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Antidepressant use in Alzheimer's disease patients: results of the REAL.FR cohort

Published online by Cambridge University Press:  07 September 2009

Christophe Arbus ,
Virginie Gardette ,
Eric Bui ,
Christelle Cantet ,
Sandrine Andrieu ,
Fati Nourhashémi ,
Laurent Schmitt  and
Bruno Vellas
Christophe Arbus*
Affiliation:
Traumatic Stress Laboratory, Paul Sabatier University, Department of Psychiatry and Medical Psychology, Purpan-Casselardit Hospital, Toulouse, France
Virginie Gardette
Affiliation:
INSERM U558, Department of Epidemiology and Public Health, Faculty of Medicine, Toulouse, France
Eric Bui
Affiliation:
Traumatic Stress Laboratory, Paul Sabatier University, Department of Psychiatry and Medical Psychology, Purpan-Casselardit Hospital, Toulouse, France
Christelle Cantet
Affiliation:
INSERM U558, Department of Epidemiology and Public Health, Faculty of Medicine, Toulouse, France
Sandrine Andrieu
Affiliation:
INSERM U558, Department of Epidemiology and Public Health, Faculty of Medicine, Toulouse, France
Fati Nourhashémi
Affiliation:
INSERM U558, Department of Epidemiology and Public Health, Faculty of Medicine, Toulouse, France Gerontopole, Department of Internal Medicine and Clinical Gerontology, Alzheimer Centre, Toulouse, France
Laurent Schmitt
Affiliation:
Traumatic Stress Laboratory, Paul Sabatier University, Department of Psychiatry and Medical Psychology, Purpan-Casselardit Hospital, Toulouse, France
Bruno Vellas
Affiliation:
INSERM U558, Department of Epidemiology and Public Health, Faculty of Medicine, Toulouse, France Gerontopole, Department of Internal Medicine and Clinical Gerontology, Alzheimer Centre, Toulouse, France
*
Correspondence should be addressed to: Christophe Arbus, Department of Psychiatry and Medical Psychology, Purpan-Casselardit Hospital, 31059 Toulouse, France. Phone: +33 561772351; Fax: +33 561777646. Email: arbus.c@chu-toulouse.fr.
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Abstract

Background: Psychotropic medication is widely prescribed in clinical practice for the management of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD). However, there have been few pharmaco-epidemiological studies or studies conducted in a natural setting on the real use of antidepressants in AD. The aim of this survey was to assess the prevalence of antidepressant use in AD and to identify the clinical factors associated with antidepressant prescription.

Methods: REAL.FR is a four-year, prospective, multi-center study. Baseline data including demographic characteristics, clinical variables and drug intake were obtained. Depressive symptoms were determined using the Neuropsychiatric Inventory (NPI).

Results: A total of 686 AD patients were included. Antidepressant treatment was prescribed for 34.8% of patients. Clinically significant depressive symptoms (NPI ≥ 4) were observed in 20.5% of the total population. Although depressed subjects were significantly more likely to be treated with antidepressants than non-depressed subjects (p<0.0001), only 60% of depressed subjects overall were prescribed an antidepressant. In multivariate analysis, clinically significant depressive symptoms were associated with antidepressant prescription although this result was only observed in subjects without a previous history of depression.

Conclusions: The available data on antidepressant efficacy in BPSD other than depression (in particular, agitation, aggression and, occasionally, psychotic symptoms) do not influence prescription choices. Depressive symptoms may be taken more seriously in the absence of a previous history of depression, leading to increased antidepressant prescription rates in individuals presenting with depression for the first time.

Keywords

psychotropicsdementiadepressive symptomsbehavioral and psychological symptomscommunity-dwelling
Type
Research Article
Information
International Psychogeriatrics , Volume 22 , Issue 1 , February 2010 , pp. 120 - 128
Copyright
Copyright © International Psychogeriatric Association 2009

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