Utilization and Unintended Effects of Antidepressants in an Ageing Population

Abstract

To summarize, within this thesis, we aimed to study characteristics and unintended effects of antidepressant use in clinical practice in an ageing population. Prevalence of antidepressant use, mainly Selective Serotonin Reuptake Inhibitors (SSRIs), increased over a 20-year period within the Rotterdam Study. In contrast, incidence of antidepressant use decreased over the years. These opposing patterns were possible explained by a longer duration of treatment. Our results suggest that antidepressants are next to the traditional indications prescribed for a wide range of – possible off-label – indications such as neuropathic pain, stress and sleeping disorders. Moreover, there is room for improvement in the initiation (23% early drop-outs) and maintenance phase of treatment. Regarding the possible unintended effects: first, antidepressants were inconsistently associated with the prevalence and occurence of microbleeds. Second, SSRI use was in cross-sectional and longitudinal analyses associated with a good sleep quality. Third, we observed that use of SSRIs was associated with hyponatremia and was transient over time, however, neither use of tricyclic antidepressants, nor other antidepressants was associated with an increased risk of hyponatremia. Fourth, we observed no association between use of SSRIs and, change in, bone mineral density