Skip to main content
SpringerLink
Log in

Factors associated with changes in antidepressant use in a community-dwelling elderly cohort: the Three-City Study

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

Abstract

Objectives

This study aimed to examine changes in antidepressant use in an elderly population over a 2-year period and to determine which factors could predict these changes.

Methods

This longitudinal study was conducted in 8,061 French community-dwelling subjects aged 65 years and over. At each wave, data on antidepressant use and general health status were collected and depressive symptoms were evaluated using a standardized instrument. Logistic regression models were used to identify baseline predictors of subsequent changes in antidepressant use.

Results

Prevalence of antidepressant use increased from 7.0% at baseline to 8.6% at 2-year follow-up. Selective serotonin reuptake inhibitors (SSRI) accounted for the main part of this increase. Four percent of the baseline nonusers took antidepressants 2 years later. This change was significantly associated with female gender, older age, higher education level, elevated depressive symptoms at baseline, history of major depression, poor self-perceived health, high consumption of nonpsychotropic drugs and cognitive impairment (in particular dementia). Approximately 5% of the elderly population was treated with antidepressants at both examinations, and most of them reported using the same class of antidepressant. Antidepressant withdrawal occurred in only 30% of antidepressant users; we did not find any factor significantly associated with termination of antidepressant use.

Conclusion

In this large elderly population, the proportion of antidepressant users increased by 23% over a 2-year period. Increasing use was found in all age groups. Our data suggested that many elderly people are chronic users of antidepressants independently of their depression status.

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

Similar content being viewed by others

References

  1. Paterniti S, Verdier-Taillefer MH, Dufouil C, Alperovitch A (2002) Depressive symptoms and cognitive decline in elderly people. Longitudinal study. Br J Psychiatry 181:406–410

    Article  PubMed  Google Scholar 

  2. Luber MP, Meyers BS, Williams-Russo PG, Hollenberg JP, DiDomenico TN, Charlson ME et al (2001) Depression and service utilization in elderly primary care patients. Am J Geriatr Psychiatry 9:169–176

    Article  PubMed  CAS  Google Scholar 

  3. Patten SB, Esposito E, Carter B (2007) Reasons for antidepressant prescriptions in Canada. Pharmacoepidemiol Drug Saf 16:746–752

    Article  PubMed  Google Scholar 

  4. Fitch K, Molnar FJ, Power B, Wilkins D, Man-Son-Hing M (2005) Antidepressant use in older people: family physicians’ knowledge, attitudes, and practices. Can Fam Physician 51:80–81

    PubMed  Google Scholar 

  5. Lawrenson RA, Tyrer F, Newson RB, Farmer RD (2000) The treatment of depression in UK general practice: selective serotonin reuptake inhibitors and tricyclic antidepressants compared. J Affect Disord 59:149–157

    Article  PubMed  CAS  Google Scholar 

  6. Lechevallier-Michel N, Gautier-Bertrand M, Alperovitch A, Berr C, Belmin J, Legrain S et al (2005) Frequency and risk factors of potentially inappropriate medication use in a community-dwelling elderly population: results from the 3C Study. Eur J Clin Pharmacol 60:813–819

    Article  PubMed  Google Scholar 

  7. Blazer DG, Hybels CF, Fillenbaum GG, Pieper CF (2005) Predictors of antidepressant use among older adults: have they changed over time? Am J Psychiatry 162:705–710

    Article  PubMed  Google Scholar 

  8. Dealberto MJ, Seeman T, McAvay GJ, Berkman L (1997) Factors related to current and subsequent psychotropic drug use in an elderly cohort. J Clin Epidemiol 50:357–364

    Article  PubMed  CAS  Google Scholar 

  9. Fourrier A, Letenneur L, Dartigues JF, Moore N, Begaud B (2001) Benzodiazepine use in an elderly community-dwelling population. Characteristics of users and factors associated with subsequent use. Eur J Clin Pharmacol 57:419–425

    Article  PubMed  CAS  Google Scholar 

  10. 3C Study Group (2003) Vascular factors and risk of dementia: design of the Three-City Study and baseline characteristics of the study population. Neuroepidemiology 22:316–325

    Article  Google Scholar 

  11. Lawton MP (1988) Scales to measure competence in everyday activities. Psychopharmacol Bull 24:609–614

    PubMed  CAS  Google Scholar 

  12. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  PubMed  CAS  Google Scholar 

  13. Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401

    Article  Google Scholar 

  14. Radloff LS, Teri L (1986) Use of the CES-D with older adults. Clin Gerontol 5:119–136

    Article  Google Scholar 

  15. Berkman LF, Berkman CS, Kasl S, Freeman DH Jr, Leo L, Ostfeld AM et al (1986) Depressive symptoms in relation to physical health and functioning in the elderly. Am J Epidemiol 124:372–388

    PubMed  CAS  Google Scholar 

  16. Hertzog C, Van Alstine J, Usala P et al (1990) Measurement properties of the Center for Epidemiological Studies Depression scales (CES-D) in older populations. Psychol Assess 2:64–72

    Article  Google Scholar 

  17. Fuhrer R, Rouillon F (1989) La version française de l’échelle CES-D (Center for Epidemiologic Studies-Depression scale). Description et traduction de l’échelle d’auto-évaluation. Psychiatr Psychobiol 4:181–190

    Google Scholar 

  18. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E et al (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33;quiz 34–57

    PubMed  Google Scholar 

  19. Steffens DC, Krishnan KR, Crump C, Burke GL (2002) Cerebrovascular disease and evolution of depressive symptoms in the cardiovascular health study. Stroke 33:1636–1644

    Article  PubMed  Google Scholar 

  20. Observatoire National des Prescriptions (1998) Etude de la prescription et de la consommation des antidépresseurs en ambulatoire. AFSSAPS, Paris

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

    Article  PubMed  Google Scholar 

  22. Linjakumpu T, Hartikainen S, Klaukka T, Koponen H, Kivela SL, Isoaho R (2002) Psychotropics among the home-dwelling elderly–increasing trends. Int J Geriatr Psychiatry 17:874–883

    Article  PubMed  CAS  Google Scholar 

  23. Mamdani MM, Parikh SV, Austin PC, Upshur RE (2000) Use of antidepressants among elderly subjects: trends and contributing factors. Am J Psychiatry 157:360–367

    Article  PubMed  CAS  Google Scholar 

  24. Blazer DG, Hybels CF, Simonsick EM, Hanlon JT (2000) Marked differences in antidepressant use by race in an elderly community sample: 1986–1996. Am J Psychiatry 157:1089–1094

    Article  PubMed  CAS  Google Scholar 

  25. Sambamoorthi U, Olfson M, Walkup JT, Crystal S (2003) Diffusion of new generation antidepressant treatment among elderly diagnosed with depression. Med Care 41:180–194

    Article  PubMed  Google Scholar 

  26. Montagnier D, Barberger-Gateau P, Jacqmin-Gadda H, Dartigues JF, Rainfray M, Peres K et al (2006) Evolution of prevalence of depressive symptoms and antidepressant use between 1988 and 1999 in a large sample of older French people: results from the Personnes Agees Quid Study. J Am Geriatr Soc 54:1839–1845

    Article  PubMed  Google Scholar 

  27. van Eijk ME, Bahri P, Dekker G, Herings RM, Porsius A, Avorn J et al (2000) Use of prevalence and incidence measures to describe age-related prescribing of antidepressants with and without anticholinergic effects. J Clin Epidemiol 53:645–651

    Article  PubMed  Google Scholar 

  28. Egberts AC, Leufkens HG, Hofman A, Hoes AW (1997) Incidence of antidepressant drug use in older adults and association with chronic diseases: the Rotterdam Study. Int Clin Psychopharmacol 12:217–223

    Article  PubMed  CAS  Google Scholar 

  29. Rosholm JU, Andersen M, Gram LF (2001) Are there differences in the use of selective serotonin reuptake inhibitors and tricyclic antidepressants? A prescription database study. Eur J Clin Pharmacol 56:923–929

    Article  PubMed  CAS  Google Scholar 

  30. Hansen DG, Sondergaard J, Vach W, Gram LF, Rosholm JU, Mortensen PB et al (2004) Socio-economic inequalities in first-time use of antidepressants: a population-based study. Eur J Clin Pharmacol 60:51–55

    Article  PubMed  CAS  Google Scholar 

  31. American Psychiatric Association (2000) Practice guideline for the treatment of patients with major depressive disorder (revision). Am J Psychiatry 157:1–45

    Google Scholar 

  32. Alexopoulos GS (2005) Depression in the elderly. Lancet 365:1961–1970

    Article  PubMed  Google Scholar 

  33. Alexopoulos GS, Buckwalter K, Olin J, Martinez R, Wainscott C, Krishnan KR (2002) Comorbidity of late life depression: an opportunity for research on mechanisms and treatment. Biol Psychiatry 52:543–558

    Article  PubMed  Google Scholar 

  34. Devanand DP, Sano M, Tang MX, Taylor S, Gurland BJ, Wilder D et al (1996) Depressed mood and the incidence of Alzheimer’s disease in the elderly living in the community. Arch Gen Psychiatry 53:175–182

    PubMed  CAS  Google Scholar 

  35. Elderkin-Thompson V, Kumar A, Bilker WB, Dunkin JJ, Mintz J, Moberg PJ et al (2003) Neuropsychological deficits among patients with late-onset minor and major depression. Arch Clin Neuropsychol 18:529–549

    Article  PubMed  Google Scholar 

  36. Fuhrer R, Dufouil C, Dartigues JF (2003) Exploring sex differences in the relationship between depressive symptoms and dementia incidence: prospective results from the PAQUID Study. J Am Geriatr Soc 51:1055–1063

    Article  PubMed  Google Scholar 

  37. Lockwood KA, Alexopoulos GS, van Gorp WG (2002) Executive dysfunction in geriatric depression. Am J Psychiatry 159:1119–1126

    Article  PubMed  Google Scholar 

  38. Blazer DG (2003) Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci 58:249–265

    PubMed  Google Scholar 

Download references

Acknowledgements

The Three-City Study is conducted under a partnership agreement between the Institut National de la Santé et de la Recherche Médicale (INSERM), the Victor Segalen-Bordeaux II University, and Sanofi-Aventis. The Fondation pour la Recherche Médicale funded preparation and initiation of the study. The Three-City Study is also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, MGEN, Institut de la Longévité, Conseils Régionaux of Aquitaine and Bourgogne, Fondation de France, and Ministry of Research-INSERM Programme "Cohortes et collections de données biologiques." The experiments comply with the current laws of the country in which they were performed.

Author information

Authors and Affiliations

  1. Institut National de la Santé et de la Recherche Médicale (INSERM-U708), Paris, France

    Agnès Soudry, Carole Dufouil, Christophe Tzourio & Annick Alpérovitch

  2. Université Paris 6, Paris, France

    Agnès Soudry, Carole Dufouil, Christophe Tzourio & Annick Alpérovitch

  3. Institut National de la Santé et de la Recherche Médicale (INSERM-U888), Montpellier, France

    Karen Ritchie

  4. Institut National de la Santé et de la Recherche Médicale (INSERM-U593), Bordeaux, France

    Jean-François Dartigues

  5. Université Bordeaux 2, Bordeaux, France

    Jean-François Dartigues

  6. INSERM Unit 708, Hôpital de La Salpêtrière, 75651, Paris cedex 13, France

    Annick Alpérovitch

Authors
  1. Agnès Soudry
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carole Dufouil
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karen Ritchie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean-François Dartigues
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christophe Tzourio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Annick Alpérovitch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Annick Alpérovitch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Soudry, A., Dufouil, C., Ritchie, K. et al. Factors associated with changes in antidepressant use in a community-dwelling elderly cohort: the Three-City Study. Eur J Clin Pharmacol 64, 51–59 (2008). https://doi.org/10.1007/s00228-007-0392-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-007-0392-3

Keywords

Search

Navigation