DESCRIPCIÓN, ANÁLISIS TEMPORAL Y ADHERENCIA AL TRATAMIENTO DE ANTIDEPRESIVOS EN ATENCIÓN PRIMARIA EN LA POBLACIÓN MAYOR DE 65 AÑOS DE CATALUÑA ENTRE 2010-2015.

Abstract

According to data from European studies, antidepressant drug consumption has increased, mainly in the elderly. The increased use in the older population represents an increased risk of adverse events, because of drug interactions in patients who usually have multiple prescribed medications and due to the pharmacodynamics of these drugs in the elderly. Therefore, we propose to describe the characteristics of this population with its prescription trend in the period between 2010 and 2015, the indications related to its use and description of adherence to antidepressant drug new users. To this end, we conducted a descriptive, retrospective study in patients aged 65 or older in the Catalonian primary care database SIDIAP, for the period 2010-2015. Our objectives were: 1) to describe demographic and clinical characteristics and the annual incidence of antidepressant use, and 2) to analyze adherence to antidepressant drugs through primary adherence, switch and discontinuation of antidepressants. In addition, we conducted a comparative study with the Dutch primary care database Nivel-PCD about indications for antidepressant drugs around the prescription of new antidepressant in the same study period. As a result, we found that in the population of Catalonia older than 64 years, there is a decrease in the incidence of antidepressant use secondary to a decrease in the prescription of selective serotonin reuptake inhibitors. We also described that the population older than 85 years have had an increase in the prescription of the group of Other antidepressants. Primary adherence in our population was 85.5%, with a 1.7% of switching in antidepressants by general practitioners and 49.4% of discontinuation by patients. The probability of discontinuation of the first antidepressant prescribed can reach up to almost 20% in the first month of the treatment episode. This result is worth noting and could be explained by a possible lack of adherence by the patient, a scarcity of knowledge about the possible delay in the therapeutic effect of these drugs or to adverse reactions in the first month of use. When comparing the Catalonian with the Dutch population, we found differences in the use of antidepressants. While in Catalonia selective serotonin reuptake inhibitors were the most used, in the Netherlands half of patients received a tricyclic antidepressant. Regarding the percentage of selected indications related to the prescription of new antidepressant drug users, depression, anxiety and, sleep disorders are the diagnoses that appear in the databases most frequently. However, while the category of non-selected indications shows an increase in the incidence in the Nivel-PCD database, in SIDIAP a fall is observed throughout the study period. Tricyclic antidepressants were the most commonly prescribed antidepressants and the increase in non-selected indications in the Netherlands could be consequence of antidepressant utilization as treatment for symptoms related to pain or related to depression that we did not include in our research because they were not syndromic diagnoses. The results of the sensitivity analyzes are in line with the main results, which provides robustness to our studies.

Date of Award	22 Feb 2022
Original language	Spanish
Supervisor	Albert Jesús Figueras Suñé (Tutor)