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Gen Hosp Psychiatry. 2011 Nov-Dec;33(6):587-93. doi: 10.1016/j.genhosppsych.2011.07.006. Epub 2011 Sep 13.

Sociodemographic and clinical factors associated with antidepressant type in a national sample of the home health care elderly.

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1
Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10601, USA. juw7002@med.cornell.edu

Abstract

OBJECTIVE:

The study examined in home health care (HHC) the demographic, functional and clinical factors by antidepressant (AD) type including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) and "Other" ADs such as bupropion and mirtazapine.

METHOD:

Cross-sectional sample (N=909) was analyzed from the 2007 National Home Health and Hospice Care Survey that included patients 65 years and older [mean=78.79 years, confidence interval (CI)=77.88-79.69 years] taking one AD.

RESULTS:

Selective serotonin reuptake inhibitors were the most commonly used (63.89%) AD, followed by "Other" ADs (14.29%), TCAs (11.31%) and SNRIs. In a multinomial regression referencing SSRIs, blacks had increased odds of tricyclic use compared to whites [odds ratio (OR)=5.96, CI=1.85-19.19]. Hispanics had decreased odds of "Other" AD (OR=0.13, CI=0.02-0.73) and SNRI use (OR=0.06, CI=0.008-0.45) compared to non-Hispanics. The HHC elderly taking psychotropic medications besides ADs were less likely to use SNRIs (OR=0.31, CI=0.11-0.88) and tricyclics (OR=0.27, CI=0.08-0.87). Advancing age was marginally associated with tricyclic use (OR=1.04, CI=0.99-1.09).

CONCLUSION:

Race/ethnicity and age differences by AD type - including blacks' increased TCA use, Hispanics' decreased SNRI and "Other" AD use, and older elderly's increased tricyclic use - suggest systematic differences in prescribing practice variations including differences by geography, patient preferences or access to care in the HHC elderly.

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