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Suboptimal antidepressant use in the elderly.

Philip S Wang1, Sebastian Schneeweiss, M Alan Brookhart

  • 1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA. pwang@rics.bwh.harvard.edu

Journal of Clinical Psychopharmacology
|March 2, 2005
PubMed
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Suboptimal antidepressant use is common in elderly patients, with many receiving potentially hazardous or low-intensity regimens. Interventions are crucial to improve antidepressant quality and outcomes for this vulnerable population.

Area of Science:

  • Geriatric Pharmacy
  • Psychiatric Pharmacotherapy
  • Health Services Research

Background:

  • Elderly populations face unique challenges in antidepressant therapy due to evolving healthcare systems.
  • Vulnerable and underserved elderly individuals require careful assessment of antidepressant regimen quality.

Purpose of the Study:

  • To evaluate the quality of antidepressant use among elderly patients with depression.
  • To identify patterns of potentially hazardous and low-intensity antidepressant regimens in this demographic.

Main Methods:

  • Retrospective cohort study of 12,130 new antidepressant users (≥65 years) from 1994-1999.
  • Utilized Pennsylvania Pharmaceutical Assistance Contract for the Elderly Program and Medicare data.
  • Defined hazardous regimens (e.g., high anticholinergic use, excessive dosage) and low-intensity regimens (e.g., low dosage, short duration, inadequate follow-up).

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Main Results:

  • 43.3% of elderly patients received suboptimal antidepressant regimens.
  • 11.9% were on potentially hazardous regimens (7.3% high anticholinergic, 5.3% excessive dosage).
  • 34.8% were on low-intensity regimens (7.6% low dosage, 19.3% short duration, 14.8% inadequate follow-up).

Conclusions:

  • Suboptimal antidepressant prescribing remains prevalent in the elderly, particularly inadequate intensity.
  • Specific patient characteristics are associated with hazardous versus low-intensity regimens.
  • Targeted interventions are necessary to enhance antidepressant quality and improve outcomes for elderly patients.