What question did this study set out to answer?

To examine how nonpsychiatric physicians prescribe antidepressants to depressed, medically ill elderly inpatients during hospitalization and after discharge.

October 1, 1997American Journal of Psychiatry

Use of antidepressants by nonpsychiatrists in the treatment of medically ill hospitalized depressed elderly patients

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Why the study?

What is the pattern of antidepressant use by nonpsychiatrists in depressed elderly medical inpatients?

Population

153 depressed elderly medical inpatients (aged 60 or older) admitted to medical services at Duke Hospital

Design

Cohort

Follow-up

median 45 weeks

Authors

HKHarold G. KoenigKing Abdulaziz University LGLinda K. GeorgeDuke University KMKeith G. MeadorVanderbilt University

Discussion

Member takes

Implication

May indicate under-treatment and suboptimal prescribing in elderly inpatients; leaves open whether targeted interventions improve patterns.

Key Points

To examine how nonpsychiatric physicians prescribe antidepressants to depressed, medically ill elderly inpatients during hospitalization and after discharge.
Evaluated 153 medical inpatients aged 60 or older at Duke Hospital diagnosed with major or minor depression via structured psychiatric interviews.
Audited medical records before admission, during hospital stay, and at discharge, with four follow-up telephone interviews conducted over a median of 45 weeks.
Overall, 40.5% of the 153 depressed patients received antidepressants, 25.5% received only benzodiazepines, and 34.0% received neither during hospitalization or follow-up.
Only 15 of 114 untreated patients began antidepressants while hospitalized, with amitriptyline being the most common agent (45.2% of treated patients) at an average maximum dose of 49 mg/day.
Among 91 patients untreated before or during admission, only 11% initiated antidepressant therapy during follow-up, typically receiving subtherapeutic amitriptyline doses of 10–30 mg/day.

Structured PICO

What is the pattern of antidepressant use by nonpsychiatrists in depressed elderly medical inpatients?

Population

153 depressed elderly medical inpatients (aged 60 or older) admitted to medical services at Duke Hospital

Intervention

Antidepressant therapy prescribed by nonpsychiatrists

Outcome

Use of antidepressants and benzodiazepines before admission, during hospitalization, and on discharge/follow-up

A low proportion of depressed older medical inpatients receive antidepressants, and those treated often receive potentially dangerous tertiary tricyclics at inadequate doses.

Cite This Study

Koenig et al. (1997) studied this question.

synapsesocial.com/papers/6a98668111136821b5f37c8a https://doi.org/10.1176/ajp.154.10.1369

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Implication

May indicate under-treatment and suboptimal prescribing in elderly inpatients; leaves open whether targeted interventions improve patterns.

Use of antidepressants by nonpsychiatrists in the treatment of medically ill hospitalized depressed elderly patients

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Use of antidepressants by nonpsychiatrists in the treatment of medically ill hospitalized depressed elderly patients

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider