More Seniors Taking Inappropriate Antidepressants

5.2% of outpatient office visits resulted in antidepressant prescriptions in 2002. By 2012, it had increased to 10.1%.

Antidepressant prescriptions for the elderly nearly doubled over a 10-year period, according to a recent study from the College of Pharmacy. The study pulled data from the National Ambulatory Medical Care Survey from 2002 – 2012.

5.2 percent of outpatient office visits resulted in antidepressant prescriptions in 2002. By 2012, it had increased to 10.1 percent.

“We have a better understanding of mental illness, and there is more public acceptance for seeking mental health treatment,” said Greg Rhee, adjunct assistant professor who specializes in pharmaceutical care and health systems.

However, that trend comes with increased risks. Rhee said several antidepressants can cause adverse drug events or interact poorly with other medications.

“These are potentially inappropriate medications that should not be prescribed because they carry greater harms than potential benefits,” Rhee said.

The study accounted for more than two million visits annually when older adults were exposed to those antidepressants, namely amitriptyline and doxepin. The findings were published in July’s Administration and Policy of Mental Health and Mental Health Services Research.

Amitriptyline and doxepin are both associated with adverse effects, including a higher risk of hospitalization and death than other antidepressants. The two drugs are considered highly anticholinergenic, which have sedating effects, and can impact circulation and regulation of blood sugar among other functions.

“We need more efforts to minimize prescribing these medications,” Rhee said.

The study also revealed that minorities and Medicaid beneficiaries were more likely to be prescribed potentially inappropriate antidepressants.

“We’re not quite sure why this is, but it raises a lot of questions,” said Rhee.

He said more research should be done in this area to uncover the root cause and explore potential interventions or steps to address it. He also hopes to further research drug-drug interactions in older adults.

“Medication safety is a public health concern, and I am particularly interested in minimizing medication-related adverse outcomes in geriatric populations,” Rhee said. “As pharmacy leaders, it is our responsibility to our patients.”

Other collaborators on the study include Jon Schommer, Ronald Hadsall and Donald Uden from the College of Pharmacy, and Ben Capistrant from the U’s School of Public Health.

—Erin McHenry