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Antidepressant Prescribing in Primary Care to Older Adults Without Major Depression.

ABSTRACT: The study compared distress levels among two groups of older adults who had been newly prescribed an antidepressant by their primary care physician, those with major depressive disorder (MDD) and those without MDD.This analysis used a convenience sample of participants (N=231) who had been newly prescribed an antidepressant in a randomized controlled trial of a program to improve antidepressant adherence and depression outcomes among older adults (?55). After determining the proportion of participants with and without MDD (using the Structured Clinical Interview for DSM-IV), the authors compared groups on demographic, clinical, and psychosocial characteristics, including the 12-Item Short-Form Health Survey physical and mental component summary scores (PCS and MCS). Logistic regression was used to test the association of these characteristics with antidepressant use in the absence of MDD.Most (57%) participants did not have MDD. This group was older (69.4 versus 64.7, p<.001), had a larger proportion of white participants (82% versus 56%, p<.001), and reported better physical (PCS, 43.4 versus 39.9, p=.03) and emotional (MCS, 40.2 versus 30.5, p<.001) well-being compared with the group with MDD. In the final regression model, white race (adjusted odds ratio [AOR]=3.11, p=.03) and better emotional well-being (AOR=1.16, p<.001) were associated with antidepressant use in the absence of MDD.Older adults prescribed antidepressants in the absence of MDD did not report similar distress levels compared with their counterparts with MDD. Given the continued emphasis on screening for depression in primary care, it is important to consider the potential for overtreatment.

SUBMITTER: Maust DT

PROVIDER: S-EPMC5411328 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Antidepressant Prescribing in Primary Care to Older Adults Without Major Depression.

Maust Donovan T DT Sirey Jo Anne JA Kales Helen C HC

Psychiatric services (Washington, D.C.) 20170103 5

<h4>Objective</h4>The study compared distress levels among two groups of older adults who had been newly prescribed an antidepressant by their primary care physician, those with major depressive disorder (MDD) and those without MDD.<h4>Methods</h4>This analysis used a convenience sample of participants (N=231) who had been newly prescribed an antidepressant in a randomized controlled trial of a program to improve antidepressant adherence and depression outcomes among older adults (≥55). After de ...[more]

PMID: 28045352

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Project description:BACKGROUND:Although currently available evidence suggests that physical exercise can be beneficial for depressed patients and might be comparable to antidepressant treatment, the best way of implementing this recommendation in clinical practice is not known. This study therefore aims to ascertain the non-inferiority of supervised physical exercise to antidepressant drug treatment, in terms of reducing depressive symptoms among patients presenting with clinical criteria of a depressive episode (ICD-10), across a follow-up period of 6?months. METHODS:It will take the form of a randomised clinical trial undertaken in a primary care setting, in which a total of 312 patients over the age of 65?years with clinically significant depression will be randomly assigned to supervised physical exercise programme, or will alternatively receive treatment with antidepressant drugs habitually used in clinical practice. Participants' physical condition will be assessed at baseline, and again at 15?days and 1, 3 and 6?months. The supervised exercise programme will consist of 2 weekly sessions in groups of 10-12 patients across a period of 6?months, in which a sports instructor will train patients to do at least 30?min of regular activity at moderate intensity on an almost daily basis, including aerobic, muscle-strengthening, flexibility, and balance-strengthening exercises. The following will be assessed at regular intervals in both groups: status of depression symptoms; level of physical activity; self-perceived health status; appearance of adverse effects; and adherence to the physical exercise programme or antidepressant treatment. The principal outcome variable will be a reduction in pre-treatment depression-symptom scale scores (Montgomery-Asberg Depression Rating Scale and Geriatric Depression Scale). DISCUSSION:In terms of the number of patients and duration of follow-up, this proposed clinical trial is a project which easily surpasses the few studies on this subject that have been previously conducted on the elderly. Its aim is to provide solid scientific evidence on a therapeutic resource -physical exercise- which has undeniable health benefits and can be applied to certain health problems, such as depressive disorders, which are of great magnitude and considerable socio-economic relevance, and have a significant impact on the quality of life of older adults. TRIAL REGISTRATION:ClinicalTrials.gov NCT03358433 (retrospectively registered on 11/25/2017).

Project description:BackgroundOlder adults with serious mental illness (SMI) often have multiple comorbidities and complex medication schedules. Shortages of behavioral health specialists (BHSs), especially in rural areas, frequently make primary care providers (PCPs) the only clinician managing this complex population. The aim of this study was to describe rural/urban psychiatric medication prescribing in older adults with SMI by PCPs and BHSs, and by clinician type.MethodsThis retrospective descriptive analysis used 2018 Medicare data to identify individuals with a bipolar, major depression, schizophrenia, or psychosis diagnosis and examined medication claims for antianxiety, antidepressants, antipsychotics, hypnotics, and anticonvulsants. Descriptive statistics summarized percentage of medications provided by PCPs and BHSs stratified by rural and urban areas and by drug class. Additional analyses compared psychiatric prescribing patterns by physicians, advanced practice registered nurses (APRNs), and physician assistants (PAs).ResultsIn urban areas, PCPs prescribed at least 50% of each psychiatric medication class, except antipsychotics, which was 45.2%. BHSs prescribed 40.7% of antipsychotics and less than 25% of all other classes. In rural areas, percentages of psychiatric medications from PCPs were over 70% for each medication class, except antipsychotics, which was 60.1%. Primary care physicians provided most psychiatric medications, between 36%-57% in urban areas and 47%-65% in rural areas. Primary care APRNs provided up to 13% of prescriptions in rural areas, which was more than the amount prescribed by BHS physicians, expect for antipsychotics. Psychiatric mental health APRNs provided up to 7.5% of antipsychotics in rural areas, but their prescribing contribution among other classes ranged between 1.1%-3.6%. PAs provided 2.5%-3.4% of medications in urban areas and this increased to 3.9%-5.1% in rural areas.ConclusionsResults highlight the extensive roles of PCPs, including APRNs, in managing psychiatric medications for older adults with SMI.

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Antidepressant Prescribing in Primary Care to Older Adults Without Major Depression.

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Antidepressant Prescribing in Primary Care to Older Adults Without Major Depression.

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