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Front. Pharmacol. | doi: 10.3389/fphar.2019.00841

Claims Data Analysis on the Dispensing of Tricyclic Antidepressants among Patients with Dementia in Germany

 Philipp Hessmann1, 2*, Jan Zeidler2, Jona Stahmeyer3, Sveja Eberhard3,  Jonathan Vogelgsang1,  Mona Abdel-Hamid1, Claus Wolff-Menzler1,  Jens Wiltfang1, 2, 3 and  Bernhard Kis1
  • 1University Medical Center Groningen, Netherlands
  • 2Leibniz University Hannover, Germany
  • 3Wissenschaftliches Institut der AOK - WIdO, Germany

Objective: A restrictive use of tricyclic antidepressants (TCA) in patients with dementia (PwD) is recommended due to the hazard of anticholinergic side effects. We evaluated the frequency of TCA dispensing in PwD over a period of one year and the use of TCA before and after the incident diagnosis of dementia.
Methods: This analysis was based on administrative data from a German statutory health insurance for a period of two years. Totally, 20,357 patients with an incident diagnosis of dementia in 2014 were included. We evaluated the dispensing of TCA in 2015. Subgroup analyses were conducted to evaluate associations between the incident diagnosis of dementia and modifications in TCA dispensing.
Results: In 2015, 1.125 dementia patients (5.5%) were treated with TCA and 31% were medicated with TCA in all four quarters of 2015. Most dispensings were conducted by general practitioners (67.9%). On average, patients received 3.7 ± 2.6 dispensing per year. Amitriptyline (56.3%), doxepin (26.8%), and trimipramine (16.8%) were dispensed most often. Subgroup analyses revealed that the dispensing of TCA remained mainly unchanged following the incident diagnosis.
Conclusion: A relevant number of PwD were treated with TCA. To maintain the patients’ safety, an improved implementation of guidelines for the pharmaceutical treatment of PwD in healthcare institutions might be required. Since 68% of the patients suffered from depression, future studies should further evaluate the indications for TCA.

Keywords: Antidepressants, tricyclic, claims data, Dementia, Pharmacotherapy

Received: 03 Dec 2018; Accepted: 01 Jul 2019.

Edited by:

Lydia Gimenez-Llort, Medical Psychology Unit, Department of Psychiatry and Forensic Medicine, School of Medicine, Autonomous University of Barcelona, Spain

Reviewed by:

Hironori Kuga, Bloomberg School of Public Health, Johns Hopkins University, United States
Tania Schink, Leibniz Institute for Prevention Research and Epidemiology (LG), Germany  

Copyright: © 2019 Hessmann, Zeidler, Stahmeyer, Eberhard, Vogelgsang, Abdel-Hamid, Wolff-Menzler, Wiltfang and Kis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Philipp Hessmann, University Medical Center Groningen, Groningen, Netherlands,