Deprescribing & Antidepressant Use in Older Adults

Research Paper Title

Long term antidepressant use in a cohort of older people.

Background

Depression is the most common mental health problem in older adults and untreated is associated with significant burden of illness for patients. This study aimed to examine longitudinal patterns of antidepressant use in older adults and determine which factors were associated with changes in use.

Methods

Adults aged 50 and over, from the Irish Longitudinal Study on Ageing, who participated at any one of the four TILDA waves (n = 8,175) were included in the analysis. Repeated measures latent class analysis (RMLCA) is the model-based approach we used to identify underlying subgroups in a population.

Results

The researchers found antidepressant use ranged from 6% to 10%, over a 6-year period. RMLCA identified three distinct classes of anti-depressant use. Notably, 6% of older adults were categorised in a ‘long-term antidepressant use’ class, with consistent use across all four waves, and 6% were categorised in an ‘Intermittent/ Developing Use’ class. We found long-term antidepressant use to be a characteristic of older adults with chronic conditions at baseline of study and striking low uptake of psychological and psychiatric services.

Conclusions

These findings provide evidence of the complex presentations of depression with comorbidities in long-term antidepressant users. While prolonged use of antidepressants in an older cohort is often rationalised due to recurrent depression and comorbidities, this study suggests little deprescribing of antidepressants and a need for greater access and provision of psychological services tailored to later life seem necessary to improve management of this condition.

Reference

O’Neill, A., McFarland, J. & Kelly, D. (2021) Long term antidepressant use in a cohort of older people. International Journal of Geriatric Psychiatry. doi: 10.1002/gps.5518. Online ahead of print.

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