Patterns of medication use in older African Americans with depression:
results from the Beat the Blues randomized clinical trial
Tom Karagiannis, PharmD1; Gina D. Bellottie, PharmD2; Amanda Birnschein2;
Laura T. Pizzi, PharmD, MPH2; Laura N. Gitlin, PhD3
Jefferson School of Population Health 2. Jefferson School of Pharmacy 3. Center for Innovative Care in Aging, Johns Hopkins University School of Nursing
BACKGROUND & OBJECTIVES
• Approximately 1 in 20 U.S. adults age 50 and over have
depression1
• More than half of these older adults have depression with
severe impairment1
• Depression exerts significant morbidity in older African
Americans (AA) by worsening health conditions and
exacerbating disability2
• This analysis examines the frequency and types of antidepressant
medications reported at baseline in a randomized clinical trial of
the Beat the Blues (BTB) non-pharmacological depression
program for older AA
• 129 participants were included in the analysis (Figure 1):
- 25 participants reported taking an antidepressant (AD
group; 19.4%)
- 104 participants did not report taking an antidepressant
(NAD group; 80.6%)
• A total of 28 antidepressant prescriptions were reported (Figure 2)
Nonantidepressant
Group
Blues?3
• Depression was assessed using the Patient Health Questionnaire
(PHQ-9)5: a nine-symptom checklist that assessed depression
• Patients were enrolled in the BTB trial during 2009 and 2010
• Eligibility criteria consisted of the following:
• Had depressive symptoms (PHQ-9 score > 5)
• Were African American
• > 55 years old
• English speaking
• Cognitively intact (mini Mental Status Exam > 24)
• Medications for depression, anxiety, sleep, memory, and pain
were documented
• Medication data were reviewed post hoc by a pharmacist to
ensure accurate name and pharmacological classification
• This analysis reports baseline data
• Chi-squared and independent t-tests were used to analyze
discrete and continuous variables, respectively
40%
35%
30%
80.6%
20%
*
5%
0%
7% 4%
SSRIs
TCAs
18%
Antidepressant
Group
71%
Participants
Participants not
Reporting an
Reporting an
Antidepressant at
Antidepressant at
Pooled Sample Baseline n = 25 (%) Baseline n = 104 (%)
68.7 (8.4)
68.3 (8.2)
68.8 (8.5)
27 (20.9%)
102 (79.1%)
2 (8%)
23 (92%)
Atypical
25 (24%)
79 (76%)
EVALUATION & CONCLUSION
• In this sample of depressed older African Americans, only onefifth reported an antidepressant at baseline
• Participants on antidepressants were statistically similar to
those not on antidepressants, including their PHQ-9 depression
score, though small groups limit our ability to examine these
differences
• As accessible health professionals, pharmacists can play a role
in identifying unmet treatment needs in depressed older adults
and create linkages to non-pharmacological approaches like
Beat the Blues
P-value
0.828
PANEL DISCLOSURE
•
0.077
Married
•
Yes
No
12 (9.3%)
117 (90.7%)
4 (16%)
21 (84%)
8 (7.7%)
96 (92.3%)
0.199
Yes
No
77 (59.7%)
52 (40.3%)
11 (44%)
14 (56%)
66 (63.5%)
38 (36.5%)
0.075
85 (81.7%)
80 (76.9%)
61 (58.7%)
41 (39.4%)
40 (38.5%)
0.454
0.605
0.219
0.434
0.82
36 (34.6%)
30 (28.8%)
28 (26.9%)
10 (9.6%)
0.282
12.57 (4.9)
0.865
Living Alone
Comorbidities
Hypertension 107 (82.9%)
22 (88%)
Arthritis
98 (76%)
18 (72%)
Hyperlipidemia
79 (61.2%)
18 (72%)
Diabetes
53 (41.1%)
12 (48%)
Memory Deficiency
49 (37.9%)
9 (36%)
Category of Depression (PHQ-9 Score Range)
45 (34.9%)
9 (36%)
Mild: 5 - 9
38 (29.5%)
8 (32%)
Moderate: 10 - 14
31 (24%)
3 (12%)
Moderatly Severe: 15 - 19
15 (11.6%)
5 (20%)
Severe: 20 - 27
PHQ-9 Mean Score (SD)
12.6 (5.1)
12.76 (5.9)
* Participants reporting antidepressants were significantly more likely to also
report an anxiolytic (p=0.027)
SNRIs
Table 1: Characteristics of Participants at Baseline
Male
Female
Participants Not
Reporting an
Antidepressant
10%
• AD participants were statistically similar to NAD in terms of age,
gender, marital status, number of co-morbid medical conditions,
depression category, and mean PHQ-9 score (Table 1)
Characteristic
Age Mean (SD)
Gender
Participants
Reporting an
Antidepressant
*
25%
Figure 2: Breakdown of
Antidepressant Use by Class
(n=28 prescriptions)
Figure 1: Breakdown of
Antidepressant Use
(n=25 participants)
19.4%
• A non-pharmacological depression program designed for
older AA
• Participants receive up to 10 sessions that integrated five
treatment components previously shown effective and
modified in BTB to resonate with cultural preferences
• Components included:
1. Case management
2. Referral and linkages to care and services
3. Depression education
4. Stress reduction techniques
5. Behavioral activation
• In this randomized control trial, more Beat the Blues
participants entered remission of depressive symptoms at
four months, versus wait list controls (43.8% vs. 26.9%)4
Table 2: Participants Reporting each Type of Medication (n=25)
15%
METHODS
What is Beat the
RESULTS, CONTINUED
RESULTS
Funding Disclosure: this study was supported by U.S. National Institute of Mental Health
(Grant No. RC1 AG036413)
Authors of this presentation have the following to disclose concerning possible financial or
personal relationships with commercial entities that may have a direct or indirect interest in
the subject matter of this presentation: Tom Karagiannis, Gina Bellottie, Amanda Birnschein,
Laura Pizzi, and Laura Gitlin all have nothing to disclose
REFERENCES
1. Major Depression with Severe Impairment among Adults. National Institute of Health. Available at:
http://www.nimh.nih.gov/health/statistics/prevalence/major-depression-with-severe-impairment-among-adults.shtml. Accessed on
October 25, 2014.
2. Lenze EJ, Rogers JC, Martire LM, et al. The association of late-life depression and anxiety with physical disability: A review of
the literature and prospectus for future research. Am J Geriatr Psychiatry. 2001;9(2):113-135.
3. Gitlin LN, Harris LF, McCoy M, Chernett NL, Jutkowitz E, Pizzi LT. A community integrated home based depression
intervention for older African Americans: description of the Beat the Blues randomized trial and intervention costs. BMC
Geriatrics. 2012;12(4):1-11
4. Gitlin LN, Fields Harris L, McCoy M, Chernett NL, Pizzi LT, Jutkowitz E, Hess E, Hauck W. A Home-based Intervention to
Reduce Depressive Symptoms and Improve Quality of Life in Older African Americans: The Beat the Blues Randomized Trial.
Annals of Internal Medicine 2013:159(4):243-52.
5. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Inter Med.
2001;16(9):606-613.
Presented at the 49th ASHP Midyear Clinical Meeting & Exhibition, Anaheim, California, December 9, 2014.