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Ishtiak-Ahmed K, Musliner KL, Christensen KS, Mortensen EL, Nierenberg AA, Gasse C. Real-World Evidence on Clinical Outcomes of Commonly Used Antidepressants in Older Adults Initiating Antidepressants for Depression: A Nationwide Cohort Study in Denmark. Am J Psychiatry 2024; 181:47-56. [PMID: 37849303 DOI: 10.1176/appi.ajp.20230356] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE The authors investigated the clinical outcomes of commonly used antidepressants among older adults who initiated first-time antidepressants for depression by analyzing the 1-year risk of selected clinically relevant outcomes. METHODS This cohort study used nationwide Danish registry data and included all older adults who redeemed a first-time (since 1995) antidepressant prescription with an indication of depression between 2006 and 2017. Only the 10 most frequently redeemed antidepressants were included in the analyses. Outcomes included discontinuation, switching, augmentation, psychiatric hospital contacts, suicide attempt or self-harm, fall-related injuries, cardiovascular events, and all-cause mortality. Incidence rate ratios (IRRs) and 95% confidence intervals were estimated using Poisson regression models, controlling for potential confounders. RESULTS The study sample included 93,883 older adults (mean age, 78.0 years, SD=7.5 years; 56% female). The most frequently prescribed antidepressants were selective serotonin reuptake inhibitors (citalopram, 47.04%; escitalopram, 11.81%; fluoxetine, 0.55%; paroxetine, 0.52%; sertraline, 11.17%), serotonin-norepinephrine reuptake inhibitors (duloxetine, 0.71%; venlafaxine, 1.54%), a tricyclic antidepressant (amitriptyline, 1.86%), and two atypical antidepressants (mianserin, 1.93%; mirtazapine, 22.87%). Compared with users of sertraline (the reference drug in this analysis, as Danish guidelines recommend it as the first-choice treatment for depression), users of most of the other nine antidepressants had a significantly higher risk of discontinuation (e.g., mirtazapine: IRR=1.55, 95% CI=1.50-1.61; venlafaxine: IRR=1.22, 95% CI=1.12-1.32), switching (amitriptyline: IRR=1.45, 95% CI=1.15-1.81; venlafaxine: IRR=1.47, 95% CI=1.20-1.80), augmentation, cardiovascular events, and mortality. Overall, mirtazapine and venlafaxine users had the most adverse outcomes compared with sertraline users. These results remained consistent in analyses stratified by sex and age (≤75 years vs. >75 years). CONCLUSIONS This real-world evidence suggests that clinical outcomes may vary among initiators of commonly used antidepressants in older adults, which may inform benefit-risk evaluation at treatment initiation, and highlights the importance of careful selection of antidepressant treatment.
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Affiliation(s)
- Kazi Ishtiak-Ahmed
- Department of Affective Disorders (Ishtiak-Ahmed, Musliner, Nierenberg, Gasse) and Psychosis Research Unit (Gasse), Aarhus University Hospital Psychiatry, Aarhus, Denmark; Department of Clinical Medicine (Ishtiak-Ahmed, Musliner, Gasse), Department of Public Health (Christensen), and Research Unit for General Practice (Christensen), Aarhus University, Aarhus, Denmark; Department of Public Health, University of Copenhagen, Copenhagen (Mortensen); Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston (Nierenberg)
| | - Katherine L Musliner
- Department of Affective Disorders (Ishtiak-Ahmed, Musliner, Nierenberg, Gasse) and Psychosis Research Unit (Gasse), Aarhus University Hospital Psychiatry, Aarhus, Denmark; Department of Clinical Medicine (Ishtiak-Ahmed, Musliner, Gasse), Department of Public Health (Christensen), and Research Unit for General Practice (Christensen), Aarhus University, Aarhus, Denmark; Department of Public Health, University of Copenhagen, Copenhagen (Mortensen); Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston (Nierenberg)
| | - Kaj Sparle Christensen
- Department of Affective Disorders (Ishtiak-Ahmed, Musliner, Nierenberg, Gasse) and Psychosis Research Unit (Gasse), Aarhus University Hospital Psychiatry, Aarhus, Denmark; Department of Clinical Medicine (Ishtiak-Ahmed, Musliner, Gasse), Department of Public Health (Christensen), and Research Unit for General Practice (Christensen), Aarhus University, Aarhus, Denmark; Department of Public Health, University of Copenhagen, Copenhagen (Mortensen); Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston (Nierenberg)
| | - Erik Lykke Mortensen
- Department of Affective Disorders (Ishtiak-Ahmed, Musliner, Nierenberg, Gasse) and Psychosis Research Unit (Gasse), Aarhus University Hospital Psychiatry, Aarhus, Denmark; Department of Clinical Medicine (Ishtiak-Ahmed, Musliner, Gasse), Department of Public Health (Christensen), and Research Unit for General Practice (Christensen), Aarhus University, Aarhus, Denmark; Department of Public Health, University of Copenhagen, Copenhagen (Mortensen); Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston (Nierenberg)
| | - Andrew A Nierenberg
- Department of Affective Disorders (Ishtiak-Ahmed, Musliner, Nierenberg, Gasse) and Psychosis Research Unit (Gasse), Aarhus University Hospital Psychiatry, Aarhus, Denmark; Department of Clinical Medicine (Ishtiak-Ahmed, Musliner, Gasse), Department of Public Health (Christensen), and Research Unit for General Practice (Christensen), Aarhus University, Aarhus, Denmark; Department of Public Health, University of Copenhagen, Copenhagen (Mortensen); Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston (Nierenberg)
| | - Christiane Gasse
- Department of Affective Disorders (Ishtiak-Ahmed, Musliner, Nierenberg, Gasse) and Psychosis Research Unit (Gasse), Aarhus University Hospital Psychiatry, Aarhus, Denmark; Department of Clinical Medicine (Ishtiak-Ahmed, Musliner, Gasse), Department of Public Health (Christensen), and Research Unit for General Practice (Christensen), Aarhus University, Aarhus, Denmark; Department of Public Health, University of Copenhagen, Copenhagen (Mortensen); Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston (Nierenberg)
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Buoli M, Legnani F, Nosari G, Pan A, Ciappolino V, Esposito CM, Ceresa A, Di Paolo M, Surace T, Auxilia AM, Capellazzi M, Tagliabue I, Cirella L, Zanelli Quarantini F, Dakanalis A, Clerici M, Capuzzi E, Caldiroli A. Which clinical factors and biochemical parameters are associated with late-life major depression? Int J Psychiatry Clin Pract 2023; 27:359-366. [PMID: 37755139 DOI: 10.1080/13651501.2023.2260426] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION Late-life major depression (MD) is a frequent and high-cost psychiatric disorder. Our purpose was to detect clinical and biological factors possibly associated with this condition to better prevent and treat it. METHODS We recruited 343 patients, consecutively admitted for a Major Depressive Episode to the inpatient clinic of Policlinico of Milan and ASST Monza, Italy. A large set of clinical and biochemical variables was collected from clinical charts. Univariate analyses were performed both dividing the sample into two groups (age < or ≥65) and considering age as a continuous quantitative variable. Regression analyses were then performed considering as independent variables only those statistically significant at univariate analyses. RESULTS Patients aged ≥ 65 resulted in having longer duration of illness, shorter duration of last antidepressant therapy, higher number of antidepressants assumed in the past, higher frequency of treatment-resistant depression, higher frequency of overweight/obesity and diabetes. As for biochemical parameters, patients ≥ 65 showed lower total plasmatic proteins and albumin, higher uric acid and creatinine. CONCLUSIONS These preliminary results suggest less effectiveness of antidepressants, more susceptibility to metabolic disorders and poor nutritional status in patients with late-life depression; such aspects may consequently be taken into consideration for a proper therapeutic approach. KEY POINTSDepression in late life seems to be associated with poorer response to antidepressants;Clinicians should prefer compounds with minimal pharmacokinetic interactions and less risk of side effects including metabolic ones;The poor nutritional status and the higher risk of metabolic disorders in older patients points out the importance of proper diet and healthy lifestyle in this group of subjects;Further studies are needed to confirm the results of this research.
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Affiliation(s)
- Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Francesca Legnani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Guido Nosari
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Pan
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Ciappolino
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Ceresa
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Di Paolo
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Teresa Surace
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Anna Maria Auxilia
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Martina Capellazzi
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Ilaria Tagliabue
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Luisa Cirella
- Healthcare Professionals Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Zanelli Quarantini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Massimo Clerici
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Enrico Capuzzi
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Alice Caldiroli
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
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Romdhani A, Lehmann S, Schlatter J. Discontinuation of Antidepressants in Older Adults: A Literature Review. Ther Clin Risk Manag 2023; 19:291-299. [PMID: 37013196 PMCID: PMC10066696 DOI: 10.2147/tcrm.s395449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/30/2023] [Indexed: 03/30/2023] Open
Abstract
Polypharmacy increases the risk of unbearable side effects, drug-drug interactions, and hospitalizations in geriatric patients. The iatrogenic risk of inadequate management of antidepressants is very important in this population. Therefore, primary care physicians and geriatricians have the responsibility of the optimization of antidepressants prescriptions. Our work is a literature review of the European and the international guidelines regarding the management of antidepressants. We reviewed the PubMed database and Google scholar for articles and reviews from 2015. We also screened relevant articles for more references and searched the web for available European guidelines relevant to our topic. We divided our findings into four main inquiries that are Indication, effectiveness, tolerability, and iatrogenic risks. Poor or absence of effectiveness should lead to a readjustment of the treatment plan. In case of unbearable side effects, antidepressants should be stopped, and alternative non-pharmacological therapies should be proposed. Doctors should look out for drug-drug interaction risks in this population and constantly adjust the prescription. Prescription of antidepressants is not always evidence based which leads to heavy iatrogenic consequences. We suggest a simple 4-questions-algorithm that aims to remind doctors of the basics of good practice and helps in the process of deprescribing an antidepressant in older adults.
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Affiliation(s)
- Ahmed Romdhani
- Département Medico-Universitaire de Gériatrie, Hôpital Paul Doumer, Assistance Publique des Hôpitaux de Paris (AP-HP), Labruyère, France
- Correspondence: Ahmed Romdhani, Email
| | - Stephanie Lehmann
- Pôle d’hospitalisation et relation ville-hôpital, Centre Hospitalier de Saint Marcellin, Isére, France
| | - Joël Schlatter
- Pharmacie, Hôpital Paul Doumer, Assistance Publique des Hôpitaux de Paris (AP-HP), Labruyère, France
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Huang Y, Xu Y, Liu A. Increased Levels of Serum Glycosylated Hemoglobin are Associated with Depressive Symptoms in a Population with Cancer (≥49 Years): An Antidepressant-Stratified Analysis. Clin Interv Aging 2021; 16:205-212. [PMID: 33564231 PMCID: PMC7866938 DOI: 10.2147/cia.s294704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/14/2021] [Indexed: 01/09/2023] Open
Abstract
Purpose Patients with cancer tend to have a high prevalence of depressive symptoms. The direct relationship between serum glycosylated hemoglobin (GHb) levels and depressive symptoms in cancer patients is still uncertain. We aimed to evaluate the association with serum GHb levels with depressive symptoms in the population (aged ≥49 years) with cancer. Patients and Methods Longitudinal data in 204 participants with cancer obtained from The Irish LongituDinal Study on Ageing (TILDA) were used to investigate the association of serum GHb levels with depressive symptoms. Results Our results suggested a positive and significant association between serum GHb levels and depression score, independent of age, gender, body mass index (BMI), currently married, education, smoking status, drink alcohol, systolic and diastolic blood pressure (BP), physical activity, self-reported cardiovascular diseases and laboratory measurement in participants with cancer (coefficient =0.141, P<0.001; Model 2) at baseline (wave 1). Higher GHb levels did associate with higher prevalence of depressive symptoms in participants with cancer (OR=2.100, 95% CI 1.105–5.036, P=0.004; Model 2) after adjustment for these same confounding factors in wave 1 was made. Stratified analysis further showed that these significant associations were interfered by antidepressants. Sensitivity analysis showed that higher serum GHb levels in subjects with cancer were linked to higher prevalence of depression events during a follow-up of 4 years. Conclusion Our results found a significant association between elevated serum GHb levels and increased risk of depressive symptoms in the population aged ≥49 years with cancer after confounding factors were adjusted.
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Affiliation(s)
- Ying Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Yilin Xu
- Oncology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China.,Jiangxi Key Laboratory of Clinical Translational Cancer Research, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Anwen Liu
- Oncology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China.,Jiangxi Key Laboratory of Clinical Translational Cancer Research, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
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