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Epidemiology
Research
Multinational comparison of new antidepressant use in older adults: a cohort study
  1. Robyn Tamblyn1,
  2. David Westfall Bates2,
  3. David L Buckeridge3,4,
  4. Will Dixon5,
  5. Alan J Forster6,7,
  6. Nadyne Girard8,
  7. Jennifer Haas9,
  8. Bettina Habib8,
  9. Siyana Kurteva3,
  10. Jack Li10,
  11. Therese Sheppard11
  1. 1Department of Medicine and Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
  2. 2Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  3. 3Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
  4. 4Direction de santé publique, Agence de la Santé et des services Sociaux de Montréal, Montreal, Quebec, Canada
  5. 5Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
  6. 6Internal Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
  7. 7Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  8. 8Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
  9. 9Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  10. 10Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
  11. 11Department of Medicine, University of Manchester, Manchester, UK
  1. Correspondence to Dr Robyn Tamblyn; robyn.tamblyn{at}mcgill.ca

Abstract

Objectives We used an international pharmacosurveillance network to estimate the rate and characteristics of antidepressant use in older adults in countries with more conservative (UK) and liberal depression guidelines (Canada, USA).

Setting Electronic health records and population-based administrative data from six jurisdictions in four countries (UK, Taiwan, USA and Canada).

Participants A historical cohort of older adults (≥65 years) who had a new episode of antidepressant use between 2009 and 2014.

Outcome measures The age and sex-standardised cumulative incidence of new episodes of antidepressant use in older adults was measured. Descriptive statistics were used to compare the proportion of new users by the antidepressant prescribed, therapeutic class, potential treatment indication and country, as well as the characteristics of the first treatment episode (standardised daily doses, duration and changes).

Results The incidence of antidepressant use between 2009 and 2014 varied from 4.7% (Montreal and Quebec City) to 18.6% (Taiwan). Tricyclic antidepressants (TCAs) were the most commonly used class in the UK (48.8%) and Taiwan (52.4%) compared with selective serotonin reuptake inhibitors (SSRIs) in North American jurisdictions (42.3%–53.3%). Chronic pain was the most common potential treatment indication (41.2%–68.2%). Among users with chronic pain, TCAs were used most frequently in the UK and Taiwan (55.2%–60.4%), whereas SSRIs were used most frequently in North America (33.5%–46.4%). Treatment was longer (252–525 vs 169–437 days), standardised doses were higher (0.7–1.3 vs 0.5–1.0) and treatment was more likely to be changed (31%–46% vs 21%–34%) among patients with depression (9.1%–43%) than those with chronic pain.

Conclusion Antidepressant use in older adults varied 24-fold by country, with the UK, which has the most conservative treatment guidelines, being among the lowest. Chronic pain was the most common potential treatment indication. Evaluation of real-world risks of TCAs is a priority for future research, given high rates of use and the potential for increased toxicity in older adults because of potent anticholinergic effects.

  • antidepressants
  • multinational comparison
  • older adults
  • epidemiology
  • pharmacosurveillance

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi-org.ezproxy.u-pec.fr/10.1136/bmjopen-2018-027663

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    Footnotes

    • Contributors RT, DWB, DLB, WD, AJF, JH and JL contributed to the study concept and design. NG, TS and BH contributed to the statistical analysis. RT drafted the manuscript. DWB, DLB, WD, AJF, NG, JH, BH, SK, JL and TS critically reviewed the manuscript for intellectual content. All authors read and approved the final manuscript.

    • Funding This project was funded by the Canadian Institutes of Health Research (CIHR) operating grant # MOP-111166.

    • Competing interests None declared.

    • Ethics approval This study received ethics approval from the McGill University Institutional Review Board (IRB # A01-B02-02A), the Institute for Clinical Evaluative Sciences, the Partners Human Research Committee IRB (Protocol # 2011P000773/PH) and the Independent Scientific Advisory Committee (ISAC) of CPRD (Protocol # 14_081R).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional are data available.

    • Patient consent for publication Not required.