Aging
Antidepressant initiation, quitting, and continued use in a nationally representative cohort of older adults Maria Springall De Pablo* Maria Springall De Pablo Diane S Lauderdale
Antidepressants (AD) are widely prescribed. There are several drug classes, and their effectiveness and side effects vary for individuals. Benzodiazepines are deemed inappropriate for older adults. Using a nationally representative longitudinal study of older adults, the National Social Life, Health and Aging Project (NSHAP), we present a descriptive analysis of AD use among 4,907 older adults, measured in 2015/16 (W3) and again in 2022/23 (W4), and sociodemographic associations of patterns of longitudinal use. W3 data were collected by interviewers examining medications in the home, but W4 was multimodal due to the pandemic. Sociodemographics include age, gender, race/ethnicity, education, assets (logged), and social isolation (marital status and frequency of group participation). 18% in W3 and 22% in W4 were AD users. In W3, 43% of AD prescriptions were for selective serotonin reuptake inhibitors (SSRI), 13% for serotonin-norepinephrine reuptake inhibitors (SNRI), and 13% for benzodiazepines. Distribution in W4 was similar. Logistic multinomial models compared correlates of sustained, quitting and initiating AD users to consistent nonusers. Among 2,728 participants in both waves, significant RRRs for female compared to male were 2.6 (95% CI 1.9, 3.5), 4.0 (95% CI 1.9, 8.5) and 1.7 (95% CI 1.1, 2.6) for sustained, quitting and initiating use, respectively. Black and Hispanic participants had much lower RRRs for sustained use, with similar results for initiation. In addition, greater log household assets were significantly associated with lower RRR (0.85; 95% CI 0.79, 0.81). Education and marital status were not associated with any of the use patterns. Greater frequency of volunteering and religious service attendance were associated with less risk of quitting AD use. Older adults are still being prescribed benzodiazepines despite guidelines. While wealth was protective, social participation appears to maintain rather than decrease AD use over time.