TY - JOUR
T1 - Comparative effectiveness of antidepressants on geriatric depression
T2 - Real-world evidence from a population-based study
AU - Hsu, Chih Wei
AU - Tseng, Wei Ting
AU - Wang, Liang Jen
AU - Yang, Yao Hsu
AU - Kao, Hung Yu
AU - Lin, Pao Yen
N1 - Publisher Copyright:
© 2021
PY - 2022/1/1
Y1 - 2022/1/1
N2 - Background: There is little real-world evidence about effectiveness of different antidepressants on geriatric depression. Methods: We used population-based claims data in Taiwan between 1997 and 2013 to include older patients (≥ 60 years of age) who were diagnosed with depression and started to use antidepressants. All patients were followed up until discontinuation of antidepressant use or the end of the study period. Treatment outcomes were set as the risk of switching to another antidepressant, receiving augmentation therapy, and psychiatric hospitalization. We used cox proportional hazards regression models to calculate hazard ratios with 95% confidence intervals (CIs) and adjust for several confounding factors (aHRs). Results: During the study period, a total of 207,946 elderly patients with depression received one of the following 11 antidepressants: sertraline, fluoxetine, paroxetine, escitalopram, citalopram, fluvoxamine, venlafaxine, duloxetine, moclobemide, mirtazapine, and bupropion. Compared to the patients treated with sertraline, those treated with fluvoxamine / venlafaxine had significantly but modestly higher risks of switching (aHR [95% CI]: 1.16 [1.11–1.21] / 1.10 [1.06–1.14]), augmentation (1.06 [1.02–1.10] / 1.08 [1.05–1.12]), and hospitalization (1.28 [1.03–1.58] / 1.37 [1.16–1.62]). Otherwise, the remaining 9 antidepressants yielded no consistent result in the three outcomes. Limitations: This study is a multi-arm and active controlled trial, lacking a placebo group. Conclusion: As treating geriatric depression, no individual antidepressant posed consistently better effectiveness in the outcomes of switching antidepressant, receiving augmentation, and psychiatric hospitalization than any other one, whereas clinicians should be cautious when prescribing fluvoxamine and venlafaxine.
AB - Background: There is little real-world evidence about effectiveness of different antidepressants on geriatric depression. Methods: We used population-based claims data in Taiwan between 1997 and 2013 to include older patients (≥ 60 years of age) who were diagnosed with depression and started to use antidepressants. All patients were followed up until discontinuation of antidepressant use or the end of the study period. Treatment outcomes were set as the risk of switching to another antidepressant, receiving augmentation therapy, and psychiatric hospitalization. We used cox proportional hazards regression models to calculate hazard ratios with 95% confidence intervals (CIs) and adjust for several confounding factors (aHRs). Results: During the study period, a total of 207,946 elderly patients with depression received one of the following 11 antidepressants: sertraline, fluoxetine, paroxetine, escitalopram, citalopram, fluvoxamine, venlafaxine, duloxetine, moclobemide, mirtazapine, and bupropion. Compared to the patients treated with sertraline, those treated with fluvoxamine / venlafaxine had significantly but modestly higher risks of switching (aHR [95% CI]: 1.16 [1.11–1.21] / 1.10 [1.06–1.14]), augmentation (1.06 [1.02–1.10] / 1.08 [1.05–1.12]), and hospitalization (1.28 [1.03–1.58] / 1.37 [1.16–1.62]). Otherwise, the remaining 9 antidepressants yielded no consistent result in the three outcomes. Limitations: This study is a multi-arm and active controlled trial, lacking a placebo group. Conclusion: As treating geriatric depression, no individual antidepressant posed consistently better effectiveness in the outcomes of switching antidepressant, receiving augmentation, and psychiatric hospitalization than any other one, whereas clinicians should be cautious when prescribing fluvoxamine and venlafaxine.
KW - Antidepressant
KW - Depression
KW - Effectiveness
KW - Elderly
KW - Population-based
UR - http://www.scopus.com/inward/record.url?scp=85117421250&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2021.10.009
DO - 10.1016/j.jad.2021.10.009
M3 - 文章
C2 - 34655698
AN - SCOPUS:85117421250
SN - 0165-0327
VL - 296
SP - 609
EP - 615
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -