Prevalence and predictors of tricyclic antidepressant use among elderly Koreans in primary-care and specialty clinics

Abstract

Compared with a 2005 report, the prevalence of TCA prescriptions in elderly patients in Korea has decreased substantially, but remains high. Various efforts should be considered to reduce TCA prescriptions in the elderly. .

The impact of social, national and community-based health insurance on health care utilization for mental, neurological and substance-use disorders in low- and middle-income countries: a systematic review

“…The majority of articles were published in Asia (n = 16, 89%), including twelve in China [28][29][30][31][32][33][34][35][36][37][38][39], two in South Korea [40,41] and two in Thailand [42,43]. One article was from Chile, South America [44] and one article reporting findings across 22 low-income, 17 lower-middle, and nine upper-middle countries as at 2003 [45] (Table 2).…”

“…One article was from Chile, South America [44] and one article reporting findings across 22 low-income, 17 lower-middle, and nine upper-middle countries as at 2003 [45] (Table 2). Thirteen of the 18 articles examined the impact of SHI on mental health care utilization [28][29][30][31][32][33][34][35][36][37][38][39]44]; whilst three examined the impact of NHI [40,41,43] and one article examined the impact of CBHI [42] on mental health care utilization. The remaining paper explored a range of financing mechanisms across 48 LMICs [45].…”

“…With respect to the MNS disorders for which utilization was examined, 33% (n = 6) of the articles included mental health care utilization for schizophrenia [29, 34-36, 39, 40]; 16.7% (n = 3) included mental health care utilization for epilepsy [28,42,43]; 11.1% (n = 2) included mental health care utilization for depressive and anxiety disorders [41,44]; with one article examining utilization for intellectual disability [30]. Of the remaining articles, three examined mental health care utilization for all F-code diagnoses (mental, behavioral and neurodevelopmental disorders) based on the ICD-10 code [33,37,38]; whilst the remaining two articles focused on mental health care utilization for those living with schizophrenia, bipolar disorder, vascular dementia, mental and behavioural disorder due to use of alcohol, manic episode, depressive episode [31] and; schizophrenia-spectrum disorders; bipolar disorder and major depression [32], respectively.…”

“…Four of the included studies explored the impact of health insurance on outpatient mental health care utilization, exclusively [35,36,41,44]; with three publications exploring inpatient and outpatient mental health care utilization [28,42,45] and ten studies focusing on the impact of health insurance on inpatient mental health care utilization exclusively [29, 31-34, 37-40, 43]. Only one study explored the impact of health insurance on utilization of rehabilitative care (occupational, physical, and speech or communication therapy) [30].…”

“…Studies comparing more-or less-favorable medications for MNS disorders included one study which examined the utilization of new AEDs (lamotrigine 100 mg), which are considered to render better control of seizures with fewer side effects [43]. A second study examined the utilization of tricyclic antidepressants (TCAs) among elderly Koreans in primary care settings measured as the proportion of antidepressants prescribed that were TCAs [41]; here the authors note that whilst TCAs show superior efficacy, they cause a number of side effects and thus newer classes of antidepressants are preferred among the elderly. A third study operationalized mental health care utilization as the number of outpatients diagnosed with schizophrenia that were prescribed Anticholinergic Medication (ACM) known for a variety of side effects including the impairment of cognitive capacity [36] whilst a fourth study examined the influence of insurance status on the prescription of clozapine, described by the author to have potentially fatal side effects, despite its high efficacy, among clinically stable outpatients with schizophrenia [35].…”