Use of Antidepressants in Older People during a 10-Year Period: An Observational Study on Prescribed Doses and Serum Levels

Abstract

Background According to previous studies, older patients frequently have serum concentrations of antidepressant medication above the recommended reference range. Objective The aim of this study was to investigate whether prescribed doses of antidepressants and the proportion of individuals with serum concentrations above the recommended reference range in older individuals (≥ 65 years) have changed over a 10-year period in Norway. Methods Serum concentration measurements and prescribed daily doses of antidepressants in 2007 and 2017 were extracted from a therapeutic drug monitoring (TDM) database at the Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway. The database contains routine follow-up serum concentration measurements of psychotropic drugs for patients from all parts of the country. For citalopram, escitalopram, sertraline, mirtazapine and venlafaxine, the differences between 2007 and 2017 in mean prescribed doses and the proportion of patients with at least one serum concentration above the reference range, according to the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) guidelines, were compared. For the proportion of patients with serum concentrations above the recommended reference range, differences between individuals aged 65-79 and ≥ 80 years were also examined. Results The analyses of prescribed doses included 806 patients from 2007 and 1932 patients from 2017, with 972 and 2441 TDM samples, respectively. Between 2007 and 2017, modest reductions in prescribed daily doses were observed for citalopram (20 vs. 17 mg/day) and escitalopram (11 vs. 10 mg/day), but the proportion of patients with serum concentrations above the recommended reference range was unchanged for both drugs, i.e. 11.5% vs. 12.4% for citalopram and 3.6% vs. 2.9% for escitalopram. For mirtazapine and venlafaxine, prescribed doses were reduced from 28 to 25 mg/day and 150 to 125 mg/day, respectively. A significant reduction in the proportion of individuals with serum concentrations above the recommended reference range was observed for mirtazapine (27.1% vs. 11.5%) and for individuals aged ≥ 80 years using venlafaxine (60.0% vs. 30.0%). For sertraline, no differences in prescribed doses or serum concentrations above the recommended reference range were observed. Conclusions Over a 10-year period, prescribed doses of antidepressants have been slightly reduced in older Norwegian patients, but a considerable proportion is still exposed to high serum concentrations of antidepressants.

Sertraline Is an Effective SARS-CoV-2 Entry Inhibitor Targeting the Spike Protein

“…SRT might be effective in inhibiting infection of SARS-CoV-2 in the central nervous system, thus preventing potential long-term neuronal damage as well as decreasing COVID-19 mortality. Second, SRT has been confirmed as safe for clinical use in specific subjects, such as older patients ( 61 , 62 ), pregnant women ( 63 ), and patients with cardiovascular complications ( 64 , 65 ), who often have increased risk for SARS-CoV-2 infection and infection-associated morbidity and mortality ( 66 , 67 ). They are also not eligible for vaccination.…”

Psychotropic Medication Use Is Associated With Greater 1-Year Incidence of Dementia After COVID-19 Hospitalization

“…In order to gain a deeper understanding of the individual medications that could drive the association signals, we performed explorative analysis on the association of commonly used psychotropic medications (16,43,44) with incident post-COVID dementia. We found that valproic acid and haloperidol had the largest effect sizes.…”

Prediction of Ventricular Arrhythmias by QRS/QTc - Ratio in Citalopram or Escitalopram Intoxication

“…Eleven percent of Norwegian senior residents are prescribed antidepressant drugs, with citalopram and escitalopram being among the most common substances. Twelve percent of users had serum concentrations of citalopram above the recommended reference range, with increasing risk of adverse effects ( 26 ).…”

“…Citalopram and escitalopram are mainly subject to hepatic metabolism by CYP2C19. CYP2C19-mutations that reduce metabolism could therefore explain high serum concentrations ( 26 ) of the mother compound (escitalopram/citalopram) compared to the metabolite demethylcitalopram in some patients. Other metabolites include didemethylcitalopram via CYP2D6 metabolism.…”