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Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders

ORCID
0000-0003-2750-0606
Affiliation
Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany; Faculty of Medicine, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany; Evangelical Foundation Neuerkerode, Braunschweig, Germany
Wolff, Jan;
ORCID
0000-0001-8171-0861
Affiliation
Vitos Hochtaunus, Friedrichsdorf, Germany
Reißner, Pamela;
GND
1076419399
ORCID
0000-0001-5892-8993
Affiliation
Vitos Clinic for Forensic Psychiatry, Eltville, Germany
Hefner, Gudrun;
GND
114687706
ORCID
0000-0001-5693-8936
Affiliation
Faculty of Medicine, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
Normann, Claus;
GND
1027542255
ORCID
0000-0003-0837-6945
Affiliation
Faculty of Medicine, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
Kaier, Klaus;
GND
131507982
ORCID
0000-0002-5666-8662
Affiliation
Faculty of Medicine, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
Binder, Harald;
GND
1145417272
ORCID
0000-0003-2820-8738
Affiliation
Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
Hiemke, Christoph;
GND
132612313
ORCID
0000-0002-8859-6907
Affiliation
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
Toto, Sermin;
GND
129665525
ORCID
0000-0002-2550-9132
Affiliation
Faculty of Medicine, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
Domschke, Katharina;
GND
121488071
ORCID
0000-0002-5921-3073
Affiliation
Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany
Marschollek, Michael;
GND
11198713X
ORCID
0000-0002-1160-5270
Affiliation
Vitos Hochtaunus, Friedrichsdorf, Germany; Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
Klimke, Ansgar

Introduction

The aim of this study was to describe the number and type of drugs used to treat depressive disorders in inpatient psychiatry and to analyse the determinants of potential drug-drug interactions (pDDI) and potentially inappropriate medication (PIM).

Methods

Our study was part of a larger pharmacovigilance project funded by the German Innovation Funds. It included all inpatients with a main diagnosis in the group of depressive episodes (F32, ICD-10) or recurrent depressive disorders (F33) discharged from eight psychiatric hospitals in Germany between 1 October 2017 and 30 September 2018 or between 1 January and 31 December 2019.

Results

The study included 14,418 inpatient cases. The mean number of drugs per day was 3.7 (psychotropic drugs = 1.7; others = 2.0). Thirty-one percent of cases received at least five drugs simultaneously (polypharmacy). Almost one half of all cases received a combination of multiple antidepressant drugs (24.8%, 95% CI 24.1%-25.5%) or a treatment with antidepressant drugs augmented by antipsychotic drugs (21.9%, 95% CI 21.3%-22.6%). The most frequently used antidepressants were selective serotonin reuptake inhibitors, followed by serotonin and norepinephrine reuptake inhibitors and tetracyclic antidepressants. In multivariate analyses, cases with recurrent depressive disorders and cases with severe depression were more likely to receive a combination of multiple antidepressant drugs (Odds ratio recurrent depressive disorder: 1.56, 95% CI 1.41-1.70, severe depression 1.33, 95% CI 1.18-1.48). The risk of any pDDI and PIM in elderly patients increased substantially with each additional drug (Odds Ratio: pDDI 1.32, 95% CI: 1.27-1.38, PIM 1.18, 95% CI: 1.14-1.22) and severity of disease (Odds Ratio per point on CGI-Scale: pDDI 1.29, 95% CI: 1.11-1.46, PIM 1.27, 95% CI: 1.11-1.44), respectively.

Conclusion

This study identified potential sources and determinants of safety risks in pharmacotherapy of depressive disorders and provided additional data which were previously unavailable. Most inpatients with depressive disorders receive multiple psychotropic and non-psychotropic drugs and pDDI and PIM are relatively frequent. Patients with a high number of different drugs must be intensively monitored in the management of their individual drug-related risk-benefit profiles.

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