Overuse of antidepressants in older outpatients with Alzheimer's disease and associated disorders: an observational study.

Forty per cent of French subjects over 65 years old with Alzheimer's disease and related disorders (ADRD) are chronically exposed to antidepressants, suggesting an overuse of these drugs. The main objective of our study was to estimate the prevalence of the overuse of antidepressants in this population and the factors associated with this. METHODOLOGY: a single-centre, prospective, cross-sectional study carried out at the Bretonneau outpatient department between 1st December 2014 and 31st May 2015. All patients aged 70 and above, suffering from ADRD (according to DSM IV criteria) and currently being prescribed an antidepressant were eligible. "Overuse" was defined as off-label prescriptions or prescriptions that went beyond the recommended duration of treatment. This was assessed by the geriatrician in charge and validated by an expert committee, who were blind to the geriatrician's assessment. RESULTS: Fifty-four patients were included in the study (mean age: 82.9 years (± 5.4); 70.4% women; 60% with mild to moderate dementia). The main indication of antidepressant treatment was a major depressive episode (59.3%). The geriatrician could not reach a conclusion on overuse in 10 cases (18.5%). Inter-rater agreement between geriatricians and the expert committee was good (kappa coefficient: 0.73 [0.5-0.95]). Finally, 33 (61%) of these patients were overusing antidepressants: a third had an off-label prescription and two thirds had exceeded the recommended treatment duration. The only factor associated with this overuse was co-prescription of psychotropic drugs (p = 0.009). CONCLUSIONS: the overuse of antidepressants is common in older patients with dementia, particularly overuse due to exceeding the treatment duration. This is significantly associated with co-prescription with another psychotropic drug, suggesting that this represents a more global problem of the overuse of psychotropic drugs.

[Overuse of antidepressant in older outpatients with Alzheimer disease and associated disorders: an observational study]. / Excès de traitement par les antidépresseurs des sujets âgés atteints de maladie d'Alzheimer ou troubles apparentés dans le secteur ambulatoire.

Forty per cent of French subjects over 65 years old with Alzheimer's disease and related disorders (MATA) are chronically exposed to antidepressants suggesting an overuse of these drugs. The main objective of our study was to estimate the prevalence and factors associated with overuse by antidepressants in this population. METHODOLOGY: Single-center, prospective, cross-sectional study carried out at the Bretonneau Day Hospital (HDJ) between December, 1st 2014 and May, 31 2015. Consecutive patients with ≥70 years of age, suffering from MATA (according to DSM IV criteria) and current prescription of antidepressant were eligible. Overuse was defined by off-label prescriptions or prescriptions beyond the recommended duration of treatment. It was assessed by the geritrician in charge and validated by an expert committee, blind from the geriatrician's assessment. RESULTS: Fifty-four patients were included in the study (mean age 82.9 years (+/- 5.4), 70.4% of women, 60% with mild to moderate dementia). The main indication of antidepressant treatment was a major depressive episode (59.3%). The geriatrician could not deal with overuse for 10 cases (18.5%). Inter-rater agreement between geriatricians and expert committee was good (kappa coefficient 0.73 [0.5-0.95]). Finally 33 (61%) of these patients had overuse of antidepressants: 1/3 had an off-label prescription and 2/3 had an exceeded treatment duration. The only factor associated with this overuse was coprescription of psychotropic drugs (p=0.009). CONCLUSIONS: Antidepressant overuse is common in demented older outpatients, especially overuse due to exceeded treatment duration. It is significantly associated with coprescription with another psychotropic drug, suggesting that it fits into a more global problem of overuse in psychotropic drugs.

Off-label use of midazolam in older inpatients: analysis of prescribing practices in a French hospital (MIDnight study).

Midazolam is a short-acting benzodiazepine approved for sedation and anesthesia induction. Recent data suggested that midazolam may also be used in off-label indications such as treatment of behavioral and psychological disturbances in older people. Given the scarcity of published data and a lack of evidence in older people in such indications, midazolam raises concern because it may also cause serious-related adverse events. To provide a better understanding of its real-life use in geriatrics, we examined the prescribing practices of midazolam in French older inpatients. Of the 460 patients aged 65 years and over hospitalized at the time of the study, 21 had a prescription of midazolam (5%) which was mainly prescribed for anxiolysis (n = 12), premedication before painful procedures (n = 5), and agitation (n = 4). Midazolam was often prescribed "as required," and the median duration of prescription was 6 months. This work results in a better knowledge and information about the use of midazolam in older people. These prescribing practices, which are not anecdotal, also plead for age-specific guidelines for the treatment of behavioral and psychological disturbances.