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Drugs & Aging

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01-10-2014 | Original Research Article

Psychotropic Medicine Utilization in Older People in New Zealand from 2005 to 2013

Authors: Henry C. Ndukwe, June M. Tordoff, Ting Wang, Prasad S. Nishtala

Published in: Drugs & Aging | Issue 10/2014

Abstract

Background

Psychotropic medicine utilization has increased worldwide among older people (aged 65 years or older), in relation to utilization of other medicines.

Objective

The aim of this population-level study was to describe and characterize the national utilization of psychotropic medicines in older people in New Zealand between 2005 and 2013.

Methods

Repeated cross-sectional analysis of population-level dispensing data was conducted from 1 January 2005 to 31 December 2013. Data on utilization of psychotropic medicines were extracted and categorized in accordance with the World Health Organization Collaborating Centre for Drug Statistics Methodology’s Anatomical Therapeutic Chemical classification system. Utilization was measured in terms of the defined daily dose (DDD) per 1,000 older people per day (TOPD).

Results

Overall, utilization of psychotropic medicines showed a 22.5 % increase between 2005 and 2013. Utilization increased for antidepressants (from 81.9 to 110.4 DDD/TOPD), antipsychotics (from 6.8 to 8.7 DDD/TOPD) and hypnotics and sedatives (from 59.4 to 65.5 DDD/TOPD); in contrast, utilization of anxiolytics decreased (from 11.4 to 10.7 DDD/TOPD). Utilization of atypical antipsychotics increased (from 4.6 to 6.8 DDD/TOPD), with the highest percentage change in DDD/TOPD being contributed by olanzapine (112.1 %), while utilization of typical antipsychotics declined (from 2.0 to 1.5 DDD/TOPD). Utilization of tetracyclic antidepressants and venlafaxine grew rapidly by 1.5 and 4.5 times, respectively, between 2005 and 2013. Utilization of zopiclone was greater than that of other hypnotics in 2013.

Conclusion

Utilization of psychotropic medicines in older people increased by one fifth between 2005 and 2013. Important findings of this study were that: (1) there was a marked increase in utilization of recently funded antidepressants; (2) utilization of atypical antipsychotics increased; (3) there was a move towards utilization of selective serotonin reuptake inhibitors; (4) utilization of zopiclone remained high; and (5) low, standard and high DDD utilization all increased with time.

Oakley Browne M, Wells J, Scott K. Te Rau Hinengaro. The New Zealand mental health survey. Wellington: Ministry of Health; 2006.

Khandelwal SK. Depressive disorders in old age. J Indian Med Assoc. 2001;99:39, 42–4.

Lenze EJ, Mulsant BH, Shear MK, et al. Comorbidity of depression and anxiety disorders in later life. Depress Anxiety. 2001;14:86–93.PubMedCrossRef

Ilyas S, Moncrieff J. Trends in prescriptions and costs of drugs for mental disorders in England, 1998–2010. Br J Psychiatry. 2012;200:393–8.PubMedCrossRef

WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment. Available from http://www.whocc.no/atc_ddd_publications/guidelines/. Accessed 9 Aug 2014.

Hollingworth SA, Lie DC, Siskind DJ, et al. Psychiatric drug prescribing in elderly Australians: time for action. Aust NZ J Psychiatry. 2011;45:705–8.CrossRef

Carrasco-Garrido P, Jiménez-García R, Astasio-Arbiza P, et al. Psychotropics use in the Spanish elderly: predictors and evolution between years 1993 and 2003. Pharmacoepidemiol Drug Saf. 2007;16:449–57.PubMedCrossRef

Olfson M, Marcus SC. National patterns in antidepressant medication treatment. Arch Gen Psychiatry. 2009;66:848–56.PubMedCrossRef

Bhattacharjee S, Karkare SU, Kamble P, et al. Datapoints: psychotropic drug utilization among elderly nursing home residents in the United States. Psychiatr Serv. 2010;61:655.PubMedCrossRef

10.

Hosia-Randell H, Pitkälä K. Use of psychotropic drugs in elderly nursing home residents with and without dementia in Helsinki, Finland. Drugs Aging. 2005;22:793–800.PubMedCrossRef

11.

Nishtala PS. Determinants of antidepressant medication prescribing in elderly residents of aged care homes in Australia: a retrospective study. Am J Geriatr Pharmacother. 2009;7:210–9.PubMedCrossRef

12.

Nishtala PS, McLachlan AJ, Bell JS, et al. Determinants of antipsychotic medication use among older people living in aged care homes in Australia. Int J Geriatr Psych. 2010;25:449–57.CrossRef

13.

Tucker M, Hosford I. Use of psychotropic medicines in residential care facilities for older people in Hawke’s Bay, New Zealand. NZ Med J. 2008;121:18–25.

14.

Norris P, Calcott P, Laugesen M. The prescribing of new antidepressants in NZ. NZ Fam Phys. 1998;25:45.

15.

McKean A, Vella-Brincat J. Regional variation in antipsychotic and antidepressant dispensing in New Zealand. Australas Psychiatry. 2010;18:467.PubMedCrossRef

16.

Roberts E, Norris P. Growth and change in the prescribing of anti-depressants in New Zealand: 1993–1997. NZ Med J. 2001;114:25–7.

17.

Roberts E, Norris P. Regional variation in anti-depressant dispensings in New Zealand: 1993–1997. NZ Med J. 2001;114:27–30.

18.

Exeter D, Robinson E, Wheeler A. Antidepressant dispensing trends in New Zealand between 2004 and 2007. Aust NZ J Psychiatry. 2009;43:1131–40.CrossRef

19.

McKean A, Vella-Brincat J. Ten-year dispensing trends of hypnotics in New Zealand. NZ Med J. 2011;124:1–3.

20.

Lafortune G, Balestat G, Disability Study Expert Group Members. Trends in severe disability among elderly people. Available fromhttp://www.oecd.org/denmark/38343783.pdf. Accessed 9 Aug 2014.

21.

Janicak PG, Marder SR, Pavuluri MN. Principles and practice of psychopharmacotherapy. 5th ed. Lippincott Williams & Wilkins; 2010.

22.

Gnjidic D, Cumming RG, Le Couteur DG, et al. Drug Burden Index and physical function in older Australian men. Br J Clin Pharmacol. 2009;68:97–105.PubMedCrossRefPubMedCentral

23.

Wheeler A, Humberstone V, Robinson G. Trends in antipsychotic prescribing in schizophrenia in Auckland. Australas Psychiatry. 2006;14:169–74.PubMedCrossRef

24.

Bandelow B, Sher L, Bunevicius R, et al. Guidelines for the pharmacological treatment of anxiety disorders, obsessive–compulsive disorder and posttraumatic stress disorder in primary care. Int J Psychiatry Clin Pract. 2012;16:77–84.PubMedCrossRef

25.

Kamble P, Chen H, Sherer J, et al. Antipsychotic drug use among elderly nursing home residents in the United States. Am J Geriatr Pharmacother. 2008;6:187–97.PubMedCrossRef

26.

Narayan S, Hilmer S, Horsburgh S, et al. Anticholinergic component of the Drug Burden Index and the anticholinergic drug scale as measures of anticholinergic exposure in older people in New Zealand: a population-level study. Drugs Aging. 2013;30:927–34.PubMedCrossRef

27.

Hollingworth SA, Siskind DJ. Anxiolytic, hypnotic and sedative medication use in Australia. Pharmacoepidemiol Drug Saf. 2010;19:280–8.PubMedCrossRef

28.

Statistics New Zealand. Census QuickStats about national highlights. Available from http://www.stats.govt.nz/Census/2013. Accessed 30 Mar 2014.

29.

Pharmaceutical Management Agency (PHARMAC). Memorandum of understanding relating to the working relationship between PHARMAC and DHBs. Available from http://www.pharmac.health.nz/about/accountability-documents/relationship-agreements. Accessed 17 Mar 2014.

30.

Braae R, McNee W, Moore D. Managing pharmaceutical expenditure while increasing access: the Pharmaceutical Management Agency (PHARMAC) experience. PharmacoEconomics. 1999;16:649–60.PubMedCrossRef

31.

Smith AJ, Tett SE. How do different age groups use benzodiazepines and antidepressants? Analysis of an Australian administrative database, 2003–6. Drugs Aging. 2009;26:113–22.PubMedCrossRef

32.

Fürst J, Kocmur M. Use of psychiatric drugs in Slovenia in comparison to Scandinavian countries. Pharmacoepidemiol Drug Saf. 2003;12:399–403.PubMedCrossRef

33.

Divac N, Toševski DL, Babić D, et al. Trends in consumption of psychiatric drugs in Serbia and Montenegro 2000–2004. Pharmacoepidemiol Drug Saf. 2006;15:835–8.PubMedCrossRef

34.

Stephenson CP, Karanges E, McGregor IS. Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011. Aust NZ J Psychiatry. 2012;47:74–87.CrossRef

35.

Damiani G, Raschetti R, Ricciardi W, et al. Impact of regional copayment policy on selective serotonin reuptake inhibitor (SSRI) consumption and expenditure in Italy. Eur J Clin Pharmacol. 2013;69:957–63.PubMedCrossRef

36.

Whyte IM, Dawson AH, Buckley NA. Relative toxicity of venlafaxine and selective serotonin reuptake inhibitors in overdose compared to tricyclic antidepressants. QJM. 2003;96:369–74.PubMedCrossRef

37.

Geddes JR, Carney SM, Davies C, et al. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet. 2003;361:653–61.PubMedCrossRef

38.

Best Practice Advocacy Centre New Zealand. Prescribing citalopram safely. Available from http://www.bpac.org.nz/BPJ/2012/february/citalopram.aspx. Accessed 30 Jun 2014.

39.

Menkes D. New Zealand’s pharmaceutical reference-pricing strategy may backfire. Lancet. 2000;355:558.PubMedCrossRef

40.

Pharmaceutical Management Agency (PHARMAC). Newly-funded antidepressant to meet unmet need—PHARMAC. Available from http://www.pharmac.govt.nz/2009/11/12/Newlyfundedantidepressanttomeetunmetneed.pdf. Accessed 9 Aug 2014.

41.

Pharmaceutical Management Agency (PHARMAC). Update: New Zealand pharmaceutical schedule. Effective December 2010. Available from http://www.pharmac.govt.nz/2010/11/18/SU.pdf. Accessed 9 Aug 2014.

42.

Pharmaceutical Management Agency (PHARMAC). Notification of sertraline and escitalopram funding decisions. Available from http://www.pharmac.govt.nz/2010/07/15/2010-07-15PHARMACnotificationofsertralineandescitalopramtenderdecisions.pdf. Accessed 9 Aug 2014.

43.

Hofmeijer-Sevink MK, Batelaan NM, van Megen HJGM, et al. Clinical relevance of comorbidity in anxiety disorders: a report from the Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord. 2012;137:106–12.PubMedCrossRef

44.

Babar Z-U-D, Grover P, Stewart J, et al. Evaluating pharmacists’ views, knowledge, and perception regarding generic medicines in New Zealand. Res Soc Adm Pharm. 2011;7:294–305.CrossRef

45.

Gleeson D, Lopert R, Reid P. How the Trans Pacific Partnership Agreement could undermine PHARMAC and threaten access to affordable medicines and health equity in New Zealand. Health Policy. 2013;112:227–33.PubMedCrossRef

46.

Gilron I, Watson CPN, Cahill CM, et al. Neuropathic pain: a practical guide for the clinician. CMAJ. 2006;175:265–75.PubMedCrossRefPubMedCentral

47.

Best Practice Advocacy Centre New Zealand. TCAs are useful for depression and neuropathic pain. Available from http://www.bpac.org.nz/BPJ/2006/December/tcas.aspx. Accessed 29 Jun 2014.

48.

Wheeler A. Atypical antipsychotic use for adult outpatients in New Zealand’s Auckland and Northland regions. NZ Med J. 2006;119:U2055.

49.

Rapoport M, Mamdani M, Shulman KI, et al. Antipsychotic use in the elderly: shifting trends and increasing costs. Int J Geriatric Psychiatry. 2005;20:749–53.CrossRef

50.

Philip NS, Mello K, Carpenter LL, et al. Patterns of quetiapine use in psychiatric inpatients: an examination of off-label use. Ann Clin Psychiatry. 2008;20:15–20.PubMedCrossRef

51.

Ravindran AV, Al-Subaie A, Abraham G. Quetiapine: novel uses in the treatment of depressive and anxiety disorders. Expert Opin Invest Drugs. 2010;19:1187–204.CrossRef

52.

Best Practice Advocacy Centre New Zealand. Antipsychotics in dementia: best practice guide. Available from http://www.bpac.org.nz/a4d/resources/guide/guide.asp. Accessed 29 Jun 2014.

53.

Best Practice Advocacy Centre New Zealand. Prescribing atypical antipsychotics in general practice. Available from http://www.bpac.org.nz/BPJ/2011/november/antipsychotics.aspx. Accessed 30 Jun 2014.

54.

McKean A, Monasterio E. Off-label use of atypical antipsychotics. CNS Drugs. 2012;26:383–90.PubMedCrossRef

55.

Monasterio E, McKean A. Off-label use of atypical antipsychotic medications in Canterbury, New Zealand. NZ Med J. 2011;124:24–9.

56.

Jackson SHD, Jansen PAF, Mangoni AA. Off-label prescribing in older patients. Drugs Aging. 2012;29:427–34.PubMedCrossRef

57.

Alexander GC, Gallagher SA, Mascola A, et al. Increasing off-label use of antipsychotic medications in the United States, 1995–2008. Pharmacoepidemiol Drug Saf. 2011;20:177–84.PubMedCrossRefPubMedCentral

58.

Glue P, Gale C. Off-label use of quetiapine in New Zealand—a cause for concern? NZ Med J. 2011;124:10–3.

59.

Gill SS, Bronskill SE, Normand SL, et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Intern Med. 2007;146:775–86.PubMedCrossRef

60.

Maher A, Maglione M, Bagley S, et al. Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis. JAMA. 2011;306:1359–69.PubMedCrossRef

61.

Ballard C, Waite J. The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer’s disease. Cochrane Database Syst Rev. 2006;(1):CD003476.

62.

Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA. 2005;294:1934–43.PubMedCrossRef

63.

Fossey J, Ballard C, Juszczak E, et al. Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial. BMJ. 2006;332:756–61.PubMedCrossRefPubMedCentral

64.

Chouinard G. Issues in the clinical use of benzodiazepines: potency, withdrawal, and rebound. J Clin Psychiatry. 2004;65:7–12.PubMed

65.

Moylan S, Giorlando F, Nordfjærn T, et al. The role of alprazolam for the treatment of panic disorder in Australia. Aust NZ J Psychiatry. 2012;46:212–24.CrossRef

66.

Fick DM, Semla TP. 2012 American Geriatrics Society Beers criteria: new year, new criteria, new perspective. J Am Geriatr Soc. 2012;60:614–5.PubMedCrossRef

67.

Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163:2716–24.PubMedCrossRef

68.

Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med. 1997;157:1531–6.PubMedCrossRef

69.

Best Practice Advocacy Centre New Zealand. Managing insomnia. Available from http://www.bpac.org.nz/BPJ/2008/June/insomnia.aspx. Accessed 20 Jun 2014.

70.

Dündar Y, Dodd S, Strobl J, et al. Comparative efficacy of newer hypnotic drugs for the short-term management of insomnia: a systematic review and meta-analysis. Hum Psychopharmacol Clin Exp. 2004;19:305–22.CrossRef

71.

Holbrook AM, Crowther R, Lotter A, et al. Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ. 2000;162:225–33.PubMedPubMedCentral

72.

Campbell A, Robertson M, Gardner M, et al. Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. J Am Geriatr Soc. 1999;47:850–3.PubMed

73.

Ministry of Health. The health of New Zealand adults 2011/12: key findings of the New Zealand Health Survey. Wellington: Ministry of Health; 2012.

74.

Glass J, Lanctôt KL, Herrmann N, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331:1169–73.PubMedCrossRefPubMedCentral

75.

Wilson SJ, Nutt D, Alford C, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol. 2010;24:1577–601.PubMedCrossRef

76.

Best Practice Advocacy Centre New Zealand. Sleep disturbances: managing parasomnias in general practice. Available from http://www.bpac.org.nz/BPJ/2012/november/parasomnias.aspx. Accessed 29 Jun 2014.

77.

Kjosavik SR, Ruths S, Hunskaar S. Psychotropic drug use in the Norwegian general population in 2005: data from the Norwegian Prescription Database. Pharmacoepidemiol Drug Saf. 2009;18:572–8.PubMedCrossRef

78.

Royal Australian and New Zealand College of Psychiatrists. The use of antipsychotics in residential aged care: clinical recommendations developed by the RANZCP Faculty of Psychiatry of Old Age (New Zealand). Available from http://www.bpac.org.nz/a4d/resources/docs/RANZCP_Clinical_recommendations.pdf. Accessed 9 Aug 2014.

79.

Banerjee S. The use of antipsychotic medication for people with dementia: time for action. Available from https://www.rcpsych.ac.uk/pdf/AntipsychoticBannerjeeReport.pdf. Accessed 9 Aug 2014.

80.

Medicines and Healthcare Products Regulatory Agency. Antipsychotic use in elderly people with dementia. Available from http://www.mhra.gov.uk/Safetyinformation/Generalsafetyinformationandadvice/Product-specificinformationandadvice/Product-specificinformationandadvice-A-F/Antipsychoticdrugs/index.htm. Accessed 9 Aug 2014.

81.

Best Practice Advocacy Centre New Zealand. Depression POEMs: patient oriented evidence that matters. Available from http://www.bpac.org.nz/resources/campaign/depression/bpac_depression_poems_wv.pdf. Accessed 30 Jun 2014.

82.

Best Practice Advocacy Centre New Zealand. Tricyclic antidepressants: prescribing points. Available from http://www.bpac.org.nz/BPJ/2006/December/docs/tcas_pages22-23.pdf. Accessed 29 Jun 2014.

83.

Croucher MJ, Gee SB. Older New Zealanders and Antipsychotic Medications Knowledge Project: understanding current prescribing practice. Wellington: PHARMAC; 2011.

Title: Psychotropic Medicine Utilization in Older People in New Zealand from 2005 to 2013
Authors: Henry C. Ndukwe
June M. Tordoff
Ting Wang
Prasad S. Nishtala
Publication date: 01-10-2014
Publisher: Springer International Publishing
Published in: Drugs & Aging / Issue 10/2014
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI: https://doi.org/10.1007/s40266-014-0205-1

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