open access publication

Article, 2024

Comparative effectiveness of selective serotonin reuptake inhibitors (SSRIs) for depression in 43,061 older adults with chronic somatic diseases: A Danish target trial emulation study

GENERAL HOSPITAL PSYCHIATRY, ISSN 0163-8343, 0163-8343, Volume 87, Pages 83-91, 10.1016/j.genhosppsych.2024.02.002

Contributors

Ahmed, Kazi Ishtiak 0000-0003-3651-4612 (Corresponding author) [1] [2] Rohde, Christopher 0000-0001-9458-506X [1] [2] Otte, Christian [3] [4] [5] [6] Gasse, Christiane [1] [2] [4] [5] [6] Kohler-Forsberg, Ole [1] [2]

Affiliations

  1. [1] Aarhus Univ Hosp Psychiat, Dept Affect Disorders, Aarhus, Denmark
  2. [NORA names: Central Denmark Region; Hospital; Denmark; Europe, EU; Nordic; OECD];
  3. [2] Aarhus Univ, Dept Clin Med, DK- 8200 Aarhus N, Denmark
  4. [NORA names: AU Aarhus University; University; Denmark; Europe, EU; Nordic; OECD];
  5. [3] German Ctr Mental Hlth DZPG, Berlin, Germany
  6. [NORA names: Germany; Europe, EU; OECD];
  7. [4] Charite Univ Med Berlin, Dept Psychiat & Neurosci, Campus Benjamin Franklin,Hindenburgdamm 30, D-12203 Berlin, Germany
  8. [NORA names: Germany; Europe, EU; OECD];
  9. [5] Charite Univ Med Berlin, Dept Psychiat & Neurosci, Campus Benjamin Franklin,Hindenburgdamm 30, D-12203 Berlin, Germany
  10. [NORA names: Germany; Europe, EU; OECD];

Abstract

Objective: To investigate the comparative effectiveness of commonly used selective serotonin reuptake inhibitors (SSRIs) for comorbid depression in older adults with chronic somatic diseases by applying a target-trialemulation framework. Methods: Danish target-trial-emulation study including 43,061 individuals aged >= 65 years (54.1% females, mean age 77.8 years) with a first redeemed prescription for depression with sertraline (n = 6673), escitalopram (n = 7104) or citalopram (n = 29,284) in 2006-2017. Individuals had cancer, cardiovascular diseases (CVD), chronicobstructive-pulmonary-disease (COPD)/asthma, diabetes, neurodegenerative disorders, or osteoporosis. Outcomes were treatment switching, combination/augmentation, psychiatric hospital contact for depression, and any psychiatric in-patient care. Follow-up was one year and adjusted Cox regression analyses calculated hazard rate ratios (HRR) within each somatic disease. Results: Across all six disease groups and four outcomes, we found that citalopram use, compared with sertraline, was associated with lower risks in several analyses, with statistically significant results in cancer, CVD, COPD/ asthma, and diabetes (e.g., HRRs for psychiatric hospital contacts for depression/any psychiatric in-patient care ranging between 0.47 and 0.61). For escitalopram, compared with sertraline, some analyses indicated poorer outcomes with significantly higher risks for combination/augmentation treatment (HRRs ranging between 1.15 and 1.40). Conclusions: Although observational studies are prone to confounding, these findings indicate clinically relevant differences between the SSRIs, with better outcomes in citalopram users and poorer outcomes in escitalopram users than sertraline, urging the need for clinical studies in this vulnerable patient population.

Keywords

Antidepressants, Comorbid depression, Comparative effectiveness, Depressive disorders, Geriatric psychiatry, SSRIs

Data Provider: Clarivate