Multinational comparison of new antidepressant use in older adults

A cohort study

Robyn Tamblyn, David Westfall Bates, David L. Buckeridge, Will Dixon, Alan J. Forster, Nadyne Girard, Jennifer Haas, Bettina Habib, Siyana Kurteva, Jack Li, Therese Sheppard

研究成果: 雜誌貢獻文章

摘要

Objectives We used an international pharmacosurveillance network to estimate the rate and characteristics of antidepressant use in older adults in countries with more conservative (UK) and liberal depression guidelines (Canada, USA). Setting Electronic health records and population-based administrative data from six jurisdictions in four countries (UK, Taiwan, USA and Canada). Participants A historical cohort of older adults (≥65 years) who had a new episode of antidepressant use between 2009 and 2014. Outcome measures The age and sex-standardised cumulative incidence of new episodes of antidepressant use in older adults was measured. Descriptive statistics were used to compare the proportion of new users by the antidepressant prescribed, therapeutic class, potential treatment indication and country, as well as the characteristics of the first treatment episode (standardised daily doses, duration and changes). Results The incidence of antidepressant use between 2009 and 2014 varied from 4.7% (Montreal and Quebec City) to 18.6% (Taiwan). Tricyclic antidepressants (TCAs) were the most commonly used class in the UK (48.8%) and Taiwan (52.4%) compared with selective serotonin reuptake inhibitors (SSRIs) in North American jurisdictions (42.3%-53.3%). Chronic pain was the most common potential treatment indication (41.2%-68.2%). Among users with chronic pain, TCAs were used most frequently in the UK and Taiwan (55.2%-60.4%), whereas SSRIs were used most frequently in North America (33.5%-46.4%). Treatment was longer (252-525 vs 169-437 days), standardised doses were higher (0.7-1.3 vs 0.5-1.0) and treatment was more likely to be changed (31%-46% vs 21%-34%) among patients with depression (9.1%-43%) than those with chronic pain. Conclusion Antidepressant use in older adults varied 24-fold by country, with the UK, which has the most conservative treatment guidelines, being among the lowest. Chronic pain was the most common potential treatment indication. Evaluation of real-world risks of TCAs is a priority for future research, given high rates of use and the potential for increased toxicity in older adults because of potent anticholinergic effects.

原文英語
文章編號e027663
期刊BMJ Open
9
發行號5
DOIs
出版狀態已發佈 - 五月 1 2019

指紋

Antidepressive Agents
Cohort Studies
Taiwan
Chronic Pain
Tricyclic Antidepressive Agents
Serotonin Uptake Inhibitors
Therapeutics
Canada
Guidelines
Quebec
Electronic Health Records
Incidence
Cholinergic Antagonists
North America
Outcome Assessment (Health Care)
Population

ASJC Scopus subject areas

  • Medicine(all)

引用此文

Tamblyn, R., Bates, D. W., Buckeridge, D. L., Dixon, W., Forster, A. J., Girard, N., ... Sheppard, T. (2019). Multinational comparison of new antidepressant use in older adults: A cohort study. BMJ Open, 9(5), [e027663]. https://doi.org/10.1136/bmjopen-2018-027663

Multinational comparison of new antidepressant use in older adults : A cohort study. / Tamblyn, Robyn; Bates, David Westfall; Buckeridge, David L.; Dixon, Will; Forster, Alan J.; Girard, Nadyne; Haas, Jennifer; Habib, Bettina; Kurteva, Siyana; Li, Jack; Sheppard, Therese.

於: BMJ Open, 卷 9, 編號 5, e027663, 01.05.2019.

研究成果: 雜誌貢獻文章

Tamblyn, R, Bates, DW, Buckeridge, DL, Dixon, W, Forster, AJ, Girard, N, Haas, J, Habib, B, Kurteva, S, Li, J & Sheppard, T 2019, 'Multinational comparison of new antidepressant use in older adults: A cohort study', BMJ Open, 卷 9, 編號 5, e027663. https://doi.org/10.1136/bmjopen-2018-027663
Tamblyn R, Bates DW, Buckeridge DL, Dixon W, Forster AJ, Girard N 等. Multinational comparison of new antidepressant use in older adults: A cohort study. BMJ Open. 2019 5月 1;9(5). e027663. https://doi.org/10.1136/bmjopen-2018-027663
Tamblyn, Robyn ; Bates, David Westfall ; Buckeridge, David L. ; Dixon, Will ; Forster, Alan J. ; Girard, Nadyne ; Haas, Jennifer ; Habib, Bettina ; Kurteva, Siyana ; Li, Jack ; Sheppard, Therese. / Multinational comparison of new antidepressant use in older adults : A cohort study. 於: BMJ Open. 2019 ; 卷 9, 編號 5.
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abstract = "Objectives We used an international pharmacosurveillance network to estimate the rate and characteristics of antidepressant use in older adults in countries with more conservative (UK) and liberal depression guidelines (Canada, USA). Setting Electronic health records and population-based administrative data from six jurisdictions in four countries (UK, Taiwan, USA and Canada). Participants A historical cohort of older adults (≥65 years) who had a new episode of antidepressant use between 2009 and 2014. Outcome measures The age and sex-standardised cumulative incidence of new episodes of antidepressant use in older adults was measured. Descriptive statistics were used to compare the proportion of new users by the antidepressant prescribed, therapeutic class, potential treatment indication and country, as well as the characteristics of the first treatment episode (standardised daily doses, duration and changes). Results The incidence of antidepressant use between 2009 and 2014 varied from 4.7{\%} (Montreal and Quebec City) to 18.6{\%} (Taiwan). Tricyclic antidepressants (TCAs) were the most commonly used class in the UK (48.8{\%}) and Taiwan (52.4{\%}) compared with selective serotonin reuptake inhibitors (SSRIs) in North American jurisdictions (42.3{\%}-53.3{\%}). Chronic pain was the most common potential treatment indication (41.2{\%}-68.2{\%}). Among users with chronic pain, TCAs were used most frequently in the UK and Taiwan (55.2{\%}-60.4{\%}), whereas SSRIs were used most frequently in North America (33.5{\%}-46.4{\%}). Treatment was longer (252-525 vs 169-437 days), standardised doses were higher (0.7-1.3 vs 0.5-1.0) and treatment was more likely to be changed (31{\%}-46{\%} vs 21{\%}-34{\%}) among patients with depression (9.1{\%}-43{\%}) than those with chronic pain. Conclusion Antidepressant use in older adults varied 24-fold by country, with the UK, which has the most conservative treatment guidelines, being among the lowest. Chronic pain was the most common potential treatment indication. Evaluation of real-world risks of TCAs is a priority for future research, given high rates of use and the potential for increased toxicity in older adults because of potent anticholinergic effects.",
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T2 - A cohort study

AU - Tamblyn, Robyn

AU - Bates, David Westfall

AU - Buckeridge, David L.

AU - Dixon, Will

AU - Forster, Alan J.

AU - Girard, Nadyne

AU - Haas, Jennifer

AU - Habib, Bettina

AU - Kurteva, Siyana

AU - Li, Jack

AU - Sheppard, Therese

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N2 - Objectives We used an international pharmacosurveillance network to estimate the rate and characteristics of antidepressant use in older adults in countries with more conservative (UK) and liberal depression guidelines (Canada, USA). Setting Electronic health records and population-based administrative data from six jurisdictions in four countries (UK, Taiwan, USA and Canada). Participants A historical cohort of older adults (≥65 years) who had a new episode of antidepressant use between 2009 and 2014. Outcome measures The age and sex-standardised cumulative incidence of new episodes of antidepressant use in older adults was measured. Descriptive statistics were used to compare the proportion of new users by the antidepressant prescribed, therapeutic class, potential treatment indication and country, as well as the characteristics of the first treatment episode (standardised daily doses, duration and changes). Results The incidence of antidepressant use between 2009 and 2014 varied from 4.7% (Montreal and Quebec City) to 18.6% (Taiwan). Tricyclic antidepressants (TCAs) were the most commonly used class in the UK (48.8%) and Taiwan (52.4%) compared with selective serotonin reuptake inhibitors (SSRIs) in North American jurisdictions (42.3%-53.3%). Chronic pain was the most common potential treatment indication (41.2%-68.2%). Among users with chronic pain, TCAs were used most frequently in the UK and Taiwan (55.2%-60.4%), whereas SSRIs were used most frequently in North America (33.5%-46.4%). Treatment was longer (252-525 vs 169-437 days), standardised doses were higher (0.7-1.3 vs 0.5-1.0) and treatment was more likely to be changed (31%-46% vs 21%-34%) among patients with depression (9.1%-43%) than those with chronic pain. Conclusion Antidepressant use in older adults varied 24-fold by country, with the UK, which has the most conservative treatment guidelines, being among the lowest. Chronic pain was the most common potential treatment indication. Evaluation of real-world risks of TCAs is a priority for future research, given high rates of use and the potential for increased toxicity in older adults because of potent anticholinergic effects.

AB - Objectives We used an international pharmacosurveillance network to estimate the rate and characteristics of antidepressant use in older adults in countries with more conservative (UK) and liberal depression guidelines (Canada, USA). Setting Electronic health records and population-based administrative data from six jurisdictions in four countries (UK, Taiwan, USA and Canada). Participants A historical cohort of older adults (≥65 years) who had a new episode of antidepressant use between 2009 and 2014. Outcome measures The age and sex-standardised cumulative incidence of new episodes of antidepressant use in older adults was measured. Descriptive statistics were used to compare the proportion of new users by the antidepressant prescribed, therapeutic class, potential treatment indication and country, as well as the characteristics of the first treatment episode (standardised daily doses, duration and changes). Results The incidence of antidepressant use between 2009 and 2014 varied from 4.7% (Montreal and Quebec City) to 18.6% (Taiwan). Tricyclic antidepressants (TCAs) were the most commonly used class in the UK (48.8%) and Taiwan (52.4%) compared with selective serotonin reuptake inhibitors (SSRIs) in North American jurisdictions (42.3%-53.3%). Chronic pain was the most common potential treatment indication (41.2%-68.2%). Among users with chronic pain, TCAs were used most frequently in the UK and Taiwan (55.2%-60.4%), whereas SSRIs were used most frequently in North America (33.5%-46.4%). Treatment was longer (252-525 vs 169-437 days), standardised doses were higher (0.7-1.3 vs 0.5-1.0) and treatment was more likely to be changed (31%-46% vs 21%-34%) among patients with depression (9.1%-43%) than those with chronic pain. Conclusion Antidepressant use in older adults varied 24-fold by country, with the UK, which has the most conservative treatment guidelines, being among the lowest. Chronic pain was the most common potential treatment indication. Evaluation of real-world risks of TCAs is a priority for future research, given high rates of use and the potential for increased toxicity in older adults because of potent anticholinergic effects.

KW - antidepressants

KW - epidemiology

KW - multinational comparison

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KW - pharmacosurveillance

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