Older adults with depression may be least likely to discontinue or switch treatment when prescribed sertraline for the first time compared with other antidepressants, suggests a report in The American Journal of Psychiatry. The study compared one-year outcomes in 93,000 Danish residents with depression who for the first time filled a prescription for one of 10 antidepressants. The research was funded in part by the Health Research Foundation of the Central Denmark Region.
“Although clinical trials are considered the gold standard in drug effectiveness research, their experimental conditions often do not represent complex, real-world settings, primarily because of the exclusion of vulnerable populations such as older adults and individuals with comorbid conditions,” wrote Kazi Ishtiak-Ahmed, Ph.D., of Denmark’s Aarhus University Hospital and colleagues. “Therefore, real-world data are essential and complementary to those clinical trials, particularly for older patients.”
Using Danish national registers, the researchers identified adults aged 65 or older who filled a prescription for one of 10 most frequently prescribed antidepressants at a community pharmacy for the first time between 2006 and 2017. Adults who were initially prescribed more than one antidepressant and/or received their first prescription in an inpatient hospital were excluded.
The final sample included 93,833 older Danish adults (average age, 78 years) who initiated one of the following:
- Selective serotonin reuptake inhibitors citalopram, escitalopram, fluoxetine, paroxetine, or sertraline
- Serotonin-norepinephrine reuptake inhibitors duloxetine or venlafaxine
- Tricyclic antidepressant amitriptyline
- Atypical antidepressants mianserin or mirtazapine
The researchers tracked the patients’ outcomes for one year following their first fill of the antidepressant prescription. These outcomes included the following:
- Discontinuation, augmentation, and/or switching of an antidepressant
- Psychiatric outpatient, inpatient, and/or emergency visits
- Suicide attempt and/or self-harm
- Fall-related injuries
- Cardiovascular events
- All-cause mortality
The researchers compared the patients’ outcomes from each antidepressant group against those in the sertraline group (sertraline is recommended as the only first-choice treatment for depression in the current Danish guidelines).
Compared with sertraline, most of the other nine antidepressants were associated with a significantly higher risk of adverse outcomes, with venlafaxine, mirtazapine, and escitalopram having higher numbers of adverse clinical outcomes. Citalopram was associated with less risk of medication augmentation and psychiatric emergency or inpatient visits than sertraline, while amitriptyline was associated with fewer fall-related injuries and less risk of any psychiatric visit.
“Overall, our results align with the existing Danish guidelines recommending sertraline as the first choice for the pharmacological treatment of depression in older adults and highlight the importance of careful selection of antidepressant treatment in the initial pharmacological treatment of depression in older patients,” Ishtiak-Ahmed and colleagues concluded.
To read more on this topic, see the Psychiatric News article “Add-On Aripiprazole May Benefit Older Adults With Refractory Depression.”
(Image: iStock/sturti)
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