Utilization patterns of antidepressants between 1991 and 2011 in a population-based cohort of middle-aged and elderly

AbstractBackgroundIn middle-aged and older patients in whom antidepressant use increased in last decades, patterns of use might be of concern The objective of this study was to investigate the patterns of prevalence, incidence and duration of antidepressant use in an ageing population.MethodsAll participants (aged > 45 years) from the population-based Rotterdam Study were followed from January 1st 1991 until death, loss to follow-up, or end of the study period (December 31st 2011). Antidepressant drug dispensing, based on pharmacy records, were subdivided into Tricyclic Antidepressants (TCAs), Selective Serotonin Reuptake Inhibitors (SSRIs) and other antidepressants. One-year prevalence, 5-year incidence and duration of antidepressant use were calculated.ResultsYearly prevalence of antidepressant use increased from 3.9% in 1991 to 8.3% of the population in 2011. The increase in SSRI use was 5.8-fold, whereas use of other antidepressants doubled and TCA use remained stable over time. Incidence of all antidepressants decreased from 23.9 to 14.2 per 1000 person-years between 1992 and 2011. The duration of a first treatment episode increased over time.ConclusionDespite the prevalence of antidepressant use increased over time, incidence did not, which is most likely explained by a longer treatment duration and recurrent episodes.

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Self-reported indications for antidepressant use in a population-based cohort of middle-aged and elderly

International Journal of Clinical Pharmacy ◽

10.1007/s11096-016-0371-9 ◽

2016 ◽

Vol 38 (5) ◽

pp. 1311-1317 ◽

Cited By ~ 12

Author(s):

Nikkie Aarts ◽

Raymond Noordam ◽

Albert Hofman ◽

Henning Tiemeier ◽

Bruno H. Stricker ◽

...

Keyword(s):

Population Based ◽

Middle Aged ◽

Antidepressant Use

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Change in self-reported outcomes and objective physical function over 7 years in middle-aged subjects with or at high risk of knee osteoarthritis

Annals of the Rheumatic Diseases ◽

10.1136/ard.2007.074088 ◽

2007 ◽

Vol 67 (4) ◽

pp. 505-510 ◽

Cited By ~ 40

Author(s):

E M Roos ◽

A B Bremander ◽

M Englund ◽

L S Lohmander

Keyword(s):

High Risk ◽

Knee Osteoarthritis ◽

Physical Function ◽

Reference Group ◽

Population Based ◽

Observation Time ◽

Middle Aged ◽

Knee Oa ◽

Aged Subjects ◽

Over Time

Objective:In the present work, we describe the clinical course and predictors of change in self-reported outcomes and objectively assessed physical function over time in middle-aged subjects at high risk of, or with knee osteoarthritis (OA).Methods:We examined 259 subjects (mean (SD) age 52.6 (10.4)) at mean 18 and 25 years after previous meniscectomy and 50 population-based age- and sex-matched reference subjects with the Knee injury and Osteoarthritis Outcome Score (KOOS), one-leg hop for distance and number of knee-bendings in 30 s. Radiographic OA was defined as equivalent to Kellgren and Lawrence grade 2 or worse.Results:At first assessment, meniscectomised subjects reported worse pain, function and quality of life compared with the reference group (p<0.001). They also performed fewer knee-bendings per 30 s (27 vs 31, p = 0.02). The meniscectomised patients worsened over the 4–10-year observation time in all measured outcomes (p<0.001), and to a greater extent than the reference group in pain (−5, 95% CI −10 to 0) and one-leg hop (−11, 95% CI −18 to −3). Being a woman, or having radiographic knee OA, enhanced the worsening in self-reported and objectively assessed outcomes. Older age and a higher body mass index (BMI) influenced objectively assessed physical function, but not self-reported outcomes.Conclusion:Worsening over time in knee-related pain and function is greater in meniscectomised subjects compared with reference subjects. Rehabilitative efforts may be warranted in middle-aged meniscectomised patients, especially in women and those who have developed radiographic knee OA, who are at greater risk of worsening.

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Prescription of antidepressants to patients on opioid maintenance therapy – a pharmacoepidemiological study

Norsk Epidemiologi ◽

10.5324/nje.v21i1.1429 ◽

2011 ◽

Vol 21 (1) ◽

Cited By ~ 3

Author(s):

Ingeborg Hartz ◽

Jørgen G. Bramness ◽

Svetlana Skurtveit

Keyword(s):

Drug Therapy ◽

Prescription Drugs ◽

Selective Serotonin Reuptake Inhibitors ◽

Antidepressant Drug ◽

Antidepressant Drugs ◽

Defined Daily Dose ◽

Prescription Database ◽

Depression And Anxiety ◽

Norwegian Prescription Database ◽

Antidepressant Use

Background and aims: Depression and anxiety are commonly reported among patients in opioid maintenance treatment (OMT). The aim of the present study was to describe aspects of prescription of antidepresant drug therapy among patients on OMT. Our research questions were: 1) What is the prevalence of antidepressant use according to age and gender? 2) Which antidepressants are used? 3) How are antidepressants used in terms of reimbursement codes, dispensed dose and duration of therapy?Methods: Pharmacoepidemiological data were retrieved from the complete national Norwegian Prescription Database which contains information on all prescription drugs (such as Anatomical Theraputical Chemical (ATC)-code, Defined Daily Dose (DDDs)), dispensed at pharmacies to individual patients. Norwegian OMT-patients (N=4374, 3035 men and 1339 women) who received methadone mixture, buprenorphine capsules or combined buprenorphine-naloxone capsules for at least 6 months in 2009 were included. Prevalence of antidepressant use in the studied patients was measured in terms of retrieval of prescriptions.Results: During 2009 21.7% of the studied patients filled at least one prescription for an antidepressant drugs (men: 21.2%; women: 22.9%). The subgroup of antidepressants most frequently dispensed was selective serotonin reuptake inhibitors (SSRIs) (33%), followed by the sedative antidepressants mianserin and mirtazapin (22%) and tricyclic antidepressants (TCAs) (20%). Except for TCAs, prescriptions of all antidepressant subgroups were reimbursed for either anxiety or depression in 90% of the cases. Overall, 46.9% of the antidepressant users were prescribed antidepressants in the category < 1 DDD per day and/or treatment < 3 months, with no gender difference.Conclusions: About one out of five OMT-patients filled a prescription for an antidepressant drug in 2009. Above 90% had their prescriptions reimbursed for either depression or anxiety. Use at low doses and/or sporadic use among half of the antidepressant users may reflect poor compliance or use for other maladies than the reimbursed disease code. Drug therapy for depression and anxiety among OMT-patients seems to be in line with recommendations for use; the SSRIs constitute the recommended drugs of choice due to their better effect/side effect profile, compared to the older antidepressants such as the TCAs.

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Treatment patterns of patients diagnosed with major depressive disorder and suicidal ideation or attempt: a U.S. population-based study utilizing real-world data

BMC Psychiatry ◽

10.1186/s12888-021-03616-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

David M. Kern ◽

M. Soledad Cepeda ◽

Frank Wiegand

Keyword(s):

Major Depressive Disorder ◽

Suicidal Ideation ◽

Depressive Disorder ◽

Selective Serotonin Reuptake Inhibitors ◽

Population Based ◽

Treatment Patterns ◽

Real World Data ◽

Major Depressive ◽

Multiple Treatment ◽

One Year

Abstract Background There is a knowledge gap regarding the treatment patterns of patients with major depressive disorder (MDD) who experience suicidal ideation or a suicide attempt (SI/SA). Methods Patients with SI/SA were identified from a large US-based claims database covering 84 million lives, during 1/1/2014–3/31/2020. Patients with MDD were indexed at their first diagnosis for SI/SA and followed up to 365 days. Treatment patterns were captured at the class level and included procedures of electroconvulsive therapy and transcranial magnetic stimulation, and pharmacotherapy including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, other antidepressants, anxiolytics, hypnotics/sedatives, antipsychotics, psychostimulants, and lithium. Results There were 42,204 MDD + SI/SA patients identified. In the year prior to the index event > 40% of individuals received an SSRI and more than one-third received an anxiolytic. Within 1 year following, 84.4% received ≥1 of the treatments of interest. Of those, 70.2% went on to a subsequent class-based regimen, 46.3% received a third, and 28.1% received ≥4. More than three-quarters of patients received multiple treatment classes simultaneously. SSRIs were the most common treatments during follow-up (61.9%), followed by other antidepressants (51.3%), anxiolytics (50.8%) and anticonvulsants (43.6%). Conclusions There was a large amount of variability and polypharmacy in the treatments received by MDD patients with SI/SA, and is much more complex than what has been previously observed in the general MDD population. Within one-year, many patients received four or more unique class-based regimens and most patients received treatments from multiple classes simultaneously, indicating the high unmet medical need and therapy refractoriness of this patient population.

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Treatment Patterns, Type of Front-Line Regimen, and Outcomes Among Older Adults with Acute Myeloid Leukemia: A Population-Based Analysis in the Modern Era

Blood ◽

10.1182/blood-2020-140603 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 15-16

Author(s):

Vanessa E Kennedy ◽

Theresa Keegan ◽

Qian Li ◽

Fran Maguire ◽

Lori S. Muffly

Keyword(s):

Older Adults ◽

Population Based ◽

Cancer Center ◽

Line Treatment ◽

Front Line ◽

Traditional Therapy ◽

Line Therapy ◽

One Year ◽

Modern Era ◽

Over Time

Background: Traditionally, intensive induction chemotherapy has been the primary front-line treatment for AML; however, older adults are often poor chemotherapy candidates and as of 2009, nearly 50% of older AML patients did not receive any treatment (Mederios, Ann Hematol 2015). Recently, several non-traditional front-line AML regimens have emerged, including hypomethylating agents (HMA), the BCL-2 inhibitor venetoclax, liposomal anthracycline and cytarabine, and targeted therapies. These non-traditional agents may offer less intense side effects and provide novel front-line options for older adults. We hypothesized the advent of non-traditional options has allowed a greater proportion of older adults to receive effective treatment, thereby improving survival for this population. Using a population-based approach, we evaluated front-line treatment patterns and outcomes of older adults with AML in the modern era. Methods: Patients ≥ 60 years with a first diagnosis of AML in the California Cancer Registry (CCR) between 2014-2017 were included. Front-line regimen was manually abstracted from unstructured free-text fields in the CCR. The CCR was linked with California's Patient Discharge Database (PDD) to obtain hematopoietic cell transplantation (HCT) information. Multivariable logistic regression examined factors associated with front-line treatment regimen and multivariable Cox proportional hazards regression examined factors associated with survival. Results: Of the 4,086 patients identified, 3,068 (75%) had sufficient treatment information to classify front-line regimen and are included; 34% were 60-69 years at diagnosis, 39% were 70-79, and 27% were ≥ 80. Thirty-three percent received front-line therapy at an NCI-designated cancer center and 12% received HCT. The median follow-up time was 121 days. Across the time period studied, 36% received traditional cytotoxic chemotherapy, 42% received non-traditional therapy, and 22% received no treatment. Of the patients receiving traditional therapy, 84% received cytarabine plus anthracycline. Of those receiving non-traditional therapy, 85% received HMA monotherapy, 8% HMA plus venetoclax, and 3% liposomal cytarabine plus anthracycline. Use of both non-traditional therapy and HCT increased over time, with 38% of patients receiving non-traditional therapy in 2014 vs 47% in 2017 (p < 0.001) and 8.4% of patients receiving HCT in 2014 compared to 11.1% in 2017 (p < 0.001.) The proportion of patients not receiving treatment did not change significantly over time, with 23% in 2014 vs 24% in 2017 (p = 0.20). Multivariable analyses (MVA) revealed receipt of treatment was significantly associated with age < 80 (p < 0.001), < 2 comorbidities (p < 0.001), and receipt of front-line therapy at an NCI-designated cancer center (p < 0.001). Compared to traditional chemotherapy, non-traditional frontline therapy was associated with age ≥ 80 (p < 0.001) and ≥ 2 comorbidities (p = 0.001). Race/ethnicity, socioeconomic status, and type of insurance were not associated with receipt of treatment or type of front-line regimen. One-year overall survival (OS) of the full cohort was 25% (CI: 23.6 - 26.5%). One-year OS was 44% (CI: 40.8 - 47.1%) for patients receiving traditional chemotherapy, 31.4% (CI: 40.8 - 47.13%) for patients receiving non-traditional therapy, and 4.38% (CI: 2.73 - 6.04%) for patients who were not treated. The MVA for OS demonstrated age ≥ 80 (HR 1.19, CI 1.04 - 1.36), ≥ 2 comorbidities (HR 1.33, CI 1.19 - 1.49), and not receiving front-line therapy at an NCI cancer center (HR 1.49, CI 1.34 - 1.65) to be independently associated with inferior OS; receipt of traditional chemotherapy (HR 0.22, CI 0.19 - 0.25) and HCT (HR 0.75, CI 0.6 - 0.93) were associated with superior OS. Conclusion Using a population-based approach, we show the patterns of care for AML treatment in older adults is changing, with an increasing proportion of patients receiving both initial treatment and HCT relative to historical reports and a significant increase in the use of newer, non-traditional therapies. Similarly, survival estimates are improving over time for patients who receive therapy. During our study period, a significant proportion of older adults with AML remain untreated, which is strikingly impacted by location of front-line care. At the population level, there remain opportunities to increase access to therapy for older adults with AML. Disclosures Muffly: Amgen: Consultancy; Servier: Research Funding; Adaptive: Research Funding.

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Social Inequalities and Loneliness as Predictors of Ageing Well: A Trend Analysis Using Mixed Models

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17155314 ◽

2020 ◽

Vol 17 (15) ◽

pp. 5314 ◽

Cited By ~ 1

Author(s):

Jens Klein ◽

Olaf von dem Knesebeck ◽

Daniel Lüdecke

Keyword(s):

Physical Functioning ◽

Mixed Models ◽

Time Trends ◽

Social Inequalities ◽

Strong Association ◽

Total Sample ◽

Population Based ◽

Ageing Population ◽

Educational Inequalities ◽

Over Time

Background: This study examines if education, income, and loneliness are associated with physical functioning and optimism in an ageing population in Germany. Furthermore, time trends of physical functioning and optimism as well as of associations with social inequality and loneliness are analyzed. Methods: The German Ageing Survey (DEAS), a longitudinal population-based survey of individuals aged 40 years and older, was used (four waves between 2008 and 2017, total sample size N = 23,572). Physical functioning and optimism were introduced as indicators of ageing well. Educational level, net equivalent income, and loneliness were used as predictors in linear mixed models for longitudinal data. Results: Time trends show that physical functioning decreases over time, while optimism slightly increases. Education and income are positively associated with physical functioning, while higher loneliness correlates with lower physical functioning. Higher optimism was associated with higher income and particularly with lower loneliness. Income and notable educational inequalities in physical functioning increase over time. Time trends of the associations with optimism show decreasing income inequalities and increasing disparities in loneliness. Conclusions: Increasing educational inequalities in physical functioning and a strong association of loneliness with optimism provide information for further interventions. Targeted health promotion among the aged and addressing maladaptive social cognition are options to tackle these issues. Key areas for action on healthy ageing include, for instance, the alignment of health systems to the needs of older populations or the creation of age-friendly environments.

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Decrease in 30-day and one-year mortality over time in patients aged ≥75 years with stage I–III colon cancer: A population-based study

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2018.08.010 ◽

2018 ◽

Vol 44 (12) ◽

pp. 1889-1893 ◽

Cited By ~ 7

Author(s):

A.J. Breugom ◽

E. Bastiaannet ◽

J.W.T. Dekker ◽

M.W.J.M. Wouters ◽

C.J.H. van de Velde ◽

...

Keyword(s):

Colon Cancer ◽

Population Based ◽

Stage I ◽

Population Based Study ◽

One Year ◽

Over Time

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Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

Heart ◽

10.1136/heartjnl-2019-315307 ◽

2019 ◽

Vol 106 (2) ◽

pp. 119-126 ◽

Cited By ~ 11

Author(s):

Amitava Banerjee ◽

Valerio Benedetto ◽

Philip Gichuru ◽

Jane Burnell ◽

Sotiris Antoniou ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Median Number ◽

Population Based ◽

Cardiovascular Comorbidities ◽

One Year ◽

Over Time

BackgroundDespite simpler regimens than vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF), adherence (taking drugs as prescribed) and persistence (continuation of drugs) to direct oral anticoagulants are suboptimal, yet understudied in electronic health records (EHRs).ObjectiveWe investigated (1) time trends at individual and system levels, and (2) the risk factors for and associations between adherence and persistence.MethodsIn UK primary care EHR (The Health Information Network 2011–2016), we investigated adherence and persistence at 1 year for oral anticoagulants (OACs) in adults with incident AF. Baseline characteristics were analysed by OAC and adherence/persistence status. Risk factors for non-adherence and non-persistence were assessed using Cox and logistic regression. Patterns of adherence and persistence were analysed.ResultsAmong 36 652 individuals with incident AF, cardiovascular comorbidities (median CHA2DS2VASc[Congestive heart failure, Hypertension, Age≥75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65-74 years, Sex category] 3) and polypharmacy (median number of drugs 6) were common. Adherence was 55.2% (95% CI 54.6 to 55.7), 51.2% (95% CI 50.6 to 51.8), 66.5% (95% CI 63.7 to 69.2), 63.1% (95% CI 61.8 to 64.4) and 64.7% (95% CI 63.2 to 66.1) for all OACs, VKA, dabigatran, rivaroxaban and apixaban. One-year persistence was 65.9% (95% CI 65.4 to 66.5), 63.4% (95% CI 62.8 to 64.0), 61.4% (95% CI 58.3 to 64.2), 72.3% (95% CI 70.9 to 73.7) and 78.7% (95% CI 77.1 to 80.1) for all OACs, VKA, dabigatran, rivaroxaban and apixaban. Risk of non-adherence and non-persistence increased over time at individual and system levels. Increasing comorbidity was associated with reduced risk of non-adherence and non-persistence across all OACs. Overall rates of ‘primary non-adherence’ (stopping after first prescription), ‘non-adherent non-persistence’ and ‘persistent adherence’ were 3.5%, 26.5% and 40.2%, differing across OACs.ConclusionsAdherence and persistence to OACs are low at 1 year with heterogeneity across drugs and over time at individual and system levels. Better understanding of contributory factors will inform interventions to improve adherence and persistence across OACs in individuals and populations.

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Trends in the use of antidepressants among older adults: Bambuí Project

Revista de Saúde Pública ◽

10.1590/s0034-8910.2014048005406 ◽

2014 ◽

Vol 48 (6) ◽

pp. 857-865 ◽

Cited By ~ 4

Author(s):

Antônio Ignácio de Loyola Filho ◽

Érico Castro-Costa ◽

Josélia Oliveira Araújo Firmo ◽

Sérgio Viana Peixoto

Keyword(s):

Older Adults ◽

Serotonin Reuptake ◽

Selective Serotonin Reuptake Inhibitors ◽

Family Income ◽

Population Based ◽

Serotonin Reuptake Inhibitors ◽

Selective Serotonin ◽

International Studies ◽

Significant Difference ◽

Antidepressant Use

OBJECTIVE To analyze the trends and factors associated with the antidepressant use among older adults. METHODS This population-based study evaluated older adults in 1997 (n = 351, baseline) and the survivors at the 15th follow-up year (n = 462, in 2012) among the aging cohort of Bambuí. The prevalence of antidepressant use was estimated, and the most commonly used antidepressants each year were identified. Prevalence ratios with 95% confidence intervals were estimated using Poisson regression with robust variance to investigate differences in the prevalence of use between 1997 and 2012. RESULTS The overall consumption of antidepressants (PR = 2.87, 95%CI 1.94;4.25) and of selective serotonin reuptake inhibitors (PR = 7.50, 95%CI 3.74;15.02) was significantly higher in 2012. However, no significant difference was observed in the use of tricyclic antidepressants between the two cohorts (PR = 0.89, 95%CI 0.49;1.62). In the 2012 cohort, antidepressant use was associated with females, increased age, increased income (≥ 4 minimum wages), self-assessment of health as reasonable, and attending ≥ 5 medical consultations in the last 12 months. CONCLUSIONS The increased consumption of antidepressants in the period due to increased use of selective serotonin reuptake inhibitors was consistent with results observed in international studies of different population groups and contexts. The positive correlation observed between antidepressant use and family income may be a warning of possible inequalities in access to mental health services.

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Neither leg muscle strength nor balance are associated with the incidence of falls in middle-aged women: A 5-year population-based prospective study

The Journals of Gerontology Series A ◽

10.1093/gerona/glab122 ◽

2021 ◽

Author(s):

Mengmeng Wang ◽

Feitong Wu ◽

Michele L Callisaya ◽

Graeme Jones ◽

Tania M Winzenberg

Keyword(s):

Muscle Strength ◽

Negative Binomial ◽

Population Based ◽

Step Test ◽

Middle Aged ◽

Injurious Falls ◽

Modifiable Factors ◽

Functional Reach Test ◽

Leg Muscle ◽

One Year

Abstract Background Muscle strength and balance are major modifiable factors of falls in older adults, but their associations with falls in middle-aged adults are under investigated. We aimed to examine the association of baseline and change in leg muscle strength (LMS) and balance with the incidence of falls in a cohort of middle-aged women. Methods This was a five-year follow-up of a population-based sample of 273 women aged 36-57 years at baseline (2011-2012). Data on LMS (by dynamometer) and balance (timed up and go test [TUG], step test [ST], functional reach test [FRT], and lateral reach test [LRT]) were obtained at baseline and five years later (2017-2018). After five years, falls were recorded monthly for one year by questionnaire (2017-2019). Negative binomial/Poisson and log binomial regressions were used as appropriate to assess associations of baseline and change in LMS and balance with any falls, injurious falls and multiple falls. Results Over one-year, 115 participants (42%) reported at least one fall. Neither baseline nor 5-year change in LMS and balance measures were associated with the risk of any falls, injurious falls, or multiple falls five years later, with or without adjusting for confounders at baseline (incidence rate ratio/relative risk ranging from 0.85 to 1.19, 0.90 to 1.20, and 0.82 to 1.36, respectively; P>0.05 for all). Conclusions Baseline or change in LMS and balance measures are not associated with incident falls among middle-aged women. The contributions of environmental and other intrinsic factors such as chronic conditions and gait/mobility problems need to be investigated.

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