Introduction: Depression is a common mental disorder that occurs in all age groups and affects both the individual and his/her family, but also the social environment. Pharmacotherapy of depression with antidepressants (AD) is one of the foundations of treatment. A proper patient treatment covers a major importance in our days, with the population aging trend and the increasing consumption of AD in Slovenia - among which the elderly receive the highest proportion and are mainly subject to polypharmacotherapy. Treatment guidelines for patients, who do not respond fully to the initial AD treatment, among others recommend the substitution of AD.
Purpose: The aim of this retrospective study was to review the dynamics of AD switch (Anatomical Therapeutic Chemical (ATC) Classification N06A) and to assess the associated factors in the elderly during hospital treatment.
Methods: Inpatients aged 65 years or over, with various forms of depression, adjustment disorder or diagnosis of a reaction to severe stress, who were hospitalized between 2016 and 2017 at the Department of Psychiatry (Psychogeriatric Unit) of the University Medical Centre Maribor, were included. Demographic and clinical data were recorded. We focused mainly on treatment with AD within a hospitalization. After the examination of patient medical records, patients were divided into groups with and without switch of AD, and a comparison was made between them. In patients with switch, we paid additional attention to the time, type of replacement and the reasons for such decision.
Results: The research sample included 175 patients in total, of which 40.6 % (71/175) were subject to at least one switch of AD during the hospitalization. Most of them were receiving AD before hospitalization. The most used pre-switching AD was citalopram/escitalopram, while mirtazapine was the most frequently prescribed post switching AD. Among switching options cross-tapering and abrupt switch prevailed. The reason for switch, identified as the most common, was lack of efficacy. At the time of patient discharge, the least prescribed drugs were the tricyclic AD, moclobemide and fluoxetine, whereas the most predominant was mirtazapine. In light of the recommendations given, AD replacements were often made too quickly. In 39.8 % of cases, they were carried out earlier than 4 weeks from initiation (in 56.0 % of these even before 2 weeks). Switchers (40 days) had statistically significant longer length of hospitalization comparing to non-switchers (24 days) (p<0,001). The higher was the number of switches, statistically significant longer has become the hospital stay for these patients (p<0,001).
Conclusion: When switches of AD are recurrent and precocious, i.e. done even before a full clinical effect can be expressed, suspension of a potentially effective drug may occur. Moreover, such action can considerably extend hospital treatment and the possibility of higher health care costs can also arise. In this respect the clinical pharmacist may play an important role in monitoring the adequacy of the therapeutic strategy.
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