Duration of new antidepressant use and factors associated with discontinuation among community-dwelling persons with Alzheimer’s disease

Abstract

Purpose To study how long antidepressants initiated after diagnoses of Alzheimer's disease (AD) were used and factors associated with discontinuation of use among persons with Alzheimer's disease (AD). In addition, differences in duration of use between the antidepressants groups were compared. Methods Register-based Medication use and Alzheimer's disease (MEDALZ) cohort included 70,718 community-dwelling people with AD who were diagnosed during the years 2005-2011. For this study, the new antidepressant users were included after 1-year washout period (N = 16,501; 68.6% females, mean age 80.9). The duration of antidepressant use was modeled with the PRE2DUP method. Factors associated with treatment discontinuation were assessed with Cox proportional hazard models and included age, gender, comorbid conditions and concomitant medications. Results Median duration of the new antidepressant use period was 309 days (IQR 93-830). For selective serotonin reuptake inhibitor (SSRI) use, the median duration was 331 days (IQR 101-829), for mirtazapine 202 days (IQR 52-635), and for serotonin and norepinephrine reuptake inhibitors (SNRIs) 134 days (IQR 37-522). After 1-year follow-up, 40.8% had discontinued antidepressant use, 54.6% after 2 years and 64.1% after 3 years. Factors associated with treatment discontinuation were age over 85, male gender, diabetes, and use of memantine, opioids, and antiepileptics whereas benzodiazepines and related drugs and antipsychotic use were inversely associated with discontinuation. Conclusions Antidepressants are used for long-term among people with AD. Need and indication for antidepressant use should be assessed regularly as evidence on their efficacy for behavioral and psychological symptoms of dementia is limited.

Study of mirtazapine for agitated behaviours in dementia (SYMBAD): a randomised, double-blind, placebo-controlled trial

“…30 In the MEDALZ cohort of 70 718 communitydwelling people with Alzheimer's disease in Europe, mirtazapine was responsible for most new prescriptions (6462 [39•2%] of 16 501 prescriptions). 31 One reason for high rates of prescription of mirtazapine in later life is to avoid the use of antipsychotics. 32 The influential NICE dementia guideline for the management of dementia is clear that antipsychotics should only be used in "agitation, aggression, distress and psychosis" when the person with dementia is at risk of harming themselves or others or where the agitation or psychosis is causing the person with dementia severe distress.…”

Gender Differences in Function, Physical Activity, Falls, Medication Use, and Life Satisfaction Among Residents in Assisted Living Settings

“…Most studies of older adults in the community or in nursing homes note that females receive more pain medication than males including opioids (Hunnicutt et al, 2018;Sandvik, Selbaek, Kirkevold, SHusebo, & Aarsland, 2016). Females are also more likely to be prescribed anxiolytics, antipsychotics, and antidepressants (Dore, Piras, Lorettu, & Pes, 2016;Fog, Straand, Engedal, & LBlix, 2019;Kettunen et al, 2019).…”

Association of recent hospitalisation with antidepressant initiation among community dwellers with Alzheimer's disease

“…Antidepressants, antipsychotics, benzodiazepines and related drugs and opioids are all associated with an increased risk of falls and subsequent head injuries and hip fractures in older persons which is an important safety concern as persons with cognitive impairment already have increased risk of falling 22,55–60 . Moreover, psychotropic drugs are often used for a long period of time among persons with dementia 61–63 even though guidelines recommend limited duration of use 7,11…”

“…54 increased risk of falling. 22,[55][56][57][58][59][60] Moreover, psychotropic drugs are often used for a long period of time among persons with dementia [61][62][63] even though guidelines recommend limited duration of use. 7,11 The main strength of our study is the coverage and validity of the large nationwide data.…”