Characteristics and drug use patterns of older antidepressant initiators in Germany
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The purpose of this study was to investigate characteristics, drug use patterns, and predictors for treatment choice in older German patients initiating antidepressant (AD) treatment.
Using the German Pharmacoepidemiological Research Database, we identified a cohort of AD initiators aged at least 65 years between 2005 and 2011. Potential indications, co-morbidity, and co-medication as well as treatment patterns such as the duration of the first treatment episode were assessed. In addition, a logistic regression model was used to identify independent predictors for initiating treatment with tricyclic ADs (TCAs) compared to selective serotonin reuptake inhibitors (SSRIs).
Overall, 508,810 individuals were included in the cohort. About 55 % of patients initiated AD treatment with TCAs, followed by 22 % receiving SSRIs. During the study period, a decrease of treatment initiation with TCAs was observed. Higher age and male sex as well as being diagnosed with depression were highly associated with SSRI treatment, whereas pain and sleeping disorders were strong predictors for initiating TCA treatment. The duration of the first treatment episode was substantially longer in SSRI users compared to TCA initiators (median 119 vs. 43 days).
Potential indications and drug use patterns in older German AD initiators varied substantially for different drug classes and single agents. Given the anticholinergic and sedative properties of TCAs, the frequent use of this drug class though probably related to indications such as pain was remarkable.
KeywordsAntidepressants Tricyclic antidepressants Older patients Drug utilization Germany
The authors would like to thank all statutory health insurances for providing data for this study, namely, the TK, AOK Bremen/Bremerhaven, DAK-Gesundheit, and the Handelskrankenkasse. They also want to thank Inga Schaffer, Sandra Ulrich, and Marieke Niemeyer for contributing to the statistical analyses and Heike Gerds for editing the manuscript.
Compliance with ethical standards
Conflict of interest
This study was funded by the Federal Institute for Drugs and Medical Devices. Kathrin Jobski, Niklas Schmedt, Tania Schink, Bianca Kollhorst, and Edeltraut Garbe, as employees of the Leibniz Institute for Prevention Research and Epidemiology–BIPS, have performed research studies sponsored by pharmaceutical companies (Bayer-Schering, Celgene, GSK, Mundipharma, Novartis, Purdue, Sanofi-Aventis, Sanofi-Pasteur MSD, Stada, and Takeda) unrelated to this study. Edeltraut Garbe has been consultant to Bayer, Nycomed, Takeda, Astellas, Novartis, and GSK unrelated to the subject of this study. Jutta Krappweis declares no conflict of interest.
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