Lindström K, Ekedahl A, Carlsten A, et al. Can selective serotonin inhibitor drugs in elderly patients in nursing homes be reduced? Scandinavian Journal of Primary Health Care, 2007:3-8
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/17354152
Full text article: https://www.tandfonline.com/doi/full/10.1080/02813430600958427
| Methods | Study design: Before-and-after study
Number of groups: One group |
| Participants | Number of participants: 119 enrolled, 107 completed
Age group 65 to 74 years: 9 participants Age group 75 to 84 years: 45 participants Age group 85 years and over: 65 participants (44%) Sex: Not described (states included in table one, but table one reports age group) Participants with dementia: Yes, 52 participants Inclusion criteria: · Residents at the participating residential aged care facility · Taking selective serotonin receptor inhibitor for at least one year Exclusion criteria: · Indications other than depression for treatment (e.g. anxiety, insomnia) or · Indication for long-term treatment with SSRIs determined by the general practitioner · Present depressive symptoms · At least two episodes of depression during the last two years · Previous unsuccessful attempts to end antidepressant therapy Country: Sweden Setting: Residential aged care facilities – 19 facilities participated across two countries |
| Interventions | Medicine: Selective serotonin receptor inhibitor
Withdrawal schedule: Tapered gradually, and ceased after six to eight weeks |
| Outcomes | Successful deprescribing
Predictors of successful deprescribing assessed using the Montgomery-Asberg Depression Rating Scale |
| Dates | Dates: September 2003 to mid-2004
Follow-up duration: Unclear, perhaps up to 28 weeks |
| Funding sources | Not described |
| Notes | Limited detail. No statement of conflicts of interest. |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | High risk | Non-randomized trial |
| Allocation concealment (selection bias) | High risk | No concurrent control group |
| Blinding of participants and personnel (performance bias) | 5 out of 5 | Open study |
| Blinding of outcome assessment (detection bias) | 5 out of 5 | Open study |
| Incomplete outcome data (attrition bias) | 1 out of 5 | Appears to be reported |
| Selective reporting (reporting bias) | 1 out of 5 | The only pre-specified criteria was a pass/fail which was reported
Protocol approved by the Human Research Ethics Committeethough it is not clear if the authors adhered to a pre-specified analysis plan. |
| Confounding (non-randomized) | 5 out of 5 | No concurrent control group. |
| Other bias | High risk | The pass/fail criteria largely rested on clinical judgment of the staff involved – very subjective measurement |
| Newcastle-Ottawa scale | ||
| Selection bias | Representativeness of the exposed cohort | Somewhat representative of older adults living in residential aged care |
| Selection of the non-exposed cohort | No concurrent control group
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| Ascertainment of exposure | Ascertainment of exposure: structured interview | |
| Demonstration that outcome of interest was not present at start of study | Demonstrated that outcome of interest was not present at start of study | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | The study controlled for SSRI withdrawal |
| Outcome bias | Assessment of outcome | Assessment of outcome by record linkage |
| Was follow-up long enough for outcomes to occur | Follow-up time is unclear, perhaps up to 28 weeks | |
| Adequacy of follow-up of cohorts | Subjects lost to follow-up unlikely to introduce bias – small number lost – > 10 % (select an adequate %) follow-up | |
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