Antidepressant treatment patterns in younger and older adults from the general population in a real-life setting.
OBJECTIVE
The treatment of depression in real-life settings appears to be influenced by health care systems. Antidepressant drugs have been found to be underused in the older population relative to younger adults when refunding of such drugs is poor. No study assessed the pattern of antidepressant use according to age in a universal health care system. The objective is to assess whether the pattern of antidepressant drug use differs between younger and older adults with respect to treatment duration, adherence to treatment, coprescription of other psychotropic drugs, switch, or combination of antidepressant drugs.


METHODS
A historical cohort study included 7747 older (65+ years) and 27,306 younger (younger than 65 years) adults representative of the beneficiaries of the French national health care insurance system who initiated a new antidepressant treatment. Follow-up after treatment initiation was at least 6 months.


RESULTS
Older patients had a significantly longer duration of treatment than younger adults (hazard ratio = 0.90; 95%CI[0.88-0.93]). Adherence was more often good in older than in younger adults when the treatment was initiated by a general practitioner (23.4% vs. 16.7%; Odds ratio (OR) = 1.35[1.25-1.46]), a hospital practitioner (OR = 1.68[1.40-2.03]) or another specialist (OR = 1.60[1.19-2.17]). The coprescription of psychotropic drugs decreased with older age in men (OR = 0.77[0.70-0.85]) and increased with older age in women (OR = 1.14[1.07-1.22]). Switches and combinations of antidepressants were not associated with age.


CONCLUSIONS
In a universal health care system, with similar reimbursement of drugs regardless of age, treatment duration, and adherence were better in the older patients than in the younger ones.
INSERM U657, Bordeaux, France; Université de Bordeaux, Bordeaux, France.
Fanny
F
Etchepare
Thibaut
T
Sanglier
Manon
M
André
Hélène
H
Verdoux
Marie
M
Tournier
D000328:Adult; D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003866:Depressive Disorder / Q000188:drug therapy*; D057915:Drug Substitution / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D055815:Young Adult; D016903:Drug Monitoring
D000928:Antidepressive Agents
antidepressant; elderly; health insurance database; use pattern