A Community Clinician Led Review of Antidepressant Drugs in a Scottish Nursing Home

Lloyd David Hughes, Catriona Elizabeth Neil, Grace Reyes

Abstract


Introduction

Prevalence rates for depression are consistently high in patients with dementia and it is known to increase morbidity and mortality levels. Management with antidepressant drugs, often viewed as innocuous medication, may have adverse drug reactions (ADRs) including orthostatic hypotension, anticholinergic effects and worsening cognition.

 

Hypothesis

In this study we hypothesized that the implementation of a clinician led review process of all antidepressant medications in a nursing home would reduce ADRs specifically related to antidepressant medications.

 

Methods

All 49 patient records in a Dundee nursing home were reviewed. All patients who were >65-years-old with dementia and a diagnosis of unipolar depression treated with a single antidepressant agent were eligible for the study. Patients were excluded if they were on any other psychoactive medications or on ≥ 5 general medications. In total 12 patients were included in the study. ADRs were recorded by antidepressant drug-class for a 2-month period before and after a GP review of antidepressant drugs.

 

Results

12 of 49 patients (25%) received treatment with antidepressant drugs including SSRIs, SNRIs and TCAs. Various ADRs were documented (Table 1).  The number of documented ADRs reduced from 5 in the control period to 2 in the study period, although this did not reach statistical significance (p-value= 0.06). Prescription of TCAs ceased after GP review with patients switched to SSRIs.

 

Conclusions

Antidepressant drugs are commonly prescribed for residents in nursing homes. A clinician led antidepressant drug review resulted in treatment changes and a trend to reduced ADRs. Importantly, TCAs (high risk drugs associated with falls) were immediately stopped after review despite being prescribed on repeat prescription for months. The authors feel reviewing all psychoactive drug prescriptions and avoiding repeat prescriptions in nursing home residents may be beneficial in reducing ADRs.


Keywords


geriatrics; nursing homes; depression

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