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Antidepressant switching patterns in the elderly

Published online by Cambridge University Press:  30 January 2018

Svetla Gadzhanova ,
Elizabeth E. Roughead  and
Lisa G. Pont Open the ORCID record for Lisa G. Pont [Opens in a new window]
Svetla Gadzhanova
Affiliation:
Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
Elizabeth E. Roughead
Affiliation:
Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
Lisa G. Pont*
Affiliation:
Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
*
Correspondence should be addressed to: Lisa G. Pont, Associate Professor, Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Sydney, Australia. Phone: +61 (02) 9514 7370. Email: Lisa.Pont@uts.edu.au.
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Abstract

Background:

Switching between antidepressants is complex due to potential adverse outcomes such as serotonin syndrome and antidepressant discontinuation syndrome, yet switching is often required due to non-response to initial treatment. This study aimed to examine the patterns and extent of antidepressant switching in a cohort of older adults in long-term residential care.

Methods:

A cohort study of medication supply data from 6011 aged care residents in 60 long-term care facilities was conducted. Incident antidepressant users were followed for 12 months and their patterns of antidepressant use determined. The type of switching from and to different antidepressant classes was determined according to National and International recommendations for antidepressant switching.

Results:

In total, 11% (n = 44) of the residents were initiated on an antidepressant medication (n = 402) switched to a different antidepressant agent within 12 months. Residents commenced on a SNRI or TCA were most likely to switch antidepressants (17% in each group). Almost half of the switches (n = 21, 48% of all switches) were not implemented according to guideline recommendations. Direct switch and taper followed by wash out and switch, accounted for all of the inappropriate switching (29% and 71%, respectfully), with half occurring to mirtazapine (N = 7) or from mirtazapine (N = 3).

Conclusions:

Over one in 10 long-term aged care residents who commence an antidepressant will switch to a different antidepressant within 12 months. Current antidepressant switching practices in long-term residential aged care may be increasing the risk of harm associated with antidepressant switching, with around half of all switches not following current guideline recommendations.

Keywords

antidepressantsaged carenursing homepsychopharmacologygeriatric medicine
Type
Original Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 9: Issue Theme: Quality of Care for Frail Older Adults , September 2018 , pp. 1365 - 1374
Copyright
Copyright © International Psychogeriatric Association 2018 

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References

Abadie, D., Rousseau, V., Logerot, S., Cottin, J., Montastruc, J. L. and Montastruc, F. (2015). Serotonin syndrome: analysis of cases registered in the French Pharmacovigilance Database. Journal of Clinical Psychopharmacology, 35, 382–388.Google Scholar
Alpert, J. and Nierenberg, A. (2002). Treatment-resistant depression: newer alternatives. Current Psychiatry, 1, 11–20.Google Scholar
Antai-Otong, D. (2003). Antidepressant discontinuation syndrome. Perspectives in Psychiatric Care, 39, 127–128.Google Scholar
Australian Government Department of Health (2016). Australian Statistics on Medicines 2015.Google Scholar
Australian Medicines Handbook (2017). Australian Medicines Handbook 2017. Adelaide: Australian Medicines Handbook Pty Ltd.Google Scholar
BC Guidelines (2013). Major Depressive Issues in Adults. Available at: http://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/depress_appd.pdf.Google Scholar
Best Practice Advocacy Centre NZ (2012). Using the New Zealand formulary: guide for switching antidepressants. Best Practice Journal, 49, 34–35.Google Scholar
Buckley, N. A., Dawson, A. H. and Isbister, G. K. (2014). Serotonin syndrome. BMJ 348, g1626.Google Scholar
Claxton, A. J., Li, Z. M. and McKendrick, J. (2000). Selective serotonin reuptake inhibitor treatment in the UK: risk of relapse or recurrence of depression. British Journal of Psychiatry, 177, 163–168.Google Scholar
Connolly, K. R. and Thase, M. E. (2011). If at first you don't succeed: a review of the evidence for antidepressant augmentation, combination and switching strategies. Drugs, 71, 43–64.Google Scholar
Gardarsdottir, H., Heerdink, E. R., van Dijk, L. and Egberts, A. C. (2007). Indications for antidepressant drug prescribing in general practice in the Netherlands. Journal of Affective Disorders, 98, 109–115.Google Scholar
Girardi, P. et al. (2009). Duloxetine in acute major depression: review of comparisons to placebo and standard antidepressants using dissimilar methods. Human Psychopharmacology: Clinical and Experimental, 24, 177–190.Google Scholar
Hall, M. and Buckley, N. (2003). Serotonin syndrome. Australian Prescriber, 26, 191.Google Scholar
Isbister, G. K., Bowe, S. J., Dawson, A. and Whyte, I. M. (2004). Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose. Journal of Toxicology. Clinical Toxicology, 42, 277–285.Google Scholar
Keks, N., Hope, J. and Keogh, S. (2016). Switching and stopping antidepressants. Australian Prescriber, 39, 76–83.Google Scholar
Marcus, S. C., Hassan, M. and Olfson, M. (2009). Antidepressant switching among adherent patients treated for depression. Psychiatric Services, 60, 617–623.Google Scholar
Mars, B., Heron, J., Gunnell, D., Martin, R. M., Thomas, K. H. and Kessler, D. (2017). Prevalence and patterns of antidepressant switching amongst primary care patients in the UK. Journal of Psychopharmacology, 31, 553–560.Google Scholar
Mullins, C. D., Shaya, F. T., Meng, F., Wang, J. and Harrison, D. (2005). Persistence, switching, and discontinuation rates among patients receiving sertraline, paroxetine, and citalopram. Pharmacotherapy, 25, 660–667.Google Scholar
Noordam, R. et al. (2015). Prescription and indication trends of antidepressant drugs in the Netherlands between 1996 and 2012: a dynamic population-based study. European Journal of Clinical Pharmacology, 71, 369.Google Scholar
Psychotropic Expert Group (2013). Therapeutic Guidelines: Psychotropic. Version 7. Melbourne: Therapeutic Guidelines.Google Scholar
Sultana, J., Spina, E. and Trifirò, G. (2015). Antidepressant use in the elderly: the role of pharmacodynamics and pharmacokinetics in drug safety. Expert Opinion on Drug Metabolism & Toxicology, 11, 883–892.Google Scholar
Taylor, D., Paton, C. and Kapur, S. (2015). The Maudely Prescribing Guidelines in Psychiatry, 12th edn. London: Wiley-Blackwell.Google Scholar
Thomas, L. et al. (2013). Prevalence of treatment-resistant depression in primary care: cross-sectional data. British Journal of General Practice, 63, e852–e858.Google Scholar
Volpi-Abadie, J., Kaye, A. M. and Kaye, A. D. (2013). Serotonin syndrome. Ochsner Journal, 13, 533–540.Google Scholar
Warner, C. H., Bobo, W., Warner, C., Reid, S. and Rachal, J. (2006). Antidepressant discontinuation syndrome. American Family Physician, 74, 449–456.Google Scholar
Western Australia Drug and Therapeutics Committee (2013). Antidepressant switching strategies. Graylands Hospital Drug Bulletin, 20, 1–4.Google Scholar
Wiechers, I. R. and Maust, D. T. (2014). Antidepressant prescribing in elderly populations. Psychiatric Services, 65, 1285.Google Scholar
Wilson, E. and Lader, M. (2015). A review of the management of antidepressant discontinuation symptoms. Therapeutic Advances in Psychopharmacology, 5, 357–368.Google Scholar
World Health Organization (2012). Duration of antidepressant treatment. Avalaible at: http://www.who.int/mental_health/mhgap/evidence/depression/q2/en/.Google Scholar
Zarate, C. A. Jr. (2017). What should be done when elderly patients with major depression have failed to respond to all treatments? The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 25, 1210.Google Scholar