Patterns Of Antidepressant Use Research Articles

Patterns of antidepressant use among older adults in Northern Ireland: An administrative data study.

ObjectiveOver recent decades, there has been a noticeable increase in the prescription of antidepressant medications, particularly among older adults. This study examines the relationship between health outcomes and patterns of antidepressant use among older adults in Northern Ireland (NI). ApproachParticipants included all (General Practitioner) GP-registered hospital patients aged fifty-five years and above on 01/01/2010 (n =395,872). Administrative data linkage included demographic information (age, sex; urbanicity); data on antidepressant use from the NI Enhanced Prescribing Database (EPD); and hospital patient admissions/discharges. Repeated measures latent class analysis (RMLCA) identified patterns of antidepressant use (2010 to 2020) in relation to the association between these patterns and health-related outcomes in 2021. ResultsRMLCA identified four latent classes : long-term antidepressant use (17.4%); decreasing antidepressant use (7.1%); increasing antidepressant use (8.4%); no-antidepressant use (67.1%). Those in the long-term and increasing antidepressant use’ classes had the highest average number of hospital visits and recorded chronic conditions in 2021. ConclusionFindings show that two distinct subgroups (comprising 26% of the hospital population) were disproportionately impacted by increased antidepressant prescription rates. Because of their increased likelihood of experiencing higher ill-health, these people are crucial targets for additional psychosocial support. ImplicationsAnalyses of this kind emphasize the importance of widening access to administrative data, enabling researchers to identify and examine at-risk groups allowing more targeted policymaking to better address their needs. Data for this project was provided by the HSC Honest Broker Service; any views or opinions presented are solely those of the author.

Associations between antidepressant use patterns during pregnancy and birth outcomes among periconception antidepressant users.

Little is known about antidepressant medication use patterns during pregnancy among periconception (before and immediately following conception) users. Additionally, the associations between these patterns and birth outcomes is unclear, after taking into account underlying depression severity. This study describes patterns of antidepressant use among periconception users and examines associations between usage patterns and birth outcomes. This retrospective cohort study included pregnant Kaiser Permanente Northern California (KPNC) members with a live birth between 2014 and 2017 and an antidepressant medication fill that overlapped the 8th week of pregnancy. Outcomes were preterm birth and neonatal intensive care unit (NICU) admission. Data were extracted from KPNC's electronic health records. Modified Poisson regression was conducted. Of the 3637 pregnancies meeting inclusion criteria, 33% (n=1204) continued antidepressant use throughout the pregnancy (refilled throughout pregnancy), 47% (n=1721) discontinued use (no refills), and 20% (n=712) stopped and reinitiated use (refill after 30+ day gap in supply). Women who continued use had 1.86 (95% confidence interval (CI) 1.53, 2.27) times the risk of preterm birth and 1.76 (95% CI: 1.42, 2.19) times the risk of NICU admission, compared to women who discontinued use during pregnancy. Similarly, women with continued use had 1.66 (95% CI: 1.27, 2.18) times the risk of preterm birth and 1.85 (95% CI: 1.39, 2.46) times the risk of NICU admission, compared to women who stopped and reinitiated use. This relationship held when examining continuous exposure; the relationship between continuous exposure and preterm delivery was stronger in later trimesters. Periconception antidepressant users who continue use during pregnancy, particularly into the second and third trimesters, may be at higher risk of adverse birth outcomes. This evidence should be considered alongside the risks associated with depression relapse.

Graphical methods for understanding changes in states: Understanding medication use pathways.

As epidemiological studies become longer and larger, the field needs novel graphical methods to visualize complex longitudinal data. The aim of this study was to present the Slinkyplot, a longitudinal crosstabulation, to illustrate patterns of antidepressant use in a large prospective cohort of older adults with mild cognitive impairment. Data from the National Alzheimer's Coordinating Center are used to track switches between different states and types of antidepressant use. A Slinkyplot is populated with rows representing the state of medication use at each timepoint and columns representing the state at each subsequent visit. The constructed Slinkyplots display the common practice of switching on and off different antidepressants over time, with citalopram, sertraline, and bupropion most commonly used followed by switching to another SSRI or SNRI as second-line treatment. Slinkyplots are an innovative graphical means of visualizing complex patterns of transitions between different states over time for large longitudinal studies.

Changes in antidepressant use in Australia: A nationwide analysis (2015-2021).

Depression and anxiety affect 4-14% of Australians every year; symptoms may have been exacerbated during the COVID-19 pandemic. We examined recent patterns of antidepressant use in Australia in the period 2015-2021, which includes the first year of the pandemic. We used national dispensing claims for people aged ⩾10 years to investigate annual trends in prevalent and new antidepressant use (no antidepressants dispensed in the year prior). We conducted stratified analyses by sex, age group and antidepressant class. We report outcomes from 2015 to 2019 and used time series analysis to quantify changes during the first year of the COVID-19 pandemic (March 2020-February 2021). In 2019, the annual prevalence of antidepressant use was 170.4 per 1000 women and 101.8 per 1000 men, an increase of 7.0% and 9.2% from 2015, respectively. New antidepressant use also increased for both sexes (3.0% for women and 4.9% for men) and across most age groups, particularly among adolescents (aged 10-17 years; 46-57%). During the first year of the COVID-19 pandemic, we observed higher than expected prevalent use (+2.2%, 95% CI = [0.3%, 4.2%]) among females, corresponding to a predicted excess of 45,217 (95% CI = [5,819, 84,614]) females dispensed antidepressants. The largest increases during the first year of the pandemic occurred among female adolescents for both prevalent (+11.7%, 95% CI = [4.1%, 20.5%]) and new antidepressant use (+15.6%, 95% CI = [8.5%, 23.7%]). Antidepressant use continues to increase in Australia overall and especially among young people. We found a differential impact of the COVID-19 pandemic in treated depression and anxiety, greater among females than males, and greater among young females than other age groups, suggesting an increased mental health burden in populations already on a trajectory of increased use of antidepressants prior to the pandemic. Reasons for these differences require further investigation.

A surrogate measure for patient reported symptom remission in administrative data

BackgroundIn real-world pragmatic administrative databases, patient reported remission is often missing.ObjectiveWe evaluate if, in administrative data, five features of antidepressant use patterns can replace patient-reported symptom remission.MethodWe re-examined data from Sequence Treatment Alternatives to Relieve Depression (STAR*D) study. Remission was measured using 50% reduction in Hamilton index. Pattern of antidepressant use was examined through five variables: (a) number of prior ineffective antidepressants, (b) duration of taking current antidepressant, (c) receiving therapeutic dose of the medication, and (d) switching to another medication, or (e) augmenting with another antidepressant. The likelihood ratio (LR) associated with each of these predictors was assessed in 90% of data (3329 cases) and evaluated in 10% of data (350 cases) set-aside for evaluation. The accuracy of predictions was calculated using Area under the Receiver Operating Curve (AROC).ResultsPatients who took antidepressants for 14 weeks (LR = 2.007) were more likely to have symptom remission. Prior use of 3 antidepressants reduced the odds of remission (LR = 0.771). Patients who received antidepressants below therapeutic dose were 5 times less likely to experience remission (LR = 0.204). Antidepressant that were augment or switched, almost never led to remission (LR = 0.008, LR = 0.002 respectively). Patterns of antidepressant use accurately (AROC = 0.93) predicted symptom remission.ConclusionWithin the first 100 days, antidepressants use patterns could serve as a surrogate measure for patient-reported remission of symptoms.

Long-term antidepressant use in a cohort of older people.

Depression is the most common mental health problem in older adults and untreated is associated with significant burden of illness for patients. This study aimed to examine longitudinal patterns of antidepressant use in older adults and determine which factors were associated with changes in use. Adults aged 50 and over, from The Irish Longitudinal Study on Ageing (TILDA), who participated at any one of the four TILDA waves (n=8175) were included in the analysis. Repeated measures latent class analysis (RMLCA) is the model-based approach we used to identify underlying subgroups in a population. We found antidepressant use ranged from 6% to 10%, over a 6-year period. RMLCA identified three distinct classes of antidepressant use. Notably, 6% of older adults were categorised in a 'long-term antidepressant use' class, with consistent use across all four waves, and 6% were categorised in an 'Intermittent/Developing Use' class. We found long-term antidepressant use to be a characteristic of older adults with chronic conditions at baseline of study and striking low uptake of psychological and psychiatric services. These findings provide evidence of the complex presentations of depression with comorbidities in long-term antidepressant users. While prolonged use of antidepressants in an older cohort is often rationalised due to recurrent depression and comorbidities, this study suggests little deprescribing of antidepressants and a need for greater access and provision of psychological services tailored to later life seem necessary improve management of this condition.

Antidepressant Use in a 3- to 12-Year Follow-up of Anxious Youth: Results from the CAMELS Trial.

The current study explored whether patient characteristics predicted patterns of antidepressant use (i.e., never used, single episode of use, or two or more episodes) in a naturalistic follow-up. Participants in the child/adolescent multimodal (CAMS) extended long-term study. (n = 318) indicated medication use over the course of eight follow-up visits, 3-12years after receiving treatment in CAMS. 40.6% of participants reported never using an antidepressant during follow-up, 41.4% reported a single episode of antidepressant use, and 18.0% reported multiple episodes of antidepressant use. Greater baseline anxiety severity marginally predicted a single episode of antidepressant use; baseline depression severity predicted multiple episodes of use. Reasons for discontinuing antidepressants included perceived ineffectiveness (31.8%), side effects (25.5%), and improvement in symptoms (18.5%). Exploratory analyses examined predictors of medication use. Findings suggest that antidepressant use is common among anxious youth, as is discontinuation of antidepressant use. Clinical implications and future directions are discussed.

Trends and Patterns of Antidepressant Use in French Children and Adolescents From 2009 to 2016: A Population-Based Study in the French Health Insurance Database.

Over the last decade, the use of antidepressants (ATDs) in children and adolescents has markedly increased in several occidental countries, but recent data in French children are missing. This study aimed to assess trends of ATD use in French children (6-11 years) and adolescents (12-17 years) and to characterize changes in ATD prescribing patterns from 2009 to 2016. Using data from the French Health Insurance Database, annual prevalence and incidence of ATD use and changes in ATD prescribing patterns were analyzed. Overall ATD prevalence of use rose slightly from 0.51% in 2009 to 0.53% in 2016 (+3.9%), with a decrease in children (0.18%-0.11%; -38.9%) and an increase in adolescents (0.86%-0.98%; +14.0%) and an overall female preponderance (56.7% in 2009; 58.7% in 2016). Serotonin reuptake inhibitor prevalence of use increased from 0.24% to 0.34%, whereas tricyclic ATD use decreased (from 0.20% to 0.16%). Similar trends were obtained with overall incidence of use, from 0.39% in 2009 to 0.36% in 2016 (-7.7%). Sertraline was the most frequently prescribed in adolescents (2009: 22.2% of all ATD prescriptions; 2016: 32.9%), whereas amitriptyline was the most prescribed in children (2009: 42.7% and 2016: 41.2%). Off-label use decreased in adolescents (from 48.4% to 34.8%) but increased in children (from 10.0% to 26.5%). Antidepressant level of use in French children and adolescents was stable in recent years and lower than that observed in other European countries and the United States.

Patterns of antidepressant use during pregnancy: a nationwide population-based cohort study.

We explored the patterns of antidepressant use during pregnancy. A cohort of women who started a pregnancy in 2014 was identified using data from the French reimbursement healthcare system (covering approximately 99% of the population). Antidepressant usage (initiated before or during pregnancy) was assessed. Explored changes in antidepressant treatment were: associations, switches, discontinuation and resumption of antidepressants during pregnancy. The cohort included 766 508 pregnancies (755 519 women). Antidepressant use during pregnancy was 25.7 per 1000 [95% CI: 25.3-26.0]. New use concerned 3.9 per 1000 [95% CI: 3.7-4.0]; the most initiated class during pregnancy was selective serotonin reuptake inhibitors (SSRIs), while the most prescribed individual drug in second and third trimesters was amitriptyline, a tricyclic. Most changes were observed before pregnancy and during the first trimester: 63% of ongoing treatments in the year before pregnancy were discontinued before conception; 68% of treatments maintained after conception were discontinued during the first trimester; switches or antidepressant associations mostly occurred during the periconceptional period or during the first trimester. Regardless of initial antidepressant, switches to sertraline were the most frequent. Associations mainly consisted of a prescription of tri-/tetracyclic or mirtazapine/mianserin in addition to an SSRI. Discontinuation during pregnancy led to treatment resumption in 22% of pregnancies. These results suggest that pregnancy was planned or the treatment especially adapted in accordance with existing recommendations in a large proportion of women under antidepressants or in whom such treatments have been initiated after starting a pregnancy.

Antidepressant switching patterns in the elderly.

A cohort study of medication supply data from 6011 aged care residents in 60 long-term care facilities was conducted. Incident antidepressant users were followed for 12 months and their patterns of antidepressant use determined. The type of switching from and to different antidepressant classes was determined according to National and International recommendations for antidepressant switching. In total, 11% (n = 44) of the residents were initiated on an antidepressant medication (n = 402) switched to a different antidepressant agent within 12 months. Residents commenced on a SNRI or TCA were most likely to switch antidepressants (17% in each group). Almost half of the switches (n = 21, 48% of all switches) were not implemented according to guideline recommendations. Direct switch and taper followed by wash out and switch, accounted for all of the inappropriate switching (29% and 71%, respectfully), with half occurring to mirtazapine (N = 7) or from mirtazapine (N = 3). Over one in 10 long-term aged care residents who commence an antidepressant will switch to a different antidepressant within 12 months. Current antidepressant switching practices in long-term residential aged care may be increasing the risk of harm associated with antidepressant switching, with around half of all switches not following current guideline recommendations.

Longitudinal trajectories of antidepressant use in pregnancy and the postnatal period.

Studies of antidepressant safety in pregnancy typically do not address complex patterns of use throughout pregnancy. We performed longitudinal trajectory modeling to describe patterns of antidepressant use in the first 32weeks of pregnancy, and test whether these trajectories are associated with a reduction in birth weight or gestational age at delivery. Our study included 166 pregnant women with deliveries between 2011 and 2015 who were prescribed an antidepressant between 91days prior to last menstrual period and 32weeks of gestation. From electronic medical records, we estimated average daily dose and cumulative dose per week for the first 32weeks of gestation and for the first 13weeks postnatal. We clustered women with similar utilization patterns using k-means longitudinal modeling and assessed the associations between trajectory group and birth weight and gestational age at delivery. We identified four cumulative dose trajectory groups and three average daily dose trajectory groups in each period. Relative to the lowest trajectory group, the highest trajectory group during pregnancy was associated with reduced birth weight in multivariable analysis (average daily highest trajectory vs. lowest trajectory β - 314.1g, 95% CI - 613.7, - 15.5) adjusted for depression severity score, maternal age, race, and pregnancy smoking. Trajectory groups were not associated with gestational age at delivery. The highest trajectory group of antidepressant use in pregnancy was associated with a modest reduction in birth weight but not with gestational age at delivery. Longitudinal trajectories allow for a dynamic visualization and quantification of medication use among pregnant women.

Risk factors for late-life depression and correlates of antidepressant use in Costa Rica: Results from a nationally-representative longitudinal survey of older adults

BackgroundRisk factors for late-life depression have been studied in high-income countries, but there have been no longitudinal studies from middle-income countries. This study reports risk factors for late-life depression and correlates of antidepressant using the Costa Rican Longevity and Healthy Aging Study (CRELES), a nationally representative cohort of adults age 60 and over. MethodsCRELES contains baseline interviews in 2005 (n=2827) with follow-up interviews in 2007 and 2009. CRELES used the Geriatric Depression Scale Short Form to identify depression using cut-offs for mild and severe depression and contained a 14-question assessment to determine physical disability. Participants self-reported antidepressant use and chronic health conditions. We examined correlates of newly screened depression and new antidepressant use among participants not depressed or not using antidepressants in the previous study wave. We used generalized estimating equations to estimate the association among variables. ResultsIncreases in disability were associated with newly screening for mild and severe depression. New medical conditions and recent widowhood were associated with newly screening for severe depression. Recent widowhood was also associated with new use of antidepressant medication. LimitationsLimitations of this study include absence of persons living in institutions, inconsistency of screening tools with clinical diagnoses, and possible effects of stigma and recall bias on screening. ConclusionsRisk factors for late-life depression in Costa Rica are similar to risk factors in high-income countries. Patterns of antidepressant use suggest providers may recognize the role of bereavement as a risk factor for late-life depression but not of disability or chronic conditions.

Trends in patterns of antidepressant use in older general population between 2006 and 2012 following publication of practice guidelines.

The French regulatory agency published in 2006 practice guidelines related to the management of depressive and anxiety disorders. The main objective of the study was to assess their impact regarding use and monitoring of antidepressant drug treatment in older patients. The secondary objective was to identify factors associated with compliance with practice guidelines. A historical fixed cohort study with dynamic follow-up time was conducted in 16,144 subjects aged 65 years and over, initiating antidepressant treatment and registered in the National Health Insurance Database between 2006 and 2012. Compliance with guidelines was assessed from year to year using segmented regression analysis. Multiple logistic regressions were used to identify factors associated with compliance with guidelines. Duration of antidepressant treatment was compliant with guidelines in 13.0% of patients aged 65-74 years and 18.5% of patients aged 75 years and over. Biological monitoring was performed in 12.6% of patients aged 65-74 years and 18.5% of patients aged 75 years and over. No significant change of rate of compliance with guidelines was observed over the study period. Compliance of prescriptions with guidelines was associated with patient's age, specialty of the prescriber, presence of chronic disease, year of treatment initiation, and presence of a university hospital in the area of residence. While treatment duration and biological monitoring were often inadequate in older patients, the publication of guidelines by the French health regulatory authorities did not lead to any significant and sustained improvement in their patterns of antidepressant use. Copyright © 2016 John Wiley & Sons, Ltd.

Trends and patterns of antidepressant use in children and adolescents from five western countries, 2005–2012

Following the FDA black box warning in 2004, substantial reductions in antidepressant (ATD) use were observed within 2 years in children and adolescents in several countries. However, whether these reductions were sustained is not known. The objective of this study was to assess more recent trends in ATD use in youth (0−19 years) for the calendar years 2005/6–2012 using data extracted from regional or national databases of Denmark, Germany, the Netherlands, the United Kingdom (UK), and the United States (US). In a repeated cross-sectional design, the annual prevalence of ATD use was calculated and stratified by age, sex, and according to subclass and specific drug. Across the years, the prevalence of ATD use increased from 1.3% to 1.6% in the US data (+26.1%); 0.7% to 1.1% in the UK data (+54.4%); 0.6% to 1.0% in Denmark data (+60.5%); 0.5% to 0.6% in the Netherlands data (+17.6%); and 0.3% to 0.5% in Germany data (+49.2%). The relative growth was greatest for 15−19 year olds in Denmark, Germany and UK cohorts, and for 10−14 year olds in Netherlands and US cohorts. While SSRIs were the most commonly used ATDs, particularly in Denmark (81.8% of all ATDs), Germany and the UK still displayed notable proportions of tricyclic antidepressant use (23.0% and 19.5%, respectively). Despite the sudden decline in ATD use in the wake of government warnings, this trend did not persist, and by contrast, in recent years, ATD use in children and adolescents has increased substantially in youth cohorts from five Western countries.

Patterns of antidepressant use in Italy: therapy duration, adherence and switching.

This study aimed to describe the prescription pattern of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) in an Italian setting, focusing on therapy duration, switching and adherence. Historic cohort study, based on administrative databases of three Italian local health-units, was conducted. Patients with a prescription of antidepressants (ADs) in 2009 were enrolled and grouped into: (1) naïve, (2) already in treatment with the same drug and (3) already in treatment with a different drug. Therapy duration, switching and adherence [as medication possession ratio-(MPR)] were evaluated. A logistic regression model was performed to identify predictors of adherence. There were 88,755 subjects recruited: 37 % naïve, 58 % already in treatment with the same drug and 4 % with different drug. A treatment duration of ≤3 months was found in 41 % of naïve patients, whereas the majority of patients already in treatment had a duration of ≥6 months. Switches occurred in 0.7 % of the whole cohort and mostly occurred between two different SSRIs. The 63 % of naïve patients had a low adherence (MPR < 60 %), whereas a good adherence (MPR ≥ 80 %) was found in 58 % of patients already in treatment with the same drug and in 39 % of those already in treatment with different drug. Predictors of adherence were: female gender, increasing comorbidity and pain absence. All ADs, except for fluoxetine and venlafaxine, showed a better adherence than paroxetine. Notwithstanding the difficulty to associate the AD prescription to the specific diagnosis of depression, this study highlighted a short duration and a low adherence of AD therapies, especially at the initiation of treatment. Physicians should carefully balance the need to prescribe these drugs, considering the great likelihood of a short duration of treatment and a very low level of adherence.

Trends, correlates, and disease patterns of antidepressant use among elderly persons in Taiwan

The population-based National Health Insurance database was used to investigate the trends, correlates, and disease patterns for elderly people in Taiwan who use antidepressants. The National Health Research Institute provided a database of 1000,000 random subjects for study. We created a sample of subjects who were older than 65years from 1997 to 2005. Trends, prevalence, and associated factors of antidepressant use were detected. We also examined the proportion of antidepressant use for psychiatric and medical disorders. The one-year prevalence of antidepressant use in elderly persons increased from 5.8% in 1997 to 9.8% in 2005. The one-year prevalence rates of tricyclic antidepressant (TCA), selective serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitor (SNRI), serotonin modulator, and other antidepressant use in 2005 were 5.3, 2.6, 0.4, 2.9, and 0.6%, respectively. Overall antidepressant use was higher for those in the 75- to 84-year-old age group, females, and those with higher Charlson Comorbidity Index scores. Among subjects using TCAs, 77.6% users did not have a psychiatric diagnosis. Psychiatric disorders were commonly found in most SSRI and SNRI users (85.1 and 90.1%, respectively). Subjects using SSRIs and SNRIs had higher proportions of psychiatric disorders such as neurotic depression, major depression, senile and presenile organic psychotic conditions, and anxiety. The prevalence of antidepressant use among elderly persons increased greatly from 1997 to 2005. SSRIs, SNRIs, and other antidepressants were used mostly by subjects with psychiatric disorders, whereas TCAs were used mostly by subjects with nonpsychiatric disorders.

Prevalence and sociodemographic patterns of antidepressant use among women of reproductive age: A prescription database study

BackgroundThere has been a steady increase in the prescription of antidepressants in developed countries in recent decades. Antidepressant treatment prevalence and sociodemographic pattern data can inform the review of clinical guidelines for depression treatment. We determined the one-year prevalence and sociodemographic pattern of antidepressant dispensing among women of childbearing age (15–45 years) in Northern Ireland (NI). MethodsA cross-sectional study using individual electronic prescribing data for 2009. Our study population was 268,917 women of childbearing age (15–45 years), with/without prescriptions, registered with the 246 out of 363GP practices in NI with high electronic prescribing data coverage. Socioeconomic deprivation (in quintiles) was measured by an area indicator attached to residential postcode. ResultsThe one-year prevalence of redeemed antidepressant prescriptions was 16.3% (95% CI 16.1–16.4). More than two-thirds of antidepressant prescriptions were for SSRIs. Thirty-five per cent of the women who redeemed prescriptions for antidepressants also redeemed prescriptions for psycholeptics within 2 months of the antidepressant prescriptions. Redeemed antidepressant prescription prevalence increased from 4.8% (15–19 years) to 24.6% (40–45 years), from 13.5% (quintile 1, least deprived) to 20.7% (quintile 5, most deprived), and with urbanity of GP practice location. LimitationOnly GP practices with high capture of electronic prescribing data were included, which may not be entirely representative of NI. We could not assess the appropriateness of prescribing according to national guidelines. ConclusionsAntidepressant use is high among women of childbearing age in NI and increases with age and socioeconomic deprivation. This reinforces the need to address the determinants of depression, and assess the appropriateness of treatment policies and practices.

Datapoints: Antidepressant Use in the European Union: Perceived Indications and Patterns

I prescribed antidepressants for depression often discontinue treatment prematurely or are only partially adherent (1), representing two major barriers to achieving successful outcomes. Most research on antidepressant treatment patterns has focused on major depression. To the best of our knowledge, patterns of use among individuals with other perceived treatment targets have not been investigated in community settings. This study used data from the Eurobarometer 2010 survey to examine such patterns of antidepressant use (2). The survey was conducted in February and March 2010 and included 27,304 individuals age 15 years and older in the 27 European Union countries. Random sampling methods and weighting ensured demographically representative samples in each country. The survey ascertained any antidepressant use, reasons for use, and patterns of use. Of the 1,960 participants who reported having used antidepressants in the past year and responded to relevant questions, 1,826 (93.7%) reported using antidepressants for depression, anxiety, chronic pain, or to enhance performance. Participants could choose more than one reason. Of the 1,826 participants, 893 (52.4%) reported using antidepressants regularly for at least four weeks, 185 (10.6%) regularly for less than four weeks, and 748 (37.1%) from time to time. The analyses found statistically significant differences in patterns of use by reason for use (design-based F518.52, df54 and 7,217, p,.001). As Figure 1 shows, individuals with more than one reason for use and those with depression were most likely to report regular use for four weeks or longer (65.7% and 63.3%, respectively); whereas only a minority of those citing performance enhancement reported regular use (18.0%). The percentages with anxiety and chronic pain reporting regular use for four weeks or longer fell in the middle—34.7% and 45.8%, respectively. Occasional use of antidepressants is a common phenomenon; however, antidepressant trials have mainly assessed efficacy and effectiveness of these medications when they are used continuously. The effectiveness of occasional use, especially among individuals with anxiety disorders and chronic pain, should be investigated.

1758 – Comparison of the patterns of antidepressant use among young and older adults in france

Antidepressant drugs have been found underused in the older population relative to younger adults, particularly in the USA before Medicare part D. No study assessed the antidepressant use according to age in France. To compare the patterns of antidepressant use among young and older adults: treatment duration, switches, association of antidepressants, coprescription of psychotropic drugs and adherence to treatment. A historical cohort study included 27,306 young adults and 7,747 older adults, who were beneficiaries of the French national health care insurance and initiated a new antidepressant treatment over the study period. They were followed for atleast six months. Most patients received only one type of antidepressant (91.81% of young adults and 91.73% of older). The coprescription of psychotropic drugs was frequent in both groups (62.91% in young adults and 62.36% in older). The associations of antidepressant drugs were rare (1.42% in young adults and 1.50% in older). Elderly patients had a significantly longer duration of treatment than young adults (m = 135.4 days, SD = 198.6 vs m = 104.3 days, SD = 159.6; HR = 0.9; 95%CI=[0.88–0.93]; p < 0,0001). Furthermore, they had a higher probability of good adherence than young adults when treatment was initiated by a general practitioner (23.28% vs 16.02%; OR = 1.3 [1.22–1.41]), a hospital practitioner (OR = 1.76 [1.35–2.30]) or a specialist other than psychiatrist (OR = 1.85 [1.26–2.70]). The use of antidepressant drugs was similar in both age groups, except for the treatment duration and adherence that were better in the older patients. This result may be attributed to the French healthcare system.

Patterns of antidepressant use in patients with cancer: An analysis from SOAPP (E2Z02: Symptom Outcomes and Practice Patterns).

59 Background: Antidepressant (AD) use is common in outpatient oncology, but the pattern and determinants of prescribing for commonly used AD are unknown. Methods: 3,106 pts with cancer of the breast, prostate, colon/rectum, or lung were enrolled from multiple sites in a study of symptoms. Five depression case-finding methods were explored: 3 based on MDASI items reported by patients (1) sadness/depression&gt;=4, (2) distress&gt;=4, (3) interference with mood&gt;=7 or enjoyment&gt;=7; 2 based on clinician’s report (4) presence of psychological distress, (5) depression being listed as one of top 3 symptoms. AD use (excluding tricyclic antidepressants and psychostimulants) was examined by depression status. Logistic regression models were used to examine the effect of demographic and clinical characteristics on AD use. Results: Rates of depressive symptoms varied by casefinding method (1=29%, 2=28%, 3=14%, 4=24%, 5=11%); 47% (1,457) pts were defined as having depressive symptoms by at least one method. AD were prescribed in 25% of depressed pts compared to 14% of non-depressed pts. After adjusting for other covariates, factors associated with greater use of AD included depression (OR=1.7, p&lt;0.01), family history of depression (OR=2.2, p&lt;0.01), female sex (OR=1.8, P&lt;0.01), younger age (OR=1.2, P=0.04), non-Hispanic White race (OR=2.0, p&lt;0.01), prior chemo/immune/ hormonal treatment (OR=1.5, p&lt;0.01), more concurrent medication use (OR=3.3, p&lt;0.01), anxiolytics use (OR=2.0, p&lt;0.01), sedative use (OR=2.1, p&lt;0.01), receiving counseling (OR=1.6, p=0.04), patient’s perception of poor QOL (OR=1.3, p=0.02), duration of current treatment &gt;1 year (OR=1.6, p&lt;0.01), and being enrolled by a CCOP (OR=1.8, p=0.01). These significant associations remained regardless of the case-finding method used for depression. Conclusions: One-fourth of solid tumor pts with depressive symptoms are taking an AD. Antidepressant prescribing varies by type of institution, race/ethnicity, age, concomitant medication exposure and several other clinical factors. There is an opportunity to improve outcomes through quality improvement initiatives related to antidepressant prescribing.