Factors associated with long-term hypnotics use in depression.

Area of Science:

• Pharmacology
• Psychiatry
• Public Health

Background:

• Hypnotics are frequently prescribed for depression, yet factors influencing their long-term use are not well understood.
• Understanding these factors is crucial for optimizing treatment and patient outcomes in depression management.

Purpose of the Study:

• To identify factors associated with long-term hypnotic use in adult patients diagnosed with depression.
• To investigate the prevalence and predictors of sustained hypnotic prescriptions in a real-world clinical setting.

Main Methods:

• A retrospective cohort study using Swedish national health registers (2007-2018).
• Included patients aged ≥18 years diagnosed with depression, excluding those with dementia, bipolar, or psychotic disorders.
• Defined long-term use as >180 daily doses across ≥3 fills over one year; logistic regression analyzed associated factors.

Main Results:

• 78,383 patients with depression were included; 30.0% met criteria for long-term hypnotic use.
• Older age (≥70 years) and a higher number of prior antidepressant prescriptions (≥3) were strongly associated with long-term hypnotic use.
• Benzodiazepine-like hypnotics (Z-drugs) were the most frequently initiated hypnotic medication.

Conclusions:

• Long-term hypnotic use is prevalent in patients with depression, especially among the elderly.
• Multiple prior antidepressant trials are a significant predictor of long-term hypnotic use, suggesting treatment resistance.
• Clinical attention should focus on older patients and those with a history of multiple antidepressant treatments to manage hypnotic use effectively.