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Antidepressant drugs for older patients on polypharmacy: a systematic review reveals best evidence for sertraline



There is almost no data on antidepressant prescribing in older adults treated with polypharmacy, although this population represents approximately 50% of older patients. These patients are frequently excluded from double-blind randomized controlled trials, meta-analyses and existing treatment guidelines. The main aim of this paper was to identify data on antidepressant prescribing in depressed older adults on polypharmacy using a systematic review.


Randomized controlled clinical trials (RCTs) and other clinical trials in Medline/PubMed without language limitation (-2017) were searched to identify those with older depressed patients on polypharmacy. Only elderly patients (>65 years as mean) were included. Only approved antidepressants were included.


The systematic search identified 26 different clinical trials, although only one clinical open label trial with sertraline met the final inclusion criteria. This sertraline trial indicated the absence of clinically important drug-drug interactions and confirmed the effectiveness and safety of sertraline in routine clinical practice. Heterogeneity in this trial was high in almost all the categories except attrition and reporting bias.


Sertraline has the highest evidence level in older adults with depression on polypharmacy. According to the results of this review and due to a low number of appropriate trials, a basic understanding of psychopharmacology is the possible approach to avoid serious problematic drug combinations in these patients. Newer RCTs are also urgently needed. This is the first systematic review including patients treated with polypharmacy, and therefore, its results are important in the field of evidence-based medicine.

Open access
Prescribing pattern of higher generation antibiotics in the out-patient setting in Bhutan hospitals


Background: The emergence of antibiotic resistance is a complex problem contributed by the interplay of various parties such as prescribers, patients or health settings. In particular, prescribers play a vital role in the use of antibiotics both in rational prescribing of drugs and influencing patients on the appropriate use. Objectives: Determine the appropriateness of the higher generation antibiotics (cephalosporin and flouroquonolone groups) in the out-patient setting of Bhutan hospitals. Materials and method: A cross-sectional study was conducted in three referral hospitals of Bhutan where the prescriptions were collected from the pharmacy. All prescriptions containing higher generation antibiotics were selected based on the appropriateness using a modified Medication Appropriateness Index. Three hundred thirty three prescriptions containing higher generation antibiotics were analyzed. Results: The use of antibiotics was common with 37.1% of the prescriptions containing antibiotics out of which 14% were higher generation antibiotics. When assessed on the appropriateness of the prescription, 55.9% of the prescriptions containing higher generation antibiotics were prescribed inappropriately. In addition, only 47.1% of the prescriptions had appropriate indications for higher generation antibiotics. Conclusion: There is a widespread inappropriate use of higher generation antibiotics in Bhutan.

Open access