Understanding differences in antidepressant use patterns among african american and white volunteers with dementia

Abstract Background Older African Americans are less likely to use antidepressants than Older White Americans. These findings are based on cross‐sectional studies or studies with limited followup periods; less is known about patterns of use (initiation, augmentation, switching, discontinuation) over many years. We describe antidepressant use patterns over 5 or more years in a large prospective sample of US volunteers with dementia. Method Our sample was 12,627 white and 1,617 African American volunteers (mean: 75.2; SD 10.5) followed approximately yearly at Alzheimer Disease Research Centers 2005‐2020. We used Webplots to visualize antidepressant use patterns over time, and will explore predictors of these patterns. Result At their first visit, 413 (21.6%) of African Americans and 5,634 (36.0%) of White Americans were using antidepressants. Among African Americans, 78 (9.3%), 33 (6.6%), and 11 (3.5%) initiated antidepressant use at visits 2,3, and 4, respectively; among White Americans 807 (13.4%), 409 (10.9%), and 211 (9.2%). Among African Americans using antidepressants, 38 (23%), 49 (9.8%), and 30 (9.4%) discontinued antidepressant use at visits 2,3, and 4 respectively; whereas among White Americans, 683 (18.7%), 419 (16.3%), and 302 (16.9%). Among African Americans using antidepressants, 37 (14.5%), 20 (12.5%), and 8 (9.1%) changed their regimen at visits 2,3, and 4 respectively; whereas among White Americans, 526 (14.4%), 239 (10.9%), and 135 (9.7%). Conclusion Compared to white volunteers, African American voluntee had lower rates of antidepressant use at baseline and lower rates of initiation at subsequent visits. Rates of discontinuation were higher among African Americans at study visit 2, but lower at later visits. Rates of regimen change were similar by race. Differences in patterns of medication use over time speak to potential equity issues that cannot be observed with cross‐sectional study designs. Further, in order to understand whether these medications are helpful in participants with dementia, it is first important to understand differences in who uses these medications, and which factors predict regimen changes and discontinuation.