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Comparing Antidepressant Treatment Patterns in Older and Younger Adults: A Claims Database Analysis
Author(s) -
Sanglier Thibaut,
Saragoussi Delphine,
Milea Dominique,
Auray JeanPaul,
Valuck Robert J.,
Tournier Marie
Publication year - 2011
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2011.03457.x
Subject(s) - medicine , polypharmacy , hazard ratio , confidence interval , depression (economics) , antidepressant , odds ratio , retrospective cohort study , population , young adult , cohort , environmental health , hippocampus , economics , macroeconomics
OBJECTIVES: To compare depressed older (≥65) and younger (25–64) adults with regard to antidepressant treatment patterns and to assess factors associated with 180‐day nonpersistence. DESIGN: Retrospective matched cohort study. SETTING: U.S. managed care population. PARTICIPANTS: Older and matched younger adults diagnosed with depression and treated with antidepressants. MEASUREMENTS: Sociodemographic characteristics, comorbidities, polypharmacy, and characteristics of antidepressant treatment at 180 days were compared between older and younger adults. Analyses were conducted before and after the implementation of Medicare Part D on January 1, 2006, to consider the effect of this policy. RESULTS: Few participants received psychotherapy, especially older ones; rates were constant before and after 2006. Before 2006, older adults more frequently received antidepressants at lower (odds ratio (OR)=5.38, 95% confidence interval (CI)=3.57–8.13) or intermediate dose (OR=2.42, 95% CI=1.93–3.02) and had poorer adherence to treatment ( P <.001) than younger adults. After 2006, older adults received similar proportions of intermediate or high antidepressant doses as younger adults, but a lower dosage was still more likely to be prescribed (OR=1.87, 95% CI=1.09–3.20) and had higher treatment adherence ( P <.001). Medication profile did not significantly affect the risk of nonpersistence, but increased with lower antidepressant dose ( P <.001). Whereas nonpersistence was higher in older adults before 2006 (hazard ratio (HR)=1.25, 95% CI=1.22–1.46), the trend reversed after 2006 (HR=0.76, 95% CI=0.66–0.88). CONCLUSION: More than half of participants with depression discontinued antidepressant treatment, and psychotherapy was rarely used. Implementation of Medicare Part D was associated with substantial changes in treatment of older adults with depression. The presence of comorbidities or polypharmacy was not associated with nonpersistence in depressed older adults.