How often are antidepressants prescribed off‐label among older adults in Germany? A claims data analysis

Schäfer, Wiebke; Reinders, Tammo; Riedel, Oliver; Haug, Ulrike

doi:10.1111/bcp.14564

Cited by 8 publications

(6 citation statements)

References 41 publications

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“…Off‐label use of antidepressant prescriptions in primary care has been reported as high as 50% in the general population in Canada 11 . Like‐wise, in older adults, a recent German study reported that more than 40% of all antidepressant prescriptions in 2009–2015 were off‐label use 12 . We are not aware of similar data from Denmark.…”

Section: Introductionmentioning

confidence: 80%

“…We do not know if they were actual off‐label uses. Antidepressants' off‐label use has been reported as 44% in German older adults in 2009–2015, 12 40% in Danish children and adolescents in 2006%–2012%, and 29% in a general population of Quebec, Canada in 2003–2015 where TCAs had the highest prevalence of off‐label use. 11 , 12 Differences in definition and assessment criteria (off‐label use in previous studies vs. missing indication in our study), year of study, and country‐specific treatment guidelines perhaps explain the discrepancies in the proportion of off‐label use across the studies.…”

Section: Discussionmentioning

confidence: 99%

“…11 Like-wise, in older adults, a recent German study reported that more than 40% of all antidepressant prescriptions in 2009-2015 were off-label use. 12 We are not aware of similar data from Denmark.…”

Section: Introductionmentioning

confidence: 98%

“… 11 Like‐wise, in older adults, a recent German study reported that more than 40% of all antidepressant prescriptions in 2009–2015 were off‐label use. 12 We are not aware of similar data from Denmark. However, using a proxy measure (discharge diagnosis of hospital in‐ and outpatient contacts), recent Danish studies reported a high level of off‐label use in the general population.…”

Section: Introductionmentioning

confidence: 98%

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Treatment indications and potential off‐label use of antidepressants among older adults: A population‐based descriptive study in Denmark

Ishtiak‐Ahmed

Liu

Christensen

et al. 2022

Int J Geriat Psychiatry

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Objectives: Off-label prescriptions of antidepressants may be of special concern in older-adults. We aimed to study the potential off-label use of antidepressants among adults ≥65 years by describing the patterns, trends, and factors associated with missing and unspecified treatment indications. Methods: We used registry data to describe indications of all antidepressant prescriptions (N = 13.8 million) redeemed by older-adults in 2006-2019. We investigated factors associated with off-label use by considering prescriptions with missing and unspecified indications of the first antidepressant prescription using a multinomial logistic regression with the 'depression' indication as a reference category and reported odds ratios (ORs) with 95% confidence intervals (CI). Results: Overall, 18.1% of all antidepressant prescriptions had missing indications, and 9.9% had unspecified indications. The proportion of potential off-label use based on missing and unspecified prescriptions remained mostly consistent during 2006-2019. We identified similar associations in user characteristics whether considering missing or unspecified first prescription. ORs with 95% CI were raised in non-western ethnicity (vs. Danish, 1.12 (0.99-1.26) for missing indication and 1.28 (1.11-1.48) for unspecified indication) and female sex (vs. male, 1.05 (1.02-1.07) and 1.05 (1.02-1.07) respectively). ORs were reduced for shorter educational attainment (vs. long, 0.90 (0.87-0.94) and 0.92 (0.88-0.96)), older age (≥81 vs. 67-70 years, 0.66 (0.65-0.71) and 0.73 (0.70-0.76)) and hospital psychiatric diagnosis (per diagnosis 0.76 (0.73-0.78) and 0.88 (0.86-0.91)). Conclusions: Nearly one-third of all antidepressant prescriptions redeemed by older-adults in Denmark had either missing or unspecified treatment indications. Whether these prescriptions were actual off-label use needs to be validated. Clinicians should pay special attention to patients' characteristics linking missing and unspecified indications and maintain adequate documentation while prescribing medication.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Section: Introductionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 98%

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Treatment indications and potential off‐label use of antidepressants among older adults: A population‐based descriptive study in Denmark

Ishtiak‐Ahmed

Liu

Christensen

et al. 2022

Int J Geriat Psychiatry

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“…The authors of a previous study based on SHI data of insurants from Baden-Wuerttemberg found a similar prescribing prevalence of antidepressants for this state than we found in our study (Ufer et al , 2007). However, the comparability of results is limited, because most authors of previous studies considering the prevalence of outpatient antidepressant prescribing focused either on specific age groups as children or elderly people, patients with specific diseases, selected drugs or did only consider incident antidepressant use (Hoffmann et al , 2014; Bohlken et al , 2015; Abbas et al , 2016; Booker et al , 2016; Drosselmeyer et al , 2016; Jobski et al , 2017; Schröder et al , 2017a; Boehlen et al , 2019; Forns et al , 2019; Hessmann et al , 2019; Giovannini et al , 2020; Jack et al , 2020; Schäfer et al , 2021). Next to real variations in prescribing practices, implications of manifold methodologies and, particularly in cross-sectional studies, potential seasonal effects must be taken into account when the results of different studies are compared (Gardarsdottir et al , 2010; Abbing-Karahagopian et al , 2014; Mars et al , 2017; Jack et al , 2020).…”

Section: Discussionmentioning

confidence: 99%

Antidepressant drug use and regional prescribing patterns in Germany: results from a large population-based study

Dörks

Hoffmann

Jobski

2022

International Clinical Psychopharmacology

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Objective To consider antidepressant prescribing on a population level with a focus on regional prescribing patterns in Germany. Basic methods Based on data from about 70 million individuals covered by all statutory health insurance funds in Germany in 2010, the prevalence of antidepressant use (overall, for drug classes and individual drugs) was calculated stratified by age and sex. Regional analyses were performed on a state and also on a district level. Main results The study population comprised 68 427 464 (female: 53.0%) persons, of which 5 052 293 (7.4%) were prescribed at least one antidepressant. The most frequently prescribed drug class was tricyclic antidepressants whereas on a substance level citalopram was most commonly used. Antidepressant prescribing was lowest in children and adolescents (0.2%) and most common in persons aged 70 years and older (13.4%). Women more often received antidepressants than men (9.7% vs. 4.8%). Prevalence of antidepressant use varied between 8.7% (Saarland) and 6.3% (Saxony-Anhalt) and was generally highest in the southwestern and lowest in the eastern states. Accordingly, districts with the highest prevalence were located in the southwestern states. Principal conclusions Antidepressant use in Germany varied considerably by age and sex and also on a state and district level.

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Patient outcome following selective serotonin reuptake inhibitor prescribing in primary care in Wales (UK)

Ahmed,

Chaplin,

Young

et al. 2024

Human Psychopharmacology

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ObjectiveThis study investigated prescribing patterns of two cohorts of patients treated with selective serotonin reuptake inhibitors (SSRI) in primary care in Wales (UK), to better understand drivers for increased usage.MethodsThis e‐cohort study included patients receiving a first READ‐coded SSRI prescription in SAIL in either 2005 or 2015. Patients were followed up for 3 years from date of SSRI prescription. Influence of age and other demographic data on prescribing patterns, and details of mental health or medication reviews that took place were identified.ResultsIn total 67,006 patients were included across the two cohorts; 29,534 in 2005, and 37,472 in 2015. Citalopram was the most commonly prescribed SSRI in both cohorts. A READ‐coded diagnosis relating to SSRI treatment could not be identified in 24,797 patients. The percentage of patients continuing treatment for 3 years was 6.9% and 11.3% in 2005 and 2015, respectively. In total, 21,150 (72%) patients in the 2005 cohort and 23,947 (64%) in the 2015 cohort received at least one medication review during follow‐up.ConclusionsThe proportion of patients continuing longer term treatment was small, whilst the number of recorded mental health and medication reviews offers some reassurance that prescribing remained appropriate.

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How often are antidepressants prescribed off‐label among older adults in Germany? A claims data analysis

Abstract: Principal investigator There was no principal investigator, as this study was not an intervention on human subject.

Cited by 8 publications

References 41 publications

Treatment indications and potential off‐label use of antidepressants among older adults: A population‐based descriptive study in Denmark

Treatment indications and potential off‐label use of antidepressants among older adults: A population‐based descriptive study in Denmark

Antidepressant drug use and regional prescribing patterns in Germany: results from a large population-based study

Patient outcome following selective serotonin reuptake inhibitor prescribing in primary care in Wales (UK)

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