The Use of Antidepressant Medication before and after the Diagnosis of Amyotrophic Lateral Sclerosis: A Population-Based Cohort Study

Pisa, Federica Edith; Logroscino, Giancarlo; Casetta, Anica; Cecotti, Laura; Verriello, Lorenzo; Bratina, Alessio; Sartori, Arianna; Lorenzo, Lucio Lazzarino de; Eleopra, Roberto; Barbone, Fabio

doi:10.1159/000374119

Cited by 14 publications

(10 citation statements)

References 37 publications

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“…Nonetheless, this finding appears consistent with the results of a recent study on ALS patients, which observed, more than 1 year before ALS diagnosis, a 2-fold prevalence ratio of antidepressant use, compared to the general population [31] . A narrative review on the relationship between exposure to antipsychotics and antidepressants, and ALS onset has hypothesized that these drugs may reduce the risk of developing ALS [15] .…”

Section: Discussionsupporting

confidence: 92%

Amyotrophic Lateral Sclerosis Incidence and Previous Prescriptions of Drugs for the Nervous System

et al. 2016

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Background: An increased frequency of psychotic disorders in amyotrophic lateral sclerosis (ALS) families compared to controls has been reported. Aim of our study was to assess the relationship between nervous system drugs prescriptions and subsequent onset of ALS in a large Italian population. Methods: The study population consisted of all subjects over 15 years at the 2001 Italian census, resident in Turin since 1996 (n = 687,324), followed up for ALS occurrence from 2002 to 2014. Exposure to nervous system drugs was measured until 2012, or until 1 year before ALS onset. The association was estimated for ever and cumulative exposure, through Cox proportional Hazards models adjusted for sex, age, education, marital status and drug co-exposure. Results: In the analysis for ever exposure, opioids were significantly inversely associated with ALS risk (hazard ratio (HR) 0.59; 95% CI 0.35-0.97), while antiepileptics (HR 1.35; 95% CI 0.92-2.00) showed a marginally significantly positive association. Examining cumulative exposure, the protective role of opioids associated with more than 4 prescriptions and the risk effect of antiepileptics for over 6 prescriptions was confirmed. Conclusions: The present study revealed associations of ALS onset with previous exposure to opioids, maybe through the activation of δ receptor and σ receptors and antiepileptics, which are novel findings to our knowledge.

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Section: Discussionsupporting

confidence: 92%

Amyotrophic Lateral Sclerosis Incidence and Previous Prescriptions of Drugs for the Nervous System

et al. 2016

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“…23,24 Patients with ALS may be prescribed with antidepressants for reasons other than depression, such as excessive salivation where the anticholinergic side effect of antidepressants is desirable and emotional outbursts where the patients suddenly and without control cry or laugh. These possibilities likely explain the more pronounced risk increase for antidepressant use after ALS diagnosis, compared to depression diagnosis, as observed in the present study.…”

Section: Discussionmentioning

confidence: 99%

Depression in amyotrophic lateral sclerosis

et al. 2016

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Objective: To examine the relative risk of depression among patients with amyotrophic lateral sclerosis (ALS), both in terms of depression diagnosis and use of antidepressant drugs, before and after diagnosis. Methods:We conducted a nested case-control study including 1,752 patients with ALS diagnosed from July 2005 to December 2010 and 8,760 controls based on the Swedish national health and population registers, to assess the associations of depression diagnosis and use of antidepressant drugs with a subsequent risk of ALS. We further followed the patients with ALS after diagnosis to estimate the association of an ALS diagnosis with the subsequent risk of depression and use of antidepressant drugs.Results: Before diagnosis, patients with ALS were at higher risk of receiving a clinical diagnosis of depression compared to controls (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.3-2.3), and the highest risk increase was noted during the year before diagnosis (OR 3.5, 95% CI 2.1-5.6). Patients with ALS also had a highly increased risk of depression within the first year after diagnosis (hazard ratio 7.9, 95% CI 4.4-14.3). Antidepressant use was more common in patients with ALS than in controls, especially during the year before (OR 5.8, 95% CI 4.5-7.5) and the year after (hazard ratio 16.1, 95% CI 11.5-22.6) diagnosis. Approximately 30% of patients with amyotrophic lateral sclerosis (ALS) show mild cognitive impairment and 15% present with overt frontotemporal dementia (FTD). Conclusions:1,2 The overlap between ALS and FTD presents a continuum of symptoms such as memory impairment, apathy, and behavioral changes, 3,4 many of which mimic the typical symptoms of depression. 5The strong emotions evoked by receiving a serious diagnosis such as ALS may also lead to increased risk of mental illnesses, including depression. Multiple studies have shown that patients with ALS are more likely to develop depression than ALS-free individuals, although the reported prevalence of depression varies greatly.6-13 Different measurements of depression together with the varying representativeness of the patient samples used in previous studies may partly explain the different prevalences reported so far.The aim of the present study was to investigate the occurrence of depression diagnosis and use of antidepressants before and after ALS diagnosis in a nationwide sample of patients with ALS, using a matched random sample of the Swedish population as the reference.

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“…The aforementioned sources of data provide patient‐level information and have been used for research on use of medications before . For each hospitalization, the hospital registry records information on patient demographics, dates of admission and discharge, and one primary and up to five secondary discharge diagnoses coded according to the International Classification of Diseases version 9 (ICD‐9‐CM) coding system.…”

Section: Methodsmentioning

confidence: 99%

Anticholinergic burden before and after hospitalization in older adults with dementia: Increase due to antipsychotic medications

Reinold

Palese

Romanese

et al. 2019

Int J Geriat Psychiatry

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Objectives: To evaluate changes in the use of antipsychotics and medications with anticholinergic activity (MACs) during hospitalization in older adults with dementia and factors associated with antipsychotic prescriptions and increased anticholinergic burden (ACB). Methods and design:This retrospective cohort study included all patients aged 65 years or older with a discharge diagnosis of dementia hospitalized at the university hospital of Udine, Italy, from 2012 to 2014. Medications dispensed within 3 months before and after hospitalization were identified in community-pharmacy dispensations while those prescribed at discharge were collected from Hospital Electronic Medical Records (EMR). ACB was assessed using the Anticholinergic Cognitive Burden score.Results: Among 1908 patients included, at discharge, 37.0% used one or more antipsychotic (9.4% before and 12.6% after hospitalization), 68.6% used one or more MAC (49.1% and 45.7%, respectively), and ACB of 38.4% of patients increased at discharge mainly because of a higher use of antipsychotics with anticholinergic activity (33% at discharge vs 12% before hospitalization). Prescription of antipsychotics at discharge was associated with prior treatment with antipsychotics (adjusted odds ratio [aOR] 4.85; 95%CI, 3.37-6.97), psychiatric conditions, (4.39; 3.47-5.54) and discharge from surgical department (2.17; 1.32-3.55). An increased ACB was associated with psychiatric conditions (1.91; 1.52-2.39), discharge from surgical (1.75; 1.09-2.80) or medical department (1.50; 1.04-2.17), and with cardiac insufficiency (1.41; 1.00-1.99).Conclusions: ACB was higher at discharge, and antipsychotics were the main drivers of this increase. Clinicians treating older adults with dementia should be aware of the risks associated with antipsychotics and that some of these medications may increase the risk of anticholinergic effects.

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The Use of Antidepressant Medication before and after the Diagnosis of Amyotrophic Lateral Sclerosis: A Population-Based Cohort Study

Cited by 14 publications

References 37 publications

Amyotrophic Lateral Sclerosis Incidence and Previous Prescriptions of Drugs for the Nervous System

Amyotrophic Lateral Sclerosis Incidence and Previous Prescriptions of Drugs for the Nervous System

Depression in amyotrophic lateral sclerosis

Anticholinergic burden before and after hospitalization in older adults with dementia: Increase due to antipsychotic medications

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