To document the use of psychotropic drugs in Quebec older adult population with a depressive or anxiety disorder.
Method:
Data from the Enquête sur la Santé des Aînés (ESA) study conducted between 2005 and 2008 using a representative sample (n = 1869) of community-dwelling adults aged 65 years and older were used to examine the use of psychotropic drugs in the Quebec older adult population.
Results:
Our results indicate that only 46.9% of the older adults with a diagnosis of depression or anxiety during the 24-month period studied according to the Régie de l'assurance maladie du Quebec (RAMQ) register used antidepressants (AD) for 400 days (12.9 months) on average during this period. Also, 59% of the RAMQ's mental health disorder patients used a mean daily dose of 5 mg of a diazepam equivalent for 338 days (10.9 months) on average during the same period. However, 10.0% of the older adults without any symptoms (ESA) at T1 and at T2 and any RAMQ depression and anxiety diagnosis between T0 and T2 were AD users during the 24-month period studied. They represent 26.2% of the AD users and consumed them for 494 days (15.9 months) on average during the 24-month period studied. Finally, the number of days of AD and benzodiazepine use was not associated with partial or total remission.
Conclusions:
This result questions the population effectiveness of these drugs in this population.
PrévilleMBoyerRGrenierSThe epidemiology of psychiatric disorders in Quebec's older adult population. Can J Psychiatry. 2008;53:822–832.
2.
PrévilleMBoyerRGrenierSOne-year incidence of psychiatric disorders in Quebec's older adult population. Can J Psychiatry. 2010;55(7):449–457.
3.
PrévilleMBoyerRGrenierSPersistence and remission of psychiatric disorders in the Quebec older adult population. Can J Psychiatry. 2010;55(8):514–522.
4.
Canadian Pharmacists Association. Compendium des produits et spécialités pharmaceutiques [Compendium of pharmaceuticals and specialties]. Ottawa (ON): Canadian Pharmacists Association; 2008. p 345–348.
GonzalezHMHintonLOrtizTAntidepressant class and dosing among older Mexican Americans: Application of geropsychiatric treatment guidelines. Am J Geriatr Psychiatry. 2006;14(1):79–83.
7.
UchidaHSuzukiTMamoDCBenzodiazepine and antidepressant use in elderly patients with anxiety disorders: A survey of 796 outpatients in Japan. J Anxiety Disord. 2009;23(4):477–481.
8.
PrévilleMHébertRAllardJFacteurs associés à l'utilisation des psychotropes chez les personnes âgées vivant dans la communauté [Factors associated with psychotropic drug use among community-dwelling older adults]. Rapport de recherche du Centre de recherche sur le vieillissement de l'Institut universitaire de gériatrie de Sherbrooke. Sherbrooke (QC): l'Institut universitaire de gériatrie de Sherbrooke; 2002.
9.
PetitjeanSLadewigDMeierCRBenzodiazepine prescribing to the Swiss adult population: Results from a national survey of community pharmacies. Int Clin Psychopharmacol. 2007;22(5):292–298.
10.
CunninghamCMHanleyGEMorganS.Patterns in the use of benzodiazepines in British Columbia: Examining the impact of increasing research and guideline cautions against long-term use. Health Policy. 2010;97(2–3):122–129.
11.
Régie de l'Assurance Maladie du Québec (RAMQ), Portrait quotidien de la consommation médicamenteuse des personnes âgées non-hébergées [Use of medication in a population of community-dwelling older adults] [Internet]. Quebec (QC): Government of Québec, RAMQ; 2001 (cited 2010 Aug 10). Available from: www.ramq.gouv.qc.ca/en/publications/rapportsetudes_rapports.shtml.
12.
KirshIDeaconBJHuedo-MedinaTBInitial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration. PLoS Med. 2008;5(2):e45.
13.
ChisholmDSandersonKAyuso-MateosJLReducing the global burden of depression: Population-level analysis of intervention cost-effectiveness in 14 world regions. Br J Psychiatry. 2004;184:393–403.
14.
PigottHWLeventhalAMAlterGSEfficacy and effectiveness of antidepressants: Current status of research. Psychother Psychosom. 2010;79:267–279.
15.
SinyorMSchafferALevittA.The sequenced treatment alternatives to relieve depression (STAR*D) trial: A review. Can J Psychiatry. 2010;55(3):126–135.
16.
TrivediMHRushAJWisniewskiSREvaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: Implications for clinical practice. Am J Psychiatry. 2006;163(1):28–40.
17.
AllardJAllaireDLeclercGThe influence of family and social relationships on the consumption of psychotropic drugs by the elderly. Arch Gerontol Geriatr. 1995;20(2):193–204.
18.
PrévilleMHébertRBoyerRCorrelates of psychotropic drug use in the elderly compared to adults aged 18–64: Results from the Quebec health survey. Aging Ment Health. 2001;5(3):216–224.
19.
DonoghueJLaderM.Usage of benzodiazepine: A review. Int J Psychiatry Clin Pract. 2010;14(2):78–87.
20.
PollockBG. Gender differences in psychotropic drug metabolism. Psychopharmacol Bull. 1997;33(2):235–241.
21.
GrahamKVidalzeballosD.Analyses of use of tranquilizers and sleeping pills across five surveys of the same population (1985–1991)—the relationship with gender, age and use of other substances. Soc Sci Med. 1998;46(3):381–395.
22.
IsacsonDBingeforsKWennbergMFactors associated with high-quantity prescriptions of benzodiazepines in Sweden. Soc Sci Med. 1993;36(3):343–351.
23.
SalinskyJVDoréCJ. Characteristics of long term benzodiazepine users in general practice. J R Coll Gen Pract. 1987;37:202–204.
24.
BurkeWJHoustonMJBoustSJUse of the Geriatric Depression Scale in dementia of the Alzheimer type. J Am Geriatr Soc. 1989;37(9):856–860.
25.
KafonekSEttingerWHRocaRInstruments for screening for depression and dementia in a long-term facility. J Am Geriatr Soc. 1989;37(1):29–34.
26.
CrumRMAnthonyJCBassettSSPopulation-based norms for the Mini-Mental State Examination by age and educational level. JAMA. 1993;269(18):2386–2391.
27.
FolsteinMFFolsteinSEMcHughPR. Mini-mental state: A practical method for grading the state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–198.
28.
StreinerDLCairneyJVeldhuizenS.The epidemiology of psychological problems in the elderly. Can J Psychiatry. 2006;51(3):185–191.
29.
RobitailleLCourchesneMSylvainJAnxiolytiques et hypnotiques. In: BarbeauGGuimondJMalletL, editors. Médicaments et personnes âgées. St-Hyacinthe (QC): Edisem et Maloine; 1991. p 567.
30.
World Health Organization. The anatomical therapeutic chemical classification system with defined daily doses (ATC/DDD) [Internet]. Geneva (CH): WHO; 2003 (cited 2010 Aug 10). Available from: http://www.who.int/classifications/atcddd/en/.
31.
MacKnightCRockwoodK.Use of the chronic disease score to measure comorbidity in the Canadian Study of Health and Aging. Int Psychogeratr. 2001;13(Supp 1):137–142.
32.
MacKnightC.1998. Validation of the chronic disease score in Canadian seniors [Thesis Master Degree of Science]. Halifax (NS): Dalhousie University.
33.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington (DC): APA; 1994.
34.
BucholzKKMarionSLShaykaJJA short computer interview for obtaining psychiatric diagnoses. Psychiatr Serv. 1996;47(3):293–297.
35.
ErdmanHPKleinMHGreistJHA comparison of two computer-administered versions of the NIMH Diagnostic Interview Schedule. J Psychiatr Res. 1992;26(1):85–95.
36.
LevitanRDBlouinAGNavarroJRValidity of the computerized DIS for diagnosing psychiatric inpatients. Can J Psychiatry. 1991;36(10):728–731.
37.
MurphyJMMonsonRRLairdNMA comparison of diagnostic interviews for depression in the Stirling County Study: Challenges for psychiatric epidemiology. Arch Gen Psychiatry. 2000;57(3):230–236.
38.
RobinsLNHelzerJECroughanJNational Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics and validity. Arch Gen Psychiatry. 1981;38(4):381–389.
39.
RobinsLNOrvaschelHAnthonyJCThe Diagnostic Interview Schedule. In: EatonWWKesslerLG, editors. Epidemiologic field methods in psychiatry. New York (NY): Academic Press; 1985. p 143–170.
40.
WittchenHURobinsLNCottlerLBCross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). Br J Psychiatry. 1991;159:645–653.
41.
World Health Organization. International classification of diseases. 9th rev. Geneva (CH): WHO; 2001.
42.
HosmerDWLemeshowS.Applied logistic regression. New York (NY): Wiley & Sons; 1989.
43.
Conseil du Médicament du Québec. Usage des antidépresseurs chez les personnes inscrites au régime public d'assurance médicaments du Québec—étude descriptive de 1999 à 2004 [Use of antidepressant among a public insured population of Quebec—descriptive study from 1999 to 2004] [Internet]. Quebec (QC): Government of Québec; 2008 (cited 2010 Aug 10). Available from: http://www.cdm.gouv.qc.ca/site/download.php?f=ab3991d371da0316410a5f035c17e328.
44.
DemyttenaereKBonnewynABruffaertsRClinical factors influencing the prescription of antidepressants and benzodiazepines: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD). J Affect Disord. 2008;110(1–2):84–93.
45.
PattenSBWangJLWilliamsJVFrequency of antidepressant use in relation to recent and past major depressive episodes. Can J Psychiatry. 2010;55(8):532–535.
46.
PattenSBKennedySHLamRWCanadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. I. Classification, burden and principles of management. J Affect Disord. 2009;117(Suppl 1):S5–S14.
47.
BallHASiribaddanaSHKovasYEpidemiology and symptomatology of depression in Sri Lanka: A cross-sectional population-based survey in Colombo district. J Affect Disord. 2010;123(1–3):188–196.
48.
SomersJMGoldnerEMWaraichPPrevalence and incidence studies of anxiety disorders: A systematic review of the literature. Can J Psychiatry. 2006;51(2):100–113.
