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Potentially inappropriate prescription of antidepressants in old people: characteristics, associated factors, and impact on mortality

  • Anne Hiance-Delahaye (a1) (a2) (a3) (a4), Florence Muller de Schongor (a1), Laurent Lechowski (a1) (a4), Laurent Teillet (a1) (a4), Jean-Jacques Arvieu (a5), Jean-Marie Robine (a6), Joël Ankri (a2) (a3) (a7) and Marie Herr (a2) (a3) (a7)...

The increasing use of antidepressants (ADs) has raised concerns about their inappropriate use in old people.


To examine the prevalence of potentially inappropriate prescribing (PIP) of ADs, their associated factors, and their impact on mortality in a sample of old people in France.


The analysis used data from the SIPAF study, a cross-sectional study consisting of 2,350 people aged ≥ 70 years. Trained nurses interviewed participants at home between 2008 and 2010. Information was collected concerning socio-demographic and health characteristics, including medication use. The study population consisted of the 318 AD users from the SIPAF study (13.5%). PIP of ADs was defined according to national and international criteria. Factors associated with PIP of ADs were assessed using a multivariate logistic regression model. The influence of PIP of ADs on mortality was assessed using a Cox model (median follow-up 2.8 years).


Among the SIPAF study, 71% of AD users were female and the mean age was 84 ± 7 years. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed ADs (19.8%). We found PIP of ADs in 36.8% of the study population, mainly the co-prescription of diuretics with SSRIs (17.6%) and the prescription of tricyclics (12.9%). PIP of ADs was associated with polypharmacy (aOR5-9 drugs 2. 61, 95% CI 1.11–6.16 and aOR≥10 drugs 2.69, 95% CI 1.06–6.87) and comorbidity (aOR3-4 chronic diseases 2.59, 95%CI 1.04–6.44 and aOR≥5 chronic diseases 2.33, 95%CI 0.94–5.79), and increased the risk of mortality during follow-up (aHR 2.30, 95%CI 1.28–4.12).


This study shows that more than one third of AD prescriptions may be inappropriate in old people. PIP of ADs was related to polypharmacy and comorbidity and increased mortality among AD users.

Corresponding author
Correspondence should be addressed to: Anne Hiance-Delahaye, Service de Gériatrie, 11 rue Chardon Lagache, Paris 75016, France. Phone: +33 (0) 144 96 31 31. Email:
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Afssaps. (2006). Bon usage des medicaments antidepresseurs dans le traitement des troubles depressifs et des troubles anxieux de l'adulte.; last accessed 5 October 2017.
American Geriatrics Society 2015 Beers Criteria Update Expert Panel. (2015). American geriatrics society 2015 updated beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 63, 22272246. doi:10.1111/jgs.13702
Bourgeois, J., Elseviers, M. M., Van Bortel, L., Petrovic, M. and Vander Stichele, R. H. (2012). The use of antidepressants in Belgian nursing homes: focus on indications and dosages in the PHEBE study. Drugs Aging, 29, 759769. doi:10.1007/s40266-012-0003-6
Carey, I. M. et al. (2008). What factors predict potentially inappropriate primary care prescribing in older people? analysis of UK primary care patient record database. Drugs Aging, 25, 693706.
Caughey, G. E., Roughead, E. E., Shakib, S., McDermott, R. A., Vitry, A. I. and Gilbert, A. L. (2010). Comorbidity of chronic disease and potential treatment conflicts in older people dispensed antidepressants. Age Ageing, 39, 488494. doi:10.1093/ageing/afq055
de Abajo, F. J. and García-Rodríguez, L. A. (2008). Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy: interaction with nonsteroidal anti-inflammatory drugs and effect of acid-suppressing agents. Archives of General Psychiatry, 65, 795803. doi:10.1001/archpsyc.65.7.795
Diniz, B. S. et al. (2014). The effect of gender, age, and symptom severity in late-life depression on the risk of all-cause mortality: the Bambuí cohort study of aging. Depression Anxiety, 31, 787795. doi: 10.1002/da.22226
Diniz, B. S. and Reynolds, C. F. (2014). Major depressive disorder in older adults: benefits and hazards of prolonged treatment. Drugs Aging, doi:10.1007/s40266-014-0196-y
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, 189198.
Gareri, P., Falconi, U., De Fazio, P. and De Sarro, G. (2000). Conventional and new antidepressant drugs in the elderly. Progress in Neurobiology, 61, 353396.
Girardi, P. et al. (2009). Duloxetine in acute major depression: review of comparisons to placebo and standard antidepressants using dissimilar methods. Human Psychopharmacology, 24, 177190. doi:10.1002/hup.1005
Gunathilake, R. et al. (2013). Mild hyponatremia is associated with impaired cognition and falls in community-dwelling older persons. Journal of the American Geriatrics Society, 61, 18381839. doi:10.1111/jgs.12468
Hanlon, J. T. et al. (2011). Potential underuse, overuse and inappropriate use of antidepressants in older veteran nursing home patients. Journal of the American Geriatrics Society, 59, 14121420. doi:10.1111/j.1532-5415.2011.03522.x
Herr, M., Arvieu, J.-J., Aegerter, P., Robine, J.-M. and Ankri, J. (2014). Unmet health care needs of older people: prevalence and predictors in a French cross-sectional survey. European Journal of Public Health, 24, 808813. doi:10.1093/eurpub/ckt179
Hollingworth, S. A., Lie, D. C., Siskind, D. J., Byrne, G. J., Hall, W. D. and Whiteford, H. A. (2011). Psychiatric drug prescribing in elderly Australians: time for action. Australian & New Zealand Journal of Psychiatry, 45, 705708. doi:10.3109/00048674.2011.594947
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A. and Jaffe, M. W. (1963). Studies of Illness in the aged: the index of adl: a standardized measure of biological and psychosocial function. JAMA, 185, 914919. doi:10.1001/jama.1963.03060120024016
Kennedy, G. J. and Marcus, P. (2005). Use of antidepressants in older patients with co-morbid medical conditions: guidance from studies of depression in somatic illness. Drugs Aging, 22, 273287.
Kennedy, S. H. et al. (2016). Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 3. Pharmacological treatments. Canadian Journal Psychiatry, 61, 540–60. doi:10.1177/0706743716659417
Knapp, M., McDaid, D., Mossialos, E. and Thornicroft, G. (2006). WHO/Europe | Publications - Mental health policy and practice across Europe. The future direction of mental health care.; last accessed 5 October 2017.
Kok, R. M. and Reynolds, C. F. (2017). Management of depression in older adults: a review. JAMA, 317, 21142122. doi:10.1001/jama.2017.5706
Laroche, M.-L., Charmes, J.-P. and Merle, L. (2007). Potentially inappropriate medications in the elderly: a French consensus panel list. European Journal of Clinical Pharmacology, 63, 725731. doi:10.1007/s00228-007-0324-2
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179186. doi:10.1093/geront/9.3_Part_1.179
Luppa, M. et al. (2012). Age- and gender-specific prevalence of depression in latest-life–systematic review and meta-analysis. Journal of Affective Disorders, 136, 212221. doi:10.1016/j.jad.2010.11.033
Mannesse, C. K. et al. (2013). Characteristics, prevalence, risk factors, and underlying mechanism of hyponatremia in elderly patients treated with antidepressants: a cross-sectional study. Maturitas, 76, 357363. doi: 10.1016/j.maturitas.2013.08.010
Mintzer, J. and Burns, A. (2000). Anticholinergic side-effects of drugs in elderly people. Journal of the Royal Society of Medicine, 93, 457462. doi:10.1177/014107680009300903
Mojtabai, R. and Olfson, M. (2011). Proportion of antidepressants prescribed without a psychiatric diagnosis is growing. Health Affairs (Project Hope), 30, 14341442. doi:10.1377/hlthaff.2010.1024
Moore, M., Yuen, H. M., Dunn, N., Mullee, M. A., Maskell, J. and Kendrick, T. (2009). Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database. BMJ, 339, b3999.
Morin, L., Fastbom, J., Laroche, M.-L. and Johnell, K. (2015). Potentially inappropriate drug use in older people: a nationwide comparison of different explicit criteria for population-based estimates. British Journal of Clinical Pharmacology, 80, 315324. doi:10.1111/bcp.12615
Mort, J. R. and Aparasu, R. R. (2000). Prescribing potentially inappropriate psychotropic medications to the ambulatory elderly. Archives of Internal Medicine, 160, 28252831.
Noordam, R., Aarts, N., Verhamme, K. M., Sturkenboom, M. C. M., Stricker, B. H. and Visser, L. E. (2015). Prescription and indication trends of antidepressant drugs in the Netherlands between 1996 and 2012: a dynamic population-based study. European Journal of Clinical Pharmacology, 71, 369375. doi:10.1007/s00228-014-1803-x
O'Mahony, D., O'Sullivan, D., Byrne, S., O'Connor, M. N., Ryan, C. and Gallagher, P. (2015). STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing, 44, 213218. doi:10.1093/ageing/afu145
Olfson, M. and Marcus, S. C. (2009). National patterns in antidepressant medication treatment. Archives of General Psychiatry 66, 848856. doi:10.1001/archgenpsychiatry.2009.81
Onder, G., Landi, F., Liperoti, R., Fialova, D., Gambassi, G., and Bernabei, R. (2005). Impact of inappropriate drug use among hospitalized older adults. European Journal of Clinical Pharmacology, 61, 453459. doi:10.1007/s00228-005-0928-3
Opondo, D. et al. (2012). Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review. PloS One, 7, e43617. doi:10.1371/journal.pone.0043617
Page, R. L. and Ruscin, J. M. (2006). The risk of adverse drug events and hospital-related morbidity and mortality among older adults with potentially inappropriate medication use. American Journal of Geriatric Pharmacotherapy, 4, 297305. doi:10.1016/j.amjopharm.2006.12.008
Pilling, S., Anderson, I., Goldberg, D., Meader, N., Taylor, C. and Two Guideline Development Groups (2009). Depression in adults, including those with a chronic physical health problem: summary of NICE guidance. BMJ, 339, b4108.
Projovic, I. et al. (2016). Risk factors for potentially inappropriate prescribing to older patients in primary care. European Journal of Clinical Pharmacology, 72, 93107. doi:10.1007/s00228-015-1957-1
Prudent, M. et al. (2008). Potentially inappropriate use of psychotropic medications in hospitalized elderly patients in France: cross-sectional analysis of the prospective, multicentre SAFEs cohort. Drugs Aging, 25, 933946.
Quinn, G. R. et al. (2014). Effect of selective serotonin reuptake inhibitors on bleeding risk in patients with atrial fibrillation taking warfarin. American Journal of Cardiology, 114, 583586. doi:10.1016/j.amjcard.2014.05.037
Raymond, C. B., Morgan, S. G. and Caetano, P. A. (2007). Antidepressant utilization in British Columbia from 1996 to 2004: increasing prevalence but not incidence. Psychiatric Services (Washington, D.C.), 58, 7984. doi:10.1176/
Robine, J.-M., Jagger, C. and Euro-REVES Group (2003). Creating a coherent set of indicators to monitor health across Europe: the Euro-REVES 2 project. European Journal of Public Health, 13, 614.
Ruths, S. et al. (2013). Trends in psychotropic drug prescribing in Norwegian nursing homes from 1997 to 2009: a comparison of six cohorts. International Journal of Geriatric Psychiatry, 28, 868876. doi: 10.1002/gps.3902
Sansone, R. A. and Sansone, L. A. (2009). Warfarin and antidepressants: happiness without hemorrhaging. Psychiatry Edgmont Pa Townsh, 6, 2429.
Sköldunger, A., Fastbom, J., Wimo, A., Fratiglioni, L. and Johnell, K. (2015). Impact of inappropriate drug use on hospitalizations, mortality, and costs in older persons and persons with dementia: findings from the SNAC study. Drugs Aging, 32, 671678. doi:10.1007/s40266-015-0287-4
Spinewine, A. et al. (2007). Appropriate prescribing in elderly people: how well can it be measured and optimised?. The Lancet, 370, 173184. doi: 10.1016/S0140-6736(07)61091-5
Usala, R. L. et al. (2015). Hyponatremia is associated with increased osteoporosis and bone fractures in a large US health system population. Journal of Clinical Endocrinology and Metabolism, 100, 30213031. doi:10.1210/jc.2015-1261
Volkert, J., Schulz, H., Härter, M., Wlodarczyk, O. and Andreas, S. (2013). The prevalence of mental disorders in older people in Western countries - a meta-analysis. Ageing Research Reviews, 12, 339353. doi:10.1016/j.arr.2012.09.004
Wang, P. S. et al. (2005). Suboptimal antidepressant use in the elderly. Journal of Clinical Psychopharmacology, 25, 118126.
Wise, J. (2013). Polypharmacy: a necessary evil. BMJ, 347, f7033. doi: 10.1136/bmj.f7033
Wong, J., Motulsky, A., Abrahamowicz, M., Eguale, T., Buckeridge, D. L. and Tamblyn, R. (2017). Off-label indications for antidepressants in primary care: descriptive study of prescriptions from an indication based electronic prescribing system. BMJ, 356, j603.
Yesavage, J. A. et al. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 3749.
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International Psychogeriatrics
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