With the increasing number of patients using antidepressants, the number of patients at risk to develop antidepressant-associated adverse drug reactions is also increasing. However, there were not much studies conducted on antidepressant safety in older adults, although older adults are of special interest due to there more frequent use of multiple concomitant drugs and more comorbidities. In this thesis, we describe that, also in Dutch primary care, antidepressants are more often prescribed between 1996 and 2012. However, antidepressants were less frequently prescribed for depression and more for other indications, such as neuropathic pain and anxiety complaints. In the Rotterdam Study, a population cohort study, we described that the use of Selective Serotonin Reuptake Inhibitors, which is a subclass of antidepressants influencing serotonergic signaling, was associated with a higher body weight (but only in women), a higher level of low-density lipoprotein cholesterol level, a lower pancreatic insulin secretion, and a lower risk of myocardial infarction. On the other hand, use of tricyclic antidepressants, which is a class of antidepressants influencing a variety of neurotransmitters, was associated with a higher heart rate and a lower variability in heart rate. Outcomes of antidepressant use (response and adverse drug reactions) could be (partly) influenced by genetic factors. In this thesis, we described that some genetic regions were associated with adverse drug reactions as well with antidepressant drug response. However, the studies conducted in this thesis were not designed to predict which patients develop adverse drug reactions. This requires additional studies.

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Keywords Pharmacoepidemiology, antidepressive agents, adverse drug reactions, pharmacogenetics
Promotor B.H.Ch. Stricker (Bruno)
Publisher Erasmus University Rotterdam
Sponsor The studies described in this thesis were made possible by the Netherlands Organization for Health Research and Development (ZonMw) Priority Medicines Elderly program (grant: 113101002). The Rotterdam Study is funded by the Erasmus Medical Center and Erasmus University, ZonMw, the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam.
ISBN 978-94-6312-000-5
Persistent URL hdl.handle.net/1765/78332
Noordam, R. (2015, July 3). Pharmaco-Epidemiological Studies on Antidepressant Use in Older Adults. Erasmus University Rotterdam. Retrieved from http://hdl.handle.net/1765/78332