Multinational comparison of new antidepressant use in older adults: a cohort study

Abstract

ObjectivesWe used an international pharmacosurveillance network to estimate the rate and characteristics of antidepressant use in older adults in countries with more conservative (UK) and liberal depression guidelines (Canada, USA).SettingElectronic health records and population-based administrative data from six jurisdictions in four countries (UK, Taiwan, USA and Canada).ParticipantsA historical cohort of older adults (≥65 years) who had a new episode of antidepressant use between 2009 and 2014.Outcome measuresThe age and sex-standardised cumulative incidence of new episodes of antidepressant use in older adults was measured. Descriptive statistics were used to compare the proportion of new users by the antidepressant prescribed, therapeutic class, potential treatment indication and country, as well as the characteristics of the first treatment episode (standardised daily doses, duration and changes).ResultsThe incidence of antidepressant use between 2009 and 2014 varied from 4.7% (Montreal and Quebec City) to 18.6% (Taiwan). Tricyclic antidepressants (TCAs) were the most commonly used class in the UK (48.8%) and Taiwan (52.4%) compared with selective serotonin reuptake inhibitors (SSRIs) in North American jurisdictions (42.3%–53.3%). Chronic pain was the most common potential treatment indication (41.2%–68.2%). Among users with chronic pain, TCAs were used most frequently in the UK and Taiwan (55.2%–60.4%), whereas SSRIs were used most frequently in North America (33.5%–46.4%). Treatment was longer (252–525 vs 169–437 days), standardised doses were higher (0.7–1.3 vs 0.5–1.0) and treatment was more likely to be changed (31%–46% vs 21%–34%) among patients with depression (9.1%–43%) than those with chronic pain.ConclusionAntidepressant use in older adults varied 24-fold by country, with the UK, which has the most conservative treatment guidelines, being among the lowest. Chronic pain was the most common potential treatment indication. Evaluation of real-world risks of TCAs is a priority for future research, given high rates of use and the potential for increased toxicity in older adults because of potent anticholinergic effects.

Trends in Antidepressants Use in Spain between 2015 and 2018: Analyses from a Population-Based Registry Study with Reference to Driving

“…The increase in the prevalence of antidepressant use is consistent with other national data and comparable with those obtained in other European countries: SSRIs and the "other antidepressants" (ATC subgroup N06AX) were the most consumed [21][22][23]. It is important to differentiate between classic N06AX antidepressants, such as mianserin or trazodone, that are less used, and the most recent ones, such as venlafaxine, mirtazapine, etc., which are trendy.…”

“…New clinical indications have appeared because different effects on cognitive function require antidepressants at doses substantially lower than those for depression [29]. A relevant percentage of antidepressant prescriptions, i.e., amitriptyline and duloxetine, may be due to chronic pain (prevalence of 62% in people over 75 years of age) [21].…”

“…Antidepressants are mainly used chronically (≥30 days). A total of 40% of antidepressants were prescribed for more than 180 days, which is, according to the average use of these medications, 251 to 525 days for SSRIs that are frequently switched to SNRIs [21]. Furthermore, antidepressants are not used as monotherapy.…”

“…Trends in antidepressants use by the population is a topic of great interest. Since commercialization of SSRIs, an increase in their use for two to three times may be observed in western countries [21,22]. For instance, in Spain, the use of antidepressants increased by 200% between 2000 and 2013, and, in a similar way as in European Union (EU) countries, SSRIs were the most consumed (70.4%) [23].…”

Psychotropic Drug-Associated Pneumonia in Older Adults

“…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].…”