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Antidepressant switching patterns in the elderly.

Svetla Gadzhanova1, Elizabeth E Roughead1, Lisa G Pont2

  • 1Quality Use of Medicines and Pharmacy Research Centre,Sansom Institute for Health Research,School of Pharmacy and Medical Sciences,University of South Australia,Adelaide,Australia.

International Psychogeriatrics
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PubMed
Summary
This summary is machine-generated.

Over 10% of older adults in long-term care switched antidepressants within a year. Many switches did not follow guidelines, potentially increasing risks like serotonin syndrome.

Keywords:
aged careantidepressantsgeriatric medicinenursing homepsychopharmacology

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Area of Science:

  • Geriatric Pharmacy
  • Psychopharmacology
  • Medication Safety

Background:

  • Switching antidepressants is necessary but complex, carrying risks of adverse events like serotonin syndrome and discontinuation syndrome.
  • Older adults in long-term care facilities represent a vulnerable population where antidepressant switching requires careful management.
  • Non-response to initial antidepressant treatment often necessitates switching to alternative agents.

Purpose of the Study:

  • To investigate the patterns and frequency of antidepressant switching among older adults residing in long-term care facilities.
  • To assess adherence to national and international guidelines for antidepressant switching in this population.

Main Methods:

  • A cohort study utilizing medication supply data from 6011 residents across 60 long-term care facilities.
  • Follow-up of incident antidepressant users for 12 months to determine antidepressant use patterns.
  • Classification of antidepressant switches based on recommended guidelines.

Main Results:

  • 11% of residents (44 out of 402) switched antidepressants within 12 months of initiation.
  • Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) were most frequently switched.
  • Approximately 48% of antidepressant switches did not comply with guideline recommendations, with direct switches and taper-washout-switch methods being implicated.

Conclusions:

  • A significant proportion of older adults in long-term care switch antidepressants within a year.
  • Current practices for switching antidepressants in this setting may elevate the risk of adverse events due to non-adherence to guidelines.
  • There is a critical need to improve antidepressant switching protocols in long-term residential aged care.