@article{ref1,
title="Comparing Antidepressant Treatment Patterns in Older and Younger Adults: A Claims Database Analysis",
journal="Journal of the American Geriatrics Society",
year="2011",
author="Sanglier, Thibaut and Saragoussi, Delphine and Milea, Dominique and Auray, Jean‐paul and Valuck, Robert J. and Tournier, Marie",
volume="59",
number="7",
pages="1197-1205",
abstract="<p><b>OBJECTIVES: </b> To compare depressed older (≥65) and younger (25-64) adults with regard to antidepressant treatment patterns and to assess factors associated with 180‐day nonpersistence.</p> <p><b>DESIGN: </b> Retrospective matched cohort study.</p> <p><b>SETTING: </b> U.S. managed care population.</p> <p><b>PARTICIPANTS: </b> Older and matched younger adults diagnosed with depression and treated with antidepressants.</p> <p><b>MEASUREMENTS: </b> Sociodemographic characteristics, comorbidities, polypharmacy, and characteristics of antidepressant treatment at 180 days were compared between older and younger adults. Analyses were conducted before and after the implementation of Medicare Part D on January 1, 2006, to consider the effect of this policy.</p> <p><b>RESULTS: </b> Few participants received psychotherapy, especially older ones; rates were constant before and after 2006. Before 2006, older adults more frequently received antidepressants at lower (odds ratio (OR)=5.38, 95% confidence interval (CI)=3.57-8.13) or intermediate dose (OR=2.42, 95% CI=1.93-3.02) and had poorer adherence to treatment (<i>P</i><.001) than younger adults. After 2006, older adults received similar proportions of intermediate or high antidepressant doses as younger adults, but a lower dosage was still more likely to be prescribed (OR=1.87, 95% CI=1.09-3.20) and had higher treatment adherence (<i>P</i><.001). Medication profile did not significantly affect the risk of nonpersistence, but increased with lower antidepressant dose (<i>P</i><.001). Whereas nonpersistence was higher in older adults before 2006 (hazard ratio (HR)=1.25, 95% CI=1.22-1.46), the trend reversed after 2006 (HR=0.76, 95% CI=0.66-0.88).</p> <p><b>CONCLUSION: </b> More than half of participants with depression discontinued antidepressant treatment, and psychotherapy was rarely used. Implementation of Medicare Part D was associated with substantial changes in treatment of older adults with depression. The presence of comorbidities or polypharmacy was not associated with nonpersistence in depressed older adults.</p><p />",
language="",
issn="0002-8614",
doi="10.1111/j.1532-5415.2011.03457.x",
url="http://dx.doi.org/10.1111/j.1532-5415.2011.03457.x"
}