Frequency and predictors of the potential overprescribing of antidepressants in elderly residents of a geographically defined U.S. population

William V. Bobo, Brandon R. Grossardt, Maria I. Lapid, Jonathan G. Leung, Cynthia Stoppel, Paul Y. Takahashi, Robert W. Hoel, Zheng Chang, Christian Lachner, Mohit Chauhan, Lee Flowers, Scott M. Brue, Mark A. Frye, Jennifer St. Sauver, Walter A. Rocca, Bruce Sutor

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

The purpose of this study was to estimate the extent of potential antidepressant overprescribing in a geographically defined U.S. population, and to determine the indications and factors that account for it. We conducted a cohort study of new antidepressant prescriptions for elderly residents of Olmsted County, Minnesota, 2005-2012, using the Rochester Epidemiology Project medical records-linkage system. Indications for antidepressants were abstracted from health records for all cohort members. Potential antidepressant overprescribing was defined based on regulatory approval, the level of evidence identified from a standardized drug information database, and multidisciplinary expert review. Predictors of potential antidepressant overprescribing were investigated using logistic regression models, stratified by general antidepressant indication (general medical indication, specific psychiatric diagnosis, and non-specific psychiatric symptoms). Potential antidepressant overprescribing occurred in 24% of 3199 incident antidepressant prescriptions during the study period, and involved primarily newer antidepressants that were prescribed for non-specific psychiatric symptoms and subthreshold diagnoses. Potential antidepressant overprescribing was associated with nursing home residence, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, having greater use of urgent or acute care services in the year preceding the index antidepressant prescription, and being prescribed antidepressants via telephone, e-mail, or patient portal. In conclusion, potential antidepressant overprescribing occurred in elderly persons and involved mainly newer antidepressants used for non-specific psychiatric symptoms and subthreshold diagnoses, and was associated with indicators of higher clinical complexity or severity and with prescribing without face-to-face patient contact.

Original languageEnglish (US)
Article numbere00461
JournalPharmacology Research and Perspectives
Volume7
Issue number1
DOIs
StatePublished - Feb 2019

Keywords

  • antidepressants
  • cohort study
  • elderly
  • overuse
  • prescribing

ASJC Scopus subject areas

  • Neurology
  • Pharmacology, Toxicology and Pharmaceutics(all)

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