Comparative Effectiveness of Second-Generation Antidepressants in Reducing the Risk of Dementia in Elderly Nursing Home Residents with Depression

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

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Study Objective Second-generation antidepressants have been shown to improve cognition and depression symptomatology, which are the major risk factors for dementia; however, little is known about the comparative effectiveness of antidepressants in reducing the risk of dementia. Thus, the objective of this study was to evaluate the long-term comparative effectiveness of different antidepressant classes in reducing the risk of dementia in elderly nursing home residents with depression. Design Propensity score-adjusted retrospective cohort study. Data Source Multistate Minimum Data Set-linked Medicare Parts A, B, and D data files. Patients A total of 25,108 nursing home residents (65 years and older) with a diagnosis of depression and without a dementia diagnosis who were Medicare beneficiaries and new users of selective serotonin reuptake inhibitors (SSRIs; 19,952 [79.5%]), serotonin-norepinephrine reuptake inhibitors (SNRIs; 2381 [9.5%]), or tetracyclic antidepressants (2775 [11.1%]) between 2007 and 2010. Measurements and Main Results New users of SSRIs, SNRIs, and tetracyclics were followed over a 2-year period for the occurrence of dementia. A Cox proportional hazards regression model was used to evaluate the comparative effectiveness of SNRIs and tetracyclics in reducing the risk of dementia, with the SSRI class used as the reference category after controlling for propensity scores and their interactions terms. The unadjusted incidence of dementia was 8.2% for SSRI users, 6.0% for SNRI users, and 7.2% for tetracyclic users. The propensity score-adjusted Cox model did not find any significant difference in the risk of dementia in elderly nursing home residents who used SNRIs (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.84-1.19) or tetracyclics (HR 1.01, 95% CI 0.87-1.17) compared with the SSRI users. Conclusion This study did not find any significant differences in reducing the risk of dementia among the new users of second-generation antidepressant classes. Further studies are needed to evaluate the profiles of second-generation antidepressants on cognition in this vulnerable population.

Original languageEnglish
Pages (from-to)38-48
Number of pages11
JournalPharmacotherapy
Volume36
Issue number1
DOIs
StatePublished - 1 Jan 2016

Fingerprint

Nursing Homes
Antidepressive Agents
Dementia
Depression
Propensity Score
Information Storage and Retrieval
Proportional Hazards Models
Cognition
Medicare Part A
Medicare Part B
Medicare Part D
Confidence Intervals
Serotonin Uptake Inhibitors
Vulnerable Populations
Medicare
Serotonin and Noradrenaline Reuptake Inhibitors
Cohort Studies
Retrospective Studies
Incidence

Keywords

  • dementia
  • depression
  • elderly
  • nursing home residents
  • second-generation antidepressants
  • selective serotonin reuptake inhibitor
  • serotonin-norepinephrine reuptake inhibitor
  • tetracyclics

Cite this

Bali, Vishal ; Holmes, Holly M. ; Johnson, Michael L. ; Chen, Hua ; Fleming, Marc Labaron ; Aparasu, Rajender R. / Comparative Effectiveness of Second-Generation Antidepressants in Reducing the Risk of Dementia in Elderly Nursing Home Residents with Depression. In: Pharmacotherapy. 2016 ; Vol. 36, No. 1. pp. 38-48.
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abstract = "Study Objective Second-generation antidepressants have been shown to improve cognition and depression symptomatology, which are the major risk factors for dementia; however, little is known about the comparative effectiveness of antidepressants in reducing the risk of dementia. Thus, the objective of this study was to evaluate the long-term comparative effectiveness of different antidepressant classes in reducing the risk of dementia in elderly nursing home residents with depression. Design Propensity score-adjusted retrospective cohort study. Data Source Multistate Minimum Data Set-linked Medicare Parts A, B, and D data files. Patients A total of 25,108 nursing home residents (65 years and older) with a diagnosis of depression and without a dementia diagnosis who were Medicare beneficiaries and new users of selective serotonin reuptake inhibitors (SSRIs; 19,952 [79.5{\%}]), serotonin-norepinephrine reuptake inhibitors (SNRIs; 2381 [9.5{\%}]), or tetracyclic antidepressants (2775 [11.1{\%}]) between 2007 and 2010. Measurements and Main Results New users of SSRIs, SNRIs, and tetracyclics were followed over a 2-year period for the occurrence of dementia. A Cox proportional hazards regression model was used to evaluate the comparative effectiveness of SNRIs and tetracyclics in reducing the risk of dementia, with the SSRI class used as the reference category after controlling for propensity scores and their interactions terms. The unadjusted incidence of dementia was 8.2{\%} for SSRI users, 6.0{\%} for SNRI users, and 7.2{\%} for tetracyclic users. The propensity score-adjusted Cox model did not find any significant difference in the risk of dementia in elderly nursing home residents who used SNRIs (hazard ratio [HR] 0.99, 95{\%} confidence interval [CI] 0.84-1.19) or tetracyclics (HR 1.01, 95{\%} CI 0.87-1.17) compared with the SSRI users. Conclusion This study did not find any significant differences in reducing the risk of dementia among the new users of second-generation antidepressant classes. Further studies are needed to evaluate the profiles of second-generation antidepressants on cognition in this vulnerable population.",
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Comparative Effectiveness of Second-Generation Antidepressants in Reducing the Risk of Dementia in Elderly Nursing Home Residents with Depression. / Bali, Vishal; Holmes, Holly M.; Johnson, Michael L.; Chen, Hua; Fleming, Marc Labaron; Aparasu, Rajender R.

In: Pharmacotherapy, Vol. 36, No. 1, 01.01.2016, p. 38-48.

Research output: Contribution to journalArticle

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N2 - Study Objective Second-generation antidepressants have been shown to improve cognition and depression symptomatology, which are the major risk factors for dementia; however, little is known about the comparative effectiveness of antidepressants in reducing the risk of dementia. Thus, the objective of this study was to evaluate the long-term comparative effectiveness of different antidepressant classes in reducing the risk of dementia in elderly nursing home residents with depression. Design Propensity score-adjusted retrospective cohort study. Data Source Multistate Minimum Data Set-linked Medicare Parts A, B, and D data files. Patients A total of 25,108 nursing home residents (65 years and older) with a diagnosis of depression and without a dementia diagnosis who were Medicare beneficiaries and new users of selective serotonin reuptake inhibitors (SSRIs; 19,952 [79.5%]), serotonin-norepinephrine reuptake inhibitors (SNRIs; 2381 [9.5%]), or tetracyclic antidepressants (2775 [11.1%]) between 2007 and 2010. Measurements and Main Results New users of SSRIs, SNRIs, and tetracyclics were followed over a 2-year period for the occurrence of dementia. A Cox proportional hazards regression model was used to evaluate the comparative effectiveness of SNRIs and tetracyclics in reducing the risk of dementia, with the SSRI class used as the reference category after controlling for propensity scores and their interactions terms. The unadjusted incidence of dementia was 8.2% for SSRI users, 6.0% for SNRI users, and 7.2% for tetracyclic users. The propensity score-adjusted Cox model did not find any significant difference in the risk of dementia in elderly nursing home residents who used SNRIs (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.84-1.19) or tetracyclics (HR 1.01, 95% CI 0.87-1.17) compared with the SSRI users. Conclusion This study did not find any significant differences in reducing the risk of dementia among the new users of second-generation antidepressant classes. Further studies are needed to evaluate the profiles of second-generation antidepressants on cognition in this vulnerable population.

AB - Study Objective Second-generation antidepressants have been shown to improve cognition and depression symptomatology, which are the major risk factors for dementia; however, little is known about the comparative effectiveness of antidepressants in reducing the risk of dementia. Thus, the objective of this study was to evaluate the long-term comparative effectiveness of different antidepressant classes in reducing the risk of dementia in elderly nursing home residents with depression. Design Propensity score-adjusted retrospective cohort study. Data Source Multistate Minimum Data Set-linked Medicare Parts A, B, and D data files. Patients A total of 25,108 nursing home residents (65 years and older) with a diagnosis of depression and without a dementia diagnosis who were Medicare beneficiaries and new users of selective serotonin reuptake inhibitors (SSRIs; 19,952 [79.5%]), serotonin-norepinephrine reuptake inhibitors (SNRIs; 2381 [9.5%]), or tetracyclic antidepressants (2775 [11.1%]) between 2007 and 2010. Measurements and Main Results New users of SSRIs, SNRIs, and tetracyclics were followed over a 2-year period for the occurrence of dementia. A Cox proportional hazards regression model was used to evaluate the comparative effectiveness of SNRIs and tetracyclics in reducing the risk of dementia, with the SSRI class used as the reference category after controlling for propensity scores and their interactions terms. The unadjusted incidence of dementia was 8.2% for SSRI users, 6.0% for SNRI users, and 7.2% for tetracyclic users. The propensity score-adjusted Cox model did not find any significant difference in the risk of dementia in elderly nursing home residents who used SNRIs (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.84-1.19) or tetracyclics (HR 1.01, 95% CI 0.87-1.17) compared with the SSRI users. Conclusion This study did not find any significant differences in reducing the risk of dementia among the new users of second-generation antidepressant classes. Further studies are needed to evaluate the profiles of second-generation antidepressants on cognition in this vulnerable population.

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