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Factors associated with discontinuation of antidepressant treatment after a single prescription among patients aged 55 or over: evidence from English primary care

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Abstract

Purpose

Antidepressants are frequently prescribed to older people with depression but little is known on predictors of discontinuation in this population. We, therefore, investigated factors associated with early discontinuation of antidepressants in older adults with new diagnoses or symptoms of depression in English primary care.

Methods

Data from a nationally representative cohort of patients aged 55 and over were used to evaluate the association between discontinuation of antidepressant medication after a single prescription and potential explanatory variables, including socio-demographic factors, polypharmacy and age-related problems such as dementia.

Results

Overall, during the study period we observed 34,715 new courses of antidepressant treatment initiated after recorded symptoms or diagnoses of depression. Antidepressant discontinuation after a single prescription was more common in people with depressive symptoms (32%) than in those with diagnosed depression (21.6%). In those diagnosed with depression and in women with depressive symptoms we found that, after adjusting for confounders, the odds of early discontinuation significantly increased after age 65 with a peak at around age 80 and then either levelled or reduced thereafter. Early discontinuation was also significantly less common in people with dementia and in those with diagnosed depression living in more rural areas.

Conclusions

Early discontinuation of antidepressants increases in the post-retirement years and is higher in those with no formal diagnosis of depression, those without dementia and those with diagnosed depression living in urban areas. Alternative treatment strategies, such as non-drug therapies, or more active patient follow-up should be further considered in these circumstances.

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Funding

This paper presents independent research funded by the National Institute for Health Research (NIHR) School for Public Health Research (SPHR-10043). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The NIHR SPHR is a partnership between the Universities of Sheffield; Bristol; Cambridge; Imperial; and University College London; The London School for Hygiene and Tropical Medicine (LSHTM); LiLaC—a collaboration between the Universities of Liverpool and Lancaster; and Fuse—The Centre for Translational Research in Public Health a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities.

Author information

Authors and Affiliations

  1. Research Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK

    Milena Falcaro & Kate Walters

  2. Population Health Sciences, University of Bristol, Bristol, UK

    Yoav Ben-Shlomo

  3. Division of Psychiatry, University College London, London, UK

    Michael King

  4. Comprehensive Clinical Trials Unit, University College London, London, UK

    Nick Freemantle

Authors
  1. Milena Falcaro
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  2. Yoav Ben-Shlomo
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  3. Michael King
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  4. Nick Freemantle
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  5. Kate Walters
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Corresponding author

Correspondence to Milena Falcaro.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

Use of THIN for scientific research was approved by the NHS South East Multi-Centre Research Ethics Committee in 2003. Scientific approval to undertake this study was obtained from IQVIA World Publications Scientific Review Committee (SRC) in November 2014 (SRC reference number: 14-068).

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Falcaro, M., Ben-Shlomo, Y., King, M. et al. Factors associated with discontinuation of antidepressant treatment after a single prescription among patients aged 55 or over: evidence from English primary care. Soc Psychiatry Psychiatr Epidemiol 54, 1545–1553 (2019). https://doi.org/10.1007/s00127-019-01678-x

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  • DOI: https://doi.org/10.1007/s00127-019-01678-x

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