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Objectives—To characterize psychotropic medication use before and after traumatic brain injury (TBI) hospitalization among older adults. A secondary objective is to determine how receipt of indicated pharmacologic treatment for anxiety and post-traumatic stress disorder (PTSD) differs following TBI. Design—Retrospective cohort Setting—United States Participants—Medicare beneficiaries age ≥65 hospitalized with TBI 2006-2010 with continuous drug coverage for 12 months before and after TBI (n=60,276). Measurements—We obtained monthly psychotropic medication use by drug class and specific drugs from Medicare Part D drug event files. International Classification of Disease, 9th Edition CM, codes were used to define anxiety (300.0x) and PTSD (309.81). Results—Average monthly prevalence of psychotropic medication use among all patients hospitalized for TBI was 44.8%; antidepressants comprised 73%. Prevalence of psychotropic medication use increased from 2006-2010. Following TBI, psychotropic medication use increased slightly (odds ratio (OR) 1.05; 95% confidence interval (CI) 1.03, 1.06.) Tricyclic antidepressant use decreased post-TBI (OR 0.76; 95% CI 0.73, 0.79) while use of the sedating antidepressants mirtazapine (OR 1.31; 95% CI 1.25, 1.37) and trazadone (OR 1.11; 95% CI 1.06, 1.17) increased. Antipsychotic (OR 1.15; 95% CI 1.12, 1.19) use also increased post-TBI. Beneficiaries newly diagnosed with anxiety (OR 0.42; 95% CI 0.36, 0.48) and/or PTSD (OR 0.39; 95% CI 0.18, 0.84) post-TBI were less likely to receive indicated pharmacologic treatment. Conclusions—Older adults hospitalized with TBI have a high prevalence of psychotropic medication use yet are less likely to receive indicated pharmacological treatment for newly diagnosed anxiety and PTSD following TBI.

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Albrecht JS, Mullins DC, Smith GS, Rao V. Psychotropic Medication Use among Medicare Beneficiaries Following Traumatic Brain Injury. The American Journal of Geriatric Psychiatry. 2017;25(4):415-424. doi:10.1016/j.jagp.2016.11.018