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The use of antidepressants in Belgian nursing homes: focus on indications and dosages in the PHEBE study

Jolyce Bourgeois UGent, Monique Elseviers UGent, Lucas Van Bortel UGent, Mirko Petrovic UGent and Robert Vander Stichele UGent (2012) DRUGS & AGING. 29(9). p.759-769
abstract
Background : Since antidepressants are prescribed for multiple indications, the use of an antidepressant cannot be equated with a diagnosis of depression. Objective : The objective of this study was to examine the quality of antidepressant prescribing in Belgian nursing homes, with a critical evaluation of indications and dosages, to see whether depression was appropriately treated in terms of drug choice, the indications for which antidepressants were being prescribed and whether there was underdosing. Methods : This analysis was based on data obtained in the Prescribing in Homes for the Elderly in Belgium (PHEBE) study, a cross-sectional, descriptive study of a representative, stratified, random sample of 1,730 residents from 76 Belgian nursing homes. The PHEBE study investigated overall drug utilization in Belgian nursing homes in 2006. Clinical and medication data for the present study were obtained from this study. A 28-item checklist of clinical conditions was designed ad hoc for the PHEBE study and sent to the residents' general practitioners (GPs) to collect clinical information. We copied the residents' medication charts, classified the drugs using the Anatomical Therapeutic Chemical (ATC) classification system codes and transferred the drug names and dosages into a database. Information on indications was retrospectively obtained from the GPs, so that we could link the indication to each medication. Minimum effective doses (MEDs) of antidepressants to treat major depression were obtained from the literature to assess underdosing. Results : The overall use of antidepressants in nursing homes was 39.5 % (95 % CI 37.2, 41.8). The physicians classified 34.2 % (95 % CI 32.0, 36.4) of the residents as having depression, and 80.9 To of these patients were treated with an antidepressant. Indications among the single antidepressant users (n = 551) were depression (66.2 %), insomnia (13.4 %), anxiety (6.2 %) and neuropathic pain (1.6 %). In the indication of depression, 74.8 % used a selective serotonin reuptake inhibitor (SSRI), predominantly citalopram, sertraline and escitalopram. Venlafaxine was used by 10.7 % of the residents. Dosages for these antidepressants were equal to or higher than the MED. But when trazodone, amitriptyline or mirtazapine were used to treat depression, respectively, 92.3, 55.5 and 44.5 % of prescribed dosages were below the MED. In the indication of insomnia, most of the time, trazodone (90.5 %) or mirtazapine (5.4 %) were used, and in lower dosages than those required for depression treatment (<MED). Tricyclic antidepressants were predominantly used for the treatment of neuropathic pain and were also used at lower dosages. Of all the residents receiving a medication for anxiety, only 13.9 % received an antidepressant (mostly an SSRI), and the remaining received a benzodiazepine. Conclusions : The number one indication for the use of an antidepressant was depression. Within this indication, mostly the recommended SSRIs were used, in dosages equal to or higher than the MED. Furthermore, we noticed that there was substantial use of sedative antidepressants for insomnia and that the physicians preferred to prescribe benzodiazepines over the recommended SSRIs to treat anxiety chronically.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
OLDER-ADULTS, LONG-TERM-CARE, COGNITIVE IMPAIRMENT, DEPRESSIVE SYMPTOMS, ANXIETY DISORDER, MEDICATION USE, RESIDENTS, PREVALENCE, TRAZODONE, DEMENTIA
journal title
DRUGS & AGING
Drugs Aging
volume
29
issue
9
pages
759 - 769
Web of Science type
Article
Web of Science id
000309250400007
JCR category
PHARMACOLOGY & PHARMACY
JCR impact factor
2.646 (2012)
JCR rank
101/259 (2012)
JCR quartile
2 (2012)
ISSN
1170-229X
DOI
10.1007/s40266-012-0003-6
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2081997
handle
http://hdl.handle.net/1854/LU-2081997
date created
2012-04-06 14:01:14
date last changed
2013-10-01 00:30:31
@article{2081997,
  abstract     = {Background : Since antidepressants are prescribed for multiple indications, the use of an antidepressant cannot be equated with a diagnosis of depression. 
Objective : The objective of this study was to examine the quality of antidepressant prescribing in Belgian nursing homes, with a critical evaluation of indications and dosages, to see whether depression was appropriately treated in terms of drug choice, the indications for which antidepressants were being prescribed and whether there was underdosing. 
Methods : This analysis was based on data obtained in the Prescribing in Homes for the Elderly in Belgium (PHEBE) study, a cross-sectional, descriptive study of a representative, stratified, random sample of 1,730 residents from 76 Belgian nursing homes. The PHEBE study investigated overall drug utilization in Belgian nursing homes in 2006. Clinical and medication data for the present study were obtained from this study. A 28-item checklist of clinical conditions was designed ad hoc for the PHEBE study and sent to the residents' general practitioners (GPs) to collect clinical information. We copied the residents' medication charts, classified the drugs using the Anatomical Therapeutic Chemical (ATC) classification system codes and transferred the drug names and dosages into a database. Information on indications was retrospectively obtained from the GPs, so that we could link the indication to each medication. Minimum effective doses (MEDs) of antidepressants to treat major depression were obtained from the literature to assess underdosing. 
Results : The overall use of antidepressants in nursing homes was 39.5 \% (95 \% CI 37.2, 41.8). The physicians classified 34.2 \% (95 \% CI 32.0, 36.4) of the residents as having depression, and 80.9 To of these patients were treated with an antidepressant. Indications among the single antidepressant users (n = 551) were depression (66.2 \%), insomnia (13.4 \%), anxiety (6.2 \%) and neuropathic pain (1.6 \%). In the indication of depression, 74.8 \% used a selective serotonin reuptake inhibitor (SSRI), predominantly citalopram, sertraline and escitalopram. Venlafaxine was used by 10.7 \% of the residents. Dosages for these antidepressants were equal to or higher than the MED. But when trazodone, amitriptyline or mirtazapine were used to treat depression, respectively, 92.3, 55.5 and 44.5 \% of prescribed dosages were below the MED. In the indication of insomnia, most of the time, trazodone (90.5 \%) or mirtazapine (5.4 \%) were used, and in lower dosages than those required for depression treatment ({\textlangle}MED). Tricyclic antidepressants were predominantly used for the treatment of neuropathic pain and were also used at lower dosages. Of all the residents receiving a medication for anxiety, only 13.9 \% received an antidepressant (mostly an SSRI), and the remaining received a benzodiazepine. 
Conclusions : The number one indication for the use of an antidepressant was depression. Within this indication, mostly the recommended SSRIs were used, in dosages equal to or higher than the MED. Furthermore, we noticed that there was substantial use of sedative antidepressants for insomnia and that the physicians preferred to prescribe benzodiazepines over the recommended SSRIs to treat anxiety chronically.},
  author       = {Bourgeois, Jolyce and Elseviers, Monique and Van Bortel, Lucas and Petrovic, Mirko and Vander Stichele, Robert},
  issn         = {1170-229X},
  journal      = {DRUGS \& AGING},
  keyword      = {OLDER-ADULTS,LONG-TERM-CARE,COGNITIVE IMPAIRMENT,DEPRESSIVE SYMPTOMS,ANXIETY DISORDER,MEDICATION USE,RESIDENTS,PREVALENCE,TRAZODONE,DEMENTIA},
  language     = {eng},
  number       = {9},
  pages        = {759--769},
  title        = {The use of antidepressants in Belgian nursing homes: focus on indications and dosages in the PHEBE study},
  url          = {http://dx.doi.org/10.1007/s40266-012-0003-6},
  volume       = {29},
  year         = {2012},
}

Chicago
Bourgeois, Jolyce, Monique Elseviers, Lucas Van Bortel, Mirko Petrovic, and Robert Vander Stichele. 2012. “The Use of Antidepressants in Belgian Nursing Homes: Focus on Indications and Dosages in the PHEBE Study.” Drugs & Aging 29 (9): 759–769.
APA
Bourgeois, Jolyce, Elseviers, M., Van Bortel, L., Petrovic, M., & Vander Stichele, R. (2012). The use of antidepressants in Belgian nursing homes: focus on indications and dosages in the PHEBE study. DRUGS & AGING, 29(9), 759–769.
Vancouver
1.
Bourgeois J, Elseviers M, Van Bortel L, Petrovic M, Vander Stichele R. The use of antidepressants in Belgian nursing homes: focus on indications and dosages in the PHEBE study. DRUGS & AGING. 2012;29(9):759–69.
MLA
Bourgeois, Jolyce, Monique Elseviers, Lucas Van Bortel, et al. “The Use of Antidepressants in Belgian Nursing Homes: Focus on Indications and Dosages in the PHEBE Study.” DRUGS & AGING 29.9 (2012): 759–769. Print.