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Concurrent benzodiazepine use in older adults treated with antidepressants in Asia

Published online by Cambridge University Press:  07 December 2017

Xiao-Mei Zhong ,
Fei Wang ,
Qinge Zhang ,
Gabor S. Ungvari ,
Chee H. Ng ,
Helen F. K. Chiu ,
Tian-Mei Si ,
Kang Sim ,
Ajit Avasthi  and
Sandeep Grover Open the ORCID record for Sandeep Grover [Opens in a new window]
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Xiao-Mei Zhong
Affiliation:
Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Hui Hospital), Guangzhou, China Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
Fei Wang
Affiliation:
Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
Qinge Zhang
Affiliation:
The National Clinical Research Center for Mental Disorders, China &Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China
Gabor S. Ungvari
Affiliation:
The University of Notre Dame Australia/Marian Centre, Perth, Australia Graylands Hospital, Perth, Australia
Chee H. Ng
Affiliation:
Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
Helen F. K. Chiu
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
Tian-Mei Si
Affiliation:
Peking University Institute of Mental Health (the sixth hospital) & National Clinical Research Center for Mental Disorders & the Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
Kang Sim
Affiliation:
Institute of Mental Health, Buangkok View, Buangkok Green Medical Park, Singapore
Ajit Avasthi
Affiliation:
Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Sandeep Grover
Affiliation:
Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Mian-Yoon Chong
Affiliation:
Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital-Kaohsiung Medical Center and School of Medicine, Chang Gung University, Taiwan
Kok-Yoon Chee
Affiliation:
Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
Shigenobu Kanba
Affiliation:
Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan
Min-Soo Lee
Affiliation:
Department of Psychiatry, College of Medicine, Korea University, Seoul, South Korea
Shu-Yu Yang
Affiliation:
Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
Pichet Udomratn
Affiliation:
Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Roy A. Kallivayalil
Affiliation:
Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla, India
Andi J. Tanra
Affiliation:
Department of Psychiatry, Hasanuddin University Faculty of Medicine, Makassar, Sulawesi Selatan, Indonesia
Margarita M. Maramis
Affiliation:
Dr. Soetomo Hospital – Faculty of Medicine, Airlangga University, Jawa Timur, Indonesia
Winston W. Shen
Affiliation:
Departments of Psychiatry, TMU-Wan Fang Medical Center and School of Medicine, Taipei Medical University, Taiwan
Norman Sartorius
Affiliation:
Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
Rathi Mahendran
Affiliation:
Department of Psychological Medicine, National University of Singapore, Singapore
Chay-Hoon Tan
Affiliation:
Department of Pharmacology, National University of Singapore, Singapore
Naotaka Shinfuku
Affiliation:
International Center for Medical Research, Kobe University School of Medicine, Kobe, Japan
Yu-Tao Xiang*
Affiliation:
Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
*
Correspondence should be addressed to: Dr Yu-Tao Xiang, Faculty of Health Sciences, University of Macau, Avenida da Universidade, Taipa, Macau SAR, 3/F, Building E12, China. Phone: +853-8822-4223; Fax: +853-2288-2314. Email: xyutly@gmail.com.
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Abstract

Background:

Little is known about the combined use of benzodiazepines and antidepressants in older psychiatric patients. This study examined the prescription pattern of concurrent benzodiazepines in older adults treated with antidepressants in Asia, and explored its demographic and clinical correlates.

Methods:

The data of 955 older adults with any type of psychiatric disorders were extracted from the database of the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) project. Demographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. Both univariate and multiple logistic regression analyses were performed.

Results:

The proportion of benzodiazepine and antidepressant combination in this cohort was 44.3%. Multiple logistic regression analysis revealed that higher doses of antidepressants, younger age (<65 years), inpatients, public hospital, major comorbid medical conditions, antidepressant types, and country/territory were significantly associated with more frequent co-prescription of benzodiazepines and antidepressants.

Conclusions:

Nearly, half of the older adults treated with antidepressants in Asia are prescribed concurrent benzodiazepines. Given the potentially adverse effects of benzodiazepines, the rationale of benzodiazepines and antidepressants co-prescription needs to be revisited.

Keywords

antidepressantbenzodiazepinesolder adultsAsia
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 5: Issue Theme: Well-Being in Dementia , May 2019 , pp. 685 - 691
Copyright
© International Psychogeriatric Association 2017 

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Footnotes

#

These authors contributed equally to this work.

References

Aarts, N., Noordam, R., Hofman, A., Tiemeier, H., Stricker, B. H. and Visser, L. E. (2014). Utilization patterns of antidepressants between 1991 and 2011 in a population-based cohort of middle-aged and elderly. European Psychiatry, 29, 365–370.Google Scholar
Biderman, A., Cwikel, J., Fried, A. V. and Galinsky, D. (2002). Depression and falls among community dwelling elderly people: a search for common risk factors. Journal of Epidemiology and Community Health, 56, 631–636.Google Scholar
Binder, R. L., Kazamatsuri, H., Nishimura, T. and McNiel, D. E. (1987). Tardive dyskinesia and neuroleptic-induced parkinsonism in Japan. American Journal of Psychiatry, 144, 1494–1496.Google Scholar
Bushnell, G. A., Stürmer, T., Gaynes, B. N., Pate, V. and Miller, M. (2017). Simultaneous Antidepressant and Benzodiazepine new use and subsequent long-term Benzodiazepine use in adults with depression, United States, 2001–2014. JAMA Psychiatry, 74, 747–755.Google Scholar
Chong, M. Y. et al. (2001). Community study of depression in old age in Taiwan: prevalence, life events and socio-demographic correlates. British Journal of Psychiatry, 178, 29–35.Google Scholar
Dai, J. et al. (2013). The prevalence of insomnia and its socio-demographic and clinical correlates in older adults in rural China: a pilot study. Aging Ment Health, 17, 761–765.Google Scholar
Dassori, A. M., Copeland, L. A., Zeber, J. E. and Miller, A. L. (2011). Factors in second-generation antipsychotic switching patterns in a national sample of older veterans with schizophrenia. Psychiatric services, 62, 47–53.Google Scholar
Fulone, I., Silva, M. T. and Lopes, L. C. (2016). Factors associated with the combined use of antidepressants and Benzodiazepines in major depression: a case-control study. Basic & clinical pharmacology & toxicology, 119, 273–277.Google Scholar
Johnson, E. O., Roth, T. and Breslau, N. (2006). The association of insomnia with anxiety disorders and depression: exploration of the direction of risk. Journal of Psychiatric Research, 40, 700–708.Google Scholar
Kruse, W. H. H. (1990). Problems and Pitfalls in the Use of Benzodiazepines in the Elderly. Drug Safety, 5, 328–344.Google Scholar
Kua, E. H. (1992). A community study of mental disorders in elderly Singaporean Chinese using the GMS-AGECAT package. Australian and New Zealand Journal of Psychiatry, 26, 502–506.Google Scholar
Leggett, A., Kavanagh, J., Zivin, K., Chiang, C., Kim, H. M. and Kales, H. C. (2015). The association between Benzodiazepine use and depression outcomes in older veterans. Journal of geriatric psychiatry and neurology, 28, 281–287.Google Scholar
Manthey, L. et al. (2011). Correlates of (inappropriate) benzodiazepine use: the Netherlands study of depression and anxiety (NESDA). British Journal of Clinical Pharmacology, 71, 263–272.Google Scholar
Masand, P. S. (2000). Side effects of antipsychotics in the elderly. Journal of Clinical Psychiatry, 61 (Suppl. 8), S43–S49.Google Scholar
Meyers, B. S. and Jeste, D. V. (2010). Geriatric psychopharmacology: evolution of a discipline. Journal of Clinical Psychiatry, 71, 1416–1424.Google Scholar
Millan, M. J. (2014). On ‘polypharmacy’ and multi-target agents, complementary strategies for improving the treatment of depression: a comparative appraisal. International Journal of Neuropsychopharmacology, 17, 1009–1037.Google Scholar
Neckelmann, D., Mykletun, A. and Dahl, A. A. (2007). Chronic insomnia as a risk factor for developing anxiety and depression. Sleep, 30, 873–880.Google Scholar
Parabiaghi, A. et al. (2011). Antidepressants utilization among elderly in Lombardy from 2000 to 2007: dispensing trends and appropriateness. European Journal of Clinical Pharmacology, 67, 1077–1083.Google Scholar
Rajaratnam, K. et al. (2016). Factors associated with antidepressant dosing in Asia: findings from the research on Asian psychotropic prescription study. Journal of Clinical Psychopharmacology, 36, 716–719.Google Scholar
Shinfuku, N. and Tan, C. H. (2008). Pharmacotherapy for schizophrenic inpatients in East Asia–changes and challenges. International Review of Psychiatry, 20, 460–468.Google Scholar
Smith, A. J. and Tett, S. E. (2009). How do different age groups use benzodiazepines and antidepressants? Analysis of an Australian administrative database, 2003–6. Drugs and Aging, 26, 113–122.Google Scholar
Soudry, A., Dufouil, C., Ritchie, K., Dartigues, J. F., Tzourio, C. and Alpérovitch, A. (2008). Factors associated with changes in antidepressant use in a community-dwelling elderly cohort: the three-city study. European Journal of Clinical Pharmacology, 64, 51–59.Google Scholar
Uchida, H. et al. (2009). Benzodiazepine and antidepressant use in elderly patients with anxiety disorders: a survey of 796 outpatients in Japan. Journal of Anxiety Disorders, 23, 477–481.Google Scholar
Ungvari, G. S., Chow, L. Y., Chiu, H. F., Ng, F. S. and Leung, T. (1997). Modifying psychotropic drug prescription patterns: a follow-up survey. Psychiatry and clinical neurosciences, 51, 309–314.Google Scholar
van Dijk, K. N., de Vries, C. S., ter Huurne, K., van den Berg, P. B., Brouwers, J. R. and de Jong-van den Berg, L. T. (2002). Concomitant prescribing of benzodiazepines during antidepressant therapy in the elderly. Journal of Clinical Epidemiology, 55, 1049–1053.Google Scholar
Volz, A., Khorsand, V., Gillies, D. and Leucht, S. (2007). Benzodiazepines for schizophrenia. Cochrane Database Systematic Review, CD006391.Google Scholar
White, C. L., Bateman, A., Fisher, W. H. and Geller, J. L. (1995). Factors associated with admission to public and private hospitals from a psychiatric emergency screening site. Psychiatric services, 46, 467–472.Google Scholar
WHO (2001). Information Needs for Research, Policy and Action on Ageing and Older Adults: A Report of the Follow-up Meeting to the 2000 Harare MDS Workshop. Geneva: World Health Organization.Google Scholar
WHO Collaborating Centre for Drug Statistic Methodology (2002). Guidelines for ATC Index with DDDs. Oslo: WHO.Google Scholar
Xiang, Y. T. et al. (2012). Adjunctive mood stabilizer and Benzodiazepine use in older Asian Patients with Schizophrenia, 2001–2009. Pharmacopsychiatry, 45, 217–222.Google Scholar
Xiang, Y. T. et al. (2013). Adjunctive antidepressant prescriptions for hospitalized patients with schizophrenia in Asia (2001-2009). Asia and Pacific Psychiatry, 5, E81–E87.Google Scholar
Xiang, Y. T. et al. (2014a). Common use of high doses of antipsychotic medications in older Asian patients with schizophrenia (2001–2009). International Journal of Geriatric Psychiatry, 29, 359–366.Google Scholar
Xiang, Y. T. et al. (2014b). Insomnia in older adults with chronic obstructive pulmonary disease (COPD) in Hong Kong: a case-control study. COPD, 11, 319–324.Google Scholar
Xiang, Y. T., Weng, Y. Z., Leung, C. M., Tang, W. K. and Ungvari, G. S. (2007). Clinical and social determinants of antipsychotic polypharmacy for Chinese patients with schizophrenia. Pharmacopsychiatry, 40, 47–52.Google Scholar
Zhang, W. H., Qiu, Z. F. and Zhang, L. J. (2004). Several ethical problems on the closed ward of psychiatric department (in Chinese). Chinese Journal of Medical Ethics, 17, 1–2.Google Scholar