Antidepressant switching patterns in the elderly

Gadzhanova, S; Roughead, EE; Pont, LG

Antidepressant switching patterns in the elderly

Gadzhanova, S Roughead, EE Pont, LG

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Publication Type:: Journal Article
Citation:: International Psychogeriatrics, 2018, 30 (9), pp. 1365 - 1374
Issue Date:: 2018-09-01

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Field	Value	Language
dc.contributor.author	Gadzhanova, S	en_US
dc.contributor.author	Roughead, EE	en_US
dc.contributor.author	Pont, LG https://orcid.org/0000-0002-8545-716X	en_US
dc.date.issued	2018-09-01	en_US
dc.identifier.citation	International Psychogeriatrics, 2018, 30 (9), pp. 1365 - 1374	en_US
dc.identifier.issn	1041-6102	en_US
dc.identifier.uri	http://hdl.handle.net/10453/134180
dc.description.abstract	© 2018 International Psychogeriatric Association. 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.	en_US
dc.relation.ispartof	International Psychogeriatrics	en_US
dc.relation.isbasedon	10.1017/S1041610217002964	en_US
dc.subject.classification	Geriatrics	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Antidepressive Agents	en_US
dc.subject.mesh	Cohort Studies	en_US
dc.subject.mesh	Depression	en_US
dc.subject.mesh	Depressive Disorder	en_US
dc.subject.mesh	Databases, Factual	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Aged, 80 and over	en_US
dc.subject.mesh	Infant	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Drug Substitution	en_US
dc.title	Antidepressant switching patterns in the elderly	en_US
dc.type	Journal Article
utslib.citation.volume	9	en_US
utslib.citation.volume	30	en_US
utslib.for	1115 Pharmacology and Pharmaceutical Sciences	en_US
utslib.for	11 Medical and Health Sciences	en_US
utslib.for	17 Psychology and Cognitive Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Graduate School of Health
utslib.copyright.status	closed_access
pubs.issue	9	en_US
pubs.publication-status	Published	en_US
pubs.volume	30	en_US

Abstract:

© 2018 International Psychogeriatric Association. 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.

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http://hdl.handle.net/10453/134180