Comparative Cognitive Profile of Second-Generation Antidepressants in Elderly Nursing Home Residents With Depression

Vishal Bali, Michael L. Johnson, Hua Chen, Marc Labaron Fleming, Holly M. Holmes, Rajender R. Aparasu

Research output: Contribution to journalArticle

Abstract

Background: Past literature suggests that the use of second-generation antidepressants improves cognition in depressed elderly patients. Objective: This study assessed the comparative cognitive profile of commonly used second-generation antidepressant classes in elderly residents with depression. Methods: A multiple propensity score adjusted retrospective cohort study was conducted using 2007-2010 Medicare Part D claims and Minimum Data Set (MDS). Elderly nursing home residents (65 years or older) with depression using a new prescription of selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tetracyclics constituted the study cohort. The outcome of interest was cognition, measured using the MDS Cognition Scale. Cognition was measured at each quarterly assessment after antidepressant initiation for a maximum of 1 year. The propensity score–adjusted repeated-measures mixed model was used to evaluate the comparative profile of SSRIs, SNRIs, and tetracyclics with respect to cognition. Results: The study cohort comprised 1518 elderly nursing home residents. Of these, 1081 received SSRIs (71.21%), 320 received tetracyclics (21.08%), and 117 received SNRIs (7.71%). The propensity score–adjusted repeated-measures mixed model did not show any statistically significant difference in cognition with the use of SSRIs (β = −0.14; 95% CI = −0.53, 0.25) or tetracyclics (β = −0.36; 95% CI = −0.80, 0.08) when compared with SNRIs, after controlling for other factors. Conclusions: The cognitive effect of SSRIs, SNRIs, and tetracyclics was similar in elderly nursing home residents with depression. Further studies are needed to evaluate the long-term cognitive effects of second-generation antidepressants in this vulnerable population.

Original languageEnglish
Pages (from-to)96-105
Number of pages10
JournalAnnals of Pharmacotherapy
Volume50
Issue number2
DOIs
StatePublished - 1 Feb 2016

Fingerprint

Nursing Homes
Cognition
Antidepressive Agents
Serotonin Uptake Inhibitors
Depression
Cohort Studies
Medicare Part D
Propensity Score
Vulnerable Populations
Prescriptions
Retrospective Studies
Serotonin and Noradrenaline Reuptake Inhibitors

Keywords

  • cognition
  • depression
  • elderly
  • nursing home residents
  • second-generation antidepressants

Cite this

Bali, Vishal ; Johnson, Michael L. ; Chen, Hua ; Fleming, Marc Labaron ; Holmes, Holly M. ; Aparasu, Rajender R. / Comparative Cognitive Profile of Second-Generation Antidepressants in Elderly Nursing Home Residents With Depression. In: Annals of Pharmacotherapy. 2016 ; Vol. 50, No. 2. pp. 96-105.
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abstract = "Background: Past literature suggests that the use of second-generation antidepressants improves cognition in depressed elderly patients. Objective: This study assessed the comparative cognitive profile of commonly used second-generation antidepressant classes in elderly residents with depression. Methods: A multiple propensity score adjusted retrospective cohort study was conducted using 2007-2010 Medicare Part D claims and Minimum Data Set (MDS). Elderly nursing home residents (65 years or older) with depression using a new prescription of selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tetracyclics constituted the study cohort. The outcome of interest was cognition, measured using the MDS Cognition Scale. Cognition was measured at each quarterly assessment after antidepressant initiation for a maximum of 1 year. The propensity score–adjusted repeated-measures mixed model was used to evaluate the comparative profile of SSRIs, SNRIs, and tetracyclics with respect to cognition. Results: The study cohort comprised 1518 elderly nursing home residents. Of these, 1081 received SSRIs (71.21{\%}), 320 received tetracyclics (21.08{\%}), and 117 received SNRIs (7.71{\%}). The propensity score–adjusted repeated-measures mixed model did not show any statistically significant difference in cognition with the use of SSRIs (β = −0.14; 95{\%} CI = −0.53, 0.25) or tetracyclics (β = −0.36; 95{\%} CI = −0.80, 0.08) when compared with SNRIs, after controlling for other factors. Conclusions: The cognitive effect of SSRIs, SNRIs, and tetracyclics was similar in elderly nursing home residents with depression. Further studies are needed to evaluate the long-term cognitive effects of second-generation antidepressants in this vulnerable population.",
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Comparative Cognitive Profile of Second-Generation Antidepressants in Elderly Nursing Home Residents With Depression. / Bali, Vishal; Johnson, Michael L.; Chen, Hua; Fleming, Marc Labaron; Holmes, Holly M.; Aparasu, Rajender R.

In: Annals of Pharmacotherapy, Vol. 50, No. 2, 01.02.2016, p. 96-105.

Research output: Contribution to journalArticle

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