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Trends, Patterns and Associated User Characteristics of Antidepressant Prescriptions in Older Adults: A Nationwide Descriptive Cohort Study in Denmark

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Abstract

Background and Objective

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.

Methods

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.

Results

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).

Conclusion

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.

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Authors and Affiliations

  1. Department of Affective Disorders, Aarhus University Hospital Psychiatry, Entrance K, Pallet Juul-Jensens Boulevard 175, 8200, Aarhus N, Denmark

    Kazi Ishtiak-Ahmed, Andrew A. Nierenberg & Christiane Gasse

  2. Psychosis Research Unit, Aarhus University Hospital-Psychiatry, Aarhus, Denmark

    Ole Köhler-Forsberg

  3. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Kazi Ishtiak-Ahmed, Ole Köhler-Forsberg & Christiane Gasse

  4. Department of Public Health, University of Copenhagen, Copenhagen K, Denmark

    Erik Lykke Mortensen

  5. Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA

    Andrew A. Nierenberg

  6. Harvard Medical School, Boston, MA, USA

    Andrew A. Nierenberg

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  1. Kazi Ishtiak-Ahmed
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  2. Ole Köhler-Forsberg
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  3. Erik Lykke Mortensen
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Corresponding author

Correspondence to Kazi Ishtiak-Ahmed.

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Funding

The study is part of the project entitled “The Outcome of Depression Care in Older Adults”. The project is funded by the Health Research Foundation of Central Denmark Region, received by Kazi Ishtiak-Ahmed. The funder had no role in writing the paper, analyzing the data, interpreting the results, and deciding to submit the manuscript for publication.

Conflicts of interest/competing interests

Kazi Ishtiak-Ahmed, Erik Lykke Mortensen, and Christiane Gasse declare they have no conflicts of interest in relation to this work. Ole Köhler-Forsberg reports receiving honoraria for lectures from Lundbeck Pharma A/S and consultant fees from WCG Clinical, all unrelated to the present work. Andrew A. Nierenberg is a consultant for Alkermes, Clexio, Ginger/Headspace Health, Janssen, Merk, Neuronetics, NeuroRx, Otsuka, Protagenics, SAGE, Sunovion, and Unravel Bioscience; has received honoraria from Belvior, EISAI, Psychiatric Annals Slack Publications, and Wiley (Depression and Anxiety); has received royalties from Guilford Publications, and Up-to-Date (Wolters Kluwer Health); has been a scientific advisory board member for Altimate, Flow, Milken Center for Strategic Philanthropy, and Myriad Bipolar; and is an adjudication committee member for Novartis.

Ethics approval

This study was approved by the Danish Data Protection Agency, and no further ethical approval is required regarding register-based research in Denmark.

Consent to participate

Not applicable.

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Not applicable.

Availability of data and materials

The data used in this study are from Statistics Denmark. They are stored in an anonymous form and are not publicly available. To use such data for research requires special permission in compliance with the Danish Data Privacy Act.

Code availability

Data codes are stored on, and are available from, Statistics Denmark’s server. The codes can be shared after special permission in compliance with the Danish Data Privacy Act.

Author contributions

KI-A: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, software, visualization, writing—original draft, writing—review and editing. OK-F: conceptualization, writing—review and editing. ELM: conceptualization, writing—review and editing. AAN: conceptualization, writing—review and editing. CG: conceptualization, resources, methodology, writing—review and editing. [According to CRediT taxonomy: http://credit.niso.org/contributor-roles-defined/]. All authors have read and approved the final submitted manuscript and agree to be accountable for this work.

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Ishtiak-Ahmed, K., Köhler-Forsberg, O., Mortensen, E.L. et al. Trends, Patterns and Associated User Characteristics of Antidepressant Prescriptions in Older Adults: A Nationwide Descriptive Cohort Study in Denmark. Drugs Aging 40, 355–368 (2023). https://doi.org/10.1007/s40266-023-01018-4

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