Leong Christine, Enns Murray W, Sareen Jitender, Alessi-Severini Silvia, Bolton James, Prior Heather J, Chateau Dan
a College of Pharmacy, Faculty of Health Sciences , University of Manitoba , Winnipeg , Canada.
b Department of Psychiatry, College of Medicine, Faculty of Health Sciences , University of Manitoba , Winnipeg , Canada.
Aging Ment Health. 2017 Jul;21(7):720-729. doi: 10.1080/13607863.2016.1154014. Epub 2016 Feb 29.
There has been much attention on appropriate prescribing in older adults in recent years. Recent guidelines favor the use of newer antidepressants over older agents based on their safety profile in this population. This study aimed to examine whether there has been a decline in older antidepressants and an increase in newer antidepressants used by older adults.
A retrospective cross-sectional study using administrative databases examined the annual incidence of antidepressant use (per 1000) of community-dwelling adults ≥60 years old between 1997/1998 and 2012/2013 in Manitoba, Canada.
The population of Manitoba ≥60 years increased by 25.6% from 188,296 to 236,569 from 1997/1998 to 2012/2013. New antidepressant use peaked to 45.9 per 1000 in 1999/2000, and then decreased steadily to 30.5 per 1000 in 2012/2013 (p < 0.0001). Incident amitriptyline use was high but declined from 15.5 to 7.4 per 1000 (p < 0.001). An increase in incident trazodone, mirtazapine, and venlafaxine use was observed (p < 0.001).
There has been an overall decrease in the annual incidence of antidepressant users in older adults over the last 16 years, with a marked decline in new amitriptyline use and an increase in the incidence of newer agents.
近年来，老年人合理用药备受关注。基于新型抗抑郁药在该人群中的安全性，近期指南倾向于使用新型抗抑郁药而非旧有药物。本研究旨在调查老年人使用旧有抗抑郁药的情况是否减少，以及使用新型抗抑郁药的情况是否增加。
一项回顾性横断面研究利用行政数据库，调查了1997/1998年至2012/2013年期间加拿大曼尼托巴省60岁及以上社区居住成年人抗抑郁药使用的年发病率（每1000人）。
从1997/1998年到2012/2013年，曼尼托巴省60岁及以上人口从188,296人增加到236,569人，增长了25.6%。新型抗抑郁药的使用在1999/2000年达到每1000人45.9例的峰值，然后稳步下降至2012/2013年的每1000人30.5例（p<0.0001）。阿米替林的使用发病率较高，但从每1000人15.5例降至7.4例（p<0.001）。观察到曲唑酮、米氮平和文拉法辛的使用发病率有所增加（p<0.001）。
在过去16年中，老年人抗抑郁药使用者的年发病率总体下降，新型阿米替林的使用显著减少，新型药物的发病率增加。
