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Treatment indications and potential off‐label use of antidepressants among older adults: A population‐based descriptive study in Denmark

OBJECTIVES: Off‐label prescriptions of antidepressants may be of special concern in older‐adults. We aimed to study the potential off‐label use of antidepressants among adults ≥65 years by describing the patterns, trends, and factors associated with missing and unspecified treatment indications. MET...

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Autores principales: Ishtiak‐Ahmed, Kazi, Liu, Xiaoqin, Christensen, Kaj Sparle, Gasse, Christiane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9828742/
https://www.ncbi.nlm.nih.gov/pubmed/36378540
http://dx.doi.org/10.1002/gps.5841
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author Ishtiak‐Ahmed, Kazi
Liu, Xiaoqin
Christensen, Kaj Sparle
Gasse, Christiane
author_facet Ishtiak‐Ahmed, Kazi
Liu, Xiaoqin
Christensen, Kaj Sparle
Gasse, Christiane
author_sort Ishtiak‐Ahmed, Kazi
collection PubMed
description OBJECTIVES: Off‐label prescriptions of antidepressants may be of special concern in older‐adults. We aimed to study the potential off‐label use of antidepressants among adults ≥65 years by describing the patterns, trends, and factors associated with missing and unspecified treatment indications. METHODS: We used registry data to describe indications of all antidepressant prescriptions (N = 13.8 million) redeemed by older‐adults in 2006–2019. We investigated factors associated with off‐label use by considering prescriptions with missing and unspecified indications of the first antidepressant prescription using a multinomial logistic regression with the ‘depression’ indication as a reference category and reported odds ratios (ORs) with 95% confidence intervals (CI). RESULTS: Overall, 18.1% of all antidepressant prescriptions had missing indications, and 9.9% had unspecified indications. The proportion of potential off‐label use based on missing and unspecified prescriptions remained mostly consistent during 2006–2019. We identified similar associations in user characteristics whether considering missing or unspecified first prescription. ORs with 95% CI were raised in non‐western ethnicity (vs. Danish, 1.12 (0.99–1.26) for missing indication and 1.28 (1.11–1.48) for unspecified indication) and female sex (vs. male, 1.05 (1.02–1.07) and 1.05 (1.02–1.07) respectively). ORs were reduced for shorter educational attainment (vs. long, 0.90 (0.87–0.94) and 0.92 (0.88–0.96)), older age (≥81 vs. 67–70 years, 0.66 (0.65–0.71) and 0.73 (0.70–0.76)) and hospital psychiatric diagnosis (per diagnosis 0.76 (0.73–0.78) and 0.88 (0.86–0.91)). CONCLUSIONS: Nearly one‐third of all antidepressant prescriptions redeemed by older‐adults in Denmark had either missing or unspecified treatment indications. Whether these prescriptions were actual off‐label use needs to be validated. Clinicians should pay special attention to patients' characteristics linking missing and unspecified indications and maintain adequate documentation while prescribing medication.
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spelling pubmed-98287422023-01-10 Treatment indications and potential off‐label use of antidepressants among older adults: A population‐based descriptive study in Denmark Ishtiak‐Ahmed, Kazi Liu, Xiaoqin Christensen, Kaj Sparle Gasse, Christiane Int J Geriatr Psychiatry Research Article OBJECTIVES: Off‐label prescriptions of antidepressants may be of special concern in older‐adults. We aimed to study the potential off‐label use of antidepressants among adults ≥65 years by describing the patterns, trends, and factors associated with missing and unspecified treatment indications. METHODS: We used registry data to describe indications of all antidepressant prescriptions (N = 13.8 million) redeemed by older‐adults in 2006–2019. We investigated factors associated with off‐label use by considering prescriptions with missing and unspecified indications of the first antidepressant prescription using a multinomial logistic regression with the ‘depression’ indication as a reference category and reported odds ratios (ORs) with 95% confidence intervals (CI). RESULTS: Overall, 18.1% of all antidepressant prescriptions had missing indications, and 9.9% had unspecified indications. The proportion of potential off‐label use based on missing and unspecified prescriptions remained mostly consistent during 2006–2019. We identified similar associations in user characteristics whether considering missing or unspecified first prescription. ORs with 95% CI were raised in non‐western ethnicity (vs. Danish, 1.12 (0.99–1.26) for missing indication and 1.28 (1.11–1.48) for unspecified indication) and female sex (vs. male, 1.05 (1.02–1.07) and 1.05 (1.02–1.07) respectively). ORs were reduced for shorter educational attainment (vs. long, 0.90 (0.87–0.94) and 0.92 (0.88–0.96)), older age (≥81 vs. 67–70 years, 0.66 (0.65–0.71) and 0.73 (0.70–0.76)) and hospital psychiatric diagnosis (per diagnosis 0.76 (0.73–0.78) and 0.88 (0.86–0.91)). CONCLUSIONS: Nearly one‐third of all antidepressant prescriptions redeemed by older‐adults in Denmark had either missing or unspecified treatment indications. Whether these prescriptions were actual off‐label use needs to be validated. Clinicians should pay special attention to patients' characteristics linking missing and unspecified indications and maintain adequate documentation while prescribing medication. John Wiley and Sons Inc. 2022-11-15 2022-12 /pmc/articles/PMC9828742/ /pubmed/36378540 http://dx.doi.org/10.1002/gps.5841 Text en © 2022 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Ishtiak‐Ahmed, Kazi
Liu, Xiaoqin
Christensen, Kaj Sparle
Gasse, Christiane
Treatment indications and potential off‐label use of antidepressants among older adults: A population‐based descriptive study in Denmark
title Treatment indications and potential off‐label use of antidepressants among older adults: A population‐based descriptive study in Denmark
title_full Treatment indications and potential off‐label use of antidepressants among older adults: A population‐based descriptive study in Denmark
title_fullStr Treatment indications and potential off‐label use of antidepressants among older adults: A population‐based descriptive study in Denmark
title_full_unstemmed Treatment indications and potential off‐label use of antidepressants among older adults: A population‐based descriptive study in Denmark
title_short Treatment indications and potential off‐label use of antidepressants among older adults: A population‐based descriptive study in Denmark
title_sort treatment indications and potential off‐label use of antidepressants among older adults: a population‐based descriptive study in denmark
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9828742/
https://www.ncbi.nlm.nih.gov/pubmed/36378540
http://dx.doi.org/10.1002/gps.5841
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