Original Article
Antidepressant Use in Geriatric Populations: The Burden of Side Effects and Interactions and Their Impact on Adherence and Costs

https://doi.org/10.1097/JGP.0b013e3181f1803dGet rights and content

Objectives

The study aimed to determine the prevalence of documented side effects and drug–drug interactions in older adults using antidepressants and their implications for adherence.

Design

Data were from the MarketScan Medicare Database, which comprises insurance claims from retirees with employer-sponsored Medicare supplemental insurance. Subjects were aged 65 years or older, new antidepressant users, and had a depression diagnosis between July 1, 2001, and December 31, 2006. Twelve commonly reported antidepressant side effects were identified in the month after drug initiation through International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses. Potential drug-drug interactions involving an anti-depressant and another drug were identified during the 1 year after antidepressant initiation using MicroMedex DRUG-REAX software. Multinomial logistic regression was used to determine the association of side effects and potential interactions with refills rates, switching, and discontinuation.

Results

The presence of a side effect was associated with a 4.7 percentage point increase in the probability of switching (from 16.5% to 21.7%) and a 3.7 percentage point increase in the discontinuation rate (from 22% to 25.7%). Among the 39,512 treatment-naive antidepressants users, 25.4% had potential contraindicated or major interactions, 36.1% had moderate interactions, and 38.5% had minor or no interactions. The presence of potential contraindicated or potential major interactions increased the probability of switching by 19.5 percentage points and had a minimal effect on discontinuation.

Conclusion

Although antidepressant medications have been demonstrated to be effective in treatment of geriatric depression, this study highlights the complexity of antidepressant prescribing in this population and the need for clinicians to be aware of potential drug-drug interactions and side effects. (Am J Geriatr Psychiatry 2011; 19:2117–221)

Section snippets

METHODS

The MarketScan Medicare Supplemental and Coordination of Benefits database was used for this study. The time period of claims assessed was January 2001 to December 2006. The database contains individual-level, deidentified insurance claims from retirees in the United States with primary or Medicare supplemental coverage through privately insured health plans. The Medicare Supplemental Database includes both the employer-paid and Medicare-paid components of care.

Adults who had at least one claim

RESULTS

The MarketScan Medicare database for 2001–2006 comprised 3,407,362 individuals; of these, 558,354 (16%) had an antidepressant prescription claim between July 1, 2001, and December 31, 2005, and 116,747 (3.4%) had an antidepressant claim and a depression diagnosis. A subset of 39,512 patients met the continuous enrollment criteria and had a clean period of 6 months with no antidepressant utilization prior their index date. Of these 39,512 patients, 18% filled a tricyclic or tetracyclic

CONCLUSION

Although antidepressant medications have been demonstrated to be effective in treatment of geriatric depression, this study highlights the complexity of antidepressant prescribing in this population. In contrast to older adults who do not use antidepressants, older adults who use antidepressants have more psychiatric and physical comorbid illness, and use a greater variety of medications. Physical comorbidities put patients at increased risk of depression, and depression may worsen the course

References (20)

  • W D'Hoore et al.

    Practical considerations on the use of the Charlson comorbidity index with administrative data bases

    J Clin Epidemiol

    (1996)
  • M Von Korff et al.

    A chronic disease score from automated pharmacy data

    J Clin Epidemiol

    (1992)
  • P Prabhakaran et al.

    What are older peoples' experiences of taking antidepressants?

    J Affect Disord

    (2002)
  • ML Bruce et al.

    Depressive episodes and dysphoria resulting from conjugal bereavement in a prospective community sample

    Am J Psychiatry

    (1990)
  • S Zisook et al.

    Depression through the first year after the death of a spouse

    Am J Psychiatry

    (1991)
  • SD Harlow et al.

    A longitudinal study of risk factors for depressive symptomatology in elderly widowed and married women

    Am J Epidemiol

    (1991)
  • CF Mendes de Leon et al.

    A prospective study of widowhood and changes in symptoms of depression in a community sample of the elderly

    Psychol Med

    (1994)
  • RJ Cadoret et al.

    The development of depressive symptoms in elderly following onset of severe physical illness

    J Fam Pract

    (1988)
  • DL Bachman et al.

    Prevalence of dementia and probable senile dementia of the Alzheimer type in the Framingham Study

    Neurology

    (1992)
  • J Wallace et al.

    Increases in depressive symptomatology in the rural elderly: results from a cross-sectional and longitudinal study

    J Abnorm Psychol

    (1992)
There are more references available in the full text version of this article.

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    Furthermore, depression in this age group is often concurrent with medical illnesses such as hypertension, diabetes mellitus, or dementia (Blazer, 2003; Greenblatt et al., 1998) and drugs for those comorbidities may have potential interactions with antidepressants (Teply et al., 2016). Finally, side effects of antidepressants, such as nausea, constipation, dizziness, headache, and sleep disturbance, impact antidepressant adherence among geriatric populations, by increasing antidepressant switching rate and discontinuation rate (Mark et al., 2011). Therefore, studying the overall effectiveness of antidepressant medications in the elderly people is a necessity.

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The authors thank Laurie Costa for excellent programming support.

This work was supported by Sanofi Aventis (to Thomson Reuters).

The study was presented as a poster in 2009 at the International Society for Pharmacoepidiology, the International Society for Pharmacoeconomics and Outcomes Research, the American Academy of Geriatric Psychiatry, and the American Society of Consultant Pharmacists.

Disclosure of Interests: Dr. Mark, Dr. Cao, and Mr. Johnston are employees of Thomson Reuters and as such have worked on projects that were funded through contracts to Thomson Reuters from major pharmaceutical companies including Alkermes, Boehringer Ingelheim, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Janssen, Merck, Pfizer, Inc., Novartis Pharmaceuticals Corp, Pharmacia, Roche, Sanofi-Aventis, and Schering Corporation; Dr. Vijay Joish was an employee of sanofi-aventis, USA, sponsor of this study, at the time the study was conducted; Dr. Hay has received research support for this study from sanofi-aventis, USA, and is also on a sanofi-aventis advisory board; David V Sheehan, MD, MBA, has received grant funding support, or been affiliated or received honoraria and travel expenses related to lectures/presentations or consultant activities from the following organizations: Abbott Laboratories, Ad Hoc Committee, Treatment Drug & Assessment Research Review, Alexa, Alza Pharmaceuticals, Palo Alto, CA, American Medical Association, American Psychiatric Association Task Force on Benzodiazepine Dependency, American Psychiatric Association Task Force on Treatments of Psychiatric Disorders, American Psychiatric Association Working Group to revise DSM-III Anxiety Disorders Section, Anclote Foundation, Anxiety Disorders Resource Center, Anxiety Drug Efficacy Case, U.S. Food & Drug Administration, Applied health Outcomes/XCENDA, AstraZeneca, Avera Pharmaceuticals, Boehringer Ingelheim, Boots Pharmaceuticals, Bristol-Myers Squibb, Burroughs Wellcome, Cephalon, Charter Hospitals, Ciba Geigy, Committee (RRC) of N.I.M.H. on Anxiety and Phobic Disorder Projects,1 Connecticut & Ohio Academies of Family Physicians, Cortex Pharmaceutical,1 Council on Anxiety Disorders, CPC Coliseum Medical Center, Cypress Bioscience, Dista Products Company, Division of Drugs & Technology, American Medical Association, EISAI, Eli Lilly, Excerpta Medica Asia, Faxmed, Inc, Forest Laboratories, Glaxo Pharmaceuticals, GlaxoSmithKline, Glaxo-Wellcome, Hospital Corporation of America, Humana, ICI, INC Research, International Clinical Research (ICR), International Society for CNS Drug Development (ISCDD),1 Janssen Pharmaceutica, Jazz Pharmaceuticals, Kali-Duphar, Labopharm, Layton Bioscience, Lilly Research Laboratories, Lundbeck, Denmark, Marion Merrill Dow, McNeil Pharmaceuticals, Mead Johnson, Medical Outcome Systems, MediciNova Merck Sharp & Dohme, National Anxiety Awareness Program, National Anxiety Foundation, National Depressive & Manic Depressive Association, National Institute of Drug Abuse, National Institute of Health (NIH), Novartis Pharmaceuticals Corp., Novo Nordisk, Organon,1,3 Orion Pharma, Parexel International Corporation, Parke-Davis, Pfizer, Pharmacia, Pharmacia & Upjohn, Philadelphia College of Pharmacy & Science, Pierre Fabre, France, Quintiles, Rhone Laboratories, Rhone-Poulenc Rorer Pharmaceuticals, Roche, Roerig, Sandoz Pharmaceuticals, Sanofi-Aventis, Sanofi-Synthelabo Recherche, Schering Corporation, Sepracor, Shire Laboratories, Inc., SmithKlineBeecham, Solvay Pharmaceuticals, Takeda Pharmaceuticals, Tampa General Hosp. University of South Florida Psychiatry Center, University of South Florida College of Medicine, TAP Pharmaceuticals, Targacept, TGH-University Psychiatry Center, Tikvah Therapeutics, Titan Pharmaceuticals, United Bioscience, The Upjohn Company, U.S. Congress-House of Representatives Committee, USF Friends of Research in Psychiatry, Board of Trustees, Warner Chilcott, World Health Organization, Worldwide Clinical Trials, Wyeth-Ayerst, ZARS, and Zeneca Pharmaceuticals.

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