Psychotropic polypharmacy reconsidered: Between-class polypharmacy in the context of multimorbidity in the treatment of depressive disorders

Rhee, Taeho Greg; Rosenheck, Robert A.

doi:10.1016/j.jad.2019.04.018

Cited by 32 publications

(17 citation statements)

References 39 publications

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“…The present study discerned most inpatients with depressive disorders to receive multiple psychotropic and non-psychotropic drugs. Rhee and Rosenheck found that 58% of depressed adults in their sample from office-based psychiatric care received more than one psychotropic drug simultaneously [79]. This number was slightly lower than the number in the present total sample (65%, not shown in Figures).…”

Section: The Present Study In Comparison To Previous Researchcontrasting

confidence: 70%

Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders

et al. 2021

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Introduction The aim of this study was to describe the number and type of drugs used to treat depressive disorders in inpatient psychiatry and to analyse the determinants of potential drug-drug interactions (pDDI) and potentially inappropriate medication (PIM). Methods Our study was part of a larger pharmacovigilance project funded by the German Innovation Funds. It included all inpatients with a main diagnosis in the group of depressive episodes (F32, ICD-10) or recurrent depressive disorders (F33) discharged from eight psychiatric hospitals in Germany between 1 October 2017 and 30 September 2018 or between 1 January and 31 December 2019. Results The study included 14,418 inpatient cases. The mean number of drugs per day was 3.7 (psychotropic drugs = 1.7; others = 2.0). Thirty-one percent of cases received at least five drugs simultaneously (polypharmacy). Almost one half of all cases received a combination of multiple antidepressant drugs (24.8%, 95% CI 24.1%–25.5%) or a treatment with antidepressant drugs augmented by antipsychotic drugs (21.9%, 95% CI 21.3%–22.6%). The most frequently used antidepressants were selective serotonin reuptake inhibitors, followed by serotonin and norepinephrine reuptake inhibitors and tetracyclic antidepressants. In multivariate analyses, cases with recurrent depressive disorders and cases with severe depression were more likely to receive a combination of multiple antidepressant drugs (Odds ratio recurrent depressive disorder: 1.56, 95% CI 1.41–1.70, severe depression 1.33, 95% CI 1.18–1.48). The risk of any pDDI and PIM in elderly patients increased substantially with each additional drug (Odds Ratio: pDDI 1.32, 95% CI: 1.27–1.38, PIM 1.18, 95% CI: 1.14–1.22) and severity of disease (Odds Ratio per point on CGI-Scale: pDDI 1.29, 95% CI: 1.11–1.46, PIM 1.27, 95% CI: 1.11–1.44), respectively. Conclusion This study identified potential sources and determinants of safety risks in pharmacotherapy of depressive disorders and provided additional data which were previously unavailable. Most inpatients with depressive disorders receive multiple psychotropic and non-psychotropic drugs and pDDI and PIM are relatively frequent. Patients with a high number of different drugs must be intensively monitored in the management of their individual drug-related risk-benefit profiles.

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Section: The Present Study In Comparison To Previous Researchcontrasting

confidence: 70%

Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders

et al. 2021

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“…disorders to receive multiple psychotropic and nonpsychotropic drugs. Rhee and Rosenheck found that 58% of depressed adults in their sample from office-based psychiatric care received more than one psychotropic drug simultaneously [79]. This number was slightly lower than the number in the present total sample (65%, not shown in Figures).…”

Section: The Present Study In Comparison To Previous Researchcontrasting

confidence: 70%

Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders

Wolff

Reißner

Hefner

et al. 2021

Preprint

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Introduction: The aim of this study was to analyse prescription patterns and the determinants of drug-drug interactions (DDI) and potentially inappropriate medication (PIM) in pharmacotherapy of depressive disorders. Methods: Our study was part of a larger pharmacovigilance project funded by the German Innovation Funds. It included all inpatients with a main diagnosis in the group of depressive episodes (F32, ICD-10) or recurrent depressive disorders (F33) discharged from eight psychiatric hospitals in Germany between 1 October 2017 and 30 September 2018 or between 1 January and 31 December 2019. Results: The study included 14,418 inpatient cases. The mean number of drugs per day was 3.7 (psychotropic drugs = 1.7; others = 2.0). Thirty-one percent of cases received at least five drugs simultaneously (polypharmacy). Almost one half of all cases received a combination of multiple antidepressant drugs (24.8%, 95% CI 24.1% - 25.5%) or a treatment with antidepressant drugs augmented by antipsychotic drugs (21.9%, 95% CI 21.3% - 22.6%). The most frequently used antidepressants were selective serotonin reuptake inhibitors, followed by serotonin and norepinephrine reuptake inhibitors and tetracyclic antidepressants. In multivariate analyses, cases with recurrent depressive disorders and cases with severe depression were more likely to receive a combination of multiple antidepressant drugs (Odds ratio recurrent depressive disorder: 1.56, 95% CI 1.41 - 1.70, severe depression 1.33, 95% CI 1.18 - 1.48). The risk of any DDI and PIM in elderly patients increased substantially with each additional drug (Odds Ratio: DDI 1.32, 95% CI: 1.27 - 1.38, PIM 1.18, 95% CI: 1.14 - 1.22) and severity of disease (Odds Ratio per point on CGI-Scale: DDI 1.29, 95% CI: 1.11 - 1.46, PIM 1.27, 95% CI: 1.11 - 1.44), respectively. Conclusion: This study identified potential sources and determinants of safety risks in pharmacotherapy of depressive disorders and provided additional data which were previously unavailable. Most inpatients with depressive disorders receive multiple psychotropic and non-psychotropic drugs and DDI and PIM are relatively frequent. Patients with a high number of different drugs must be intensively monitored in the management of their individual drug-related risk-benefit profiles.

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“…Despite common prescription of multiple psychotropic medications in various populations (e.g., psychiatric, elderly, dementia, and community-dwelling population) (Hartikainen et al, 2005;Brett et al, 2017;Nørgaaard et al, 2017;Rhee and Rosenheck, 2019), very few studies focused on the effects of psychotropic polypharmacy. Nevertheless, an association between the use of multiple psychotropic drugs and falls in older adults has been reported.…”

Section: Discussionmentioning

confidence: 99%

Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility

et al. 2020

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Objectives: With their broad spectrum of action, psychotropic drugs are among the most common medications prescribed to the elderly. Consequently, the number of older adults taking multiple psychotropic drugs has more than doubled over the last decade. To improve knowledge about the deleterious effects of psychotropic polypharmacy, we investigated whether there is a threshold number of psychotropic molecules that could lead to impairment of global cognition, executive function, or mobility. Furthermore, relationships between the number of psychotropic molecules and cognitive and mobility impairment were examined. Design: Cross-sectional studySetting: University Hospital of Caen (France) and advertisements in medical offices Participants: Community-dwelling older adults 55 years and older (n = 177; 69.8 ± 9.3 years; 81% women) Measurements: Number of psychotropic molecules taken daily, global cognition assessed with the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), processing speed with the Trail Making Test (TMT) A, executive function with the TMT B and TMT B-A, and mobility with the Time Up and Go (TUG). The threshold numbers of psychotropic molecules were determined by ROC curves analysis. Based on these threshold values, multinomial logistic regression adjusting for covariates was then performed.Results: Logistic regressions showed that the threshold of two daily psychotropic molecules, identified by the ROC curves analysis, increases the risk of impaired executive function (p = .05 and.005 for the TMT B and TMT B-A, respectively), global cognition (p = .006 and.001 for the MMSE and MoCA, respectively), and mobility (p = .005 for the TUG), independent of confounding factors, including comorbidities. Furthermore, psychotropic polypharmacy would affect mobility through executive functions.Conclusion: Impairment of global cognition, executive function, and mobility when as few as two psychotropic molecules are consumed in relatively healthy young older adults should alert physicians when prescribing combinations of psychotropic medications.

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Psychotropic polypharmacy reconsidered: Between-class polypharmacy in the context of multimorbidity in the treatment of depressive disorders

Abstract: Objectives: Both psychiatric polypharmacy and multimorbidity are common in depressed adults. We examine recent patterns of psychotropic polypharmacy with attention to concurrent multimorbidity in the treatment of depressive disorders in outpatient psychiatric care.

Cited by 32 publications

References 39 publications

Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders

Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders

Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders

Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility

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