Department of Affective Disorders, Aarhus University Hospital Psychiatry, Entrance K, Pallet Juul-Jensens Boulevard 175, 8200, Aarhus N, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Drugs Aging. 2023 Apr;40(4):355-368. doi: 10.1007/s40266-023-01018-4. Epub 2023 Mar 15.
Antidepressant use in older adults (≥ 65 years) is understudied in large population-based samples, particularly in recent years and regarding user characteristics. We aimed to describe the trends, patterns, and associated user characteristics of all antidepressant prescriptions redeemed by older adults at community pharmacies in Denmark during 2015-2019.
This register-based study used a cross-sectional design to characterize antidepressant prescription trends and patterns, and a cohort design to describe user characteristics associated with antidepressant prescription initiation. We used descriptive statistics to characterize trends and patterns, and Poisson regression for analyzing user characteristics.
During the years 2015-2019, 17.9% of 1.2 million older adults redeemed 4.84 million antidepressant prescriptions, where 48.5% were selective serotonin reuptake inhibitors, followed by noradrenergic and specific serotonergic antidepressants (26.2%), serotonin-norepinephrine reuptake inhibitors (12.7%), tricyclic antidepressants (11.2%), and others (1.4%). Amitriptyline and nortriptyline, considered potentially inappropriate medications, were among the 10 most frequently redeemed antidepressants. Only 60.5% of prescriptions had a treatment indication of depression. Prescription-proportion trends by drug classes and individual antidepressants remained consistent. A higher incidence rate ratio (IRR) and 95% confidence interval (CI) of initiating antidepressants was associated with female sex (IRR 1.20, 95% CI 1.07-1.34), older age (e.g., 81-85 years vs. 65-70 years: IRR 1.74, 95% CI 1.44-2.11), living in rural areas (North Denmark vs. Capital Region: IRR 1.31, 95% CI 1.09-1.58), and having somatic and psychiatric diagnoses (e.g., per one psychiatric diagnosis: IRR 1.10, 95% CI 1.05-1.15), while a lower ratio was associated with being non-Western (vs. Danish: IRR 0.50, 95% CI 0.28-0.89) and having hospital contacts for psychiatric treatment (per each contact: IRR 0.96, 95% CI 0.93-1.00).
SSRIs were the most commonly redeemed antidepressants, with consistent trends in Danish older adults. Besides clinical conditions, sociodemographics, e.g., sex, age, ethnicity, and place of residence, may influence antidepressant use.
在大型基于人群的样本中，针对年龄较大的成年人（≥65 岁）的抗抑郁药使用情况研究较少，尤其是在最近几年，且关于使用者特征的研究更少。我们旨在描述丹麦社区药房中年龄较大的成年人在 2015-2019 年间所有抗抑郁药处方的趋势、模式和相关使用者特征。
本注册研究采用横断面设计来描述抗抑郁药处方趋势和模式，以及队列设计来描述与抗抑郁药处方起始相关的使用者特征。我们使用描述性统计来描述趋势和模式，并使用泊松回归分析使用者特征。
在 2015-2019 年期间，120 万年龄较大的成年人中有 17.9%使用了 484 万份抗抑郁药处方，其中 48.5%为选择性 5-羟色胺再摄取抑制剂，其次是去甲肾上腺素和特异性 5-羟色胺能抗抑郁药（26.2%）、5-羟色胺-去甲肾上腺素再摄取抑制剂（12.7%）、三环类抗抑郁药（11.2%）和其他药物（1.4%）。阿米替林和去甲替林，被认为是潜在的不适当药物，是最常被开出的 10 种抗抑郁药之一。只有 60.5%的处方有抑郁的治疗指征。按药物类别和个别抗抑郁药划分的处方比例趋势保持一致。女性（RR 1.20，95%CI 1.07-1.34）、年龄较大（例如，81-85 岁与 65-70 岁：RR 1.74，95%CI 1.44-2.11）、居住在农村地区（北丹麦与首都大区：RR 1.31，95%CI 1.09-1.58）和患有躯体和精神疾病诊断（例如，每增加一个精神疾病诊断：RR 1.10，95%CI 1.05-1.15）与开始使用抗抑郁药的更高发生率比相关，而非西方（与丹麦：RR 0.50，95%CI 0.28-0.89）和因精神科治疗而有住院接触（每次接触：RR 0.96，95%CI 0.93-1.00）与较低的比值相关。
SSRIs 是丹麦年龄较大的成年人中最常开出的抗抑郁药，且有一致的趋势。除了临床情况外，社会人口统计学特征，如性别、年龄、种族和居住地，也可能影响抗抑郁药的使用。
