An Approach to Deprescribe Antidepressants for Depression in Older Adults: Consensus, Multidisciplinary Practice Recommendations

Eric A Lee^{1

2}, Chih-An Wong³, Lorena Barrio⁴, Eduardo R Godoy^{2

5}, Daniel Hackett⁶, Nolan Thompson⁷, Mark Dreskin⁸, Sid Kumar³, Peter Khang^{2

9}, Steven G Steinberg^{10

11}, Christopher C Distasio^{2

12}, Nancy E Gibbs¹³, Kim Thai¹⁴, Stephen C Cheng¹⁵, Monica Yoshinaga¹⁵, Michael H Kanter^{2

16}, Benjamin I Broder^{11

17}

Affiliations

¹ Department of Internal Medicine, Southern California Permanente Medical Group, West Los Angeles, CA, USA.
² Department of Clinical Sciences, The Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA.
³ Department of Psychiatry, Southern California Permanente Medical Group, Baldwin Park, CA, USA.
⁴ Department of Psychiatry, Southern California Permanente Medical Group, Woodland Hills, CA, USA.
⁵ Department of Family Medicine, Southern California Permanente Medical Group, Harbor City, CA, USA.
⁶ Department of Psychiatry, Southern California Permanente Medical Group, Riverside, CA, USA.
⁷ Department of Psychiatry, Southern California Permanente Medical Group, Panorama City, CA, USA.
⁸ Department of Family Medicine, Southern California Permanente Medical Group, Los Angeles, CA, USA.
⁹ Department of Geriatrics, Continuing Care, and Palliative Medicine, Southern California Permanente Medical Group, Los Angeles, CA, USA.
¹⁰ Department of Family Medicine, Southern California Permanente Medical Group, Panorama City, CA, USA.
¹¹ Department of Health Systems Science, The Bernard J Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA.
¹² Department of Neurology, Southern California Permanente Medical Group, Harbor City, CA, USA.
¹³ Department of Geriatrics and Continuing Care, Southern California Permanente Medical Group, Baldwin Park, CA, USA.
¹⁴ Department of Physical Medicine and Rehabilitation, Southern California Permanente Medical Group, Baldwin Park, CA, USA.
¹⁵ Drug Use Management, Kaiser Permanente Independence Park, Downey, CA, USA.
¹⁶ Department of Research and Evaluation, Southern Calfironia Permanente Medical Group, Pasadena, CA, USA.
¹⁷ Department of Quality and Clinical Analysis, Southern California Permanente Medical Group (Regional Offices), Pasadena, CA, USA.

PMID: 36999271
PMCID: PMC10266842
DOI: 10.7812/TPP/22.052

An Approach to Deprescribe Antidepressants for Depression in Older Adults: Consensus, Multidisciplinary Practice Recommendations

Eric A Lee et al. Perm J. 2023.

. 2023 Jun 15;27(2):1-8.

doi: 10.7812/TPP/22.052. Epub 2023 Mar 31.

Authors

Affiliations

¹ Department of Internal Medicine, Southern California Permanente Medical Group, West Los Angeles, CA, USA.
² Department of Clinical Sciences, The Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA.
³ Department of Psychiatry, Southern California Permanente Medical Group, Baldwin Park, CA, USA.
⁴ Department of Psychiatry, Southern California Permanente Medical Group, Woodland Hills, CA, USA.
⁵ Department of Family Medicine, Southern California Permanente Medical Group, Harbor City, CA, USA.
⁶ Department of Psychiatry, Southern California Permanente Medical Group, Riverside, CA, USA.
⁷ Department of Psychiatry, Southern California Permanente Medical Group, Panorama City, CA, USA.
⁸ Department of Family Medicine, Southern California Permanente Medical Group, Los Angeles, CA, USA.
⁹ Department of Geriatrics, Continuing Care, and Palliative Medicine, Southern California Permanente Medical Group, Los Angeles, CA, USA.
¹⁰ Department of Family Medicine, Southern California Permanente Medical Group, Panorama City, CA, USA.
¹¹ Department of Health Systems Science, The Bernard J Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA.
¹² Department of Neurology, Southern California Permanente Medical Group, Harbor City, CA, USA.
¹³ Department of Geriatrics and Continuing Care, Southern California Permanente Medical Group, Baldwin Park, CA, USA.
¹⁴ Department of Physical Medicine and Rehabilitation, Southern California Permanente Medical Group, Baldwin Park, CA, USA.
¹⁵ Drug Use Management, Kaiser Permanente Independence Park, Downey, CA, USA.
¹⁶ Department of Research and Evaluation, Southern Calfironia Permanente Medical Group, Pasadena, CA, USA.
¹⁷ Department of Quality and Clinical Analysis, Southern California Permanente Medical Group (Regional Offices), Pasadena, CA, USA.

PMID: 36999271
PMCID: PMC10266842
DOI: 10.7812/TPP/22.052

No abstract available

Keywords: Deprescribing; Depression in Older Adults.

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Conflict of interest statement

Conflicts of InterestNone declared

Figures

**Figure 2:**
Example of a Smart Phrase to taper sertraline.

**Figure 1:**
Flow diagram to deprescribe SSRIs or SNRIs for the indication of depression in older adults.* ADS = antidepressant discontinuation syndrome; APP = advanced practice provider; DO = doctor of osteopathic medicine; EMR = electronic medical record; LVN = licensed vocational nurse; MD = medical doctor; PHQ-9 = Patient Health Questionnaire-9; RAR = refill authorization request; RN = registered nurse; SNRI = serotonin and norepinephrine reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor; TAV = telephone appointment visit.

See this image and copyright information in PMC

References

1. Health, United States, 2015 - Individual Charts and Tables: Spreadsheet . Table 80. Selected prescription drug classes used in the past 30 days, by sex and age: United States, selected years 1988-1994 through 2009-2012. CDC/National Center for Health Statistics/Division of Analysis and Epidemiology. Page last reviewed. April 27, 2016. Accessed 5 September 2021. www.cdc.gov/nchs/hus/contents2015.htm#080
1. Rotella F, Mannucci E. Depression as a risk factor for diabetes: A meta-analysis of longitudinal studies. J Clin Psychiatry. 2013;74(1):31–37. 10.4088/JCP.12r07922 - DOI - PubMed
1. Maust DT, Strominger J, Bynum JPW, et al. Prevalence of psychotropic and opioid prescription fills among community-dwelling older adults with dementia in the US. JAMA. 2020;324(7):706–708. 10.1001/jama.2020.8519 - DOI - PMC - PubMed
1. Pratt LA, Brody DJ, Gu Q. Antidepressant Use among Persons Aged 12 and over: United States, 2011–2014. NCHS Data Brief, No 283. Hyattsville, MD: National Center for Health Statistics; 2017. Accessed 4 September 2021. www.cdc.gov/nchs/products/databriefs/db283.htm#:~:text=Long%2Dterm%20ant...
1. Bhat V, Kennedy SH. Recognition and management of antidepressant discontinuation syndrome. J Psychiatry Neurosci. 2017;42(4):E7–E8. 10.1503/jpn.170022 - DOI - PMC - PubMed

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An Approach to Deprescribe Antidepressants for Depression in Older Adults: Consensus, Multidisciplinary Practice Recommendations

Affiliations

An Approach to Deprescribe Antidepressants for Depression in Older Adults: Consensus, Multidisciplinary Practice Recommendations

Authors

Affiliations

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources