title: Characteristics and drug use patterns of older antidepressant initiators in Germany.
abstract: OBJECTIVE
  The purpose of this study was to investigate characteristics, drug use patterns, and predictors for treatment choice in older German patients initiating antidepressant (AD) treatment.
  
  
  METHODS
  Using the German Pharmacoepidemiological Research Database, we identified a cohort of AD initiators aged at least 65 years between 2005 and 2011. Potential indications, co-morbidity, and co-medication as well as treatment patterns such as the duration of the first treatment episode were assessed. In addition, a logistic regression model was used to identify independent predictors for initiating treatment with tricyclic ADs (TCAs) compared to selective serotonin reuptake inhibitors (SSRIs).
  
  
  RESULTS
  Overall, 508,810 individuals were included in the cohort. About 55 % of patients initiated AD treatment with TCAs, followed by 22 % receiving SSRIs. During the study period, a decrease of treatment initiation with TCAs was observed. Higher age and male sex as well as being diagnosed with depression were highly associated with SSRI treatment, whereas pain and sleeping disorders were strong predictors for initiating TCA treatment. The duration of the first treatment episode was substantially longer in SSRI users compared to TCA initiators (median 119 vs. 43 days).
  
  
  CONCLUSIONS
  Potential indications and drug use patterns in older German AD initiators varied substantially for different drug classes and single agents. Given the anticholinergic and sedative properties of TCAs, the frequent use of this drug class though probably related to indications such as pain was remarkable.
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany. kathrin.jobski@uni-oldenburg.de.|Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstrasse 140, 26111, Oldenburg, Germany. kathrin.jobski@uni-oldenburg.de.
authors.forename: Kathrin
authors.identifier: http://orcid.org/0000-0002-3957-9721
authors.initials: K
authors.lastname: Jobski
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
authors.forename: Niklas
authors.initials: N
authors.lastname: Schmedt
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
authors.forename: Bianca
authors.initials: B
authors.lastname: Kollhorst
authors.affiliation: Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany.
authors.forename: Jutta
authors.initials: J
authors.lastname: Krappweis
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
authors.forename: Tania
authors.initials: T
authors.lastname: Schink
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.|Core Scientific Area Health Sciences, University of Bremen, Bremen, Germany.
authors.forename: Edeltraut
authors.initials: E
authors.lastname: Garbe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000145:classification / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressants; Drug utilization; Germany; Older patients; Tricyclic antidepressants