Use of antidepressants for dementia in elderly long-term care residents increasing in Ontario

TORONTO — Data from a population-based, time-series analysis conducted in Ontario demonstrate the dispensing rate of benzodiazepines among elderly patients with dementia living in long-term care facilities decreased, while the prescribing rate of sedative and non-sedative antidepressants in this population more than doubled over the last 10 years (2004-2013). On the other hand, the dispensing rate of atypical antipsychotics still remains high and is projected to remain high.

According to Akshya Vasudev, MBBS, MD, MRCPsych, PG Cert Med Ed, assistant professor of geriatric psychiatry in the department of psychiatry at Western University, London, ON, two out of three elderly patients in long-term care settings suffer from dementia. Of these, about 80% present with neuropsychiatric symptoms like anxiety, depression, agitation, psychiatric distress, psychosis and/or insomnia. Psychotropic medications are often used to manage these symptoms, though guidelines worldwide have cautioned against the use of antipsychotics as first-line treatment, he said.

Akshya Vasudev

Using data from various Canadian databases, Vasudev and colleagues analyzed dispensing patterns among all patients aged 66 years or older with dementia living in long-term care facilities in Ontario between January 1, 2004 and March 31, 2013 (n = 49,251). The mean age of patients was 84 years and 73.51% were female.

Based on their data, Vasudev et al reported a large increase in the dispensing rate of both sedative and non-sedative antidepressants. Specifically, the rate of sedative antidepressant use nearly doubled, from 16% to 31%, and the rate of non-sedative antidepressant use increased from 26% to more than 36%. Fortunately, according to Vasudev, there was a decrease in the use of benzodiazepines (from about 38% to around 18%) and a slight fall in atypical antipsychotics (from 38% to 34%) over the last 10 years. However, the use of antiepileptics remained high, despite recent guidelines showing that they can cause further memory problems in the context of treatment of dementia, he said.

Vasudev noted limitations of the study, including inherent biases associated with retrospective analyses, and the fact that health care databases do not code dementia using research based diagnostic criteria.

“Usage of sedative antidepressants in patients with dementia living in long-term care, including drugs like mirtazapine and trazodone, has doubled over the last 10 years and will likely continue to increase over the next 4 years, without any evidence base to drive this usage. This could be potentially dangerous as such drugs, by their nature are sedating and would make such vulnerable patients prone to further confusion and likely falls,” Vasudev told Healio.com/Psychiatry. – by Stacey L. Adams

Disclosure: Vasudev reports no relevant financial disclosures.

Reference:

Vasudev A. Increasing usage of sedative anti-depressants in long-term care homes among elderly with dementia: A population-based time-series analysis. Presented at: The American Psychiatric Association Annual Meeting; May 16-20, 2015; Toronto.