title: Older adults recently started on psychotropic medication: where are the symptoms?
abstract: OBJECTIVE
  The objective of this study is to understand the characteristics of older adults on newly prescribed psychotropic medication with minimal psychiatric symptoms.
  
  
  METHODS
  Naturalistic cohort study of non-institutionalized older adults in Pennsylvania participating in the Pharmaceutical Assistance Contract for the Elderly. Persons newly prescribed antidepressant or anxiolytic monotherapy or combination therapy were contacted for clinical assessment by a telephone-based behavioral health service. The initial assessment included standardized mental health screening instruments and scales including the Blessed Orientation-Memory-Concentration test, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Medical Outcomes Survey (SF-12). In addition, patients were asked for their understanding of the prescription indication.
  
  
  RESULTS
  Of the 254 participants who met minimal symptom criteria (Patient Health Questionnaire-9 < 5 and Generalized Anxiety Disorder-7 < 5), women comprised slightly more of the anxiolytic compared with antidepressant monotherapy group (88.9% vs. 76.7%, p = 0.04). The most common self-reported reason for prescription of an antidepressant or anxiolytic was depression or anxiety, respectively, despite near-absence of these symptoms on clinical assessment. Comparing monotherapy to combination therapy groups, those with combination therapy were more likely to report a history of depression (12.6% vs. 1.8%, p < 0.001) and also report depression as the reason for the prescription (40.2% vs. 21.0%, p < 0.01).
  
  
  CONCLUSIONS
  In this sample of older adults on new psychotropic medication with minimal psychiatric symptoms, there are few patient characteristics that distinguish those on antidepressant versus anxiolytic monotherapy or those on monotherapy versus combination therapy. While quality of care in late-life mental health has focused on improving detection and treatment, there should be further attention to low-symptom patients potentially receiving inappropriate pharmacotherapy.
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
authors.forename: Donovan T
authors.initials: DT
authors.lastname: Maust
authors.forename: Shirley H
authors.initials: SH
authors.lastname: Chen
authors.forename: Amy
authors.initials: A
authors.lastname: Benson
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Mavandadi
authors.forename: Joel E
authors.initials: JE
authors.lastname: Streim
authors.forename: Suzanne
authors.initials: S
authors.lastname: DiFilippo
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Snedden
authors.forename: David W
authors.initials: DW
authors.lastname: Oslin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy; D015331:Cohort Studies; D003866:Depressive Disorder / Q000188:drug therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy*; D008875:Middle Aged; D010414:Pennsylvania; D011569:Psychiatric Status Rating Scales
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents
keywords: older adults; primary care; psychotropic medication