Multinational comparison of new antidepressant use in older adults: a cohort study
Objectives We 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).Setting Electronic health records and population-based administrati...
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| Format: | Article |
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BMJ Publishing Group
2019-05-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/5/e027663.full |
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| author | Robyn Tamblyn David Westfall Bates David L Buckeridge Will Dixon Alan J Forster Nadyne Girard Jennifer Haas Bettina Habib Siyana Kurteva Jack Li Therese Sheppard |
| author_facet | Robyn Tamblyn David Westfall Bates David L Buckeridge Will Dixon Alan J Forster Nadyne Girard Jennifer Haas Bettina Habib Siyana Kurteva Jack Li Therese Sheppard |
| author_sort | Robyn Tamblyn |
| collection | DOAJ |
| description | Objectives We 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).Setting Electronic health records and population-based administrative data from six jurisdictions in four countries (UK, Taiwan, USA and Canada).Participants A historical cohort of older adults (≥65 years) who had a new episode of antidepressant use between 2009 and 2014.Outcome measures The 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).Results The 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.Conclusion Antidepressant 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. |
| format | Article |
| id | doaj-art-bce2827ba78848708e0906afc3f0850a |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-bce2827ba78848708e0906afc3f0850a2025-02-08T20:30:10ZengBMJ Publishing GroupBMJ Open2044-60552019-05-019510.1136/bmjopen-2018-027663Multinational comparison of new antidepressant use in older adults: a cohort studyRobyn Tamblyn0David Westfall Bates1David L Buckeridge2Will Dixon3Alan J Forster4Nadyne Girard5Jennifer Haas6Bettina Habib7Siyana Kurteva8Jack Li9Therese Sheppard102 Department of Medicine, McGill University, Montreal, Quebec, CanadaSHARE–Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway4 Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, CanadaArthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UKClinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada2 Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, CanadaDepartment of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA3 Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, CanadaEpidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, CanadaGraduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, TaiwanUniversity of Manchester, Arthritis Research UK Centre for Epidemiology, Manchester, United KingdomObjectives We 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).Setting Electronic health records and population-based administrative data from six jurisdictions in four countries (UK, Taiwan, USA and Canada).Participants A historical cohort of older adults (≥65 years) who had a new episode of antidepressant use between 2009 and 2014.Outcome measures The 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).Results The 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.Conclusion Antidepressant 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.https://bmjopen.bmj.com/content/9/5/e027663.full |
| spellingShingle | Robyn Tamblyn David Westfall Bates David L Buckeridge Will Dixon Alan J Forster Nadyne Girard Jennifer Haas Bettina Habib Siyana Kurteva Jack Li Therese Sheppard Multinational comparison of new antidepressant use in older adults: a cohort study BMJ Open |
| title | Multinational comparison of new antidepressant use in older adults: a cohort study |
| title_full | Multinational comparison of new antidepressant use in older adults: a cohort study |
| title_fullStr | Multinational comparison of new antidepressant use in older adults: a cohort study |
| title_full_unstemmed | Multinational comparison of new antidepressant use in older adults: a cohort study |
| title_short | Multinational comparison of new antidepressant use in older adults: a cohort study |
| title_sort | multinational comparison of new antidepressant use in older adults a cohort study |
| url | https://bmjopen.bmj.com/content/9/5/e027663.full |
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