Antidepressant Adherence Research Articles

Insight into improving antidepressant adherence and symptoms by pharmacist intervention: A review

Purpose: To assess the effectiveness of antidepressant medication adherence-improving intervention by a pharmacist and its impact on clinical symptoms of depression among outdoor depressive patients. Methods: Various databases such as PubMed, Embase, and Scopus were used sources for the literature published during the last 20 years. Pharmacist intervention studies involving adult depressed patients (≥ 17 years old) and treated with antidepressants were included. Twelve studies met the inclusion criteria. Results: These studies depicted various levels of interventions in which pharmacist counseled and educated the patients to support medication adherence. In only one of the studies, pharmacist intervention exercised significant effect on the depression features of patients. Conclusion: The findings suggest that the implication of antidepressant medication adherenceimproving intervention by pharmacist leads to the improved adherence of adult depressive patients to antidepressants. However, pharmacist intervention did not show any significant influence on depression symptomology, necessitating further studies on the topic. Keywords: Pharmacist care, Depression, Antidepressants, Intervention, Medication adherence

Pharmaco-epidemiology of antidepressant exposure in a UK cohort record-linkage study.

Antidepressants are the most commonly prescribed psychiatric medication but concern has been raised about significant increases in their usage in high income countries. We aimed to quantify antidepressant prevalence, incidence, adherence and predictors of use in the adult population. The study record-linked administrative prescribing and morbidity data to the Generation Scotland cohort ( N = 11,052), between 2009 and 2016. Prevalence and incidence of any antidepressant use was determined. Antidepressant adherence was measured using Proportion of Days Covered and Medication Possession Ratio. Time-to-event analysis for incident antidepressant use within 5 years of Generation Scotland: Scottish Family Health Study (GS:SFHS) recruitment was performed to reveal patient-level predictors of use. Almost one-third (28.0%, 95%CI 26.9-29.1) of the adults in our sample were prescribed at least one antidepressant in the 5-year period 2012-2016. There was a 36.2% increase in annual prevalence between 2010 and 2016. Incidence was 2.4(2.1-2.7)% per year. The majority of antidepressant episodes (57.6%) were greater than 9 months duration and adherence was generally high (69.0% with Proportion of Days Covered >80%). Predictors of new antidepressant use included history of affective disorder, being female, physical comorbidities, higher neuroticism scores, and lower cognitive function scores. Antidepressant prevalence is greater than previously reported but incidence remains relatively stable. We found the majority of antidepressant episodes to be of relatively long duration with good estimated adherence. Our study supports the hypothesis that increased long-term use among existing (and returning) users, along with wider ranges of indications for antidepressants, has significantly increased the prevalence of these medications.

Pharmacist-led telehealth disease management program for patients with diabetes and depression

Introduction The aim of this study was to determine whether a pharmacist-led telehealth disease management program is superior to usual care of nurse-led telehealth in improving diabetes medication adherence, haemoglobin A1C (A1C), and depression scores in patients with concomitant diabetes and depression. Methods Patients with diabetes and depression were randomized to pharmacist-led or nurse-led telehealth. Veterans with type 1 or type 2 diabetes, an A1C ≥ 7.5%, diagnosis of depression, and access to a landline phone were invited to participate. Patients were randomized to usual care of nurse-led telehealth or pharmacist-led telehealth. Patients were shown how to use the telehealth equipment by the nurse or pharmacist. In the pharmacist-led group, the patients received an in-depth medication review in addition to the instruction on the telehealth equipment. Results After six months, the pharmacist-led telehealth arm showed significant improvements for cardiovascular medication adherence (14.0; 95% confidence interval (CI) 0.4 to 27.6), antidepressant medication adherence (26.0; 95% CI 0.9 to 51.2), and overall medication adherence combined (13.9; 95% CI 6.6 to 21.2) from baseline to six-month follow-up. There was a significant difference in A1C between each group at the six-month follow-up in the nurse-led telehealth group (6.9 ± 0.9) as compared to the pharmacist-led telehealth group (8.8 ± 2.0). There was no significance in the change in patient health questionnaire-9 (PHQ-9) and Center for Epidemiologic Studies Depression Scale (CES-D) from baseline to follow-up in both groups. Discussion Pharmacist-led telehealth was efficacious in improving medication adherence for cardiovascular, antidepressants, and overall medications over a six-month period as compared to nurse-led telehealth. There was no significant improvement in overall depression scores.

Rates and Determinants of Use of Pharmacotherapy and Psychotherapy by Patients With Major Depressive Disorder.

Rates and determinants of pharmacological and psychotherapy use were assessed after a major depressive disorder diagnosis. In a retrospective claims study that included 2007-2016 records from the IBM MarketScan research databases, use of pharmacotherapy and psychotherapy was tracked in a population of 24,579 patients with a diagnosis of major depressive disorder. Univariate and multiple variable analyses were used to identify determinants of antidepressant adherence (proportion of days covered ≥.8) and intensive psychotherapy at the beginning of treatment (at least four psychotherapy visits in the first 4 weeks after initiating psychotherapy). In the 12 months following a diagnosis of major depressive disorder, most individuals received pharmacotherapy or psychotherapy (94.7%), and unimodal therapy was more common (58.5%) than bimodal therapy (36.2%). When antidepressants were initiated (N=13,524), 41.7% and 32.0% of patients were adherent in the acute and continuation phases, respectively. Initial antidepressant dosages were outside guideline recommendations for 34.5% of patients prescribed these medications. When psychotherapy was initiated, the median number of visits in the year after a patient's diagnosis was seven. Most patients (54.7%) did not continue to receive either antidepressant or psychotherapy treatment after month 5 following their diagnosis. A shorter time from diagnosis to treatment and a lower percentage of treatment costs paid by the patient were associated with increased antidepressant adherence and intensive psychotherapy use. Findings indicate that treatment guideline recommendations are not followed for a large proportion of patients with major depressive disorder and that improvement is needed in multiple areas to enhance effective treatment.

Consumer-related factors influencing antidepressant adherence in unipolar depression: a qualitative study

PurposeTo explore factors which facilitate and negatively impact adherence, at initiation, implementation and discontinuation phases of adherence to antidepressant medicines.Patients and methodsSemi-structured, face-to-face interviews were conducted with patients suffering from unipolar depression. The digitally audio-recorded and transcribed verbatim were used. Transcripts were thematically content analyzed and data managed using N-Vivo software.ResultsTwenty-three interviews were conducted. The predominant factors facilitating initiation of therapy included self-motivation and severity of depression. Factors aiding persistence with therapy included belief in, and effectiveness of, antidepressants. Stigma and fear of adverse events inhibited initiation of therapy, whilst adverse events and ineffectiveness of antidepressants contributed to discontinuation. Patients with strong perceptions of the necessity and few concerns about antidepressants were more likely to adhere to treatment at all phases of adherence.ConclusionDifferent factors influence medication adherence at the different phases of adherence. These factors were based on individual perceptions about depression and its treatment, and actual experiences of antidepressant treatment. This information should be considered by health care professionals in delivering targeted and tailored interventions to foster adherence. Strategies to address medication non-adherence in unipolar depression patients should consider the phase of adherence and individual perceptions about depression and its treatment, along with previous experiences with treatment for depression.

Antidepressant adherence in United States active duty Army Soldiers: A small descriptive study

While much is known about depression and antidepressant adherence associations with illness perceptions, medication beliefs, social support, and stigma in the general population, there is a dearth of knowledge among United States active duty Army Soldiers. The study objective was to explore antidepressant adherence and correlations between antidepressant adherence and illness perceptions, medication beliefs, social support, stigma and select demographic variables among Army Soldiers with depression. Results indicated age and gender were significantly correlated with and predictive of adherence. Low adherence was found. Findings suggest Soldiers who are younger and those who are female are more likely to report higher levels of adherence.

PDB11 - The Impact of Antidepressant Medications on Clinical Outcomes of Patients with Type 2 Diabetes: A Systematic Review

Antidepressant usage has risen sharply in patients with diabetes, calling into question the intervening effects on glucose metabolism. The aim of the current study was to assess the impact of antidepressant utilization on clinical outcomes of adult patients with type 2 diabetes mellitus. A systematic literature search was conducted according to PRISMA guidelines using three databases (PsycINFO, PubMed, and SCOPUS) to identify relevant articles through December 2017. Controlled search terminology included ‘diabetes mellitus’ in combination with ‘antidepressant’, ‘blood glucose’, ‘hemoglobin A1c’ (HgbA1c), ‘fasting blood glucose’ (FBG) and related terms. Relevant studies assessing the effect of antidepressant therapy upon glucose-related outcomes were included. Non-English studies, non-human studies, case reports and review articles were excluded. The key outcome being evaluated was the overall influence of antidepressant therapy upon HgbA1c or FBG. Among 990 articles identified, 25 studies were included in the final review. Samples included in studies ranged from 18 to 95 years, with study durations ranging from 8 weeks to 6 years. Among included studies, nine (36%) were US-based. A total of 14 studies (56%) indicated that antidepressant usage was associated with improvement in either FBG or HgbA1c while nine studies (36%) showed no association or non-statistically significant changes and two studies (8%) indicated negative association in HgbA1c or fasting plasma glucose. Antidepressants evaluated in the studies included milnacipran, fluoxetine, agomelatine, sertraline, citalopram, alprazolam, nortriptyline, bupropion, fludiazepam, and paroxetine compared with placebo, cognitive behavioral therapy (CBT) or no treatment. Some important limitations found in the evaluated studies were small sample size (ranging from 13 to 7016 patients) and not considering antidepressant adherence level and severity of diabetes. With antidepressants being increasingly prescribed in patients with diabetes, it is important to understand their impact on clinical outcomes of diabetes, potentially influencing treatment decisions in diabetes care.

A systematic review of measures of medication adherence in consumers with unipolar depression.

To identify and evaluate the range of adherence measures used to assess different phases of medication adherence (initiation, implementation, and discontinuation) to antidepressants, including the psychometric properties of the measures. This systematic review followed the PRISMA statement. Medline, Embase, International Pharmaceutical Abstracts, CINAHL and PsychINFO were searched (1994-2015) for articles which reviewed or reported the psychometric properties of adherence measures in adults with unipolar depression without co-morbidity. Included articles were reviewed for the reliability and validity of their adherence measures. 26 studies met the inclusion criteria. Most assessed medication adherence at implementation and/or discontinuation phases. Self-report measures were the most frequently used, followed by electronic lid devices and pharmacy records. Standardized self-report measures such as Morisky, Green, and Levine Self-Reported Medication Taking Scale (MGLS) and Antidepressant Adherence Scale (AAS) demonstrated acceptable reliability and validity, while medication claims data showed good reliability as a long-term measure. Although the psychometric properties of various measures have been evaluated across the three phases of adherence, a standout measure with strong reliability and validity was not apparent. No single measure demonstrated reliability and validity throughout the adherence process. A range of different subjective and objective adherence measures is recommended to assess medication adherence across the different phases.

Research Roundup

FDA data on pimavanserin show favorable risk profile Review finds little evidence of addictive power of gabapentinoids Use of montelukast for asthma linked with neuropsychiatric effects Open‐label trial finds psilocybin improves depressive symptoms Study finds antidepressant adherence varies little between physicians ADHD medication use during pregnancy linked with CNS disorders in infants Two tested doses of valbenazine found safe for tardive dyskinesia

The mental health community: An underserved and undertreated population: Encouraging research but challenges remain

The mental health community: An underserved and undertreated population: Encouraging research but challenges remain

The Relation Between Mastery, Anticipated Stigma and Depression Among Older Adults in a Primary Care Setting.

The current study evaluates the interaction between mastery, depression, and psychological barriers to care among older adults in a primary care setting, including the longitudinal effects of anticipated stigma and mastery on depressive symptoms. The sample was composed of 70 depressed older adults (age ≥ 60) who were newly recommended antidepressant treatment by their physicians. This cohort is part of a larger study examining the usefulness of the Treatment Initiation and Participation program to improve medication adherence. Anticipated stigma significantly predicted greater depression among older adults with low mastery, but not among those with high mastery. Mastery was found to moderate the relationship between anticipated stigma and depressive symptoms among older adults. Increased mastery over 28 weeks was also associated with greater reductions in depressive symptoms at follow-up, controlling for antidepressant strength and adherence. Bolstering older adults' sense of mastery in treatment could provide a source of resilience for older adults facing depression.

The association of antidepressant treatment with COPD maintenance medication use and adherence in a comorbid Medicare population: A longitudinal cohort study.

Using 2006-2012 Medicare data, this retrospective cohort study identified patients with newly diagnosed COPD and new-onset major depression. Two exposures-antidepressant use (versus non-use) and adherence measured by proportion of days covered (PDC) (PDC ≥0.8 versus <0.8)-were assessed quarterly. We used marginal structural models to estimate the effects of prior antidepressant use and adherence on subsequent COPD maintenance inhaler use and adherence outcomes, accounting for time-varying confounders. A total of 25458 COPD-depression patients, 82% with antidepressant treatment, were followed for a median of 2.5years. Nearly half (48%) used at least 1 COPD maintenance inhaler in any given quarter; among users, 3 in 5 (61%) had a PDC of <0.8. Compared to patients with no antidepressant treatment, those with antidepressant use were more likely to use (relative ratio [RR]=1.15, 95% confidence interval [CI]=1.12-1.17) and adhere to (RR=1.08, 95%=1.03-1.14) their COPD maintenance inhalers. Patients who adhered to antidepressant treatment were more likely to use and adhere to COPD maintenance inhalers. Regularly treated depression may increase use of and adherence to necessary maintenance medications for COPD. Antidepressant treatment may be a key determinant to improving medication-taking behaviors among COPD patients comorbid with depression.

Impact of adherence to antidepressants on healthcare outcomes and costs among patients with type 2 diabetes and comorbid major depressive disorder

Objective: To evaluate the association between adherence to antidepressants and an effect on clinical outcomes and healthcare costs in patients with major depressive disorder (MDD) and comorbid type 2 diabetes (T2D).Methods: This retrospective study used MarketScan claims data from January 2012 to March 2014. Study entry was the first claim for an antidepressant and a diagnosis code for MDD and T2D in the prior 6 months. Adherence and persistence with antidepressant therapy in the first 180 days were defined as medication possession ratio (MPR) ≥ 80% and length of therapy (LOT), with no treatment gap of >15 days, respectively. T2D control (HbA1c <7%), oral diabetes medication adherence, and healthcare costs were measured in the 12 month post-index period. The impact of antidepressant adherence and persistence on outcomes was assessed using multivariable analyses.Results: Among the 1361 patients included, the mean age was 59 years and 55% were women. About one-third of the patients were adherent (35.9%, mean MPR = 40%), persistent (32.0%, average LOT = 100 days), and adherent/persistent (31.2%) on antidepressants. Being adherent, persistent, or adherent/persistent to antidepressants was associated with a two-fold improvement in adherence to oral diabetes medications. Of those with HbA1c data (n = 121), adherence or adherence/persistence to antidepressants was associated with patients being five times more likely to have T2D control (odds ratio [OR]: 4.95; 95% confidence interval [CI]: 1.39, 17.59, p = .0134). Comparison between antidepressant-persistent and non-persistent patients was not significant. Mean difference in adjusted all-cause annual costs showed lower costs among antidepressant-adherent and adherent/persistent patients (adherent: -$350, 95% CI: -$462, -$247; adherent/persistent: -$1165; 95% CI: -$1280, -$1060).Conclusions: Patients with better antidepressant adherence and adherence/persistence demonstrated better HbA1c control, with lower all-cause total and medical costs. Adherence, persistence, or adherence/persistence to antidepressants was associated with improved adherence to oral diabetes medications.

Medicare Accountable Care Organizations and Antidepressant Use by Patients With Depression.

This study examined whether Medicare accountable care organization (ACO) programs were associated with early changes in antidepressant use or adherence among beneficiaries with depression. A difference-in-difference design was used to compare claims from Medicare fee-for-service beneficiaries (2009-2013) and ACO patients with those from local control groups. Outcome measures were total antidepressant days supplied, filling one or more antidepressant prescriptions, and proportion of days covered (PDC) by supply among antidepressant users (adherence). Among antidepressant users, ACO contracts were associated with slight differential increases in PDC (.4-.8 percentage point, p≤.03), depending on ACO program and entry year. The proportion of patients with one or more prescriptions was unchanged or decreased slightly for ACO patients with depression, such that total supply did not consistently increase. Medicare ACO programs were associated with early modest increases in antidepressant adherence but not with increases in the proportion of patients with depression who received antidepressants.

Adherence and healthcare utilization among older adults with COPD and depression

Background and objectiveAdherence to chronic obstructive pulmonary disease (COPD) maintenance medications and antidepressants may reduce healthcare utilization among multimorbid individuals with COPD and depression. We quantified the independent effects of adherence to antidepressants and COPD maintenance medications on healthcare utilization among individuals co-diagnosed with COPD and depression. ProceduresWe conducted a retrospective cohort study using a 2006–2012 5% random sample of Medicare beneficiaries co-diagnosed with COPD and depression who had two or more prescription fills of both COPD maintenance medications and antidepressants. We measured adherence to medications using the proportion of days covered per 30-day period. The primary outcomes were all-cause emergency department (ED) visits and hospitalizations. Beneficiaries were followed over a minimum 12-month follow-up period. ResultsOf the 16,075 beneficiaries meeting inclusion criteria, 21% achieved adherence ≥80% to COPD maintenance medications and 55% achieved adherence ≥80% to antidepressants. Compared to no use and controlling for antidepressant adherence and potential confounders, higher (≥80%) levels of adherence to COPD maintenance medications were associated with decreased risk of ED visits (hazard ratio (HR) 0.79; 95% CI 0.74, 0.83) and hospitalizations (HR 0.82; 95% CI 0.78, 0.87). Similarly, higher levels (≥80%) of adherence to antidepressants resulted in decreased risk of ED visits (HR 0.74; 95% CI 0.70, 0.78) and hospitalizations (HR 0.77; 95% CI 0.73, 0.81) compared to no use. ConclusionsClinicians can assist in the improved management of their multimorbid patients' health by treating depression among patients with COPD and monitoring and encouraging adherence to the regimens they prescribe.

With a little help from my friends?: racial and gender differences in the role of social support in later-life depression medication adherence.

Social support has been shown to be an important factor in improving depression symptom outcomes, yet less is known regarding its impact on antidepressant medication adherence. This study sought to evaluate the role of perceived social support on adherence to new antidepressant medication prescriptions in later-life depression. Data from two prospective observational studies of participants ≥60 years old, diagnosed with depression, and recently prescribed a new antidepressant (N = 452). Perceived social support was measured using a subscale of the Duke Social Support Index and medication adherence was assessed using a validated self-report measure. At four-month follow up, 68% of patients reported that they were adherent to antidepressant medication. Examining the overall sample, logistic regression analysis demonstrated no significant relationship between perceived social support and medication adherence. However, when stratifying the sample by social support, race, and gender, adherence significantly differed by race and gender in those with inadequate social support: Among those with low social support, African-American females were significantly less likely to adhere to depression treatment than white females (OR = 4.82, 95% CI = 1.14-20.28, p = 0.032) and white males (OR = 3.50, 95% CI = 1.03-11.92, p = 0.045). There is a significant difference in antidepressant medication adherence by race and gender in those with inadequate social support. Tailored treatment interventions for low social support should be sensitive to racial and gender differences.

Effect of pharmacist intervention on improving antidepressant medication adherence and depression symptomology: A systematic review and meta-analysis.

Depression is a widespread disease with effective pharmacological treatments, but low medication adherence. Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients. The aim of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders. A systematic review of controlled trials (both randomized and non-randomized) was conducted. Studies were obtained through a search of PubMed, Academic Search Premier, and Cochrane Library databases. Studies which included a pharmacist intervention to improve medication adherence in outpatients age 17 and above with a depressive disorder diagnosis and antidepressant treatment were included. Twelve publications met inclusion criteria, representing a total of 15,087 subjects: 1379 (9%) intervention and 13,708 (91%) control. The interventions in each selected publication included some level of in-person counseling and education to promote antidepressant adherence. The pooled odds ratio for medication adherence at 6 months was 2.50 (95% CI 1.62 to 3.86). There were no significant differences noted in subgroup meta-analyses except study location (US, Middle East or Europe) and setting. Only one of the identified studies reported statistically significant impacts of the pharmacist intervention on patient depression symptoms. The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients. However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms. Additional longitudinal research is recommended to investigate the multidimensional relationships between pharmacist interventions, patient adherence, and clinical outcomes. Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients. The purpose of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders. A systematic review of randomized and non-randomized controlled trials was conducted of the twelve studies which met inclusion criteria. The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients. However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms.

Assessing disruptions in adherence to antidepressant treatments after breast cancer diagnosis.

Long-term treatment with antidepressants can lessen the symptoms of depression, but health-related crises-such as a cancer diagnosis-may disrupt ongoing depression care. The study aims to estimate the effect of receiving a breast cancer diagnosis on antidepressant adherence among women with depression. Using SEER-Medicare administrative claims, we identified women aged 65+ with newly diagnosed breast cancer between 2008 and 2011, who were diagnosed with depression and used antidepressants during the year before pre-diagnosis year. We compared antidepressant adherence among women with breast cancer to similar women without cancer using generalized estimation equations. Antidepressant adherence was estimated using the proportion of days covered 1year before and after the index date. We included 1142 women with breast cancer and pre-existing depression and 1142 matched non-cancer patients with pre-existing depression. Mean antidepressant adherence was similar for both groups in the year before and after the index date (all around 0.71); adherence decreased by approximately 0.01 following breast cancer diagnosis in cancer group, with similar reductions among non-cancer group (p=0.19). However, substantial proportion of patients had inadequate adherence to antidepressants in the post-diagnosis period, and almost 40% of patients in each group discontinued antidepressants over the study period. Antidepressant adherence was not associated with receiving a breast cancer diagnosis beyond what would have been expected in a similar cohort of women without cancer; however, adherence was poor among both groups. Ensuring adequate ongoing depression care is important to improve cancer care and patient quality of life in the long term. Copyright © 2017 John Wiley & Sons, Ltd.

Antidepressant adherence patterns in older patients: use of a clustering method on a prescription database

According to the World Health Organization, depression will become the second most important cause of disability worldwide by 2020. Our objective was to identify patterns of adherence to antidepressant treatments in older patients using several indicators of adherence and to characterize these patterns in terms of medication exposure. We conducted a retrospective cohort study using the French National Health Insurance reimbursement database. Incident antidepressant users aged more than 65 were included from July 1, 2010, to June 30, 2011, and followed up for 18 months. Antidepressant and other psychotropic drugs (opioids, benzodiazepines, antipsychotics, anti-epileptics) were recorded. Adherence to antidepressant treatment was assessed by several measures including proportion of days covered, discontinuation periods, persistence of treatment, and doses dispensed. Patients were classified according to their adherence patterns using a mixed clustering method. We identified five groups according to antidepressant adherence. One group (n = 7505, 26.9%) was fully adherent with regard to guidelines on antidepressant use. Two patterns of nonadherent users were identified: irregular but persistent users (n = 5131, 18.4%) and regular but nonpersistent users (n = 9037, 32.4%). Serotonin reuptake inhibitors were the most frequently dispensed antidepressant class (70.6%), followed by other antidepressants (43.3%, mainly serotonin-norepinephrine reuptake inhibitors and tianeptine) and tricyclic antidepressants (TCAs) (13.4%). Nonadherent users more frequently had a dispensing of TCA, opioid, and anti-epileptic medication than adherent users. Health policies to improve adherence to antidepressant treatment may require better training of physicians and pharmacists, insisting on the important role of the continuation period of antidepressant treatment.

Antidepressant Prescribing in Primary Care to Older Adults Without Major Depression.

The study compared distress levels among two groups of older adults who had been newly prescribed an antidepressant by their primary care physician, those with major depressive disorder (MDD) and those without MDD. This analysis used a convenience sample of participants (N=231) who had been newly prescribed an antidepressant in a randomized controlled trial of a program to improve antidepressant adherence and depression outcomes among older adults (≥55). After determining the proportion of participants with and without MDD (using the Structured Clinical Interview for DSM-IV), the authors compared groups on demographic, clinical, and psychosocial characteristics, including the 12-Item Short-Form Health Survey physical and mental component summary scores (PCS and MCS). Logistic regression was used to test the association of these characteristics with antidepressant use in the absence of MDD. Most (57%) participants did not have MDD. This group was older (69.4 versus 64.7, p<.001), had a larger proportion of white participants (82% versus 56%, p<.001), and reported better physical (PCS, 43.4 versus 39.9, p=.03) and emotional (MCS, 40.2 versus 30.5, p<.001) well-being compared with the group with MDD. In the final regression model, white race (adjusted odds ratio [AOR]=3.11, p=.03) and better emotional well-being (AOR=1.16, p<.001) were associated with antidepressant use in the absence of MDD. Older adults prescribed antidepressants in the absence of MDD did not report similar distress levels compared with their counterparts with MDD. Given the continued emphasis on screening for depression in primary care, it is important to consider the potential for overtreatment.