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Differences in prescribing psychotropic drugs for elderly with depression

Published online by Cambridge University Press:  22 February 2016

Yu-Chi Huang ,
Liang-Jen Wang  and
Mian-Yoon Chong
Yu-Chi Huang
Affiliation:
Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Liang-Jen Wang
Affiliation:
Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Mian-Yoon Chong*
Affiliation:
Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
*
Mian-Yoon Chong, Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, 123 Ta-Pei Road, Niao-Sung, Kaohsiung 83342, Taiwan. Tel: +886-7-7317123 ext 8753; Fax: +886-7-7326817; E-mail: [email protected]
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Abstract

Objective

The escalating tendency of elderly population aged 65 and over, which grown up to 9% since 2001 in Taiwan, remarks the important issue of mental health among ageing population. Depression in the elderly is frequently undetected or inadequately treated. This study aimed to investigate the pharmacotherapy of elderly patients with depression by comparing the patterns of prescribing psychotropic drugs (psychotropics) of psychiatrists and non-psychiatrists.

Methods

A random sampling of 5% of inpatients from the National Health Insurance (NHI) database in Taiwan from 2001 to 2003 was selected. In all, 1058 (0.9%) inpatients aged 65 and older with a diagnosis of any depressive disorder were included. The psychotropic prescribing pattern and the dosages used were analysed and compared. Physician specialties were based on the record of NHI database. Non-psychiatrists were defined by physicians other than psychiatry.

Results

A total of 88% of elderly depressed inpatients had two or more comorbid physical illnesses. The most commonly prescribed psychotropics were: antidepressants (71.4%), anxiolytics (62.6%) and hypnotics (51.4%). Psychiatrists had a higher rate of prescribing psychotropics, except anxiolytics, than non-psychiatrists. Although selective serotonin reuptake inhibitors were commonly prescribed, non-psychiatrists preferred the use of tricyclic antidepressants and moclobemide. Trazodone was the most preferred antidepressant, but was generally used in low dosages.

Conclusion

Psychiatrists generally utilised higher dosages of newer antidepressants than non-psychiatrists. Differences in the prescribing pattern of psychotropics existed between physician specialties. Further investigations are warranted to determine how the selection and dosing of drugs influence the outcome of depression on the elderly.

Keywords

antidepressantsgeriatric depressioninpatientpharmacoepidemiologyprescription pattern
Type
Original Articles
Information
Acta Neuropsychiatrica , Volume 28 , Issue 5 , October 2016 , pp. 296 - 303
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Copyright
© Scandinavian College of Neuropsychopharmacology 2016 

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References

1. Ellison, JM, Kyomen, HH, Harper, DG. Depression in later life: an overview with treatment recommendations. Psychiatr Clin North Am 2012;35:203–229.CrossRefGoogle ScholarPubMed
2. Chong, MY, Tsang, HY, Chen, CS et al. Community study of depression in old age in Taiwan: prevalence, life events and socio-demographic correlates. Br J Psychiatry 2001;178:29–35.CrossRefGoogle ScholarPubMed
3. Gerson, S, Mistry, R, Bastani, R et al. Symptoms of depression and anxiety (MHI) following acute medical/surgical hospitalization and post-discharge psychiatric diagnoses (DSM) in 839 geriatric US veterans. Int J Geriatr Psychiatry 2004;19:1155–1167.Google Scholar
4. Blazer, DG, Hybels, CF, Pieper, CF. The association of depression and mortality in elderly persons: a case for multiple, independent pathways. J Gerontol A Biol Sci Med Sci 2001;56:M505–M509.CrossRefGoogle Scholar
5. Diniz, BS, Nunes, PV, Machado-Vieira, R, Forlenza, OV. Current pharmacological approaches and perspectives in the treatment of geriatric mood disorders. Curr Opin Psychiatry 2011;24:473–477.CrossRefGoogle ScholarPubMed
6. Wu, CS, Shau, WY, Chan, HY, Lee, YC, Lai, YJ, Lai, MS. Utilization of antidepressants in Taiwan: a nationwide population-based survey from 2000 to 2009. Pharmacoepidemiol Drug Saf 2012;21:980–988.Google Scholar
7. Raymond, CB, Morgan, SG, Caetano, PA. Antidepressant utilization in British Columbia from 1996 to 2004: increasing prevalence but not incidence. Psychiatric Services 2007;58:79–84.CrossRefGoogle Scholar
8. Sonnenberg, CM, Deeg, DJ, Comijs, HC, van Tilburg, W, Beekman, AT. Trends in antidepressant use in the older population: results from the LASA-study over a period of 10 years. J Affect Disord 2008;111:299–305.CrossRefGoogle Scholar
9. Soudry, A, Dufouil, C, Ritchie, K, Dartigues, JF, Tzourio, C, Alperovitch, A. Factors associated with antidepressant use in depressed and non-depressed community-dwelling elderly: the three-city study. Int J Geriatr Psychiatry 2008;23:324–330.Google Scholar
10. Kuo, CC, Chien, IC, Lin, CH et al. Prevalence, correlates, and disease patterns of antidepressant use in Taiwan. Compr Psychiatry 2011;52:662–669.CrossRefGoogle ScholarPubMed
11. Harman, JS, Crystal, S, Walkup, J, Olfson, M. Trends in elderly patients’ office visits for the treatment of depression according to physician specialty: 1985-1999. J Behav Health Serv Res 2003;30:332–341.Google Scholar
12. Uchida, N, Chong, MY, Tan, CH et al. International study on antidepressant prescription pattern at 20 teaching hospitals and major psychiatric institutions in East Asia: analysis of 1898 cases from China, Japan, Korea, Singapore and Taiwan. Psychiatry Clin Neurosci 2007;61:522–528.Google Scholar
13. Alexopoulos, GS. Pharmacotherapy for late-life depression. J Clin Psychiatry 2011;72:e04.Google Scholar
14. Gum, AM, Cheavens, JS. Psychiatric comorbidity and depression in older adults. Curr Psychiatry Rep 2008;10:23–29.Google Scholar
15. Semark, B, Engstrom, S, Brudin, L et al. Factors influencing the prescription of drugs of different price levels. Pharmacoepidemiol Drug Saf 2013;22:286–293.CrossRefGoogle ScholarPubMed
16. Young, AS, Klap, R, Sherbourne, CD, Wells, KB. The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry 2001;58:55–61.Google Scholar
17. Kok, RM, Nolen, WA, Heeren, TJ. Efficacy of treatment in older depressed patients: a systematic review and meta-analysis of double-blind randomized controlled trials with antidepressants. J Affect Disord 2012;141:103–115.CrossRefGoogle ScholarPubMed
18. Lin, MH, Chou, MY, Liang, CK, Peng, LN, Chen, LK. Population aging and its impacts: strategies of the health-care system in Taipei. Ageing Res Rev 2010;9(Suppl 1):S23–S27.Google Scholar
19. Chien, IC, Bih, SH, Chou, YJ, Lin, CH, Lee, WG, Chou, P. Trends in the use of psychotropic drugs in Taiwan: a population-based national health insurance study, 1997–2004. Psychiatric services 2007;58:554–557.CrossRefGoogle ScholarPubMed
20. Gartlehner, G, Hansen, RA, Morgan, LC et al. Second-generation antidepressants in the pharmacologic treatment of adult depression: an update of the 2007 comparative effectiveness review. Rockville: Agency for Healthcare Research and Quality, 2011.Google ScholarPubMed
21. World Health Organization. Collaborating Centre for Drug Statistics Methodology, 2012. http://www.whocc.no/atc_ddd_index/, 2012.Google Scholar
22. Almeida, OP. Approaches to decrease the prevalence of depression in later life. Curr Opin Psychiatry 2012;25:451–456.Google Scholar
23. Lim, LL, Chang, W, Yu, X, Chiu, H, Chong, MY, Kua, EH. Depression in Chinese elderly populations. Asia Pac Psychiatry 2011;3:46–53.CrossRefGoogle Scholar
24. Chiu, E, Ames, D, Draper, B, Snowdon, J. Depressive disorders in the elderly: a review. In: Herrman H, Maj M, Sartorius N editors. Depressive disorders. Chichester, UK: John Wiley & Sons, Ltd., 2009.Google Scholar
25. Chong, MY. Recognition of old age depression in chinese. In: Herrman H, Maj M, Sartorius N editors. Depressive disorders. Chichester, UK: John Wiley & Sons, Ltd., 2009.Google Scholar
26. Montgomery, SA. Late-life depression: rationalizing pharmacological treatment options. Gerontology 2002;48:392–400.CrossRefGoogle ScholarPubMed
27. Sim, K, Lee, NB, Chua, HC et al. Newer antidepressant drug use in East Asian psychiatric treatment settings: REAP (Research on East Asia Psychotropic Prescriptions) Study. Br J Clin Pharmacol 2006;63:431–437.CrossRefGoogle ScholarPubMed
28. Wilson, K, Mottram, P. A comparison of side effects of selective serotonin reuptake inhibitors and tricyclic antidepressants in older depressed patients: a meta-analysis. Int J Geriatr Psychiatry 2004;19:754–762.Google Scholar
29. Cheng, JS, Huang, WF, Lin, KM, Shih, YT. Characteristics associated with benzodiazepine usage in elderly outpatients in Taiwan. Int J Geriatr Psychiatry 2008;23:618–624.CrossRefGoogle ScholarPubMed
30. Bartels, SJ, Horn, S, Sharkey, P, Levine, K. Treatment of depression in older primary care patients in health maintenance organizations. Int J Psychiatry Med 1997;27:215–231.Google Scholar
31. Chang, CM, Wu, EC, Chang, IS, Lin, KM. Benzodiazepine and risk of hip fractures in older people: a nested case-control study in Taiwan. Am J Geriatr Psychiatry 2008;16:686–692.CrossRefGoogle ScholarPubMed
32. Flint, AJ. Treatment-resistant depression in late life. CNS Spectr 2002;7:733–738.CrossRefGoogle ScholarPubMed
33. Sable, JA, Dunn, LB, Zisook, S. Late-life depression. How to identify its symptoms and provide effective treatment. Geriatrics 2002;57:18–19. 22-13, 26 passim.Google Scholar
34. Rapp, SR, Parisi, SA, Wallace, CE. Comorbid psychiatric disorders in elderly medical patients: a 1-year prospective study. J Am Geriatr Soc 1991;39:124–131.CrossRefGoogle ScholarPubMed