title: Self-reported indications for antidepressant use in a population-based cohort of middle-aged and elderly.
abstract: Background Population-based studies investigating indications for antidepressant prescribing mostly rely on diagnoses from general practitioners. However, diagnostic codes might be incomplete and drugs may be prescribed 'off-label' for indications not investigated in clinical trials. Objective We aimed to study indications for antidepressant use based on self-report. Also, we studied the presence of depressive symptoms associated with the self-reported indications. Setting Our study population of antidepressant users was selected based on interview data between 1997 and 2013 from the prospective population-based Rotterdam Study cohort (age >45 years). Method Antidepressant use, self-reported indication for use, and presence of depressive symptoms (Center for Epidemiological Studies Depression Scale) were based on interview. Self-reported indications were categorized by the researchers into officially approved, clinically-accepted and commonly mentioned off-label indications. Main outcome measures A score of 16 and higher on the Center for Epidemiological Studies Depression Scale was considered as indicator for clinically-relevant depressive symptoms. Results The majority of 914 antidepressant users reported 'depression' (52.4 %) as indication for treatment. Furthermore, anxiety, stress and sleep disorders were reported in selective serotonin reuptake inhibitor and other antidepressant users (ranging from 5.9 to 13.3 %). The indication 'pain' was commonly mentioned by tricyclic antidepressant users (19.0 %). Indications were statistically significantly associated with higher depressive symptom scores when compared to non-users (n = 10,979). Conclusions Depression was the main indication for antidepressant treatment. However, our findings suggest that antidepressants are also used for off-label indications, subthreshold disorders and complex situations, which were all associated with clinically-relevant depressive symptoms in the middle-aged and elderly population.
authors: Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors: Nikkie
authors: N
authors: Aarts
authors: Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors: Raymond
authors: R
authors: Noordam
authors: Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors: Albert
authors: A
authors: Hofman
authors: Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Psychiatry, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Child and Adolescent Psychiatry, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors: Henning
authors: H
authors: Tiemeier
authors: Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands. b.stricker@erasmusmc.nl.|Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands. b.stricker@erasmusmc.nl.|Inspectorate of Health Care, Utrecht, The Netherlands. b.stricker@erasmusmc.nl.
authors: Bruno H
authors: BH
authors: Stricker
authors: Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.|Apotheek Haagse Ziekenhuizen - HAGA, The Hague, The Netherlands.
authors: Loes E
authors: LE
authors: Visser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D057566:Self Report
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressive agents; Depression; Off-label use; Self-report; The Netherlands