Incidence of antidepressant use in community‐dwelling persons with and without Alzheimer's disease: 13‐year follow‐up

Puranen, Arto; Taipale, Heidi; Koponen, Marjaana; Tanskanen, Antti; Tolppanen, Anna‐Maija; Tiihonen, Jari; Hartikainen, Sirpa

doi:10.1002/gps.4450

Cited by 30 publications

(25 citation statements)

References 26 publications

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“…In addition, due to the long exposure assessment, we were able to use a 5‐year time lag between exposure and outcome, which is longer than in main analyses of most of the previous studies and accounts at least partially for the reverse causality. The 5‐year time lag is justified by our previous studies in the same population, showing that a steep increase in the use of antidepressants and antipsychotics occurs in this time window.…”

Section: Discussionmentioning

confidence: 96%

The risk of Alzheimer's disease associated with benzodiazepines and related drugs: a nested case–control study

Tapiainen

Taipale

Tanskanen

et al. 2018

Acta Psychiatr Scand

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Benzodiazepine and related drug use in general was associated with modestly increased risk of AD. No major differences were observed between different subcategories of BZDRs (i.e. benzodiazepines, Z drugs, short-/medium-acting or long-acting BZDRs). As dose-response relationship abolished after adjustment for other psychotropics, it is possible that the association may partially be due to antidepressants and/or antipsychotics, or concomitant use of these medications.

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Section: Discussionmentioning

confidence: 96%

The risk of Alzheimer's disease associated with benzodiazepines and related drugs: a nested case–control study

Tapiainen

Taipale

Tanskanen

et al. 2018

Acta Psychiatr Scand

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“…Antidepressant drug use is more prevalent in older adults than in the general population, with the highest rates seen in institutionalized older people [98,99]. Antidepressant use is more common in persons with AD compared with those without dementia [100]. The incidence of antidepressant use in older adult populations varies by country with a range of 4.7-18.6% [101].…”

Section: Antidepressantsmentioning

confidence: 99%

Psychotropic Drug-Associated Pneumonia in Older Adults

2020

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The use of psychotropic drugs (antipsychotics, benzodiazepines and benzodiazepine-related drugs, and antidepressants) is common, with a prevalence estimates range of 19-29% among community dwelling older adults. These drugs are often prescribed for off-label use, including neuropsychiatric symptoms. The older adult population also has high rates of pneumonia and some of these cases may be associated with adverse drug events. In this narrative review, we summarize the findings from current observational studies on the association between psychotropic drug use and pneumonia in older adults. In addition to studies assessing the use of psychotropics, we included antiepileptic drugs, as they are also central nervous system-acting drugs, whose use is becoming more common in the aging population. The use of antipsychotics, benzodiazepine, and benzodiazepine-related drugs are associated with increased risk of pneumonia in older adults (≥ 65 years of age), and these findings are not limited to this age group. Minimal and conflicting evidence has been reported on the association between antidepressant drug use and pneumonia, but differences between study populations make it difficult to compare findings. Studies regarding antiepileptic drug use and risk of pneumonia in older persons are lacking, although an increased risk of pneumonia in antiepileptic drug users compared with non-users in persons with Alzheimer's disease has been reported. Tools such as the American Geriatric Society Beers Criteria and the STOPP/START criteria for potentially inappropriate medications aids prescribers to avoid these drugs in order to reduce the risk of adverse drug events. However, risk of pneumonia is not mentioned in the current criteria and more research on this topic is needed, especially in vulnerable populations, such as persons with dementia.

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“…[11][12][13] Results from studies of the elderly investigating the underuse and overuse of antidepressants are controversial. [16][17][18] A recent review of seniors aged 55 years and older found antidepressant use in only 20% to 45% of persons with depression. 9,14,15 However, it was also reported that antidepressants are often used without justification and that antidepressant prescriptions may be influenced by social factors such as loneliness or by the presence of somatic comorbidities.…”

Section: Introductionmentioning

confidence: 99%

“…9,14,15 However, it was also reported that antidepressants are often used without justification and that antidepressant prescriptions may be influenced by social factors such as loneliness or by the presence of somatic comorbidities. [16][17][18] A recent review of seniors aged 55 years and older found antidepressant use in only 20% to 45% of persons with depression. 19 A cross-sectional US-American study pointed out that only 45.6% of older patients with depression received any treatmentmostly pharmacotherapy-whereas psychotherapy was present in only 8.4%.…”

Section: Introductionmentioning

confidence: 99%

Evidence for underuse and overuse of antidepressants in older adults: Results of a large population‐based study

Boehlen

Freigofas

Herzog

et al. 2019

Int J Geriat Psychiatry

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Objectives Depression is common among elderly people. However, diagnosis and adequate treatment is frequently difficult. Research on underuse and overuse of antidepressants in elderly persons is scarce. This study investigates the utilization and appropriateness of pharmacological and psychological depression treatment in a large cohort of community‐dwelling adults. Methods A subsample of 3117 participants (aged 55‐85 y) of the third follow‐up (2008‐2010) of the large population‐based German ESTHER study was included. Depression was assessed using the eight‐item Patient Health Questionnaire (PHQ‐8). In the course of a home visit, study doctors collected complete information on medication. Logistic regression analyses were conducted to determine the relationship of depression with both underuse and overuse of antidepressants. The analyses were then adjusted for socioeconomic variables, psychosomatic comorbidities, and motivation to seek help. Results One hundred sixty‐three participants (5.2%; 95% confidence interval [CI], 4.5‐6.1) fulfilled the criteria for major depression. Underuse of antidepressants was present in 126 depressed participants (77.3%; 70.1‐83.5). Persons who were motivated to seek help, who had an established depression diagnosis, or who were taking more than five different medications had lower odds of underuse. Anxiety was associated with higher odds for underuse. Overuse of antidepressants (prescription without clinical indication) was found in 96 cases (41.7%; 35.3‐48.4) of all antidepressant prescriptions. Conclusions Depression treatment in older adults is frequently insufficient; it appears to depend on diagnosis as well as the patients' motivation to seek help. Education regarding the diagnosis of depression in the elderly as well as guidelines for appropriate treatment is needed.

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Incidence of antidepressant use in community‐dwelling persons with and without Alzheimer's disease: 13‐year follow‐up

Cited by 30 publications

References 26 publications

The risk of Alzheimer's disease associated with benzodiazepines and related drugs: a nested case–control study

The risk of Alzheimer's disease associated with benzodiazepines and related drugs: a nested case–control study

Psychotropic Drug-Associated Pneumonia in Older Adults

Evidence for underuse and overuse of antidepressants in older adults: Results of a large population‐based study

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