patterns of clinicians when such first‐line agents are switched or augmented. OBJECTIVE: To examine switching and augmentation patterns used during the inpatient and post‐discharge period in geriatric patients with major depression (ICD‐9‐CM codes 296.20‐296.36) treated initially with fluoxetine, mirtazapine, sertraline, or venlaxafine. METHOD: Data were obtained from the CQI+SM Outcomes Measurement System, an ORYX (JCAHO) accepted performance improvement system, which tracked patients admitted to geropsychiatric inpatient programs in 111 general hospitals across 33 states between 1997–1999. A Medication Usage Questionnaire was used to track medications prescribed just prior to admission, at time of discharge, and at three‐month post‐discharge follow‐up. RESULTS: From admission to discharge, over one‐third to one‐half (37.4–52.1%) of patients switched or augmented specific antidepressant agent. Switching and augmenting rates decreased somewhat from discharge to follow‐up (10.5–29.6%) and from admission to follow‐up (30.5–38.9%). Remarkably, over twenty distinct antidepressant agents were used when switching occurred, and fifteen distinct antidepressant agents were used to augment the initial antidepressant agent. CONCLUSIONS: A significant number of patients do not appear to improve adequately on their agent of first choice. The great variety of treatment combinations suggests there is no clearly preferred treatment strategy for partial and non‐responders. Practice guidelines for treatment strategies to augment and switch in older patients with depression would be beneficial for both clinicians and patients.

OBJECTIVES: An array of antidepressant agents are available in the treatment of geropsychiatric patients with depression. While most current agents, such as the selective serotonin reuptake inhibitors (SSRI's) (e.g., fluoxetine; sertraline) and agents acting upon both serotonin and norepinephrine (e.g., mirtazapine; venlaxafine), are reasonably effective in ameliorating depressive symptomatology, less is known about the impact of these agents on other common areas of deficit in older depressed patients, such as cognition. This study examines change in cognitive functioning in geropsychiatric patients (age 55 and older) with major depression (ICD‐9‐CM codes 296.20‐296.36) treated with fluoxetine (n = 269), mirtazapine (n = 275), sertraline (n = 713), or venlaxafine (n = 259). METHODS: Data were obtained from the CQI+SM Outcomes Measurement System, a Joint Commission of Accredited Hospital Organizations (JCAHO) ORYX accepted performance improvement system, which tracked patients admitted to geropsychiatric inpatient programs in 111 general hospitals across 33 states between 1997–1999. Cognitive functioning was measured at admission and discharge using the Mini‐Mental State Examination (MMSE) (Folstein, Folstein, & McHugh, 1975). A Medication Usage Questionnaire was used to track medications prescribed to patients just prior to admission and at discharge. One‐way Analyses of Variance and if significant, Tukey's pairwise comparisons, were used to compare medication groups. RESULTS: At admission, patients exhibited moderate evidence of cognitive impairment (Mean MMSE score of 21 out of 30). Medication groups were indistinguishable on change scores in cognitive functioning from time of admission to discharge (average length of stay around 16 days). The average change score on the MMSE was 1.1 to 1.6 points, suggesting very mild improvement. CONCLUSIONS: Antidepressant agents in this analysis were associated with modest improvement in cognitive functioning as assessed by the MMSE. New treatment modalities that improve cognition along with depressive symptomatology in older patients would be beneficial.