Antidepressant use at the threshold: people prescribed antidepressants around the time of a dementia diagnosis.
Antidepressant use is common in people with dementia, and many start around the time of diagnosis. We hypothesised that those who commenced antidepressants at dementia diagnosis started for dementia-related symptoms, distinct from those with longstanding prescriptions, resulting in different characteristics in electronic records.
We carried out a retrospective cohort study using linked primary care (Lambeth DataNet) and mental health (Clinical Record Interactive Search) data for patients with dementia in south London, UK in 2009-22. Antidepressant prescription starting within one year before or after dementia diagnosis identified as 'new'. Dementia and anxiety were described using coded fields, a rating scale for neuropsychiatric symptoms and natural language processing of full-text.
Of 3713 patients with dementia, 28% were prescribed an antidepressant in the year of dementia diagnosis. 42% of these were 'new' prescriptions. Compared to the no antidepressant group, 'new' starters were more likely to be female (odds ratio (OR) 1.33, 95% 1.08-1.64) and have vascular dementia (OR 1.44, 1.13-1.83). Compared to longstanding antidepressant group, 'new' had similar depression and anxiety symptoms, but fewer coded mentions (OR 0.50, 0.39-0.65), especially those 'new' from non-White ethnicities. Deprescribing was equally unlikely in 'new' and longstanding (6.3% vs 5.5% per year of follow-up).
There is a high prevalence and lack of deprescribing, despite guidelines cautioning antidepressants. This points to unmet needs at the threshold of dementia. Clinicians should ensure good documentation of indication for antidepressants and proactive medication reviews for people with dementia.
We carried out a retrospective cohort study using linked primary care (Lambeth DataNet) and mental health (Clinical Record Interactive Search) data for patients with dementia in south London, UK in 2009-22. Antidepressant prescription starting within one year before or after dementia diagnosis identified as 'new'. Dementia and anxiety were described using coded fields, a rating scale for neuropsychiatric symptoms and natural language processing of full-text.
Of 3713 patients with dementia, 28% were prescribed an antidepressant in the year of dementia diagnosis. 42% of these were 'new' prescriptions. Compared to the no antidepressant group, 'new' starters were more likely to be female (odds ratio (OR) 1.33, 95% 1.08-1.64) and have vascular dementia (OR 1.44, 1.13-1.83). Compared to longstanding antidepressant group, 'new' had similar depression and anxiety symptoms, but fewer coded mentions (OR 0.50, 0.39-0.65), especially those 'new' from non-White ethnicities. Deprescribing was equally unlikely in 'new' and longstanding (6.3% vs 5.5% per year of follow-up).
There is a high prevalence and lack of deprescribing, despite guidelines cautioning antidepressants. This points to unmet needs at the threshold of dementia. Clinicians should ensure good documentation of indication for antidepressants and proactive medication reviews for people with dementia.
Authors
Heybe Heybe, Verma Verma, Pozuelo Moyano Pozuelo Moyano, Stewart Stewart, Mueller Mueller, Davis Davis
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