Pharmacoepidemiological research findings consistently suggest that patients treated with older tricyclic antidepressants rarely complete an effective course of treatment - either in terms of obtaining an adequate dose of antidepressant, or completing a minimum period of treatment if an adequate dose is achieved.
Initial choice of antidepressant appears to be an important factor in determining subsequent treatment patterns: patients who initiate treatment with a selective serotonin reuptake inhibitor (SSRI) are considerably more likely to complete an effective course of treatment - which should be reflected in better outcomes. Concerns have been raised about the added costs that this approach to treatment would entail, however, research to date has failed to show that tricyclic antidepressants are more cost-effective than SSRIs, despite the difference in costs of these medicines.
It is likely that a shift to the use of SSRI antidepressants as first choice drug therapy for depression would have a significant impact on improving outcomes, without increasing total costs.
Cardiovascular risk of antidepressant use in elderly me... Annals of Epidemiology |
Annals of Epidemiology, Volume 15, Issue 8, September 2005, Pages 643-644 C.M. Blanchette, L. Simoni-Wastila, B. Stuart Abstract PurposeTo compare the cardiovascular risk of antidepressant users, cumulatively and by class, to nonantidepressant users in a representative sample of the U.S. elderly population.MethodsA historical pooled cohort study of all elderly non-HMO community dwelling Medicare beneficiaries represented in the 1998–1999 and 2000–2001 Medicare Current Beneficiary Survey to assess the incidence of AMI (ICD-9: 410 or 411). Antidepressant users were defined by at least one antidepressant drug mention in the year prior to the year of observation for AMI. Class users were defined as unique users of the corresponding class (SSRI, cyclic, other) according to 2005 U.S. Pharmacopeia therapeutic categories and individuals who switched drug classes at any time during the study were defined as combination users. Logistic regression models were used to compare odds of experiencing an AMI. Covariates included age, sex, race, poverty status, cardiovascular drug therapy, anticoagulant medication therapy, smoking history and current status, poverty status, and the DCG/HCC to adjust for severity, which includes 189 conditions, including depression and related disorders that are treated with antidepressants. ResultsAntidepressant users numbered 1,905 (584 SSRI users, 388 cyclic users, 111 other users, and 822 combination users). Nonantidepressant users numbered 8,892. The incidence of AMI was 2.1 % in the sample, 1.9 % in nonantidepressant users, 3 % in all antidepressant users, 3.4 % in all SSRI users, 2.1 % in cyclic users, 1.8 % in all other users, and 3.4 % in combination users. Logistic models revealed that antidepressant users (OR = 1.46, 95 % CI: 1.02–2.08) and SSRI users (OR = 1.86, 95 % CI: 1.07–3.22) were found to have significantly greater odds of AMI compared to nonantidepressant users. ConclusionStudy findings conflict with previous studies, which have found SSRIs to be AMI protective. Study limitations include its restriction to the Medicare population and the 1-year maximum observation period. |
Are SSRI antidepressants clinically homogeneous? The Lancet |
The Lancet, Volume 344, Issue 8921, 20 August 1994, Page 550 BernardJ. Carroll |
View More Related Articles |
View Record in Scopus |
A Secondary Analysis of a Duration Response Association Between Selective Serotonin Reuptake Inhibitor Use and the Risk of Acute Myocardial Infarction in the Aging Population