Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-27T19:53:48.502Z Has data issue: false hasContentIssue false
  • English
  • Français

Antidepressant use and mortality in very old people

Published online by Cambridge University Press:  18 March 2016

Gustaf Boström ,
Carl Hörnsten ,
Jon Brännström ,
Mia Conradsson ,
Peter Nordström ,
Per Allard ,
Yngve Gustafson  and
Håkan Littbrand
Gustaf Boström*
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Carl Hörnsten
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Jon Brännström
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Mia Conradsson
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Peter Nordström
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Per Allard
Affiliation:
Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
Yngve Gustafson
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Håkan Littbrand
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
*
Correspondence should be addressed to: Gustaf Boström, Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-90187 Umeå, Sweden. Phone: +46 90 785 87 55; Fax: +46 90 13 06 23. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Antidepressant treatment may increase the risk of death. The association between antidepressants and mortality has been evaluated in community-dwelling older people, but not in representative samples of very old people, among whom dementia, multimorbidity, and disability are common.

Methods:

Umeå 85+/GERDA study participants (n = 992) aged 85, 90, and ≥95 years were followed for up to five years. Cox proportional hazard regression models were used to analyze mortality risk associated with baseline antidepressant treatment, adjusted for potential confounders.

Results:

Mean age was 89 years; 27% of participants had dementia, 20% had stroke histories, 29% had heart failure, and 16% used antidepressants. In age- and sex-adjusted analyses, antidepressant use was associated with a 76% increased mortality risk (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.41–2.19). Adding adjustment for Geriatric Depression Scale score, HR was 1.62 (95% CI, 1.29–2.03). The association was not significant when adjusting for additional confounding factors (HR = 1.08; 95% CI, 0.85–1.38). Interaction analyses in the fully adjusted model revealed a significant interaction between sex and antidepressant use (HR: 1.76; 95% CI, 1.05–2.94). Among male and female antidepressant users, the HRs for death were 0.76 (95% CI, 0.47–1.24) and 1.28 (95% CI, 0.97–1.70), respectively.

Conclusion:

Among very old people, baseline antidepressant treatment does not seem to be independently associated with increased mortality risk. However, the risk may be different in men and women. This difference and the potential risk of initial treatment require further investigation in future cohort studies of very old people.

Keywords

depressionantidepressantsage 80 and overdementiaresidential facilitiesfrail elderlyepidemiologymortality
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 7 , July 2016 , pp. 1201 - 1210
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alden, D., Austin, C. and Sturgeon, R. (1989). A correlation between the geriatric depression scale long and short forms. Journal of Gerontology, 44, P124–P125. doi: 10.1093/geronj/44.4.P124.Google Scholar
Almeida, O. P., Alfonso, H., Hankey, G. J. and Flicker, L. (2010). Depression, antidepressant use and mortality in later life: the health in men study. PLoS One, 5, e11266. doi: 10.1371/journal.pone.0011266.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.Google Scholar
Anderson, G. D. (2005). Sex and racial differences in pharmacological response: where is the evidence? Pharmacogenetics, pharmacokinetics, and pharmacodynamics. Journal of Womens Health, 14, 19–29. doi: 10.1089/jwh.2005.14.19.Google Scholar
Andrews, P. W., Thomson, J. A. Jr., Amstadter, A. and Neale, M. C. (2012). Primum non nocere: an evolutionary analysis of whether antidepressants do more harm than good. Frontiers in Psychology, 3, 117. doi: 10.3389/fpsyg.2012.00117.Google Scholar
Ariyo, A. A. et al. (2000). Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans. Cardiovascular health study collaborative research group. Circulation, 102, 1773–1779. doi: 10.1161/01.CIR.102.15.1773.Google Scholar
Banerjee, S. et al. (2011). Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. Lancet, 378, 403–411. doi: 10.1016/S0140-6736(11)60830-1.Google Scholar
Bergdahl, E. et al. (2005). Depression among the oldest old: the Umeå 85+ study. International Psychogeriatrics, 17, 557–575. doi: 10.1017/S1041610205002267.Google Scholar
Byers, A. L. and Yaffe, K. (2011). Depression and risk of developing dementia. Nature reviews. Neurology, 7, 323–331. doi: 10.1038/nrneurol.2011.60.Google Scholar
Cadieux, R. J. (1999). Antidepressant drug interactions in the elderly. Understanding the P-450 system is half the battle in reducing risks. Postgraduate Medicine, 106, 231–232, 237–240, 245–249.CrossRefGoogle ScholarPubMed
Castro, V. M. et al. (2013). QT interval and antidepressant use: a cross sectional study of electronic health records. British Medical Journal, 346, f288. doi: 10.1136/bmj.f288.Google Scholar
Collin, C., Wade, D. T., Davies, S. and Horne, V. (1988). The Barthel ADL Index: a reliability study. International Disability Studies, 10, 61–63. doi: 10.3109/09638288809164103.Google Scholar
Conradsson, M., Rosendahl, E., Littbrand, H., Gustafson, Y., Olofsson, B. and Lövheim, H. (2013). Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment. Aging & Mental Health, 17, 638–645. doi: 10.1080/13607863.2012.758231.Google Scholar
Coupland, C., Dhiman, P., Morriss, R., Arthur, A., Barton, G. and Hippisley-Cox, J. (2011). Antidepressant use and risk of adverse outcomes in older people: population based cohort study. British Medical Journal, 343. doi: 10.1136/bmj.d4551.Google Scholar
de Craen, A. J., Heeren, T. J. and Gussekloo, J. (2003). Accuracy of the 15-item geriatric depression scale (GDS-15) in a community sample of the oldest old. International Journal of Geriatric Psychiatry, 18, 63–66. doi: 10.1002/gps.773.Google Scholar
Field, T. S. et al. (2001). Risk factors for adverse drug events among nursing home residents. Archives of Internal Medicine, 161, 1629–1634. doi: 10.1001/archinte.161.13.1629.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi: 10.1016/0022-3956(75)90026-6.Google Scholar
Fratiglioni, L., Viitanen, M., von Strauss, E., Tontodonati, V., Herlitz, A. and Winblad, B. (1997). Very old women at highest risk of dementia and Alzheimer's disease: incidence data from the Kungsholmen project, Stockholm. Neurology, 48, 132–138. doi: 10.1212/WNL.48.1.132.CrossRefGoogle ScholarPubMed
Giron, M. S., Forsell, Y., Bernsten, C., Thorslund, M., Winblad, B. and Fastbom, J. (2001). Psychotropic drug use in elderly people with and without dementia. International Journal of Geriatric Psychiatry, 16, 900–906. doi: 10.1002/gps.438.Google Scholar
Hajjar, E. R. et al. (2003). Adverse drug reaction risk factors in older outpatients. The American Journal of Geriatric Pharmacotherapy, 1, 82–89. doi: 10.1016/S1543-5946(03)90004-3.Google Scholar
Jorge, R. E., Robinson, R. G., Arndt, S. and Starkstein, S. (2003). Mortality and poststroke depression: a placebo-controlled trial of antidepressants. The American Journal of Psychiatry, 160, 1823–1829. doi: 10.1176/appi.ajp.160.10.1823.Google Scholar
Lenze, E. J. et al. (2001). The association of late-life depression and anxiety with physical disability: a review of the literature and prospectus for future research. The American Journal of Geriatric Psychiatry, 9, 113–135. doi: 10.1097/00019442-200105000-00004.Google Scholar
Midlöv, P., Andersson, M., Östgren, C. J. and Mölstad, S. (2014). Depression and use of antidepressants in Swedish nursing homes: a 12-month follow-up study. International Psychogeriatrics, 26, 669–675. doi: 10.1017/S1041610213002354.Google Scholar
Ryan, J. et al. (2008). Late-life depression and mortality: influence of gender and antidepressant use. The British Journal of Psychiatry, 192, 12–18. doi: 10.1192/bjp.bp.107.039164.Google Scholar
Sheikh, J. and Yesavage, J. (1986). Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist, 5, 165–173. doi: 10.1300/J018v05n01_09.Google Scholar
Shrive, F. M., Stuart, H., Quan, H. and Ghali, W. A. (2006). Dealing with missing data in a multi-question depression scale: a comparison of imputation methods. BMC Medical Research Methodology, 6, 57. doi: 10.1186/1471-2288-6-57.Google Scholar
Smalbrugge, M., Jongenelis, L., Pot, A. M., Beekman, A. T. and Eefsting, J. A. (2008). Screening for depression and assessing change in severity of depression. Is the Geriatric Depression Scale (30-, 15- and 8-item versions) useful for both purposes in nursing home patients? Aging & Mental Health, 12, 244–248. doi: 10.1080/13607860801987238.Google Scholar
Stek, M. L., Gussekloo, J., Beekman, A. T., van Tilburg, W. and Westendorp, R. G. (2004). Prevalence, correlates and recognition of depression in the oldest old: the Leiden 85-plus study. Journal of Affective Disorders, 78, 193–200. doi: 10.1016/S0165-0327(02)00310-5.Google Scholar
Streim, J. E. et al. (2000). Drug treatment of depression in frail elderly nursing home residents. The American Journal of Geriatric Psychiatry, 8, 150–159. doi: 10.1097/00019442-200005000-00010.Google Scholar
Taylor, C. B. et al. (2005). Effects of antidepressant medication on morbidity and mortality in depressed patients after myocardial infarction. Archives of General Psychiatry, 62, 792–798. doi: 10.1001/archpsyc.62.7.792.Google Scholar
Tombaugh, T. N. and McIntyre, N. J. (1992). The mini-mental state examination: a comprehensive review. Journal of the American Geriatrics Society, 40, 922–935. doi: 10.1111/j.1532-5415.1992.tb01992.x.Google Scholar
van Noord, C., Eijgelsheim, M. and Stricker, B. H. (2010). Drug- and non-drug-associated QT interval prolongation. British Journal of Clinical Pharmacology, 70, 16–23. doi: 10.1111/j.1365-2125.2010.03660.x.Google Scholar
von Heideken Wågert, P. et al. (2006). Health status in the oldest old. Age and sex differences in the Umeå 85+ Study. Aging Clinical and Experimantal Research, 18, 116–126. doi: 10.1007/BF03327426.Google Scholar
Wallin, K., Boström, G., Kivipelto, M. and Gustafson, Y. (2013). Risk factors for incident dementia in the very old. International Psychogeriatrics, 25, 1135–1143. doi: 10.1017/S1041610213000409.CrossRefGoogle ScholarPubMed
Wilkinson, P. and Izmeth, Z. (2012). Continuation and maintenance treatments for depression in older people. The Cochrane Database of Systematic Reviews, 11, CD006727. doi: 10.1002/14651858.CD006727.pub2.Google Scholar