Skip to main content
SpringerLink
Log in

Antidepressants utilization among elderly in Lombardy from 2000 to 2007: dispensing trends and appropriateness

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the prevalence and incidence of antidepressant (AD) use in the elderly during an 8-year period and to evaluate AD treatment appropriateness.

Methods

A population-based dispensation study on community-dwelling elderly of a large area in Lombardy was performed. Data were drawn from the regional administrative database and from a general practice registry. For each year, prevalence of AD use (i.e., at least one recorded dispensation) and AD treatment (i.e., at least four recorded dispensations) was compared.

Results

The prevalence of AD use and treatment doubled and tripled, respectively. The greatest shift occurred between 2000 and 2002 and was entirely due to SSRIs. The most pronounced increase was seen in females who accounted for 72% of all dispensations. The increase in prevalence was not mirrored by incident use, which slightly decreased (OR: 0.98; 95% CI: 0.98–0.98). The proportion of those who received a minimally adequate AD treatment grew over the years (OR: 1.63; 95% CI: 1.59–1.68). The increase in prevalence of AD treatment was most pronounced among older age groups (ORs between 1.02 and 1.06 for age classes ≥75 years relative to the 65–69 age class; P < 0.001) and was proportional to that of depressive disorders.

Conclusions

A dramatic rise in dispensations was observed. The increasing prevalence of minimally adequately treated subjects and a possible decrease in untreated depression may reflect an improvement in the pharmacological treatment of depression. The increase in prevalence and not in the incidence of dispensations could be related to an inappropriate prolongation of treatment duration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Middleton N, Gunnell D, Whitley E, Dorling D, Frankel S (2001) Secular trends in antidepressant prescribing in the UK, 1975–1998. J Public Health 23:262–267

    Article  CAS  Google Scholar 

  2. Donoghue JM, Tylee A (1996) The treatment of depression: prescribing patterns of antidepressants in primary care in the UK. Br J Psychiatry 168:164–168

    Article  PubMed  CAS  Google Scholar 

  3. McManus P, Mant A, Mitchell PB, Montgomery WS, Marley J, Auland ME (2000) Recent trends in the use of antidepressant drugs in Australia, 1990–1998. Med J Aust 173:458–461

    PubMed  CAS  Google Scholar 

  4. Helgason T, Tomasson H, Zoega T (2004) Antidepressants and public health in Iceland: time series analysis of national data. Br J Psychiatry 184:157–162

    Article  PubMed  Google Scholar 

  5. Hemels ME, Koren G, Einarson TR (2002) Increased use of antidepressants in Canada: 1981–2000. Ann Pharmacother 36:1375–1379

    Article  PubMed  Google Scholar 

  6. Pincus HA, Tanielian TL, Marcus SC, Olfson M, Zarin DA, Thompson J, Magno Zito J (1998) Prescribing trends in psychotropic medications: primary care, psychiatry, and other medical specialties. JAMA 279:526–531

    Article  PubMed  CAS  Google Scholar 

  7. Olfson M, Marcus SC, Druss B, Elinson L, Tanielian T, Pincus HA (2002) National trends in the outpatient treatment of depression. JAMA 287:203–209

    Article  PubMed  Google Scholar 

  8. Olfson M, Marcus SC (2009) National patterns in antidepressant medication treatment. Arch Gen Psychiatry 66:848–856

    Article  PubMed  Google Scholar 

  9. Harman JS, Edlund MJ, Fortney JC (2009) Trends in antidepressant utilization from 2001 to 2004. Psychiatr Serv 60:611–616

    Article  PubMed  Google Scholar 

  10. Hansen DG, Søndergaard J, Vach W, Gram LF, Rosholm JU, Kragstrup J (2003) Antidepressant drug use in general practice: inter-practice variation and association with practice characteristics. Eur J Clin Pharmacol 59:143–149

    PubMed  Google Scholar 

  11. Knapp M, McDaid D, Mossialos E, Thornicroft G (2007) Mental health policy and practice across Europe: an overview. In: Knapp M, McDaid D, Mossialos E, Thornicroft G (eds) The future direction of mental health care. Open University Press, Maidenhead, pp 1–14

    Google Scholar 

  12. Olfson M, Marcus SC, Pincus HA, Zito JM, Thompson JW, Zarin DA (1998) Antidepressant prescribing practices of outpatient psychiatrists. Arch Gen Psychiatry 55:310–316

    Article  PubMed  CAS  Google Scholar 

  13. Mottram P, Wilson K, Strobl J (2006) Antidepressants for depressed elderly. Cochrane Database Syst Rev 25(1):CD003491

    Google Scholar 

  14. Barbui C, Campomori A, D'Avanzo B, Negri E, Garattini S (1999) Antidepressant drug use in Italy since the introduction of SSRIs: national trends, regional differences and impact on suicide rates. Soc Psychiatry Psychiatr Epidemiol 34:152–156

    Article  PubMed  CAS  Google Scholar 

  15. Castelpietra G, Morsanutto A, Pascolo-Fabrici E, Isacsson G (2008) Antidepressant use and suicide prevention: a prescription database study in the region Friuli Venezia Giulia, Italy. Acta Psychiatr Scand 118:382–388

    Article  PubMed  CAS  Google Scholar 

  16. Henriksson S, Boëthius G, Håkansson J, Isacsson G (2003) Indications for and outcome of antidepressant medication in a general population: a prescription database and medical record study, in Jämtland county, Sweden, 1995. Acta Psychiatr Scand 108:427–431

    Article  PubMed  CAS  Google Scholar 

  17. Gardarsdottir H, Egberts AC, van Dijk L, Sturkenboom MC, Heerdink ER (2009) An algorithm to identify antidepressant users with a diagnosis of depression from prescription data. Pharmacoepidemiol Drug Saf 18:7–15

    Article  PubMed  Google Scholar 

  18. Beekman ATF, Copeland JRM, Prince MJ (1999) Review of community prevalence of depression in late life. Br J Psychiatry 174:307–311

    Article  PubMed  CAS  Google Scholar 

  19. Steffens DC, Skoog I, Norton MC, Hart AD, Tschanz JT, Plassman BL, Wyse BW, Welsh-Bohmer KA, Breitner JC (2000) Prevalence of depression and its treatment in an elderly population. The Cache County Study. Arch Gen Psychiatry 57:601–607

    Article  PubMed  CAS  Google Scholar 

  20. Alexopoulos GS, Vrontou C, Kakuma T, Meyers BS, Young RC, Klausner E, Clarkin J (1996) Disability in geriatric depression. Am J Psychiatry 153:877–885

    PubMed  CAS  Google Scholar 

  21. Williamson G, Schulz R (1992) Physical illness and symptoms of depression among elderly outpatients. Psychol Aging 7:343–351

    Article  PubMed  CAS  Google Scholar 

  22. Beekman ATF, Deeg DJH, Braam AW, Smit JH, Van Tilburg W (1997) Consequences of major and minor depression in later life: a study of disability, well-being and service utilization. Psychol Med 27:1397–1409

    Article  PubMed  CAS  Google Scholar 

  23. Berardi D, Menchetti M, De Ronchi D, Rucci P, Leggieri G, Ferrari G (2002) Late-life depression in primary care: a nationwide Italian epidemiological survey. J Am Geriatr Soc 50:77–83

    Article  PubMed  Google Scholar 

  24. Mamdani MM, Parikh SV, Austin PC, Upshur RE (2000) Use of antidepressants among elderly subjects: trends and contributing factors. Am J Psychiatry 157:360–377

    Article  PubMed  CAS  Google Scholar 

  25. Mamdani M, Rapoport M, Shulman KI, Herrmann N, Rochon PA (2005) Mental health-related drug utilization among older adults: prevalence, trends, and costs. Am J Geriatr Psychiatry 13:892–900

    PubMed  Google Scholar 

  26. Raymond CB, Morgan SG, Caetano PA (2007) Antidepressant utilization in British Columbia from 1996 to 2004: increasing prevalence but not incidence. Psychiatr Serv 58:79–84

    Article  PubMed  Google Scholar 

  27. Newman SC, Schopflocher D (2008) Trends in antidepressant prescriptions among the elderly in Alberta during 1997 to 2004. Can J Psychiatry 53:704–707

    PubMed  Google Scholar 

  28. Barbui C, Percudani M, Fortino I, Tansella M, Petrovich L (2005) Past use of selective serotonin reuptake inhibitors and the risk of cerebrovascular events in the elderly. Int Clin Psychopharmacol 20:169–171

    Article  PubMed  Google Scholar 

  29. Percudani M, Barbui C, Fortino I, Petrovich L (2005) Antidepressant drug prescribing among elderly subjects: a population-based study. Int J Geriatr Psychiatry 20:113–118

    Article  PubMed  Google Scholar 

  30. Percudani M, Barbui C, Fortino I, Petrovich L (2004) Antidepressant drug use in Lombardy, Italy: a population-based study. J Affect Disord 83:169–175

    Article  PubMed  Google Scholar 

  31. Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R (2008) Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med 358:252–260

    Article  PubMed  CAS  Google Scholar 

  32. Eyding D, Lelgemann M, Grouven U, Härter M, Kromp M, Kaiser T, Kerekes MF, Gerken M, Wieseler B (2010) Reboxetine for acute treatment of major depression: systematic review and meta-analysis of published and unpublished placebo and selective serotonin reuptake inhibitor controlled trials. BMJ 341:c4737. doi:10.1136/bmj.c4737

    Article  PubMed  Google Scholar 

  33. Weilburg JB, O'Leary KM, Meigs JB, Hennen J, Stafford RS (2003) Evaluation of the adequacy of outpatient antidepressant treatment. Psychiatr Serv 54:1233–1239

    Article  PubMed  Google Scholar 

  34. Munoz-Arroyo R, Sutton M, Morrison J (2006) Exploring potential explanations for the increase in antidepressant prescribing in Scotland using secondary analyses of routine data. Br J Gen Pract 56:423–428

    PubMed  Google Scholar 

  35. Kendrick T, King F, Albertella L, Smith P (2005) GP treatment decisions for patients with depression. Br J Gen Pract 55:280–286

    PubMed  Google Scholar 

  36. Cameron IM, Lawton K, Reid IC (2009) Appropriateness of antidepressant prescribing: an observational study in a Scottish primary-care setting. Br J Gen Pract 59:644–649

    Article  PubMed  Google Scholar 

  37. Poluzzi E, Motola D, Silvani C, De Ponti F, Vaccheri A, Montanaro N (2004) Prescriptions of antidepressants in primary care in Italy: pattern of use after admission of selective serotonin reuptake inhibitors for reimbursement. Eur J Clin Pharmacol 59:825–831

    Article  PubMed  Google Scholar 

  38. Fabiani L, Scatigna M, Panopoulou K, Sabatini A, Sessa E, Donato F, Marchi M (2004) Health Search-Research Institute of the Italian Society of General Practice: the creation of a research database in general practice. Epidemiol Prev 28:156–162

    PubMed  Google Scholar 

  39. Cricelli C, Mazzaglia G, Samani F, Marchi M, Sabatini A, Nardi R, Ventriglia G, Caputi AP (2003) Prevalence estimates for chronic diseases in Italy: exploring the differences between self-report and primary care databases. J Public Health Med 25:254–257

    Article  PubMed  Google Scholar 

  40. WHO Collaborating Centre for Drug Statistics Methodology (2002) Guidelines for ATC classification and DDD assignment, 5th ed. WHO, Oslo

  41. National Institute for Clinical Excellence (2010) Depression in adults: full guidance. NICE, London. http://guidance.nice.org.uk/CG90/Guidance/pdf/English. Accessed 17 November 2010

  42. Thorpe L, Whitney DK, Kutcher SP, Kennedy SH, CANMAT Depression Work Group (2001) Clinical guidelines for the treatment of depressive disorders. VI. Special populations. Can J Psychiatry 46(Suppl 1):63–76

    Google Scholar 

  43. Moore M, Yuen HM, Dunn N, Mullee MA, Maskell J, Kendrick T (2009) Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database. BMJ. doi:10.1136/bmj.b3999

    Google Scholar 

  44. Krueger KP, Berger BA, Felkey B (2005) Medication adherence and persistence: a comprehensive review. Adv Ther 22:313–356

    Article  PubMed  Google Scholar 

  45. Hansen DG, Rosholm JU, Gichangi A, Vach W (2007) Increased use of antidepressants at the end of life: population-based study among people aged 65 years and above. Age Ageing 36:449–454

    Article  PubMed  Google Scholar 

  46. Weich S, Nazareth I, Morgan L, King M (2007) Treatment of depression in primary care. Socio-economic status, clinical need and receipt of treatment. Br J Psychiatry 191:164–169

    Article  PubMed  Google Scholar 

  47. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS (2003) The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 289:3095–3105

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was partially supported by the Lombardy Region Health Ministry (Project ‘Epidemiologia dei farmaci – EPIFARM’). C.F. holds a fellowship granted in part by Rotary Clubs Milano Naviglio Grande San Carlo, Milano Scala and Inner Wheel Milano San Carlo. The authors thank the Italian College of General Practitioners (SIMG) for having made available prevalence data on depression.

The authors have no conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Mario Negri Institute for Pharmacological Research, Via La Masa 19, 20156, Milan, Italy

    Alberto Parabiaghi, Carlotta Franchi, Mauro Tettamanti, Angelo Barbato, Barbara D’Avanzo & Alessandro Nobili

  2. Regional Health Ministry, Lombardy Region, Via Pola, 9/11, 20124, Milan, Italy

    Ida Fortino, Angela Bortolotti & Luca Merlino

Authors
  1. Alberto Parabiaghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlotta Franchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mauro Tettamanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Angelo Barbato
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Barbara D’Avanzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ida Fortino
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Angela Bortolotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Luca Merlino
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alessandro Nobili
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alberto Parabiaghi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Parabiaghi, A., Franchi, C., Tettamanti, M. et al. Antidepressants utilization among elderly in Lombardy from 2000 to 2007: dispensing trends and appropriateness. Eur J Clin Pharmacol 67, 1077–1083 (2011). https://doi.org/10.1007/s00228-011-1054-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-011-1054-z

Keywords

Search

Navigation