Differences In Antidepressant Use Research Articles

Racial Differences in Antidepressant Use in Nursing Facility Residents With Moderate to Severe Cognitive Impairment.

Objective To describe and compare the use of antidepressants between Black or African descent and White nursing facility residents with moderate to severe cognitive impairment. Design This was a secondary data analysis using baseline data from the Function and Behavior Focused Care for Nursing Facility Residents with Dementia randomized control trial. Setting Participants were recruited from 10 urban and two rural nursing facilities from Maryland. Methods Participants had to be 55 years of age or older, English-speaking, reside in long-term care at time of recruitment, and score a 15 or less on the Mini Mental-State Examination. A total of 336 residents participated at baseline. Data were collected by a research evaluator through observation, proxy report from staff caring for the resident the day of testing, and patient charts. Main Outcomes A significant difference of antidepressant use between Black or African descent and White nursing facility residents with moderate to severe cognitive impairment would be noted when controlling for depression, age, gender, functional status, agitation, and number of co-morbidities. Results In adjusted models, Black or African descent residents were less likely to be prescribed antidepressants compared with White residents. Conclusion Racial differences were noted regarding antidepressant use among nursing facility residents with moderate to severe cognitive impairment, but it is unknown if race could impact prescribing practices when indications for use are known. Further research is needed to ascertain if knowing the specific indications for use might contribute to racial disparities with antidepressant prescribing in nursing facility residents with moderate to severe cognitive impairment.

Antidepressant use in Turkey by provinces: panel data analysis

Abstract Objectives The objective of this analysis is to show differences in antidepressant use by year and by provinces of Turkey and to understand possible factors that cause these differences. Methods The drug data were obtained from the IMS Health Turkey Medical Index, and the per capita usage was calculated by proportioning with the population. Provinces with combined data were excluded from the study. Sixty provinces with complete data obtained from the IMS Health and Turkish Statistical Institute (TUIK) were included in the analysis. Physician visits per capita annual data were extracted from the Ministry of Health statistics. Population and per capita gross domestic product data of provinces were obtained from TUIK. A panel data regression model was established in the study. Key findings The model explained 99.25% of the variation in antidepressant consumption unit per person, which is a dependent variable. In our study, it was observed that there was no statistically significant effect of age and income in antidepressant usage. However, per capita physician consultation and the total population have a significant effect on per capita antidepressant use. Therefore, when the other variables are kept constant and the total population increases by 1%, the coefficient of antidepressant use per capita increases by 0.62%. Conclusions According to our analysis, in the majority of the provinces, antidepressant use exceeded the expected level. If the population density of Turkey increases, the ratio of antidepressant usage in the total consumption of drugs may grow. It is necessary to investigate whether there is overuse and to determine underlying causes and preventive measures.

Antidepressant dispensing before, during, and after pregnancy in New Zealand, 2005‒2014

Depression during pregnancy is associated with a number of negative impacts on maternal and infant health, therefore good control of depression in pregnant women is crucial. There is a lack of population-level information about patterns of antidepressant use during pregnancy in New Zealand. To describe antidepressant dispensing patterns before, during, and after pregnancy in New Zealand, 2005-2014. Antidepressant dispensing records from 270days prior to pregnancy through to 360days after pregnancy end were linked with 805990 pregnancies in the New Zealand Pregnancy Cohort. Proportions (and 95% confidence intervals) with at least one dispensing were calculated for the periods before, during, and after pregnancy and compared over time and by maternal characteristics. Dispensing during the first trimester was lower than in the pre-pregnancy and post-pregnancy periods, and dropped further in later trimesters. The proportion of pregnancies during which an antidepressant was dispensed rose from 3.1 to 4.9% over the study years. Around 80% of those with a dispensing received a selective serotonin reuptake inhibitor. Dispensing before, during, and after pregnancy varied by ethnicity, age, smoking status, and body mass index. Among women taking an antidepressant before pregnancy, younger women and those of Māori, Pacific, or Asian ethnicity were less likely to continue therapy during pregnancy. This study has established a baseline for antidepressant use around pregnancy in New Zealand, documented increasing use over time, and demonstrated that known ethnic differences in antidepressant use are also evident in the pregnant population.

Development and validation of an analytical procedure to detect spatio-temporal differences in antidepressant use through a wastewater-based approach

Wastewater-based epidemiology applies the analysis of human metabolic excretion products of xenobiotics in wastewater to estimate the community-wide use of these compounds. A new bioanalytical method was developed, optimised and validated for the analysis of a broad range of antidepressants and their metabolites at trace concentrations in influent wastewater. The assay was based on solid-phase extraction and liquid chromatography coupled to tandem mass spectrometry. For most compounds, Oasis® HLB cartridges were used for sample preparation. Oasis® MCX cartridges were used for extraction of normirtazapine, moclobemide, sertraline, and melitracen in particular. The Kinetex XBC18 column with a gradient elution resulted in appropriate separation for the analytes under investigation. Validation was done according to the European Medicines Agency guidelines on bioanalytical method validation. For 27 compounds, the performance criteria met the requirements for method validation. For these analytes, the lower limit of quantification (LLOQ) ranged between 1 and 25 ng/L. Furthermore, all targeted biomarkers showed high in-sample stability during 24 h, with the exception of mianserin. The validated assay was applied to influent wastewater samples collected from four wastewater treatment plants in Belgium. Among these four locations, a total of 18 out of 27 biomarkers for antidepressant use were present in the samples in concentrations above the LLOQ. Additionally, the proposed methodology proved capable of analysing high resolution spatio-temporal trends. Mann-Kendall trend analyses showed that antidepressant use is stable throughout the week, except for trazodone which increased throughout the week.

Distinctive use of newer and older antidepressants in major geographical areas: A nationally representative register-based study

BackgroundIt is unknown whether newer, mainly selective serotonin reuptake inhibitors, and older tricyclic antidepressants are used similarly regardless of the geographical area of residence and education. MethodsWe included four randomly sampled cohorts of the Finnish working aged population (n = 998,540–1,033,135). The sampling (Dec 31st in 1995, 2000, 2004 and 2010) resulted in non-overlapping time windows where each participant was followed up for four years for the first antidepressant use. Using Cox proportional hazards models, we examined whether the hazard of antidepressant use differed between the capital area and three other areas (Southern, Western and Northern/Eastern Finland). Educational differences were examined using four sub-groups: capital area/high education (reference category); other areas/high education; capital area/low education; and other areas/low education. ResultsHazard ratios for the use of newer antidepressants were significantly lower in all other areas compared to the capital area after adjustment for age, sex, marital status, employment status, education, income, and area-level unemployment. Findings remained consistent in all time windows, differences increasing slightly. In the sub-group analysis those with low education had the lowest level of use in all areas, also within the capital area. The results were opposite for older antidepressants in all but the last time window. LimitationsSome degree of unmeasured confounding and exposure misclassification is likely to exist. ConclusionsNewer antidepressants were more commonly used in the capital than in the other areas, and among those with high versus low education. These differences in antidepressant use suggest socioeconomic inequalities in the mental health treatment quality.

A longitudinal study of educational differences in antidepressant use before and after hospital care for depression

Despite social inequalities in depression various studies report small or even reversed social gradients for antidepressant treatment, suggesting unmet need for treatment among those with low social position. However, few studies assess need for treatment or compare longitudinal antidepressant use patterns between socioeconomic groups. We used a nationally representative register cohort of Finnish adults with hospital care for depression in 1998-2007 (n = 7249). We compared the prevalence of any use and daily use of antidepressants across educational groups in consecutive 3-month periods up to 5 years before admission and 5 years after discharge, adjusting for important confounders. We found no educational differences in any antidepressant use in the 5 years leading to hospital care for depression but a 3-4 percentage-point higher prevalence among those with high education in the 3-month periods immediately preceding and following hospital care for depression. Furthermore, decline in the prevalence of antidepressant use after discharge was more rapid in low education resulting in a significant 4-6 percentage-point higher prevalence among the highly educated lasting until 2.5 years after discharge. Daily use was significantly more common among the highly educated for a year before admission, immediately after discharge and for 2.5 years thereafter, the excess being 3-8 percentage-points. Our results suggest rather equitable access to antidepressant treatment at the time of evident need, i.e. immediately after discharge from hospital care for depression. However, early discontinuation of treatment as well as below guideline use of antidepressants were more common among the low educated.

Effects of Eliminating Drug Caps on Racial Differences in Antidepressant Use Among Dual Enrollees With Diabetes and Depression

PurposeBlack patients with diabetes are at greater risk of underuse of antidepressants even when they have equal access to health insurance. This study aimed to evaluate the impact of removing a significant financial barrier to prescription medications (drug caps) on existing black-white disparities in antidepressant treatment rates among patients with diabetes and comorbid depression. MethodsWe used an interrupted time series with comparison series design and a 5% representative sample of all fee-for-service Medicare and Medicaid dual enrollees to evaluate the removal of drug caps on monthly antidepressant treatment rates. We evaluated the impact of drug cap removal on racial gaps in treatment by modeling the month-to-month white-black difference in use within age strata (younger than 65 years of age or 65 years of age or older). We compared adult dual enrollees with diabetes and comorbid depression living in states with strict drug caps (n = 221) and those without drug caps (n = 1133) before the policy change. Our primary outcome measures were the proportion of patients with any antidepressant use per month and the mean standardized monthly doses (SMDs) of antidepressants per month. FindingsThe removal of drug caps in strict drug cap states was associated with a sudden increase in the proportion of patients treated for depression (4 percentage points; 95% CI, 0.03–0.05, P < 0.0001) and in the intensity of antidepressant use (SMD: 0.05; 95% CI, 0.03–0.07, P < 0.001). Although antidepressant treatment rates increased for both white and black patients, the white-black treatment gap increased immediately after Part D (0.04 percentage points; 95% CI, 0.01–0.08) and grew over time (0.04 percentage points per month; 95% CI, 0.002–0.01; P < 0.001). ImplicationsPolicies that remove financial barriers to medications may increase depression treatment rates among patients with diabetes overall while exacerbating treatment disparities. Tailored outreach may be needed to address nonfinancial barriers to mental health services use among black patients with diabetes.

Disparities in antidepressant use in pregnancy.

BackgroundThe American College of Obstetricians and Gynecologists and the American Psychiatric Association both recommend pharmacotherapy for perinatal depression when the benefits outweigh the risks. While minority adults are less likely to use antidepressant medications compared to Non-Hispanic Whites, whether this pattern occurs among pregnant women is unclear.ObjectiveWe sought to determine the frequency of antidepressant medication use reported during ambulatory care visits for pregnant women and whether these rates varied by race.MethodsWe combined the 2006–2010 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) to obtain nationally representative estimates of outpatient preventive care visits for pregnant women. We then obtained estimates of the prevalence of reported depression and antidepressant use during outpatient visits for pregnant women. To determine whether these estimates varied by race, we used multivariable logistic regression analyses accounting for survey design using SAS 9.2 (PROC SURVEYLOGISTIC) to estimate odds ratios of reported antidepressant use after adjustment for age, insurance status and region of the country.ResultsAntidepressant use was reported during 2.2% of all outpatient visits for pregnant women. Providers indicated a depression diagnosis in 4.5% of visits. Among visits for depressed pregnant women, providers reported antidepressant use 25.4% of the time for all visits. Antidepressant use during pregnancy varied significantly by race/ethnicity. Among visits for Non-Hispanic White women, 3.1% included a code for antidepressant use vs. just 1.0% for Non-White women (P<0.0001). After adjustment for age, insurance status, and region of the country, this association persisted with Non-Hispanic White (vs. Non-White) pregnant women having higher odds of antidepressant use (adjusted OR 3.3, 95% CI 2.1, 5.3).ConclusionNon-Hispanic White women were more likely than Non-White women to be using antidepressants during pregnancy. Whether differences in antidepressant use by race/ethnicity indicates over-treatment of non-Hispanic White women or under-treatment of minorities remains unclear. This disparity warrants investigation with the goal of optimizing maternal mental health while minimizing potential adverse sequelae of antidepressants on developing fetuses.

Socioeconomic differences in antidepressant use in the PATH through life study: Evidence of health inequalities, prescribing bias, or an effective social safety net?

BackgroundDepression is more common amongst those who are economically disadvantaged. However there is inconsistent evidence concerning the relationship between socioeconomic position and antidepressant use. Moreover, evidence of greater antidepressant use amongst those of lower socioeconomic position may reflect their greater psychiatric morbidity, a prescribing bias towards pharmacological treatments, or provide evidence of an effective social safety net. This study investigates these issues whilst addressing methodological limitations of earlier studies. MethodData were from a large, random community survey of Australian adults (N=4493) with linked administrative data for primary-care service use. Depression was measured using the Patient Health Questionnaire, with other measures of current mental health and history of depression included in analysis. Multiple personal indicators and a combined measure of social disadvantage were considered. A series of analyses systematically examined competing explanations for socioeconomic differences in depression and antidepressant treatment. ResultsMarkers of socioeconomic disadvantage were associated with a greater likelihood of antidepressant use. This finding was not attributable to the higher rates of depression amongst the disadvantaged. A similar pattern of results was evident for non-pharmaceutical treatments (primary care consultations). Socioeconomic position was not associated with use of complementary medications for depression, not covered by Australia's social safety net. LimitationsAnalysis did not consider specialist mental health services. ConclusionsSocially disadvantaged respondents reported greater antidepressant use and service use after controlling for current depression symptoms. This pattern of findings suggests Australia's universal health-care system and social safety net may help address potential inequalities in health care.

Structural brain abnormalities common to posttraumatic stress disorder and depression.

Posttraumatic stress disorder (PTSD) and major depression are reliably associated with reductions in brain volume in markedly similar areas. To our knowledge, no volumetric studies have directly contrasted these conditions. We investigated which, if any, grey matter reductions would be uniquely associated with each disorder. We also investigated more subtle independent effects: specifically, correlations between brain volume and self-report measures of psychopathology. We obtained structural magnetic resonance imaging scans from participants with PTSD, major depression and healthy controls exposed to trauma. Participants completed standardized self-report measures of anxiety and depression. We used voxel-based morphometry, applying the DARTEL algorithm within SPM5 to identify associated volumetric changes. We enrolled 24 patients with PTSD, 29 with major depression and 29 controls in our study. The clinical groups had regions of markedly smaller volume compared with the control group, particularly in prefrontal areas, but did not differ from each other. Greater self-reported anxiety was inversely related to volume in several areas, particularly the inferior temporal cortex, among patients with PTSD, but was associated with some volume increases in patients with major depression. Greater self-reported depression showed similar but weaker effects, being inversely related to brain volume in patients with PTSD but positively related to volume in the cuneus and precuneus of those with major depression. To maintain the representativeness of the sample, patients with PTSD were not excluded if they had typical comorbid conditions, such as depression. Patients were not all medication-free, but we controlled for group differences in antidepressant use in the analyses. We identified commonalities in areas of brain volume in patients with PTSD and those with major depression, suggesting that existing findings concerning reductions in prefrontal areas in particular may not be specific to PTSD but rather related to features of the disorder that are shared with other conditions, such as depression. More subtle differences between patients with PTSD and those with major depression were represented by distinct structural correlates of self-reported anxiety and depression.

No increase in depression with low-dose maintenance peginterferon in prior non-responders with chronic hepatitis C

Background Peginterferon and ribavirin treatment of chronic hepatitis C (CHC) is frequently associated with dose-limiting neuropsychiatric toxicity. The purpose of this study is to determine whether prolonged administration of low-dose peginterferon-α2a is associated with an increase in the rate and severity of depression compared to untreated controls. Methods 129 non-responders to full-dose peginterferon and ribavirin treatment were randomized to low-dose maintenance treatment with peginterferon-α2a 90 μg/week or no treatment for 3.5 years. Depression was assessed using the Beck Depression Inventory (BDI-II) and the Composite International Diagnostic Interview (CIDI) at baseline and at 12, 24, 36, and 48 months. “Clinical depression” was defined as BDI-II ≥ 11 and/or meeting DSM-IV criteria for major depression on the CIDI. Serial cortisol and serotonin plasma concentrations were obtained in a subgroup of patients. Results Rates of clinical depression did not significantly differ over time or between treatment groups. Baseline clinical depression was the only significant predictor of clinical depression over time (p < 0.001). Rates of clinical depression were also significantly higher in patients experiencing liver disease progression (p = 0.016). Antidepressant use did not significantly differ between groups. Adjusted whole blood serotonin levels dropped significantly over time (p = 0.04), but there was no group by time effect. Limitations Lack of significant group differences in antidepressant use does not completely preclude significant mood changes masked by antidepressants. Results may differ in treatment naïve CHC patients or in those receiving full-dose peginterferon. Conclusions Prolonged low-dose peginterferon-α2a treatment is not associated with an increase in the frequency or severity of clinical depression in prior non-responder patients with chronic hepatitis C.

Ethnic differences in antidepressant use before suicide

Ethnic differences in antidepressant use before suicide

Ethnic differences in antidepressant use before suicide

Ethnic differences in antidepressant use before suicide

Antidepressant Use by Race

Back to table of contents Previous article Next article Letter to the EditorFull AccessAntidepressant Use by RaceHELEN C. KALES, M.D., FREDERIC C. BLOW, PH.D., and ALAN M. MELLOW, M.D., PH.D., HELEN C. KALESSearch for more papers by this author, M.D., FREDERIC C. BLOWSearch for more papers by this author, PH.D., and ALAN M. MELLOWSearch for more papers by this author, M.D., PH.D., Ann Arbor, Mich.Published Online:1 Jun 2001https://doi.org/10.1176/appi.ajp.158.6.974-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We read the recent article by Dan G. Blazer, M.D., Ph.D., et al. (1) with great interest. The article draws important attention to marked differences in antidepressant use by race in an elderly community sample and is a significant contribution to the literature in this area. We certainly agree with the authors that differences in antidepressant use between Caucasian and African American elders could have many causes.These could include, as the authors noted, practitioners’ underdiagnosis of depression in elderly African Americans (in spite of the known similar prevalences of the disorder in these races when assessed in large-scale controlled studies). In fact, there is a growing literature suggesting that this phenomenon occurs in a variety of settings. In two separate studies of patients admitted to geropsychiatric acute inpatient units, Fabrega et al. (2) noted a lower proportion of elderly African Americans diagnosed with mood disorders and higher proportions of elderly African Americans diagnosed with psychotic disorders, and Mulsant et al. (3) found that elderly African American patients were significantly more likely to receive a diagnosis of schizophrenia. Leo et al. (4), in a study examining geropsychiatric consultation, found that African Americans were diagnosed with psychotic disorders and dementia significantly more often and with mood disorders significantly less often than Caucasians. In a large retrospective examination of a group of elderly patients treated within the Veterans Affairs health care system, we found that African Americans were significantly less likely to receive a diagnosis of depression than Caucasians (5); the rate of mood disorder diagnoses in elderly African Americans was less than half that of elderly Caucasians.Differences in depression diagnoses between races in elderly samples could be due to patient factors (less reporting, different symptom presentation, or less use of formal health care settings for treating depression) or provider factors (misdiagnosis or clinician bias). On the basis of these findings, we agree that it is possible that the subjects in the study by Dr. Blazer et al. were much less likely to receive antidepressants because they were much less likely to be given the diagnosis of major depression in the clinical setting. The question remains as to whether elderly patients of different races receive different treatments once a diagnosis of depression is made. Further studies are needed to examine the contribution of both patient and provider factors to racial differences in this area.

Antidepressant Use by Race

Back to table of contents Previous article Next article Letter to the EditorFull AccessAntidepressant Use by RaceHELEN C. KALES, M.D., FREDERIC C. BLOW, PH.D., and ALAN M. MELLOW, M.D., PH.D., HELEN C. KALESSearch for more papers by this author, M.D., FREDERIC C. BLOWSearch for more papers by this author, PH.D., and ALAN M. MELLOWSearch for more papers by this author, M.D., PH.D., Ann Arbor, Mich.Published Online:1 Jun 2001https://doi.org/10.1176/appi.ajp.158.6.974-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We read the recent article by Dan G. Blazer, M.D., Ph.D., et al. (1) with great interest. The article draws important attention to marked differences in antidepressant use by race in an elderly community sample and is a significant contribution to the literature in this area. We certainly agree with the authors that differences in antidepressant use between Caucasian and African American elders could have many causes.These could include, as the authors noted, practitioners’ underdiagnosis of depression in elderly African Americans (in spite of the known similar prevalences of the disorder in these races when assessed in large-scale controlled studies). In fact, there is a growing literature suggesting that this phenomenon occurs in a variety of settings. In two separate studies of patients admitted to geropsychiatric acute inpatient units, Fabrega et al. (2) noted a lower proportion of elderly African Americans diagnosed with mood disorders and higher proportions of elderly African Americans diagnosed with psychotic disorders, and Mulsant et al. (3) found that elderly African American patients were significantly more likely to receive a diagnosis of schizophrenia. Leo et al. (4), in a study examining geropsychiatric consultation, found that African Americans were diagnosed with psychotic disorders and dementia significantly more often and with mood disorders significantly less often than Caucasians. In a large retrospective examination of a group of elderly patients treated within the Veterans Affairs health care system, we found that African Americans were significantly less likely to receive a diagnosis of depression than Caucasians (5); the rate of mood disorder diagnoses in elderly African Americans was less than half that of elderly Caucasians.Differences in depression diagnoses between races in elderly samples could be due to patient factors (less reporting, different symptom presentation, or less use of formal health care settings for treating depression) or provider factors (misdiagnosis or clinician bias). On the basis of these findings, we agree that it is possible that the subjects in the study by Dr. Blazer et al. were much less likely to receive antidepressants because they were much less likely to be given the diagnosis of major depression in the clinical setting. The question remains as to whether elderly patients of different races receive different treatments once a diagnosis of depression is made. Further studies are needed to examine the contribution of both patient and provider factors to racial differences in this area.