Pharmacological treatment of late-life major depressive disorder – Results from the AMSP drug surveillance program from 2007 to 2023

BACKGROUND: Late-life depression (LLD) is a frequent and debilitating condition associated with higher somatic comorbidity and increased medication burden. Although antidepressant treatment is widely used, evidence on real-world prescribing patterns and age-related differences in inpatient settings remains limited. Understanding such patterns is essential to improve safety and effectiveness of pharmacological management in older adults with major depressive disorder (MDD). METHODS: Data were obtained from the "Arzneimittelsicherheit in der Psychiatrie" (AMSP) drug surveillance program, covering reference-day surveys from psychiatric hospitals in Germany and Austria between 2007 and 2023. Adult inpatients with a primary ICD-10 diagnosis of MDD were divided into two age groups (< 65 years vs. > 64 years). Psychotropic drug use was analyzed descriptively, with age-group differences and temporal trends assessed using relative risk measures. RESULTS: Among 25,881 inpatients with MDD, 5297 (20.4%) were aged >64 years. Psychotic depression (16.9% vs. 9.1%; RR = 1.86, CI 1.70-2.03) and psychotropic polypharmacy were more prevalent in older adults. Antidepressants were used in the treatment of 89.6% of older and 84.1% of younger patients. Older adults more frequently received antipsychotic (57.4% vs. 45.9%) as well as tranquilizing and hypnotic drugs, while SSRIs and TCAs were more common in younger adults. CONCLUSION: Pharmacological treatment of LLD was characterized by greater use of antipsychotic, tranquilizing and hypnotic drugs, and more complex combination therapies. These findings underscore the need for individualized prescribing, vigilant monitoring, and deprescribing strategies to enhance drug safety in inpatients with LLD.