Advertisement

European Journal of Clinical Pharmacology

, Volume 73, Issue 1, pp 105–113 | Cite as

Characteristics and drug use patterns of older antidepressant initiators in Germany

  • Kathrin JobskiEmail author
  • Niklas Schmedt
  • Bianca Kollhorst
  • Jutta Krappweis
  • Tania Schink
  • Edeltraut Garbe
Pharmacoepidemiology and Prescription

Abstract

Purpose

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.

Methods

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).

Results

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).

Conclusions

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.

Keywords

Antidepressants Tricyclic antidepressants Older patients Drug utilization Germany 

Notes

Acknowledgments

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.

Supplementary material

228_2016_2145_MOESM1_ESM.docx (44 kb)
ESM 1 (DOCX 44 kb)
228_2016_2145_MOESM2_ESM.docx (40 kb)
ESM 2 (DOCX 39 kb)
228_2016_2145_MOESM3_ESM.docx (40 kb)
ESM 3 (DOCX 39 kb)
228_2016_2145_MOESM4_ESM.docx (47 kb)
ESM 4 (DOCX 47 kb)
228_2016_2145_MOESM5_ESM.docx (42 kb)
ESM 5 (DOCX 42 kb)
228_2016_2145_MOESM6_ESM.docx (58 kb)
ESM 6 (DOCX 57 kb)

References

  1. 1.
    Organisation for Economic Cooperation and Development (OECD) (2013) Health at a Glance 2013 OECD INDICATORS. doi: 10.1787/health_glance-2013-en
  2. 2.
    Lohse MJ, Müller-Oerlinghausen B (2012) Psychopharmaka. In: Schwabe U, Paffrath D (eds) Arzneiverordnungs-Report 2012. Berlin, Heidelberg, pp 833–879Google Scholar
  3. 3.
    Benkert O, Hippius H (2015) Kompendium der Psychiatrischen Pharmakotherapie. doi: 10.1007/978-3-642-54769-0
  4. 4.
    Maercker A (2015) Alterspsychotherapie und klinische Gerontopsychologie. doi: 10.1007/978-3-642-54723-2
  5. 5.
    Holt S, Schmiedl S, Thürmann PA (2010) Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int 107:543–551. doi: 10.3238/arztebl.2010.0543 PubMedPubMedCentralGoogle Scholar
  6. 6.
    Renom-Guiteras A, Meyer G, Thürmann PA (2015) The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol. doi: 10.1007/s00228-015-1860-9 PubMedPubMedCentralGoogle Scholar
  7. 7.
    Dörks M, Langner I, Dittmann U et al (2013) Antidepressant drug use and off-label prescribing in children and adolescents in Germany: results from a large population-based cohort study. Eur Child Adolesc Psychiatry 22:511–518. doi: 10.1007/s00787-013-0395-9 CrossRefPubMedGoogle Scholar
  8. 8.
    Hoffmann F, Glaeske G, Bachmann CJ (2014) Trends in antidepressant prescriptions for children and adolescents in Germany from 2005 to 2012. Pharmacoepidemiol Drug Saf 23:1268–1272. doi: 10.1002/pds.3649 CrossRefPubMedGoogle Scholar
  9. 9.
    Riedel-Heller SG, Matschinger H, Schork A, Angermeyer MC (2001) The utilization of antidepressants in community-dwelling and institutionalized elderly—results form a representative survey in Germany. Pharmacopsychiatry 34:6–12. doi: 10.1055/s-2001-15186 CrossRefPubMedGoogle Scholar
  10. 10.
    Coupland C, Dhiman P, Morriss R, Arthur A (2011) Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ 343:d4551. doi: 10.1136/bmj.d4551 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Gardarsdottir H, Souverein PC, Egberts TCG, Heerdink ER (2010) Construction of drug treatment episodes from drug-dispensing histories is influenced by the gap length. J Clin Epidemiol 63:422–427. doi: 10.1016/j.jclinepi.2009.07.001 CrossRefPubMedGoogle Scholar
  12. 12.
    Schmedt N, Jobski K, Kollhorst B et al (2016) Treatment patterns and characteristics of older antipsychotic users in Germany. Int Clin Psychopharmacol. doi: 10.1097/YIC.0000000000000119 PubMedGoogle Scholar
  13. 13.
    Greevy RA, Huizinga MM, Roumie CL et al (2011) Comparisons of persistence and durability among three oral antidiabetic therapies using electronic prescription-fill data: the impact of adherence requirements and stockpiling. Clin Pharmacol Ther 90:813–819. doi: 10.1038/clpt.2011.228 CrossRefPubMedGoogle Scholar
  14. 14.
    Quan H, Li B, Couris CM et al (2011) Updating and validating the charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173:676–682. doi: 10.1093/aje/kwq433 CrossRefPubMedGoogle Scholar
  15. 15.
    Sultana J, Italiano D, Spina E et al (2014) Changes in the prescribing pattern of antidepressant drugs in elderly patients: an Italian, nationwide, population-based study. Eur J Clin Pharmacol 70:469–478. doi: 10.1007/s00228-013-1636-z CrossRefPubMedGoogle Scholar
  16. 16.
    Trifiro G, Dieleman J, Sen EF et al (2010) Risk of ischemic stroke associated with antidepressant drug use in elderly persons. J Clin Psychopharmacol 30:252–258CrossRefPubMedGoogle Scholar
  17. 17.
    Abbing-Karahagopian V, Huerta C, Souverein PC et al (2014) Antidepressant prescribing in five European countries: application of common definitions to assess the prevalence, clinical observations, and methodological implications. Eur J Clin Pharmacol 70:849–857. doi: 10.1007/s00228-014-1676-z CrossRefPubMedGoogle Scholar
  18. 18.
    Lemmer B, Brune K (2010) Pharmakotherapie, 14th ed. doi: 10.1007/978-3-642-10541-8
  19. 19.
    Kamphuis J, Taxis K, Schuiling-Veninga CCM et al (2015) Off-label prescriptions of low-dose quetiapine and mirtazapine for insomnia in the Netherlands. J Clin Psychopharmacol 35:468–470. doi: 10.1097/JCP.0000000000000338 PubMedGoogle Scholar
  20. 20.
    Noordam R, Aarts N, Verhamme KM et al (2015) Prescription and indication trends of antidepressant drugs in the Netherlands between 1996 and 2012: a dynamic population-based study. Eur J Clin Pharmacol 71:369–375. doi: 10.1007/s00228-014-1803-x CrossRefPubMedGoogle Scholar
  21. 21.
    Goesling J, Clauw DJ, Hassett AL (2013) Pain and depression: an integrative review of neurobiological and psychological factors. Curr Psychiatry Rep. doi: 10.1007/s11920-013-0421-0 PubMedGoogle Scholar
  22. 22.
    Gehling M (2010) Correspondence (letter to the editor): pain therapy. Dtsch Ärzteblatt Int 107:900 . doi: 10.3238/arztebl.2010.0900a author reply 900–901Google Scholar
  23. 23.
    Gallagher P, O’Mahony D (2008) STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with beers’ criteria. Age Ageing 37:673–679. doi: 10.1093/ageing/afn197 CrossRefPubMedGoogle Scholar
  24. 24.
    Deutsche Gesellschaft für Psychiatrie Psychotherapie und Nervenheilkunde (DGPP (2009) S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression-Kurzfassung. https://www.dgppn.de/fileadmin/user_upload/_medien/download/pdf/kurzversion-leitlinien/s3-nvl-unipolare-depression-kf.pdf. Accessed 7 Feb 2016
  25. 25.
    Deutsche Gesellschaft für Psychiatrie Psychotherapie Psychosomatik und Nervenheilkunde (DGPPN) (2015) S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression. http://www.leitlinien.de/mdb/downloads/nvl/depression/depression-2aufl-vers2-lang.pdf. Accessed 7 Feb 2016
  26. 26.
    Porsteinsson AP, Drye LT, Pollock BG et al (2014) Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA 311:682–691. doi: 10.1001/jama.2014.93 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Spina E, Trifirò G (2016) Pharmacovigilance in psychiatry. doi: 10.1007/978-3-319-24741-0
  28. 28.
    Lu CY, Roughead E (2012) New users of antidepressant medications: first episode duration and predictors of discontinuation. Eur J Clin Pharmacol 68:65–71. doi: 10.1007/s00228-011-1087-3 CrossRefPubMedGoogle Scholar
  29. 29.
    Wiegand MH (2008) Antidepressants for the treatment of insomnia: a suitable approach? Drugs 68:2411–2417. doi: 10.2165/0003495-200868170-00001 CrossRefPubMedGoogle Scholar
  30. 30.
    Wehling M (2013) Drug Therapy for the Elderly. doi: 10.1007/978-3-7091-0912-0
  31. 31.
    Pfistermeister B, Schenk C, Kornhuber J et al (2013) Different indications, warnings and precautions, and contraindications for the same drug-an international comparison of prescribing information for commonly used psychiatric drugs. Pharmacoepidemiol Drug Saf 22:329–333. doi: 10.1002/pds.3389 CrossRefPubMedGoogle Scholar
  32. 32.
    Schneeweiss S, Avorn J (2005) A review of uses of health care utilization databases for epidemiologic research on therapeutics. J Clin Epidemiol 58:323–337. doi: 10.1016/j.jclinepi.2004.10.012 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Leibniz Institute for Prevention Research and Epidemiology–BIPSBremenGermany
  2. 2.Department of Health Services ResearchCarl von Ossietzky University OldenburgOldenburgGermany
  3. 3.Federal Institute for Drugs and Medical Devices (BfArM)BonnGermany
  4. 4.Core Scientific Area Health SciencesUniversity of BremenBremenGermany

Personalised recommendations