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Elderly patients whose physicians are white or have urban practices are more likely to use antidepressants

Selective serotonin reuptake inhibitors (SSRIs), newer antidepressants introduced at the end of 1987, have fewer side effects and require simpler dosing and management than older antidepressants. This makes it easier for primary care physicians to prescribe them for elderly patients. Although elderly antidepressant use tripled from 1987 to 1997, the elderly continued to receive their antidepressants from the same type of usual care providers, according to a new study. However, elderly patients of physicians who were white or had urban practices were more likely to use antidepressants than patients of other physicians.

Researchers, supported in part by the Agency for Healthcare Research and Quality (HS13353), asked 2,261 black and 1,875 white elderly community residents of a five-county area in North Carolina about their prescription medications, demographic and health status, and usual medical care provider. They categorized members into predisposing (demographic), enabling (medical care access), and need (health status) categories. The team collected data in the periods 1986-1987, 1989-1990, 1992-1993, and 1996-1997. They used models to examine the association between antidepressant use and provider race, sex, age, location of practice, and primary versus specialist care.

Use of antidepressants increased from 3.7 percent in 1986-1987 to 10.9 percent in 1996-1997, which was mostly attributable to the introduction of SSRIs. A minor but steady increase in the use of non-SSRIs also occurred over time. The majority of elderly patients who were prescribed antidepressants had a provider who was white, male, a primary care practitioner younger than 44, and practicing in an urban area. These provider characteristics may reflect the treatment preferences associated with the race of their patients and provision of pharmaceutical information to the physician, which is more prevalent in urban areas.

See "Provider characteristics related to antidepressant use in older people," by Gerda G. Fillenbaum, Ph.D., Celia F. Hybels, Ph.D., Carl F. Pieper, Dr.P.H., and others, in the June 2006 Journal of the American Geriatric Society 54, pp. 942-949.

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