Antidepressant use in geriatric populations: the burden of side effects and interactions and their impact on adherence and costs.
ABSTRACT The study aimed to determine the prevalence of documented side effects and drug–drug interactions in older adults using antidepressants and their implications for adherence.
Data were from the MarketScan Medicare Database,which comprises insurance claims from retirees with employer-sponsored Medicare supplemental insurance. Subjects were aged 65 years or older, new antidepressant users, and had a depression diagnosis between July 1, 2001, and December 31, 2006.Twelve commonly reported antidepressant side effects were identified in the month after drug initiation through International Classification of Diseases, Ninth Revision,Clinical Modification diagnoses. Potential drug- drug interactions involving an antidepressant and another drug were identified during the 1 year after antidepressant initiation using MicroMedex DRUG-REAX software. Multinomial logistic regression was used to determine the association of side effects and potential interactions with refills rates, switching, and discontinuation.
The presence of a side effect was associated with a 4.7 percentage point increase in the probability of switching (from 16.5% to 21.7%) and a 3.7 percentage point increase in the discontinuation rate (from 22% to 25.7%). Among the 39,512 treatment-naive antidepressants users, 25.4% hadpotential contraindicated or major interactions, 36.1% had moderate interactions,and 38.5% had minor or no interactions. The presence of potential contraindicated or potential major interactions increased the probability of switching by 19.5 percentage points and had a minimal effect on discontinuation.
Although antidepressant medications have been demonstrated to be effective in treatment of geriatric depression, this study highlights the complexity of antidepressant prescribing in this population and the need for clinicians to be aware of potential drug- drug interactions and side effects.
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ABSTRACT: Late-life depression (LLD) is a major public health concern that can have devastating effects on older individuals and their families. Behavioral theories predict that decreases in response contingent positive reinforcement and increases in negatively reinforced avoidance behaviors, often accompanied by aversive life events, result in the selection and maintenance of depression. Based on these theories, behavioral activation treatments for depression are designed to facilitate structured increases in enjoyable activities that increase opportunities for contact with positive reinforcement. We discuss the applicability of behavioral models for LLD, and we briefly review current behavioral activation interventions for LLD with an emphasis on implications for future behavior-analytic research. Behavioral activation has been demonstrated to be effective in reducing depression and increasing healthy behavior in older adults. Potential challenges and considerations for future research are discussed. We suggest that applied behavior analysts and clinical behavior analysts are particularly well suited to expand on the knowledge base and practical application of behavioral activation interventions with this population.The Behavior analyst / MABA 01/2013; 36(1):33-53. · 1.08 Impact Factor
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ABSTRACT: Objectives This study examined the relationships between late-onset depressive symptoms, antidepressants and single and dual task gait in older adults. Design: Cross-sectional study. Setting The Irish Longitudinal Study of Ageing (TILDA), a nationally representative cohort study. Participants Community-dwelling adults aged ≥60 years, with Mini-Mental State Examination score ≥24, no history of Parkinson’s disease or early onset depression and unaided completion of a gait assessment (n=1998). This study compared participants with and without potentially clinically relevant depressive symptoms (i.e. ≥16 on the Centre for Epidemiological Studies Depression scale) and (ii) participants who were and were not on anti-depressant therapy. Measurements: Gait measures were obtained during single and dual task (reciting alternate letters of alphabet, A-C-E) walking using a 4.88 m GAITRite® walkway. Regression analysis was used to examine the associations between each group and gait adjusting for socio-demographics and health. Results In the unadjusted models, depressive symptoms and anti-depressant use were associated with gait deficits. After adjusting for covariates, anti-depressant use was associated with reduced gait speed and stride length in single and dual task walking, however depressive symptoms were not associated with any deficits. Conclusions As gait impairments are associated with an increased risk of adverse outcomes including falls, clinicians should be aware of the impact of anti-depressants on gait in older adults. Subsequent to this, interventions aimed at improving physical function which is a known precursor to falls and functional disability should be recommended.American Journal of Geriatric Psychiatry 05/2014; 23(2). DOI:10.1016/j.jagp.2014.04.005 · 3.52 Impact Factor
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ABSTRACT: Almorexant is a dual orexin receptor antagonist (DORA) with sleep-enabling effects in humans. Insomnia is often associated with mental health problems, including depression. Hence, potential interactions with antidepressants deserve attention. Desipramine was selected as a model drug because it is mainly metabolized by CYP2D6, which is inhibited by almorexant in vitro. A single-center, randomized, placebo-controlled, two-way crossover study in 20 healthy male subjects was conducted to evaluate the pharmacokinetic and pharmacodynamic interactions between almorexant and desipramine. Almorexant 200 mg or matching placebo (double-blind) was administered orally once daily in the morning for 10 days, and a single oral dose of 50 mg desipramine (open-label) was administered on Day 5. Almorexant increased the exposure to desipramine 3.7-fold, suggesting that almorexant is a moderate inhibitor of desipramine metabolism through inhibition of CYP2D6. Conversely, desipramine showed no relevant effects on the pharmacokinetics of almorexant. Pharmacodynamic evaluations indicated that almorexant alone reduced visuomotor coordination, postural stability, and alertness, and slightly increased calmness. Desipramine induced a reduction in subjective alertness and an increase in pupil/iris ratio. Despite the increase in exposure to desipramine, almorexant and desipramine in combination showed the same pharmacodynamic profile as almorexant alone, except for prolonging reduced alertness and preventing the miotic effect of almorexant. Co-administration also prolonged the mydriatic effect of desipramine. Overall, repeated administration of almorexant alone or with single-dose desipramine was well tolerated. The lack of a relevant interaction with antidepressants, if confirmed for other DORAs, would be a key feature for a safer class of hypnotics.European Neuropsychopharmacology 08/2014; 24(8). DOI:10.1016/j.euroneuro.2014.05.002 · 5.40 Impact Factor