Antidepressant prescribing in nursing homes: is there a place for tricyclics?

Borson, Soo; Scanlan, James M.; Doane, K W; Gray, Shelly L.

doi:10.1002/gps.766

Cited by 16 publications

(5 citation statements)

References 21 publications

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“…There was an overall high prescription rate of antidepressants (43%). The findings are consistent with other studies (Arthur et al, 2002, Borson et al, 2002Snowdon et al, 1996) showing increased prescribing of antidepressants in care homes. There was a wide variability in prescribing rates between facilities.…”

supporting

confidence: 93%

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Are people living in nursing homes receiving antidepressants in adequate doses?

Butler

Radhakrishnan

2018

Int. Psychogeriatr.

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supporting

confidence: 93%

“…In Leicestershire, UK, 11% of nursing home residents were receiving antidepressants in 1990, and the rate rose to 19% by 1997 (Arthur et al, 2002). Borson et al (2002) reported that in nursing facilities in the US 59% of the elderly on antidepressants received SSRIs.…”

mentioning

confidence: 99%

Are people living in nursing homes receiving antidepressants in adequate doses?

Butler

Radhakrishnan

2018

Int. Psychogeriatr.

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“…However, it should be noted that prescriptions are sometimes motivated by non-psychiatric symptoms such as pain, isolated insomnia, incontinence, and pruritus. The dosages used are lower than when treating depression (Borson et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

Antidepressant use in Alzheimer's disease patients: results of the REAL.FR cohort

Arbus

Gardette

Bui

et al. 2009

Int. Psychogeriatr.

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Background: Psychotropic medication is widely prescribed in clinical practice for the management of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD). However, there have been few pharmaco-epidemiological studies or studies conducted in a natural setting on the real use of antidepressants in AD. The aim of this survey was to assess the prevalence of antidepressant use in AD and to identify the clinical factors associated with antidepressant prescription.Methods: REAL.FR is a four-year, prospective, multi-center study. Baseline data including demographic characteristics, clinical variables and drug intake were obtained. Depressive symptoms were determined using the Neuropsychiatric Inventory (NPI).Results: A total of 686 AD patients were included. Antidepressant treatment was prescribed for 34.8% of patients. Clinically significant depressive symptoms (NPI ≥ 4) were observed in 20.5% of the total population. Although depressed subjects were significantly more likely to be treated with antidepressants than non-depressed subjects (p<0.0001), only 60% of depressed subjects overall were prescribed an antidepressant. In multivariate analysis, clinically significant depressive symptoms were associated with antidepressant prescription although this result was only observed in subjects without a previous history of depression.Conclusions: The available data on antidepressant efficacy in BPSD other than depression (in particular, agitation, aggression and, occasionally, psychotic symptoms) do not influence prescription choices. Depressive symptoms may be taken more seriously in the absence of a previous history of depression, leading to increased antidepressant prescription rates in individuals presenting with depression for the first time.

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“…Les ISRS sont actuellement recommandés en première intention dans le traitement des états dépressifs du sujet âgé [14] alors que les antidépresseurs tricycliques sont déconseillés en raison de leur effet délétère sur les fonctions cognitives des personnes âgées surtout celles atteintes d'un état de démence [15]. Il est également recommandé d'utiliser un antidépresseur sans effet cholinergique [12].…”

Section: Discussionunclassified

Etude critique de la prise en charge de 159 personnes âgées en consultation de psychiatrie

Thabet¹,

Ammar²,

Charfi³

et al. 2014

Pan Afr Med J

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IntroductionLe phénomène de vieillissement des populations est associé à une augmentation de la prévalence de la morbidité liée à l’âge. La prescription des psychotropes chez le sujet âgé est de plus en plus fréquente dans les institutions, les doses sont de plus en plus élevées, avec un recours fréquent à une poly pharmacothérapie. Nous nous sommes proposé de décrire les conduites thérapeutiques chez le sujet âgé consultant en psychiatrie, en vue de les confronter aux dernières recommandations en la matière.MéthodesL’étude était de type rétrospectif et descriptif. Elle a concerné les sujets âgés d'au moins 60 ans ayant consulté pour la première fois en psychiatrie, au CHU Hédi Chaker à Sfax, en 2010 ou 2011.RésultatsNous avons colligé 159 dossiers. L’âge moyen était de 73 ans. La démence et les troubles de l'humeur étaient les diagnostics les plus fréquents. Sur le plan thérapeutique, une poly thérapie faite d'au moins deux psychotropes de familles différentes a été prescrite pour 55,9%. Chez 60.3% des sujets, le traitement a été prescrit d'emblée à dose complète. Aucun dossier ne faisait état d'une prise en charge psychothérapeutique.ConclusionLa prise en charge des malades de notre étude n’était pas conforme aux recommandations, notamment en matière d'association médicamenteuse, de progression des doses et d'association de la psychothérapie à la pharmacothérapie. L'information des médecins et leur sensibilisation aux particularités du sujet âgé contribuerait à optimiser les soins qui leur sont prodigués, y compris en psychiatrie.

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Antidepressant prescribing in nursing homes: is there a place for tricyclics?

Cited by 16 publications

References 21 publications

Are people living in nursing homes receiving antidepressants in adequate doses?

Are people living in nursing homes receiving antidepressants in adequate doses?

Antidepressant use in Alzheimer's disease patients: results of the REAL.FR cohort

Etude critique de la prise en charge de 159 personnes âgées en consultation de psychiatrie

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