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Supplementary data: A real-world analysis of antidepressant medications in US veterans aged 60 years and older: a comparative analysis

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posted on 2025-01-29, 14:56 authored by Ryan Pittman, S. Scott Sutton, Joseph Magagnoli, Tammy H. Cummings

These are peer-reviewed supplementary materials for the article 'A real-world analysis of antidepressant medications in US veterans aged 60 years and older: a comparative analysis' published in the Journal of Comparative Effectiveness Research.

  • Table S1: Complete list of antidepressants
  • Table S2: Complete list of non-antidepressant augmentation drugs
  • Table S3: Complete breakdown of baseline comorbidities
  • Table S4: Outcomes by treatment
  • Table S5: Psychiatric hospitalization definition
  • Table S6: Average number of observation days in study for each treatment for each outcome
  • Table S7: Psychological hospitalization hazard ratios (reference = sertraline)
  • Table S8: aHR for changing, augmenting, or hospitalization for patients with at least a 90-day observation period, right censored after 730 days (2 years)

Aim: To compare the safety and efficacy of antidepressants (AD) among older adults with major depressive disorder (MDD) by assessing treatment change, augmentation and hospitalization rates. Methods: This retrospective study analyzed data from the Veterans Affairs (VA) database, including 142,138 patients aged ≥60 years diagnosed with MDD. Patients prescribed bupropion, citalopram, duloxetine, escitalopram, fluoxetine, mirtazapine, paroxetine, sertraline, or venlafaxine were included. Outcomes were treatment change, augmentation and hospitalization rates. Hazard ratios (aHRs) were calculated using sertraline as the reference. Results: Of the patients, 39.6% required augmentation, 18.1% changed antidepressant treatment and 13.3% were hospitalized. The corresponding incidence rate was 544, 124 and 122 events per 1000 person-years. Compared with sertraline, mirtazapine users had the highest AD change risk (aHR 1.34, 95% CI: 1.29–1.40), while duloxetine users had the lowest (aHR 0.87, 95% CI: 0.83–0.92). Duloxetine also had the lowest augmentation risk (aHR 0.89, 95% CI: 0.86–0.92). Mirtazapine users also had the highest risks of augmentation (aHR 1.15, 95% CI: 1.12–1.18) and hospitalization (aHR 1.14, 95% CI: 1.07–1.23). Bupropion had the lowest hospitalization risk (aHR 0.77, 95% CI: 0.71–0.84). Conclusion: Antidepressant choice significantly influences treatment outcomes in older adults with MDD. Duloxetine demonstrated the best profile with the lowest risks of AD change and augmentation, while mirtazapine posed the highest risks of all three outcomes. Personalized treatment strategies are crucial to improving outcomes in this population.

Funding

This material is the result ofwork supported with resources and the use of facilities at the Dorn Research institute, Columbia VA Health Care System, Columbia,South Carolina.

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