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Older adults recently started on psychotropic medication: where are the symptoms?
Author(s) -
Maust Donovan T.,
Chen Shirley H.,
Benson Amy,
Mavandadi Shahrzad,
Streim Joel E.,
DiFilippo Suzanne,
Snedden Thomas M.,
Oslin David W.
Publication year - 2015
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.4187
Subject(s) - anxiety , medical prescription , medicine , depression (economics) , psychiatry , generalized anxiety disorder , anxiolytic , antidepressant , mental health , cohort , economics , pharmacology , macroeconomics
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. Copyright © 2014 John Wiley & Sons, Ltd.