title: Comparing antidepressant treatment patterns in older and younger adults: a claims database analysis.
abstract: OBJECTIVE
  To compare depressed older (≥65) and younger (25-64) adults with regard to antidepressant treatment patterns and to assess factors associated with 180-day nonpersistence.
  
  
  METHODS
  Retrospective matched cohort study.
  
  
  METHODS
  U.S. managed care population.
  
  
  METHODS
  Older and matched younger adults diagnosed with depression and treated with antidepressants.
  
  
  METHODS
  Sociodemographic characteristics, comorbidities, polypharmacy, and characteristics of antidepressant treatment at 180 days were compared between older and younger adults. Analyses were conducted before and after the implementation of Medicare Part D on January 1, 2006, to consider the effect of this policy.
  
  
  RESULTS
  Few participants received psychotherapy, especially older ones; rates were constant before and after 2006. Before 2006, older adults more frequently received antidepressants at lower (odds ratio (OR)=5.38, 95% confidence interval (CI)=3.57-8.13) or intermediate dose (OR=2.42, 95% CI=1.93-3.02) and had poorer adherence to treatment (P<.001) than younger adults. After 2006, older adults received similar proportions of intermediate or high antidepressant doses as younger adults, but a lower dosage was still more likely to be prescribed (OR=1.87, 95% CI=1.09-3.20) and had higher treatment adherence (P<.001). Medication profile did not significantly affect the risk of nonpersistence, but increased with lower antidepressant dose (P<.001). Whereas nonpersistence was higher in older adults before 2006 (hazard ratio (HR)=1.25, 95% CI=1.22-1.46), the trend reversed after 2006 (HR=0.76, 95% CI=0.66-0.88).
  
  
  CONCLUSIONS
  More than half of participants with depression discontinued antidepressant treatment, and psychotherapy was rarely used. Implementation of Medicare Part D was associated with substantial changes in treatment of older adults with depression. The presence of comorbidities or polypharmacy was not associated with nonpersistence in depressed older adults.
authors: Université Claude Bernard Lyon I, Villeurbanne, France. thsa@lundbeck.com
authors: Thibaut
authors: T
authors: Sanglier
authors: Delphine
authors: D
authors: Saragoussi
authors: Dominique
authors: D
authors: Milea
authors: Jean-Paul
authors: JP
authors: Auray
authors: Robert J
authors: RJ
authors: Valuck
authors: Marie
authors: M
authors: Tournier
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D003863:Depression / Q000188:drug therapy* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D019338:Polypharmacy; D011613:Psychotherapy; D012189:Retrospective Studies; D012959:Socioeconomic Factors
chemical_list: D000928:Antidepressive Agents