A real-world analysis of antidepressant medications in US veterans aged 60 years and older: a comparative analysis
Aim: To compare the safety and efficacy of antidepressants (AD) among older adults with major depressive disorder (MDD) by assessing treatment change, augmentation and hospitalization rates. Methods: This retrospective study analyzed data from the Veterans Affairs (VA) database, including 142,138...
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Becaris Publishing Limited
2025-01-01
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| Series: | Journal of Comparative Effectiveness Research |
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| author | Ryan D Pittman S Scott Sutton Joseph Magagnoli Tammy H Cummings |
| author_facet | Ryan D Pittman S Scott Sutton Joseph Magagnoli Tammy H Cummings |
| author_sort | Ryan D Pittman |
| collection | DOAJ |
| description | Aim: To compare the safety and efficacy of antidepressants (AD) among older adults with major depressive
disorder (MDD) by assessing treatment change, augmentation and hospitalization rates. Methods:
This retrospective study analyzed data from the Veterans Affairs (VA) database, including 142,138
patients aged ≥60 years diagnosed with MDD. Patients prescribed bupropion, citalopram, duloxetine,
escitalopram, fluoxetine, mirtazapine, paroxetine, sertraline, or venlafaxine were included. Outcomes
were treatment change, augmentation and hospitalization rates. Hazard ratios (aHRs) were calculated
using sertraline as the reference. Results: Of the patients, 39.6% required augmentation, 18.1% changed
antidepressant treatment and 13.3% were hospitalized. The corresponding incidence rate was 544, 124
and 122 events per 1000 person-years. Compared with sertraline, mirtazapine users had the highest AD
change risk (aHR 1.34, 95% CI: 1.29–1.40), while duloxetine users had the lowest (aHR 0.87, 95% CI:
0.83–0.92). Duloxetine also had the lowest augmentation risk (aHR 0.89, 95% CI: 0.86–0.92). Mirtazapine
users also had the highest risks of augmentation (aHR 1.15, 95% CI: 1.12–1.18) and hospitalization (aHR
1.14, 95% CI: 1.07–1.23). Bupropion had the lowest hospitalization risk (aHR 0.77, 95% CI: 0.71–0.84).
Conclusion: Antidepressant choice significantly influences treatment outcomes in older adults with MDD.
Duloxetine demonstrated the best profile with the lowest risks of AD change and augmentation, while
mirtazapine posed the highest risks of all three outcomes. Personalized treatment strategies are crucial
to improving outcomes in this population. |
| format | Article |
| id | doaj-art-8d089fdd51b9437bb9e4f433a614597c |
| institution | Kabale University |
| issn | 2042-6313 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Becaris Publishing Limited |
| record_format | Article |
| series | Journal of Comparative Effectiveness Research |
| spelling | doaj-art-8d089fdd51b9437bb9e4f433a614597c2025-01-27T15:24:59ZengBecaris Publishing LimitedJournal of Comparative Effectiveness Research2042-63132025-01-0114210.57264/cer-2024-0187A real-world analysis of antidepressant medications in US veterans aged 60 years and older: a comparative analysisRyan D Pittman0https://orcid.org/0000-0001-7447-5752S Scott Sutton1https://orcid.org/0000-0002-3889-6178Joseph Magagnoli2https://orcid.org/0000-0002-8568-0097Tammy H Cummings3https://orcid.org/0000-0001-7978-7157Dorn Research Institute, Columbia VA Health Care System, Columbia, SC, USA; Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USADorn Research Institute, Columbia VA Health Care System, Columbia, SC, USA; Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USADorn Research Institute, Columbia VA Health Care System, Columbia, SC, USA; Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USADorn Research Institute, Columbia VA Health Care System, Columbia, SC, USA; Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USAAim: To compare the safety and efficacy of antidepressants (AD) among older adults with major depressive disorder (MDD) by assessing treatment change, augmentation and hospitalization rates. Methods: This retrospective study analyzed data from the Veterans Affairs (VA) database, including 142,138 patients aged ≥60 years diagnosed with MDD. Patients prescribed bupropion, citalopram, duloxetine, escitalopram, fluoxetine, mirtazapine, paroxetine, sertraline, or venlafaxine were included. Outcomes were treatment change, augmentation and hospitalization rates. Hazard ratios (aHRs) were calculated using sertraline as the reference. Results: Of the patients, 39.6% required augmentation, 18.1% changed antidepressant treatment and 13.3% were hospitalized. The corresponding incidence rate was 544, 124 and 122 events per 1000 person-years. Compared with sertraline, mirtazapine users had the highest AD change risk (aHR 1.34, 95% CI: 1.29–1.40), while duloxetine users had the lowest (aHR 0.87, 95% CI: 0.83–0.92). Duloxetine also had the lowest augmentation risk (aHR 0.89, 95% CI: 0.86–0.92). Mirtazapine users also had the highest risks of augmentation (aHR 1.15, 95% CI: 1.12–1.18) and hospitalization (aHR 1.14, 95% CI: 1.07–1.23). Bupropion had the lowest hospitalization risk (aHR 0.77, 95% CI: 0.71–0.84). Conclusion: Antidepressant choice significantly influences treatment outcomes in older adults with MDD. Duloxetine demonstrated the best profile with the lowest risks of AD change and augmentation, while mirtazapine posed the highest risks of all three outcomes. Personalized treatment strategies are crucial to improving outcomes in this population.antidepressantsaugmentationdepressionhospitalizationmedication changing |
| spellingShingle | Ryan D Pittman S Scott Sutton Joseph Magagnoli Tammy H Cummings A real-world analysis of antidepressant medications in US veterans aged 60 years and older: a comparative analysis Journal of Comparative Effectiveness Research antidepressants augmentation depression hospitalization medication changing |
| title | A real-world analysis of antidepressant medications in US veterans aged 60 years and older: a comparative analysis |
| title_full | A real-world analysis of antidepressant medications in US veterans aged 60 years and older: a comparative analysis |
| title_fullStr | A real-world analysis of antidepressant medications in US veterans aged 60 years and older: a comparative analysis |
| title_full_unstemmed | A real-world analysis of antidepressant medications in US veterans aged 60 years and older: a comparative analysis |
| title_short | A real-world analysis of antidepressant medications in US veterans aged 60 years and older: a comparative analysis |
| title_sort | real world analysis of antidepressant medications in us veterans aged 60 years and older a comparative analysis |
| topic | antidepressants augmentation depression hospitalization medication changing |
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