Pittman Ryan D, Sutton S Scott, Magagnoli Joseph, Cummings Tammy H
Dorn Research Institute, Columbia VA Health Care System, Columbia, SC, USA.
Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA.
J Comp Eff Res. 2025 Feb;14(2):e240187. doi: 10.57264/cer-2024-0187. Epub 2025 Jan 21.
To compare the safety and efficacy of antidepressants (AD) among older adults with major depressive disorder (MDD) by assessing treatment change, augmentation and hospitalization rates. This retrospective study analyzed data from the Veterans Affairs (VA) database, including 142,138 patients aged ≥60 years diagnosed with MDD. Patients prescribed bupropion, citalopram, duloxetine, escitalopram, fluoxetine, mirtazapine, paroxetine, sertraline, or venlafaxine were included. Outcomes were treatment change, augmentation and hospitalization rates. Hazard ratios (aHRs) were calculated using sertraline as the reference. Of the patients, 39.6% required augmentation, 18.1% changed antidepressant treatment and 13.3% were hospitalized. The corresponding incidence rate was 544, 124 and 122 events per 1000 person-years. Compared with sertraline, mirtazapine users had the highest AD change risk (aHR 1.34, 95% CI: 1.29-1.40), while duloxetine users had the lowest (aHR 0.87, 95% CI: 0.83-0.92). Duloxetine also had the lowest augmentation risk (aHR 0.89, 95% CI: 0.86-0.92). Mirtazapine users also had the highest risks of augmentation (aHR 1.15, 95% CI: 1.12-1.18) and hospitalization (aHR 1.14, 95% CI: 1.07-1.23). Bupropion had the lowest hospitalization risk (aHR 0.77, 95% CI: 0.71-0.84). Antidepressant choice significantly influences treatment outcomes in older adults with MDD. Duloxetine demonstrated the best profile with the lowest risks of AD change and augmentation, while mirtazapine posed the highest risks of all three outcomes. Personalized treatment strategies are crucial to improving outcomes in this population.
通过评估治疗变化、增效治疗及住院率，比较抗抑郁药（AD）在患有重度抑郁症（MDD）的老年人中的安全性和有效性。这项回顾性研究分析了退伍军人事务部（VA）数据库中的数据，包括142138名年龄≥60岁且被诊断为MDD的患者。纳入了处方安非他酮、西酞普兰、度洛西汀、艾司西酞普兰、氟西汀、米氮平、帕罗西汀、舍曲林或文拉法辛的患者。观察指标为治疗变化、增效治疗及住院率。以舍曲林作为对照计算风险比（aHRs）。在这些患者中，39.6%需要增效治疗，18.1%更换了抗抑郁药治疗，13.3%住院治疗。相应的发病率分别为每1000人年544、124和122例事件。与舍曲林相比，使用米氮平的患者更换抗抑郁药的风险最高（aHR 1.34，95%CI：1.29 - 1.40），而使用度洛西汀的患者风险最低（aHR 0.87，95%CI：0.83 - 0.92）。度洛西汀的增效治疗风险也最低（aHR 0.89，95%CI：0.86 - 0.92）。使用米氮平的患者增效治疗（aHR 1.15，95%CI：1.12 - 1.18）和住院（aHR 1.14，95%CI：1.07 - 1.23）的风险也最高。安非他酮的住院风险最低（aHR 0.77，95%CI：0.71 - 0.84）。抗抑郁药的选择对患有MDD的老年人的治疗结果有显著影响。度洛西汀表现出最佳的情况，更换抗抑郁药和增效治疗的风险最低，而米氮平在所有三项结果中风险最高。个性化的治疗策略对于改善该人群的治疗结果至关重要。
