Study Finds High Polypharmacy Rates Among Those With History of Depression

The prevalence of polypharmacy is 2 times higher among Iranian patients with a recent history of depressive disorder compared with those without such a history, according to new research published in BMC Psychology. Among these patients, those who were female, had a higher socioeconomic status, lower physical activity, and were tobacco users were more likely to be polymedicatied, authors wrote.

Despite the growing public health challenge of polypharmacy, the majority of studies carried out on this topic have been conducted in developed regions and focused on elderly populations, researchers explained.

Past research has also revealed depressive disorders (DD) are highly correlated with polypharmacy prevalence, while the relationship may be bidirectional. Identifying patients with DD and at a higher risk of polypharmacy could help improve their quality of health care as well.

In an effort to elucidate the correlations between polypharmacy and a recent history of DD, investigators assessed data from a population-based sample of patients residing in a less developed region of southwestern Iran.

The Pars Cohort Study (PCS) is a 10-year cohort study that was launched in 2016. Participants underwent face-to-face interviews, physical examinations, and biological sampling. All those who answered "yes" to the prompt, "Has your physician told you that you have a depressive disorder and you need treatment for that during the last 12 months?" were classified as having a recent history of depression.

Researchers noted currently used drugs, including over-the-counter medications and complementary products; polypharmacy was defined as using 5 or more different medications concurrently.

Of the 9264 participants, mean (SD) age was 52.6 (9.7) years, and a slight majority of patients (54%) were female. The prevalence of polypharmacy was 22.6% (95% CI, 20.7–24.6) while genitourinary system (55.4%) and nervous system (29.1%) medications were the most commonly reported drug classes used.

A total of 1795 (19.4%) of individuals were found to have a DD in the past year. Mean patient age of this cohort was 53.3 (9.5) years and 70% were female. Data recorded between 2016 and 2019 were included in the current study.

Researchers found, “factors associated with polypharmacy included female gender (odds ratio [OR]: 1.51), Fars ethnicity (OR: 1.52), lower physical activity (OR: 1.74), and higher socioeconomic status (OR: 1.40). The prevalence of antidepressant use among males was higher than females (P < .001).”

Additional analyses revealed:

• More than 40% (n = 3027) of participants without a recent history of DD were not on any medication, compared with 17.2% (n = 309) among patients with a recent history of DD
• More than 51.7% of individuals with a recent history of DD and 76.6% of participants without a recent history of DD were on less than 2 different drugs at the time of the study
• Non-selective monoamine reuptake inhibitors and selective serotonin reuptake inhibitors were used comparably in females (around 14%), males (around 41%), and elderly people (around 20%)

Polypharmacy constitutes a leading cause of medication nonadherence and nonadherence among those taking antidepressants can result in complications in DD management, potentially leading to a higher chance of relapse.

Authors hypothesized their findings could “be a result of the health-seeking and medication utilization behaviors of patients [whose] DD has been diagnosed in a society without any active specialized psychiatric clinic.”

They also stressed the importance of recognizing the higher risk of polypharmacy among younger females with a recent history of DD.

In the current analyses, researchers were unable to investigate the effects of untreated or relapsed depression on polypharmacy, marking a limitation. The study also excluded any patients under the age of 40 and was cross-sectional in nature.

Reference

Ghaed-Sharaf M, Hariri S, Poustchi H, et al. The pattern of medication use, and determinants of the prevalence of polypharmacy among patients with a recent history of depressive disorder: results from the pars cohort study. BMC Psychol. Published online January 18, 2022. doi:10.1186/s40359-022-00716-9