Prevalence Of Antidepressant Use Research Articles

Antidepressant Utilization in British Columbia From 1996 to 2004: Increasing Prevalence but Not Incidence

Antidepressant Utilization in British Columbia From 1996 to 2004: Increasing Prevalence but Not Incidence

Antidepressant drugs: prevalence, incidence and indication of use in general practice of Southern Italy during the years 2003–2004

To estimate 1-year prevalence, 1-year incidence and indication of use of antidepressant (AD) drug treatment in general practice of Southern Italy during the years 2003-2004. Among 142,346 individuals registered in the lists of 119 general practitioners of Southern Italy, we identified users of different AD types: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs) and other antidepressants. Annual prevalence of AD use was measured as the number of individuals receiving at least one AD prescription in the years 2003-2004, divided by the number of patients registered in the general practitioner (GP) lists. One-year incidence of AD treatment was calculated as the number of new users of AD, divided by the number of total patients free from AD prescriptions in the previous year. Overall, 1-year prevalence of AD use was 5.08 (95% confidence interval (CI): 4.97-5.20) per 100 inhabitants in the year 2003, with a 20% increase in 2004 (6.00, 5.88-6.13). Prevalence of SSRI use markedly increased from 3.80 (3.73-3.90) in 2003 to 4.51 (4.40-4.61) in 2004. The incidence rates of SSRI, TCA and other antidepressant use were 2.11 (2.03-2.19), 0.38 (0.35-0.41) and 0.53 (0.49-0.57) respectively. Depressive disorders were the main indication of use of any AD user (mostly for SSRI users), followed by anxious disturbances. SSRIs, particularly those recently marketed, have been increasingly used during the last years, mainly to treat affective disorders.

Prevalence and patterns of antidepressant drug use during pregnancy

The aim of this study was to determine the extent and patterns of antidepressant use before, during and after pregnancy in a large population in The Netherlands. Health care records and prescription data from one of the largest Dutch health insurance companies were analysed. The study cohort consisted of 29,005 women who had live births in the period between January 2000 and July 2003. Antidepressant drug use during a specified period was defined as there being a record of a prescription during that period. During the first trimester of pregnancy 2% of all pregnant women of the study cohort were found to have taken antidepressants; in the second and third trimesters, this figure had dropped to 1.8% of all pregnancies. Antidepressant use before as well as during pregnancy was almost twofold higher in women over 35 years of age than in those under 35 years. Almost 60% of the women who used antidepressants before pregnancy stopped taking them in the first trimester, and a smaller number stopped thereafter. Of all women using antidepressants during pregnancy, one third started this medication during gestation. In the 3 months following delivery, the prevalence of antidepressant use was the same as before pregnancy (2.9%). There was no shift to benzodiazepines in the group of women who stopped taking antidepressants during pregnancy. Although paroxetine and fluoxetine were the most frequently used antidepressants among the study group, all modern antidepressants were used. A considerable number of women are being exposed to antidepressants throughout pregnancy up until delivery. One consequence of this is that their newborns need special care and supervision during the first days of life. However, women who stop taking the medication may risk a relapse of their illness, and this may also have a negative effect on the child.

Provider Characteristics Related to Antidepressant Use in Older People

To determine whether the characteristics of the usual medical care providers of older antidepressant users changed between 1986 and 1997 with the introduction of selective serotonin reuptake inhibitors. Longitudinal study. Five-county Piedmont area of North Carolina. Stratified random sample of African-American (n=2,261) and white (n=1,875) community residents aged 65 to 105. Sample members provided information on prescription medications, demographic and health status, and usual medical care provider (matched to North Carolina Health Professions Data Systems files to ascertain provider characteristics) in 1986/87, 1989/90, 1992/93, and 1996/97. Most (77.5%) named a provider (name unmatchable for 4.1%). Sample member characteristics were aggregated into probability (propensity) scores summarizing predisposing (demographic), enabling (medical care access), and need (health status) categories. Along with wave of study and whether a provider was named, these were entered as control variables in generalized estimating equation models that examined the association between provider race (white vs nonwhite), sex, age, location of practice, and primary versus specialist care and antidepressant use. The characteristics of the usual medical care providers remained stable over the decade, although prevalence of antidepressant use increased. Two provider characteristics--race and area of practice (but not the interaction between them)--were significantly associated with patients' use of antidepressants. Patients of white physicians and of physicians with urban practices were more likely to use antidepressants. Although use of antidepressants has increased over time, there has been little change in the characteristics of users' usual medical care providers.

Prevalence of psychotropic drug use in nursing homes for the aged in Quebec and in the French-speaking area of Switzerland

The use of psychotropic drugs is high in institutionalised elderly, which raises the question of its appropriateness. This study aimed to: (1) estimate the use of psychotropics, for each family, in terms of the prevalence and dosage among the elderly in nursing homes in French-speaking Switzerland and Quebec; and (2) assess, for each family of psychotropic drugs and for each care facility, the prevalence of use and departure from average prescription (ratio of observed-to-expected prevalence). An administrative database was used for this cross-sectional analysis. The sample included 8183 Quebec and 7592 Swiss long-term care residents. Three classes of psychotropics (antipsychotics, antidepressants, hypnotics-anxiolytics) were defined as dichotomous variables. Logistic regressions were conducted to identify residents characteristics associated with the use of each psychotropic type and to compute expected prevalence. Swiss residents were slightly older and less dependent than Quebec residents. Use of psychotropic drugs was higher in Swiss than in Quebec residents, on the whole as well as for each family of drug. A total of 78.1% of Swiss residents used at least one drug as compared to 66.9% in Quebec. Ninety percent of residents were given less than 7 defined daily doses per week, irrespective of the drug family. According to Beer's criteria, only 4.9% of prescriptions were inadequate. In Quebec and in Switzerland, the prevalence of antidepressant use was associated with the prevalence of hypnotic-anxiolytic use. No ratios of observed-to-expected reached statistical significance. There was a considerable use of psychotropics in Quebec and Switzerland with, seemingly, no dramatic departure from the average practice. Our data cannot tell if there is a global overuse of psychotropics, but indicated that dosage and medication selection seem adequate. Physicians should critically reassess the necessity of prescribed medications for their patients.

Trends in the use of antidepressants in a national sample of commercially insured pediatric patients, 1998 to 2002.

The aim of this study was to estimate the prevalence of use of prescription antidepressants among children and adolescents by using nationwide data and to examine trends in use from 1998 to 2002. Ambulatory prescription claims data for a nationwide random sample of more than 1.9 million life-years of commercially insured children (aged 18 years or younger) for the years 1998, 1999, 2000, 2001, and 2002 were examined retrospectively. The main outcome measure was trend in prevalence of antidepressant use. The overall prevalence of antidepressant use among children increased from 160 per 10000 (1.6 percent) in 1998 to 240 per 10000 (2.4 percent) in 2002, for an adjusted annual increase of 9.2 percent. The growth in the overall prevalence of antidepressant use was greater among girls (a 68 percent increase) than boys (a 34 percent increase). In 2002, antidepressant use was highest among girls aged 15 to 18 years, at 640 per 10000 (6.4 percent). The trend of increasing overall use of antidepressants among children and adolescents appears to have been driven primarily by greater use of selective serotonin reuptake inhibitors. The growth in the prevalence of use of antidepressant medications among youths appears to be continuing, and the rate of increase between 1998 and 2002 is similar to the rate of increase seen in the period of the second-generation antidepressants (late 1980s to mid-1990s).

Self-reported depression and use of antidepressants after stroke: a national survey.

Depression after stroke is often described as underdiagnosed and undertreated. However, there are few data on self-reported depression and use of antidepressants in stroke patients at large. In the Swedish national quality assessment register, Riks-Stroke, 15 747 stroke survivors are recorded. They were asked about depressive mood and antidepressant treatment 3 months after stroke. Age-specific prevalence of antidepressant use after stroke was calculated. At 3 months after stroke, 12.4% of male and 16.4% of female stroke survivors reported that they always or often felt depressed. In a multiple logistic regression model, female sex, age younger than 65 years, living alone, having had a recurrent stroke, being dependent on others, and institutional living 3 months after stroke were independent predictors of self-reported depression. Antidepressant medication was used by 22.5% of men and 28.1% of women who had had a stroke. Of patients using antidepressant drugs, 67.5% did not report depressive mood. However, 8.4% of the entire cohort reported depressive mood but no treatment with antidepressants. When compared with the general population, approximately twice as many of the stroke patients were using antidepressant treatment. In this national survey, 1 in 7 patients reported that they felt depressed and the use of antidepressant drugs after stroke was common. The widespread use of antidepressants challenges the contention that antidepressants are generally underused after stroke. However, the substantial proportion reporting depressive mood but not using treatment with antidepressants suggests that patient selection for treatment should be more precise.

Depression and Its Treatments

The aim of the present study was to gather information within a specific college population about the general prevalence of anti-depressant use and psychotherapy for depression, which treatments people tend to prefer, people's perceptions of the helpfulness of treatments, and if this information was consistent with the research and the current status of the managed health care system. The results demonstrate a high prevalence rate, that people tend to prefer psychotherapy, and that the managed health care system is not providing the best or equal coverage of treatments for depression.

Trends in Prescribing of Selective Serotonin Reuptake Inhibitors and Other Newer Antidepressant Agents in Adult Primary Care.

BACKGROUND: The introduction of selective serotonin reuptake inhibitors (SSRIs) represented a breakthrough in depression treatment due to their safety and ease of use. The purpose of this study was to extend previous work on trends in antidepressant use to include recent data and to provide more detailed analysis of prescribing trends for SSRIs and newer non-SSRI antidepressants, specifically in adult primary care practice. METHOD: Adult primary care visits from the National Ambulatory Medical Care Survey (NAMCS) between 1989 and 2000 were analyzed. Chi-square tests for trend and multivariable logistic regression models were utilized to examine patterns of antidepressant use over time. SSRIs (citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline) and newer non-SSRI antidepressants (bupropion, mirtazapine, nefazodone, venlafaxine) were classified as newer agents. RESULTS: 89,424 adult primary care visits were recorded in the NAMCS during the period studied. Antidepressant use increased in primary care from 2.6% ( approximately 6 million visits) in 1989 to 7.1% ( approximately 20.5 million) in 2000 (p <.001). SSRI and newer non-SSRI use increased linearly from 1989 to 2000 (p <.001), with an adjusted odds ratio for use of 1.27 per year (95% confidence interval = 1.25 to 1.29). The increase in antidepressant use was due to these newer agents (13.5% of all antidepressant use in 1989 to 82.3% in 2000) with each new agent adding to a stable base of previously introduced newer antidepressant agents. CONCLUSIONS: The prevalence of antidepressant use in adult primary care has risen dramatically since 1989, largely reflecting use of newer agents. The detailed pattern of increased use of these medications is striking, with each new agent adding to aggregate use without concomitant decrease in previously introduced newer agents. Such trends reflect more widespread pharmacologic treatment of depressed primary care patients.

Drs. Laukkala and Colleagues Reply

Back to table of contents Previous article Next article Letter to the EditorFull AccessDrs. Laukkala and Colleagues ReplyTANJA LAUKKALA, M.D., Ph.D., ERKKI ISOMETSÄ, M.D., Ph.D., JUHA HÄMÄLÄINEN, M.D., M.A., MARTTI HEIKKINEN, M.D., Ph.D., SARI LINDEMAN, M.D., Ph.D., M.Sc., and HILLEVI ARO, M.D., Ph.D., TANJA LAUKKALASearch for more papers by this author, M.D., Ph.D., ERKKI ISOMETSÄSearch for more papers by this author, M.D., Ph.D., JUHA HÄMÄLÄINENSearch for more papers by this author, M.D., M.A., MARTTI HEIKKINENSearch for more papers by this author, M.D., Ph.D., SARI LINDEMANSearch for more papers by this author, M.D., Ph.D., M.Sc., and HILLEVI AROSearch for more papers by this author, M.D., Ph.D., Helsinki, FinlandPublished Online:1 Jan 2003https://doi.org/10.1176/appi.ajp.160.1.190AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We thank Drs. Patten and Beck for their interest in our article and for an opportunity to discuss our study in more detail. We found that in 1996 in Finland, of the subjects with a major depressive episode during the previous 12 months, only 13% (among the 25% with a current major depressive episode) were taking antidepressant medications. These results are comparable with those from an Australian general population study by Goldney et al. (1), in which 19% of the subjects with a current major depressive episode in 1998 were currently taking antidepressants. In a multinational European telephone survey comprising general population samples from 1993 to 1997 (2), 7% of those with current depressive disorders were currently taking antidepressants.The unadjusted point prevalence of antidepressant use in Finland in 1996 in our study was 2.6% (158 of 5,993), information that we omitted from our article because of space limitations. This is concordant with the Finnish antidepressant reimbursement statistics for 1996 (3), which suggest a 2.3% point prevalence for antidepressant use. For comparison, the multinational European survey (2) reported point prevalences of about 1% for antidepressant use. The Canadian figures by Drs. Patten and Beck appear high to us but may be explained by a higher level of antidepressant use in Canada during the time period investigated (not specified) or by methods differences. One of these differences is that we reported current use, and Drs. Patten and Beck report use in the preceding month—a longer time period.In our study, 44% of those taking antidepressant medication had a major depressive episode during the preceding 12 months; half (56%) of the antidepressant users took antidepressant medication without a major depressive episode during the preceding year. What proportion of these subjects was receiving antidepressants for continuation and maintenance treatment of depression and what for other possible indications remains unknown. In a survey of primary health care antidepressant use in Helsinki, Finland, in 1995 (4), about 75% of antidepressants were prescribed for depression. In the multinational European survey (2), the proportion of use for depression was even lower (44%). Since not all antidepressants are used for the treatment of depression, we do not find the calculations by Drs. Patten and Beck to be well founded.Nevertheless, we agree with Drs. Patten and Beck on the need for improved methods in estimating need for antidepressant treatment. As the use of antidepressants is steadily rising, the pharmaco-epidemiology of their use is a moving target. In Finland, we are currently working with the data from the large Health 2000 Survey, which will provide information about antidepressant use for depressive and anxiety disorders in the country for 2000–2001.

Prevalence of antidepressant use among older people: population-based observations.

To assess the prevalence of antidepressant use with respect to age, gender, and time during a 5-year period from 1993 to 1997. A retrospective, population-based study in which data regarding a cross-sectional series of annual antidepressant use were obtained from administrative claims and census databases for more than 1.4 million older persons during calendar years 1993 through 1997. All residents of Ontario aged 65 or older. Changes in the prevalence of antidepressant users as a function of age group, gender, and time. A general, positive, linear trend in the prevalence of antidepressant users with increasing age group was consistently detected regardless of gender and year assessed (P < .001 for both genders and all years). The age-adjusted relative risk of women being dispensed an antidepressant relative to men was significantly higher during each year but seemed to decrease slightly over time: 1.74 (95% CI, 1.72-1.76) in 1993 and 1.65 (95% CI, 1.63-1.67) in 1997. The multiple linear regression model revealed significant relationships between the prevalence of antidepressant users and increasing age group, female gender, and increasing year of assessment (P < .001 for each variable). The prevalence was observed to range from a low of 5.6% in 65 to 69-year-old men in 1993 to a high of 17.2% among 85 to 89-year-old women in 1997. Our findings reveal that the prevalence of antidepressant users is dynamic and is significantly and independently associated with age, gender, and time of assessment.

Changes in the pattern of antidepressant use upon the introduction of the new antidepressants: a prescription database study.

To study whether the newer antidepressants have changed the patterns of antidepressant use, and whether the claimed better adverse effect profile of the lower antidepressants is reflected in their use as monitored by a prescription database. By means of a prescription database (OPED), the use of antidepressants from 1991 to 1993 in Odense, Denmark, was analysed. The 1-year prevalence of antidepressant use increased significantly from 1.60% to 2.00%, which still is below the claimed 1-year prevalence of depression of at least 5%. The increase was mainly due to a rapidly increasing use of the newer antidepressants, accompanied by a moderate decline in the use of older antidepressants (mainly tricyclic antidepressants). The patterns of antidepressant use were very polymorphic, with about 5% being on continuous use for all 3 years and groups of each 20-30% being treated with: (1) several series or (2) one series or (3) only by one prescription. The share of patients presenting only one prescription (20%) was the same for older and newer antidepressants. Likewise, the rate of shifts from older to newer antidepressants or vice versa was the same (7% vs 6%). The duration of treatment did not differ much between older and newer antidepressants. Relative to the defined daily dose (DDD), the older antidepressants were given in much lower doses (median 0.63 DDD) than the newer antidepressants (median 1.05 DDD). It is concluded that many depressed patients are still not receiving antidepressant treatment and that the claimed better adverse effect profile of the newer antidepressants was not clearly reflected in their use.

Antidepressant drug use in an ambulatory elderly population: A 14‐year overview

AbstractThe objective of the work was to identify changes in antidepressant drug use and determine if the prevalence of antidepressant use has changed over 14 years. A longitudinal analysis comparing antidepressant drug use at 14 yearly intervals from 1978–79 to 1991–92 was undertaken using the longitudinal health screening program of ambulatory elderly participants (Florida Geriatric Research Program). Participants included all subjects screened in the Florida Geriatric Research Program from 1 August 1978 to 31 July 1992. The outcome measures were self‐reported antidepressant drug use.Approximately 3.0 per cent (range of 2.3 to 3.2 per cent over 14 yearly intervals) of participants in this program reported the use of an antidepressant drug. There was no statistically significant change in antidepressant use between 1978–79 and 1991–92 (p &gt; 0.6630). Across all study intervals women reported more frequent use of antidepressant drugs than men. In 1991–92, amitriptyline and imipramine represented over 50 per cent of all antidepressant drug use in this elderly population. Less than 6 per cent of all antidepressant drug use was for fluoxetine, the newest selective serotonin uptake inhibitor.The majority of elderly patients are receiving older tertiary amine tricyclic antidepressants such as amitriptyline, imipramine and doxepin that are not the preferred drugs for the elderly. Educational programs are needed to improve antidepressant prescribing for geriatric patients.

Causes and Correlates of Recurrent Falls in Ambulatory Frail Elderly

To determine causes and clinical correlates of recurrent falls in ambulatory frail elderly people, we evaluated 70 recurrent fallers and 56 nonfallers (mean age = 87 years) from two long-term care facilities. Evaluations included a detailed history, physical examination, performance-oriented mobility assessment, and laboratory studies. Primary causes including stroke, parkinsonism, blindness, drug-related hypotension, and arthritis were established for the most recent fall in 51 (73%) fallers. Eighteen fallers (26%) had multiple conditions that could not be prioritized for their contribution to the fall. Fallers were more often women, were functionally more impaired, and were taking more medications than nonfallers. Specific diseases did not distinguish fallers from nonfallers. Fallers of both sexes took more steps to turn 360 degrees, could not stand up from a chair without pushing off, had a higher prevalence of antidepressant use, and had impaired position sensation. These easily obtained clinical variables characterized nearly three-quarters of ambulatory elderly nursing home residents with a history of recurrent falls.