Artykuły w czasopismach na temat „Antidepressant medication”
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Adhikari, Kamala, Scott B. Patten, Sangmin Lee i Amy Metcalfe. "Adherence to and Persistence with Antidepressant Medication during Pregnancy: Does It Differ by the Class of Antidepressant Medication Prescribed?" Canadian Journal of Psychiatry 64, nr 3 (25.09.2018): 199–208. http://dx.doi.org/10.1177/0706743718802809.
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Objective: Pregnant women are often concerned about the impact of medication use on their pregnancy, such as congenital abnormalities. This study examined the rate of adherence to and persistence with antidepressant medications during pregnancy based on the class of antidepressants prescribed. Methods: Women who gave birth between 2012 and 2015 in Alberta, Canada; had ≥1 diagnosis of depression within 1 year of preconception in outpatient physician claims, emergency department, or hospitalization administrative data; and were adherent (medication possession ratio ≥80%) to ≥2 consecutive antidepressant prescriptions during the preconception year ( n = 1865) were included in this retrospective cohort study. The rates of adherence and persistence (prescription refill gap ≤30 days) were calculated by antidepressant class and were compared using chi-square tests. Results: During pregnancy, 834 (44.7%; 95% CI, 42.4% to 47.0%) women discontinued antidepressants. Among those continuing antidepressants, the overall rate of adherence was 62.6% (95% CI, 59.4% to 65.7%). The rate differed significantly by medication class ( P < 0.0001), with a rate of 75.1% (95% CI, 68.3% to 80.9%) for serotonin-norepinephrine inhibitors, 60.9% (95% CI, 57.2% to 64.5%) for selective serotonin reuptake inhibitors, 42.8% (95% CI, 19.9% to 69.3%) for nonselective monoamine reuptake inhibitors, and 37.5% (95% CI, 22.5% to 55.4%) for atypical antidepressants. Only, 40.7% (95% CI, 37.5 to 44.1) of women were persistent with antidepressants for the full pregnancy period—the rate differed significantly by medication class ( P < 0.0001). Conclusions: Adherence to and persistence with antidepressants is low during pregnancy and varies by medication class. Low adherence and persistence can interfere with a therapeutic effect of antidepressants, which may contribute to the worsening of depression symptoms.
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Antimisiaris, Demetra, Brittany McHolan, Daniela Moga i Cortney Mospan. "Medication Related Problems". Senior Care Pharmacist 36, nr 2 (1.02.2021): 68–82. http://dx.doi.org/10.4140/tcp.n.2021.68.
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When selecting and managing psychoactive medications in older people, it is equally important to focus on avoidance of toxicity as it is to focus on efficacy. Higher psychoactive medication load is associated with increased rate and risk of all cause hospitalization. The medication classes used to treat depression and related comorbidities include antidepressants, antipsychotics, stimulants, mood stabilizers, lithium, anxiolytics and sedative hypnotics. This discussion will examine considerations to help avoid medication related problems relevant to medications used to treat depression in the antidepressant pharmacological class.
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Antimisiaris, Demetra, Brittany McHolan, Daniela Moga i Cortney Mospan. "Medication Related Problems". Senior Care Pharmacist 36, nr 2 (1.02.2021): 68–82. http://dx.doi.org/10.4140/tcp.n.2021.68.
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When selecting and managing psychoactive medications in older people, it is equally important to focus on avoidance of toxicity as it is to focus on efficacy. Higher psychoactive medication load is associated with increased rate and risk of all cause hospitalization. The medication classes used to treat depression and related comorbidities include antidepressants, antipsychotics, stimulants, mood stabilizers, lithium, anxiolytics and sedative hypnotics. This discussion will examine considerations to help avoid medication related problems relevant to medications used to treat depression in the antidepressant pharmacological class.
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Istilli, Plínio Tadeu, Adriana Inocenti Miasso, Cláudia Maria Padovan, José Alexandre Crippa i Carlos Renato Tirapelli. "Antidepressants: knowledge and use among nursing students". Revista Latino-Americana de Enfermagem 18, nr 3 (czerwiec 2010): 421–28. http://dx.doi.org/10.1590/s0104-11692010000300018.
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This study examined the knowledge of nursing students in regard to using antidepressant medication and proposes actions such that nurses contribute to a safe and effective antidepressant therapy. This cross-sectional and descriptive study was conducted in a public nursing school in the state of São Paulo, Brazil, between March and November 2008. Fifty-two (19%) out of the 273 participants were using or had used antidepressants. Instruction concerning the use of antidepressants was provided by physicians. Even after receiving instruction concerning the antidepressant treatment before its administration, the majority of users (cII1=0.07, p> 0.05) still had doubts about its use. Fluoxetine was the most prevalent antidepressant. Actions to improve knowledge concerning the use of antidepressant medications, their side and therapeutic effects, seem to be necessary and relevant.
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Adams, Nicholas Norman. "Do Newer Antidepressant Drugs Really Have Reduced Side Effects? Examining a Random “Real World” Sample of 300+ Receivers of Medications". IAFOR Journal of Psychology & the Behavioral Sciences 6, nr 1 (12.12.2020): 75–100. http://dx.doi.org/10.22492/ijpbs.6.1.05.
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Newer antidepressant drugs are frequently cited as having reduced side effect profiles to that of their older counterparts. However, recent studies have begun to dispute this claim, citing selective sampling, short clinical trials, and clinical trial environments as influencing reported outcomes. At present, little research on antidepressant side effects draws on RWD (Real-World Data). Despite this, interest in examining RWD samples for antidepressant drug side effects is increasing as of 2020. The reported study asked a random sample of 300+ individuals taking a variety of different antidepressant medications to complete online drug side effect self-report scales with previously high validity. Newer antidepressants belonging to the atypical antidepressant drug class were reported as having only slightly reduced side effects of weight gain compared with older SSRI-class medications. No reduced side effects of increased depression, anxiety, sexual dysfunction (SD), sleepiness, or suicidal ideation (SI) were found for the newer atypical-class medications vs older SSRI-class agents. Medication adherence did not differ significantly between SSRI and atypical classes. No evidence for reduced side effects was found for newer SSRI and atypical antidepressants vs older same-class drugs when comparing six new and old medications drawn from atypical and SSRI classes. However, atypical antidepressants were associated with increased use of adjunct medications to bolster primary treatment.
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Thommasen, Harvey V., Earle Baggaley, Carol Thommasen i William Zhang. "Prevalence of Depression and Prescriptions for Antidepressants, Bella Coola Valley, 2001". Canadian Journal of Psychiatry 50, nr 6 (maj 2005): 346–52. http://dx.doi.org/10.1177/070674370505000610.
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Objective: To determine the prevalence of depression–anxiety disorders and the degree to which physicians prescribed antidepressants for Aboriginal and non-Aboriginal populations living in a remote rural community in British Columbia in 2001. Methods: To obtain data for our main outcome measures, we retrospectively reviewed the charts of 2375 patients living in the Bella Coola Valley as of September 2001 and attending the Bella Coola Medical Clinic. Results: The 2001 prevalence rate of depression–anxiety disorders in the Bella Coola Valley was 7.5% (177/2375). Depression was the most common problem (86%) in these patients. Women had a higher rate of depression–anxiety disorders (10.3%) than did men (4.7%) ( P < 0.001). Non-Aboriginal people had a slightly higher rate (8.5%) than did Aboriginal people (6.3%); however, the difference was not statistically significant. Antidepressant medications were commonly prescribed for chronic pain and insomnia. The general pattern of antidepressant medication use in 2001 among both Aboriginal and non-Aboriginal people living in the Bella Coola Valley was as follows: peak use of antidepressants was in the middle to late years; the rate for women was roughly double the rate for men; and proportionately more Aboriginal people, especially the women, were taking antidepressants. Conclusions: Depression–anxiety disorder prevalence rates for Aboriginal and non-Aboriginal populations are similar. When using antidepressant medication prescriptions as a community health indicator, health care administrators should be aware that antidepressant medications are commonly prescribed for conditions other than depression–anxiety disorder.
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Viktorin, A., R. Uher, A. Reichenberg, S. Z. Levine i S. Sandin. "Autism risk following antidepressant medication during pregnancy". Psychological Medicine 47, nr 16 (22.05.2017): 2787–96. http://dx.doi.org/10.1017/s0033291717001301.
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BackgroundPrevious studies have examined if maternal antidepressant medication during pregnancy increase the risk of autism spectrum disorder (ASD) in the offspring, but the results have been conflicting.MethodsIn a population-based cohort of 179 007 children born in 2006 and 2007 and followed through 2014 when aged 7 and 8, we estimated relative risks (RRs) of ASD and 95% confidence intervals (CIs) from Cox regression in children exposed to any antidepressant medication during pregnancy, and nine specific antidepressant drugs. Analyses were adjusted for potential confounders and were conducted in the full population sample, and in a clinically relevant sub-sample of mothers with at least one diagnosis of depression or anxiety during life.ResultsThe adjusted RR of ASD in children of mothers who used antidepressant medication during pregnancy was estimated at 1.23 (95% CI 0.96–1.57), and at 1.07 (95% CI 0.80–1.43) in women with a history of depression or anxiety. Analyses of specific antidepressants initially revealed increased RRs of offspring ASD confined to citalopram and escitalopram (RR: 1.47; 95% CI 0.92–2.35) and clomipramine (RR: 2.86; 95% CI 1.04–7.82).ConclusionMedication with antidepressants during pregnancy does not appear to be causally associated with an increased risk of ASD in the offspring. Instead, the results suggest that the association is explained by factors related to the underlying susceptibility to psychiatric disorders. Based on these findings, the risk of ASD in the offspring should not be a consideration to withhold treatment with commonly used antidepressant drugs from pregnant women.
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Meyers, Barnett S. "Late-Life Delusional Depression: Acute and Long-Term Treatment". International Psychogeriatrics 7, S1 (październik 1995): 113–24. http://dx.doi.org/10.1017/s1041610295002390.
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Treatment studies of delusional major depression demonstrate a poor response to standard antidepressant medications. Longitudinal studies demonstrate high relapse rates, even in patients receiving postdischarge antidepressants. The poor medical and psychiatric outcomes for late-life delusional depression and the increased risk for adverse medication reactions in this population underscore the importance of developing effective postrecovery treatments.Studies of mixed-age adults demonstrate the effectiveness of acute treatment with either electroconvulsive therapy or combination pharmacotherapy with high doses of neuroleptics and antidepressants. In considering these results in relation to the treatment of late-life delusional depression, attention must be given to the particular vulnerabilities to medication side effects of elderly patients.The potential effectiveness of continuation treatment with combined antidepressant-neuroleptic therapy is discussed. Clinical and methodologic issues related to studying the effectiveness of combination treatment in elderly patients are emphasized.
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Bjørklund, Louise, Henriette Thisted Horsdal, Ole Mors, Søren Dinesen Østergaard i Christiane Gasse. "Trends in the psychopharmacological treatment of bipolar disorder: a nationwide register-based study". Acta Neuropsychiatrica 28, nr 2 (11.09.2015): 75–84. http://dx.doi.org/10.1017/neu.2015.52.
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ObjectiveIn bipolar disorder, treatment with antidepressants without concomitant use of mood stabilisers (antidepressant monotherapy) is associated with development of mania and rapid cycling and is therefore not recommended. The present study aimed to investigate the psychopharmacological treatment patterns in bipolar disorder over time, with a focus on antidepressant monotherapy.MethodsCohort study with annual cross-sectional assessment of the use of psychotropic medications between 1995 and 2012 for all Danish residents aged 10 years or older with a diagnosis of bipolar disorder registered in the Danish Psychiatric Central Research Register. Users of a given psychotropic medication were defined as individuals having filled at least one prescription for that particular medication in the year of interest.ResultsWe identified 20 618 individuals with bipolar disorder. The proportion of patients with bipolar disorder using antidepressants, atypical antipsychotics and anticonvulsants increased over the study period, while the proportion of patients using lithium, typical antipsychotics and benzodiazepines/sedatives decreased. The proportion of patients treated with antidepressant monotherapy decreased from 20.5% in 1997 to 12.1% in 2012, and among antidepressant users, the proportion in monotherapy decreased from 47.7% to 23.9%, primarily driven by a decrease in the use of tricyclic antidepressants.ConclusionThe results show an increase in the proportion of patients with bipolar disorder being treated with antidepressants in the period from 1997 to 2012. However, in accordance with international treatment guidelines, the extent of antidepressant monotherapy decreased during the same period.
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Galbally, Megan, Andrew J. Lewis, Jarrad Lum i Anne Buist. "Serotonin Discontinuation Syndrome Following in Utero Exposure to Antidepressant Medication: Prospective Controlled Study". Australian & New Zealand Journal of Psychiatry 43, nr 9 (1.01.2009): 846–54. http://dx.doi.org/10.1080/00048670903107583.
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Objectives: The aim of the present study was to examine neonatal symptoms previously reported to be associated with exposure to antidepressant medication in late pregnancy in a group of infants exposed to antidepressants, using a prospective and controlled design. Method: A prospective case–control study recruited 27 pregnant women taking antidepressant medication and 27 matched controls who were not taking antidepressant medication in pregnancy. Of the 27 women taking medication, 25 remained on medication in the third trimester and, of these, 23 women had complete data available. In pregnancy and after delivery women were assessed with the Beck Depression Inventory-II and a purpose-designed questionnaire. After delivery mothers were asked a set of nine questions pertaining to symptoms of discontinuation in their newborn and questions about pregnancy and delivery complications. Results: There was an increased risk of discontinuation symptoms in neonates exposed to antidepressant medication in late pregnancy and an association with higher dose medication. The study group were found to be significantly more likely to display behaviour such as crying, jitteriness, tremor, feeding, reflux and sneezing and sleep for <3 h after a feed. They also had significantly higher rates of jaundice and admissions to the special care nursery. Conclusions: Exposure to antidepressants in late pregnancy is associated with a range of symptoms in the neonate that are consistent with the effects of exposure to antidepressants in late pregnancy. The clusters of symptoms most highly correlated are the gastrointestinal and central nervous system symptoms. These finding helps to identify the common symptoms associated with a neonatal serotonin discontinuation syndrome.
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Hafferty, Jonathan D., Eleanor M. Wigmore, David M. Howard, Mark J. Adams, Toni-Kim Clarke, Archie I. Campbell, Donald J. MacIntyre i in. "Pharmaco-epidemiology of antidepressant exposure in a UK cohort record-linkage study". Journal of Psychopharmacology 33, nr 4 (27.02.2019): 482–93. http://dx.doi.org/10.1177/0269881119827888.
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Objectives: Antidepressants are the most commonly prescribed psychiatric medication but concern has been raised about significant increases in their usage in high income countries. We aimed to quantify antidepressant prevalence, incidence, adherence and predictors of use in the adult population. Methods: The study record-linked administrative prescribing and morbidity data to the Generation Scotland cohort ( N = 11,052), between 2009 and 2016. Prevalence and incidence of any antidepressant use was determined. Antidepressant adherence was measured using Proportion of Days Covered and Medication Possession Ratio. Time-to-event analysis for incident antidepressant use within 5 years of Generation Scotland: Scottish Family Health Study (GS:SFHS) recruitment was performed to reveal patient-level predictors of use. Results: Almost one-third (28.0%, 95%CI 26.9–29.1) of the adults in our sample were prescribed at least one antidepressant in the 5-year period 2012–2016. There was a 36.2% increase in annual prevalence between 2010 and 2016. Incidence was 2.4(2.1–2.7)% per year. The majority of antidepressant episodes (57.6%) were greater than 9 months duration and adherence was generally high (69.0% with Proportion of Days Covered >80%). Predictors of new antidepressant use included history of affective disorder, being female, physical comorbidities, higher neuroticism scores, and lower cognitive function scores. Conclusions: Antidepressant prevalence is greater than previously reported but incidence remains relatively stable. We found the majority of antidepressant episodes to be of relatively long duration with good estimated adherence. Our study supports the hypothesis that increased long-term use among existing (and returning) users, along with wider ranges of indications for antidepressants, has significantly increased the prevalence of these medications.
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Webb, Lauren M., Kathryn E. Phillips, Man Choi Ho, Marin Veldic i Caren J. Blacker. "The Relationship between DNA Methylation and Antidepressant Medications: A Systematic Review". International Journal of Molecular Sciences 21, nr 3 (28.01.2020): 826. http://dx.doi.org/10.3390/ijms21030826.
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Major depressive disorder (MDD) is the leading cause of disability worldwide and is associated with high rates of suicide and medical comorbidities. Current antidepressant medications are suboptimal, as most MDD patients fail to achieve complete remission from symptoms. At present, clinicians are unable to predict which antidepressant is most effective for a particular patient, exposing patients to multiple medication trials and side effects. Since MDD’s etiology includes interactions between genes and environment, the epigenome is of interest for predictive utility and treatment monitoring. Epigenetic mechanisms of antidepressant medications are incompletely understood. Differences in epigenetic profiles may impact treatment response. A systematic literature search yielded 24 studies reporting the interaction between antidepressants and eight genes (BDNF, MAOA, SLC6A2, SLC6A4, HTR1A, HTR1B, IL6, IL11) and whole genome methylation. Methylation of certain sites within BDNF, SLC6A4, HTR1A, HTR1B, IL11, and the whole genome was predictive of antidepressant response. Comparing DNA methylation in patients during depressive episodes, during treatment, in remission, and after antidepressant cessation would help clarify the influence of antidepressant medications on DNA methylation. Individuals’ unique methylation profiles may be used clinically for personalization of antidepressant choice in the future.
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Rai, Salakan, i Aizad Yusof. "An audit on prescribing practice and risk of serotonin syndrome among patients with chronic pain". BJPsych Open 7, S1 (czerwiec 2021): S152. http://dx.doi.org/10.1192/bjo.2021.425.
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AimsTo determine the incidence of prescribing practice with associated risk of serotonin toxicity among patients with chronic pain conditions.BackgroundSerotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity, usually from drug interactions. Concurrent use of antidepressants is strongly linked to serotonin syndrome, with recent data revealing record numbers of NHS prescribed antidepressants in 2019. Antidepressant medications are also used in chronic pain management for their anti-neuropathic pain properties. However, it is well-recognised that a significant number of chronic pain patients suffer from anxiety and depression. This cohort of patients is therefore vulnerable to being exposed to multiple concurrent antidepressant agents, and thus at relatively higher risk of serotonin syndrome compared to other patient groups. Additionally, these patients are likely to be exposed to the concurrent use of antidepressants and certain analgesic agents particularly phenylpiperidine derivatives which increases serotonin toxicity risk.MethodMedications of patients presenting to a secondary care pain clinic within the last year were looked into. Patients were selected at random by pain management secretaries. Concurrent use of multiple antidepressant agents including Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin Noradrenaline Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants (TCAs) or Tetracyclic Antidepressant (TeCA) was noted. Additionally, concurrent use of any of these antidepressant agents and phenylpiperidine derivatives such as Fentanyl and Tramadol was noted.ResultData on medications of 97 patients were collected. A total of 28 patients (28.8%) were observed to have at-risk medication combinations. Out of these, five patients were on both SSRI and TCA. Two patients were on both TCA and TeCA. Four other patients were on either a combination of SSRI and SNRI, SNRI and TCA, SSRI and TeCA, or TCA and TCA. Three patients were on both Fentanyl patches and an antidepressant. Fourteen patients were on both an antidepressant and Tramadol. None of these patients were diagnosed with serotonin syndrome; however, it is unclear as to whether these patients experienced milder symptoms of the syndrome.ConclusionA considerable number of patients in this group were on medication combinations putting them at risk of serotonin syndrome. Despite no documented patient harm, there is an urgent need for an increased awareness among prescribers on drug interactions which may lead to this syndrome and a subsequent change in prescribing practice.
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Wiles, Nicola, Abigail Taylor, Nicholas Turner, Maria Barnes, John Campbell, Glyn Lewis, Jill Morrison i in. "Management of treatment-resistant depression in primary care: a mixed-methods study". British Journal of General Practice 68, nr 675 (24.09.2018): e673-e681. http://dx.doi.org/10.3399/bjgp18x699053.
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BackgroundNon-response to antidepressant medication is common in primary care. Little is known about how GPs manage patients with depression that does not respond to medication.AimTo describe usual care for primary care patients with treatment-resistant depression (TRD).Design and settingMixed-methods study using data from a UK primary care multicentre randomised controlled trial.MethodIn total, 235 patients with TRD randomised to continue with usual GP care were followed up at 3-month intervals for a year. Self-report data were collected on antidepressant medication, number of GP visits, and other treatments received. In addition, 14 semi-structured face-to-face interviews were conducted with a purposive sample after the 6-month follow-up and analysed thematically.ResultsMost patients continued on the same dose of a single antidepressant between baseline and 3 months (n = 147/186 at 3 months, 79% (95% confidence interval [CI] = 73 to 85%)). Figures were similar for later follow-ups (for example, 9–12 months: 72% (95% CI = 63 to 79%). Medication changes (increasing dose; switching to a different antidepressant; adding a second antidepressant) were uncommon. Participants described usual care mainly as taking antidepressants, with consultations focused on other (physical) health concerns. Few accessed other treatments or were referred to secondary care.ConclusionUsual care in patients with TRD mainly entailed taking antidepressants, and medication changes were uncommon. The high prevalence of physical and psychological comorbidity means that, when these patients consult, their depression may not be discussed. Strategies are needed to ensure the active management of this large group of patients whose depression does not respond to antidepressant medication.
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Barbosa, P., O. Nombora, J. Monteiro i L. Ribeiro. "Terbinafine and antidepressants: Potential risk of medication induced mania". European Psychiatry 64, S1 (kwiecień 2021): S199. http://dx.doi.org/10.1192/j.eurpsy.2021.528.
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Introduction Mood destabilization and induced manic episodes are well-known phenomenon under antidepressant medications. However, even with a cautious introduction of antidepressants, it’s important to be aware of possible pharmacological interactions. Terbinafine is a known inhibitor of CYP2D6, a major hepatic metabolizer of a full list of antidepressant medications, and so capable of raising their serum levels and potentiating their side effects.ObjectivesWith this case report we aim to emphasize the importance of cautious usage of Terbinafine when combined with antidepressant medications.MethodsWe present a clinical case of an induced first manic episode after the introduction of Terbinafine in a patient under antidepressant medication and a qualitative review on the topic, using PubMed database.ResultsA 66-year-old woman, with an history of Major Depressive Disorder, previously medicated with Venlafaxine 75mg/day and Mirtazapine 30mg/day, was brought to the emergency department because of psychomotor agitation. She also had an history of seasonal fluctuating mood, although never fulfilling the criteria for Bipolar Disorder. At admission, her clinical status was compatible with a manic episode. This episode followed two months after the initiation of Terbinafine for onychomycosis.Conclusions There are few studies that have shown antidepressant toxicity mediated by an interaction with Terbinafine. As far as we know this is the first case of induced mania after the introduction of Terbinafine. Therefore, it is important to remind that Terbinafine is a potential interacting agent when combined with psychotropic medications.
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Schmidt, Norman B., i Julia D. Smith. "Do Medications Matter in the Context of Cognitive Behavior Therapy for Panic Disorder?" Journal of Cognitive Psychotherapy 19, nr 4 (październik 2005): 347–54. http://dx.doi.org/10.1891/jcop.2005.19.4.347.
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Patients with panic disorder are frequently medicated when they participate in psychotherapy such as cognitive behavioral therapy (CBT). The present study examined the effects of overall medication status, medication type (benzodiazepine versus antidepressant), and medication dose in a large sample of patients with panic disorder (N = 178) participating in CBT. Overall, medications exhibited very little effect on outcome. After controlling for the effects of CBT, however, taking higher doses of antidepressants was associated with poorer end-state functioning. Results are discussed in relation to better understanding the role of combining psychopharmacological and psychosocial treatments for panic disorder.
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Tamburrino, Marijo B., Rollin W. Nagel, Mangeet K. Chahal i Denis J. Lynch. "Antidepressant Medication Adherence". Primary Care Companion to The Journal of Clinical Psychiatry 11, nr 5 (15.10.2009): 205–11. http://dx.doi.org/10.4088/pcc.08m00694.
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Zimmerman, Mark. "The Influence of Comorbid Anxiety Disorders on the Selection of Antidepressant Medication in Depressed Patients". CNS Spectrums 11, S1 (styczeń 2006): 4–6. http://dx.doi.org/10.1017/s1092852900028194.
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Although there is a wide array of choices of antidepressants, there is little empirical evidence to guide clinicians in their selection. Most reviews of the antidepressant literature, including the American Psychiatric Association's (APA) Practice Guideline for the Treatment of Major Depressive Disorder, conclude that these medications are generally equally effective. Consistent with this, a recent metaanalysis of studies comparing two or more new-generation antidepressants found little evidence that any medication was superior to the others. Although the APA guideline suggests that the choice of antidepressant be based principally on side effects, tolerability, patient preference, and cost, it also reviewed evidence of differential treatment response related to patients' clinical profiles. For patients with nonpsychotic, nonbipolar major depressive disorder (MDD), the guideline indicated that the presence of anxiety symptoms, atypical features, melancholic subtype, symptom severity, and borderline personality disorder may be associated with differential response to antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are recommended for high anxiety, SSRIs and clomipramine for obsessive-compulsive disorder (OCD) symptoms, tricyclic antidepressants (TCAs) for severe depression and melancholia, and SSRIs and monoamine oxidase inhibitors (MAOIs) for atypical depression.What is most striking in the guideline's review is how limited in scope and utility are the data to guide the outpatient psychiatrist in selecting an antidepressant. Melancholia and severe depression are relatively infrequently encountered in the outpatient setting. The most common comorbidities in depressed outpatients are anxiety disorders, but the guideline simply says that bupropion may be anxiogenic and should be avoided, and that although MAOIs may work well in depressed patients with anxiety, other medications are preferred. It does not discuss the possible influence of specific comorbidities on antidepressant selection.
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Groot, Peter C., i Jim van Os. "Outcome of antidepressant drug discontinuation with taperingstrips after 1–5 years". Therapeutic Advances in Psychopharmacology 10 (styczeń 2020): 204512532095460. http://dx.doi.org/10.1177/2045125320954609.
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Background: Stopping antidepressants is often difficult due to withdrawal. Taperingstrips were developed to facilitate antidepressant discontinuation according to the recently described Horowitz-Taylor method, allowing for personalised titration of discontinuation to the intensity of withdrawal. A taperingstrip consists of antidepressant or other medication, packaged in a 28-day roll of small daily pouches, each with the same or slightly lower dose than the one before it. We previously reported that the short-term success rate of antidepressant taperingstrips was 71%. Here, we examine longer-term outcome after 1–5 years. Methods: Patients whose doctor had ordered taperingstrips between January 2015 and December 2019 were sent a questionnaire for participation in anonymised research in January 2020. Of 1012, 483 participated, of whom 408 (85%) had attempted antidepressant tapering. Results: Of the 408 patients included, 192 (47%) had used strips for tapering venlafaxine, 142 (35%) for paroxetine and 74 (18%) for other antidepressants. Median length of antidepressant use was 4 years, and most (61%) had tried to come off without taperingstrips at least once. After 1–5 years, 270 patients (66%) remained off antidepressants after tapering their antidepressant, 6 (2%) had successfully reduced their medication, 87 (21%) had restarted due to (self-reported) relapse, 35 had restarted for another indication (9%), and 10 (3%) reported another outcome. People with more severe experience of withdrawal prior to tapering, and people who had been on antidepressants for a shorter period of time, were more likely to remain off medication after 1–5 years. Conclusion: The previously reported 71% short-term success rate of taperingstrips in the most severely affected group, was matched by a 68% rate after 1–5 years. The evidence-based approach of personal tapering to counter withdrawal, as used for drugs causing withdrawal, for example, benzodiazepines, may represent a simple solution for an important antidepressant-related public health problem, without extra costs.
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Beck, Cynthia A., Jeanne VA Williams, Jian Li Wang, Aliya Kassam, Nady El-Guebaly, Shawn R. Currie, Colleen J. Maxwell i Scott B. Patten. "Psychotropic Medication Use in Canada". Canadian Journal of Psychiatry 50, nr 10 (1.08.2005): 605–13. http://dx.doi.org/10.1177/070674370505001006.
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Background: Psychotropic medication use can be employed as an indicator of appropriate treatment for mental disorders. The Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) offers the first opportunity to characterize Canadian psychotropic medication use on a national level within diagnostic groups as assessed by a full version of the Composite International Diagnostic Interview (CIDI). Method: We assessed the prevalence of antidepressant, sedative-hypnotic, mood stabilizer, psychostimulant, and antipsychotic use over 2 days overall and in subgroups defined by CIDI-diagnosed disorders and demographics. We employed sampling weights and bootstrap methods. Results: Overall psychotropic drug utilization was 7.2%. Utilization was higher for women and with increasing age. With any lifetime CIDI-diagnosed disorder assessed in the CCHS 1.2, utilization was 19.3%, whereas without such disorders, it was 4.1%. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly used antidepressants for those with a past-year major depressive episode (17.8%), followed by venlafaxine (7.4%). Among people aged 15 to 19 years, antidepressant use was 1.8% overall and 11.7% among those with past-year depression; SSRIs made up the majority of use. Sedative-hypnotics were used by 3.1% overall, increasing with age to 11.1% over 75 years. Conclusions: International comparison is difficult because of different evaluation methods, but antidepressant use may be higher and antipsychotic use lower in Canada than in recent European and American reports. In light of the relative lack of contemporary evidence for antidepressant efficacy in adolescents, it is likely that antidepressant use among those aged 15 to 19 years will continue to decline. The increased use of sedative-hypnotics with age is of concern, given the associated risk of adverse effects among seniors.
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Henriksson, S., R. Asplund, G. Boëthius, T. Hällström i G. Isacsson. "Infrequent use of antidepressants in depressed individuals (an interview and prescription database study in a defined Swedish population 2001–2002)". European Psychiatry 21, nr 6 (wrzesień 2006): 355–60. http://dx.doi.org/10.1016/j.eurpsy.2006.04.003.
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AbstractPurpose:To investigate whether antidepressants are over-used, under-used, or misused, by determining to what extent the depressed individuals in a defined population are treated with antidepressant medication and, from the other end, to what extent prescribed antidepressants are aimed for the treatment of depression.Subjects and method:From an individual based prescription database in the County of Jämtland, 2048 individuals representative for the general population were selected. The presence of current depression in these individuals was screened by a mailed self-screening questionnaire. Individuals with depression according to the questionnaire were interviewed by a psychiatrist using a structured interview (SCAN) to confirm the diagnosis. Their use of antidepressants was obtained from the prescription database.Results:Sixty-two (4.5%) out of 1375 were diagnosed with depression and 17 (27%) of these were taking an antidepressant. In addition 44 individuals, currently not depressed, were taking antidepressants. Twenty-five of these were interviewed per telephone and it was found that the indications for 18 of them were continuation treatment of depression, and for seven of them pain, sleep disturbance or anxiety.Conclusion:Antidepressants appear to be under-used in the population. Only one in four of the depressed individuals was treated with antidepressant medication. Those who had antidepressant medication without being currently depressed had, with few exceptions, either continuation treatment for depression in remission or treatment on other approved indications.
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Spinrad, A., S. Darki-Morag i D. Taliaz. "Optimizing prediction of response to antidepressant medications using machine learning and environmental data". European Psychiatry 64, S1 (kwiecień 2021): S755. http://dx.doi.org/10.1192/j.eurpsy.2021.2000.
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IntroductionMajor depressive disorder (MDD) is complex and multifactorial, posing a major challenge of tailoring the optimal medication for each patient. Current practice for MDD treatment mainly relies on trial-and-error, with estimated 42%-53% response rates for antidepressant use.ObjectivesWe sought to generate an accurate predictor of response to a panel of antidepressants and optimize treatment selection using a data-driven approach analyzing combinations of clinical and demographic factors.MethodsWe analyzed the response patterns of patients to five antidepressant medications in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study and the Pharmacogenomic Research Network Antidepressant Medication Pharmacogenomic Study (PGRN-AMPS), and employed state-of-the-art machine learning (ML) tools to generate a predictive algorithm. To validate our results and confirm the algorithm’s external generalizability outside of its training groups, we assessed its capacity to predict individualized antidepressant responses on a separate validation and test sets consisting of 1,021 patients overall from both studies.ResultsThe algorithm’s ML prediction models achieved an average accuracy of 0.6416 (64.16%, SD 4.4) across the analyzed medications, and a cumulative accuracy of 0.6012 (60.12%), AUC of 0.601, sensitivity of 0.6034 (60.34%) and specificity of 0.599 (59.9%).ConclusionsThese findings support applying ML to accumulating data derived from large studies to achieve a much-needed improvement in the treatment of depression. By an immediate analysis of large amount of combinatorial data at the point of care, such prediction models may support doctors’ prescription decisions, potentially allowing them to tailor the right antidepressant medication sooner.DisclosureDekel Taliaz is the founder and CEO of Taliaz and reports stock ownership in Taliaz. Amit Spinrad and Sne Darki-Morag serve as data scientists in Taliaz.
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Parker, Gordon, i Dusan Hadzi-Pavlovic. "Prediction of Response to Antidepressant Medication by a Sign-Based Index of Melancholia". Australian & New Zealand Journal of Psychiatry 27, nr 1 (marzec 1993): 56–61. http://dx.doi.org/10.3109/00048679309072124.
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We examine the capacity of a new melancholia index (focussing on CORE signs indicative of psychomotor change) to predict response to antidepressant medication. In a naturalistic study, depressed patients were assessed and rated by their treating psychiatrist, and we focus on those who received antidepressants for three weeks or more. Those subjects who returned high CORE scores (putative melancholia) at baseline improved more over the initial six weeks, but analyses suggested that the differential improvement outcome was independent of medication. Thus, CORE scores predicted outcome for those receiving antidepressant medication, but possible mechanisms remain unresolved.
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Dunlop, Boadie W., Philip E. Polychroniou, Jeffrey J. Rakofsky, Charles B. Nemeroff, W. Edward Craighead i Helen S. Mayberg. "Suicidal ideation and other persisting symptoms after CBT or antidepressant medication treatment for major depressive disorder". Psychological Medicine 49, nr 11 (12.09.2018): 1869–78. http://dx.doi.org/10.1017/s0033291718002568.
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AbstractBackgroundPersisting symptoms after treatment for major depressive disorder (MDD) contribute to ongoing impairment and relapse risk. Whether cognitive behavior therapy (CBT) or antidepressant medications result in different profiles of residual symptoms after treatment is largely unknown.MethodsThree hundred fifteen adults with MDD randomized to treatment with either CBT or antidepressant medication in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study were analyzed for the frequency of residual symptoms using the Montgomery Asberg Depression Rating Scale (MADRS) item scores at the end of the 12-week treatment period. Separate comparisons were made for treatment responders and non-responders.ResultsAmong treatment completers (n= 250) who responded to CBT or antidepressant medication, there were no significant differences in the persistence of residual MADRS symptoms. However, non-responders treated with medication were significantly less likely to endorse suicidal ideation (SI) at week 12 compared with those treated with CBT (non-responders to medication: 0/54, 0%, non-responders to CBT: 8/30, 26.7%;p= .001). Among patients who terminated the trial early (n= 65), residual MADRS item scores did not significantly differ between the CBT- and medication-treated groups.ConclusionsDepressed adults who respond to CBT or antidepressant medication have similar residual symptom profiles. Antidepressant medications reduce SI, even among patients for whom the medication provides little overall benefit.
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Patten, S. B., J. V. A. Williams i C. Mitton. "Costs associated with mood and anxiety disorders, as evaluated by telephone survey". Chronic Diseases in Canada 28, nr 4 (2008): 155–62. http://dx.doi.org/10.24095/hpcdp.28.4.05.
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Costing studies are central to health policy decisions. Available costing estimates for mood and anxiety disorders in Canada may, however, be out of date. In this study, we estimated a set of direct health care costs using data collected in a provincial telephone survey of mood and anxiety disorders in Alberta. The survey used random digit dialing to reach a sample of 3394 household residents aged 18 to 64. A telephone interview included items assessing costs without reference to whether these were incurred by the respondent, government or a health plan. The survey interview also included the Mini Neuropsychiatric Diagnostic Interview (MINI). Costs for antidepressant medications appear to have increased since the last available estimates were published. Surprisingly, most medication costs for antidepressants were incurred by respondents without an identified disorder. Also, an unexpectedly large proportion of medication costs were for psychotropic medications other than antidepressants and anxiolytic-sedative-hypnotics. These results suggest that major changes have occurred in the costs associated with antidepressant treatment. Available cost-of-illness data may be outdated, and some assumptions made by previous studies may now be invalid.
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Stuchtey, Fidelis Christin, Andrea Block, Francis Osei i Pia-Maria Wippert. "Lipid Biomarkers in Depression: Does Antidepressant Therapy Have an Impact?" Healthcare 10, nr 2 (9.02.2022): 333. http://dx.doi.org/10.3390/healthcare10020333.
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Studies have revealed mixed results on how antidepressant drugs affect lipid profiles of patients with major depression disorder (MDD). Even less is known about how patients respond to a switch of antidepressant medication with respect to their metabolic profile. For this, effects of a switch in antidepressants medication on lipid markers were studied in MDD patients. 15 participants (females = 86.67%; males = 13.33%; age: 49.45 ± 7.45 years) with MDD and a prescribed switch in their antidepressant medication were recruited at a psychosomatic rehabilitation clinic. Participants were characterized (with questionnaires and blood samples) at admission to the rehabilitation clinic (baseline, T0) and followed up with a blood sample two weeks (T1) later. HDL, LDL, total cholesterol, and triglycerides were determined (T0), and their change analyzed (Wilcoxon test) at follow up (T1). Decrements in HDL (p = 0.041), LDL (p < 0.001), and total cholesterol (p < 0.001) were observed two weeks after a switch in antidepressant medication. Triglycerides showed no difference (p = 0.699). Overall, LDL, HDL, and total cholesterol are affected by a change in antidepressant drugs in patients with MDD. These observations are of clinical relevance for medical practitioners in the planning and management of treatment strategies for MDD patients.
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El-Mallakh, Rif S., R. Jeannie Roberts, Alan Swann, Pat R. Rutherford i Anton Surja. "Tardive dysphoria: antidepressant-induced chronic depression". Irish Journal of Psychological Medicine 28, nr 1 (marzec 2011): 38–41. http://dx.doi.org/10.1017/s0790966700011976.
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AbstractObjectives: A significant number of depressed individuals experience inadequate benefit from long-term antidepressant use. This paper investigates the hypothesis that in some individuals persistent use of antidepressants may be prodepressant.Methods: Literature regarding the effect of long-term use of antidepressants was reviewed by searching PubMed and Ovid data bases with terms: antidepressant tachyphylaxis, treatment-resistant depression, chronic depression and antidepressant tolerance.Results: Antidepressant treatment-resistant patients frequently had a positive initial response to antidepressants. When resistance appeared, initial increases in dose or medication changes usually resulted in transient improvement. Eventually, the episodic course of the original depressive illness was replaced with a continuous, unresponsive depressive syndrome. We propose the term tardive dysphoria to describe this phenomenon.Conclusions: The phenomenon of antidepressantinduced depression, or tardive dysphoria, needs to be experimentally examined in blinded, randomised antidepressant discontinuation studies.
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Groot, Peter C., i Jim van Os. "Successful use of tapering strips for hyperbolic reduction of antidepressant dose: a cohort study". Therapeutic Advances in Psychopharmacology 11 (styczeń 2021): 204512532110393. http://dx.doi.org/10.1177/20451253211039327.
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Background: Tapering strips facilitate antidepressant discontinuation, allowing for personalised titration of discontinuation to the intensity of withdrawal. A tapering strip consists of antidepressant or other medication, packaged in a 28-day roll of daily pouches, each with the same or slightly lower dose than the one before. Previous studies demonstrated 70% real-world effectiveness of tapering strips. Here, we present a third, questionnaire-based retrospective cohort study in a large sample. Methods: Patients whose doctor had prescribed tapering strips between October 2015 and December 2018 were sent a questionnaire for participation after completion of tapering between December 2015 and January 2020. Of 1240 individuals who returned a questionnaire (response rate: 59%), 987 (80%) used an antidepressant, of whom 824 (83%) had wished to discontinue their antidepressant. Results: The sample was demographically representative of antidepressant users in the Netherlands. Less than 40% of participants had heard of tapering strips through their clinicians – Internet was the most frequent source. Of the 824 individuals, 341 (41%) had used strips for tapering venlafaxine, 206 (25%) for paroxetine and 277 (34%) for other antidepressants. Median duration of antidepressant use was 5–10 years, and most (71%) had tried to come off without tapering strips at least once. Most patients (72%) were able to discontinue their antidepressant, using a median of two strips to taper over a median period of 56 days. Females and individuals with (1) more severe experience of withdrawal during the use of tapering strips, (2) more years of use of antidepressant medication and (3) more previous attempts at discontinuation were less likely to be able to discontinue their antidepressant medication with tapering strips. Conclusion: The results of this study validate, for the third time, the observation that tapering strips can address the problem of antidepressant withdrawal symptoms in individuals attempting to discontinue antidepressants.
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Gadzhanova, Svetla, Elizabeth E. Roughead i Lisa G. Pont. "Antidepressant switching patterns in the elderly". International Psychogeriatrics 30, nr 9 (30.01.2018): 1365–74. http://dx.doi.org/10.1017/s1041610217002964.
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ABSTRACTBackground:Switching between antidepressants is complex due to potential adverse outcomes such as serotonin syndrome and antidepressant discontinuation syndrome, yet switching is often required due to non-response to initial treatment. This study aimed to examine the patterns and extent of antidepressant switching in a cohort of older adults in long-term residential care.Methods:A cohort study of medication supply data from 6011 aged care residents in 60 long-term care facilities was conducted. Incident antidepressant users were followed for 12 months and their patterns of antidepressant use determined. The type of switching from and to different antidepressant classes was determined according to National and International recommendations for antidepressant switching.Results:In total, 11% (n = 44) of the residents were initiated on an antidepressant medication (n = 402) switched to a different antidepressant agent within 12 months. Residents commenced on a SNRI or TCA were most likely to switch antidepressants (17% in each group). Almost half of the switches (n = 21, 48% of all switches) were not implemented according to guideline recommendations. Direct switch and taper followed by wash out and switch, accounted for all of the inappropriate switching (29% and 71%, respectfully), with half occurring to mirtazapine (N = 7) or from mirtazapine (N = 3).Conclusions:Over one in 10 long-term aged care residents who commence an antidepressant will switch to a different antidepressant within 12 months. Current antidepressant switching practices in long-term residential aged care may be increasing the risk of harm associated with antidepressant switching, with around half of all switches not following current guideline recommendations.
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Tamburrino, Marijo B., Rollin W. Nagel i Denis J. Lynch. "Managing Antidepressants in Primary Care: Physicians' Treatment Modifications". Psychological Reports 108, nr 3 (czerwiec 2011): 799–804. http://dx.doi.org/10.2466/02.13.15.pr0.108.3.799-804.
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To examine antidepressant management practices in primary care, patients ( N = 148) given an antidepressant for at least one month completed the Beck Depression Inventory (BDI–II), the Patient Health Questionnaire–9 (PHQ–9), and a demographic survey. Participants' mean age was 50.7 yr. and 80% were women. Patients' charts indicated whether physicians had made changes to prescribed antidepressants or dose either 6 wk. before or 6 wk. after study entry. For the 87% of participants whose depression status could be determined, 10% met dysthymic disorder criteria and only 33% had had a medication change in the previous month. Major depressive disorder occurred in 37% but only 18% had had a medication change. Co-existing dysthymic disorder and major depressive disorder were diagnosed in 34%, with 24% receiving a medication change. Participants not receiving a medication change had mean BDI-II scores indicating moderate depression. Lack of antidepressant adjustment suggests physicians may need to monitor depressive symptoms closely using protocols and prompts.
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Lam, Raymond W., Ron Peters, Nicholas Sladen-Dew i Siemion Altman. "A Community-Based Clinic Survey of Antidepressant Use in Persons with Schizophrenia". Canadian Journal of Psychiatry 43, nr 5 (czerwiec 1998): 513–16. http://dx.doi.org/10.1177/070674379804300511.
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Objective: To determine the rates of antidepressant and antipsychotic use in the treatment of schizophrenia. Method: The primary therapists at 8 community mental health centres in a metropolitan Canadian city completed a survey questionnaire for all of their active clients. Information was collected about diagnoses, medication treatments, and clinical variables. Results: There were 3555 clients, 1552 (43.7%) of which had a diagnosis of schizophrenia. Of clients with schizophrenia, 94% were prescribed antipsychotic medications, and 11.6% of these were also prescribed antidepressant medications. There were differences between the combination-treatment group and the antipsychotic-alone group in gender ratio, rates of concurrent diagnoses of mood disorder, level of current functioning, and total number of hospitalizations. Conclusion: In this community-based sample of clients with schizophrenia, antidepressants and antipsychotics are commonly prescribed in combination, even though the rate of concurrent mood disorders diagnoses is low. Further studies should clarify the efficacy and indications for antidepressant use in this population.
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Parker, Gordon, Ian M. Anderson i Peter Haddad. "Clinical trials of antidepressant medications are producing meaningless results". British Journal of Psychiatry 183, nr 2 (sierpień 2003): 102–4. http://dx.doi.org/10.1192/bjp.183.2.102.
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A recent alert from the UK Committee on Safety of Medicines stated that the dangers of treatment of depression with paroxetine outweigh the benefits in those under 18. Such a warning should focus our minds on the evidence on which clinical practice is based. Antidepressant treatment of depression in the under-18s has been thought to be justified because clinical trials show that it works so well in over-18s. But is that a reasonable assessment of the evidence? Kirsch et al (2002) use the analogy of ‘The Emperor's New Clothes' to describe the findings from their meta-analysis of randomised placebo-controlled trials of antidepressants. They conclude that antidepressant medication appears to have only a small effect on outcome over and above placebo. In this analogy psychiatry is the emperor, drug trials are the fraudsters and the deception is being revealed by a growing body of critical opinion proposing that, once methodological problems with clinical trials are taken into account, antidepressants either do not work at all or have an effect that is so small as to be clinically unimportant (Andrews, 2001; Moncrieff, 2002). A large number of randomised placebo-controlled trials of antidepressants have been carried out over the past decades, mostly funded by the pharmaceutical industry, and it is now recognised that about 50% of negative trials go unpublished (Thase, 1999). Meanwhile, unipolar depression has jumped into the top five of the world's total burden of disease, and there is an imperative need for effective and safe treatments. Do we need more randomised controlled trials (RCTs) of antidepressant medications, or has that research paradigm outlived its usefulness? In this month's debate, Professor Gordon Parker, University of New South Wales and Black Dog Institute, Australia, and Drs Ian Anderson and Peter Haddad from the University of Manchester discuss whether clinical trials for antidepressant medication produce meaningless results.
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Avalos, Lyndsay Ammon, Hong Chen i De-Kun Li. "Antidepressant medication use, depression, and the risk of preeclampsia". CNS Spectrums 20, nr 1 (luty 2015): 39–47. http://dx.doi.org/10.1017/s1092852915000024.
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ObjectiveTo assess the effects of depression and antidepressant medication use during pregnancy on the risk of preeclampsia.MethodsWe conducted a retrospective, population-based cohort study that linked automated clinical and pharmacy databases including comprehensive electronic medical records of 21,589 pregnant Kaiser Permanente Northern California members between 2010 and 2012.ResultsThe overall risk of preeclampsia was 4.5%. The timing of antidepressant medication exposure was an important factor. A significant increase in the risk of preeclampsia emerged for women with a depression diagnosis who took antidepressant medications during the second trimester compared to women with untreated depression (adjusted relative risk [aRR]: 1.6, 95% CI: 1.06, 2.39) and to women without depression (aRR: 1.70, 95% CI: 1.30, 2.23). Similar associations existed for women who took antidepressant medications, but without depression. In contrast, depressed women with psychotherapy showed no increased risk of preeclampsia compared to women with untreated depression or no depression. There was also a statistically significant relationship between the duration of antidepressant medication use and preeclampsia. The observed association appeared stronger for selective serotonin reuptake inhibitor (SSRI) use, although a nonsignificant trend was also noted for use of norepinephrine-dopamine reuptake inhibitors (NDRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).ConclusionStudy findings suggest that antidepressant use during pregnancy may increase the risk of preeclampsia, especially use during the second trimester.
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Nunn, C. M. H. "Efficacy of antidepressant medication". British Journal of Psychiatry 183, nr 5 (listopad 2003): 463–64. http://dx.doi.org/10.1192/bjp.183.5.463-a.
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Hall, David, David H. Wiles i Robin G. McCreadie. "Compliance with antidepressant medication". British Journal of Psychiatry 157, nr 3 (wrzesień 1990): 453–54. http://dx.doi.org/10.1192/bjp.157.3.453b.
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Arean, Patricia A., Jennifer Alvidrez, Mitchell Feldman, Lowell Tong i Rebecca Shermer. "The Role of Provider Attitudes in Prescribing Antidepressants to Older Adults: Leverage Points for Effective Provider Education". International Journal of Psychiatry in Medicine 33, nr 3 (wrzesień 2003): 241–56. http://dx.doi.org/10.2190/r57t-2a9n-nu19-gntu.
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Objectives: The purpose of this study was to determine if primary care provider knowledge of late-life depression, attitudes about treatment of depression in late life, and experience treating late-life depression affect the likelihood internists would prescribe antidepressants to older patients. Methods: This study was a primary care provider survey study. From a pool of 456 eligible mailed surveys, 253 providers completed (55% response rate) a survey assessing provider self-reported knowledge about treating late-life depression with antidepressants, their attitudes about older patients' acceptance and response to antidepressant medications, their professional and personal experience with antidepressant medication, and their comfort with prescribing antidepressants to older patients was created for this study. Results: Univariate analyses indicated that 75% of primary care providers were knowledgeable about the use of antidepressant treatment in older people, and 86% said they felt comfortable treating depression in older patients. Multivariate analyses indicated that the decision to treat older patients with antidepressants was largely influenced by time to treat patients, provider belief that antidepressants could treat late-life depression, their comfort with treating late-life depression, and having had older patients respond to anti-depressant treatment in the past ( R2 = .52, p < .001). Conclusions: This study shows that attitudinal and experiential factors play an important role in the likelihood that a provider will treat an older, depressed patient with an antidepressant, more so than knowledge about how to prescribe an anti-depressant to older patients. Residency programs for primary care practitioners should include education about the efficacy of antidepressant treatment in older people and should involve hands-on experience in treating late-life depression.
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Leckband, Susan G. "Pharmacogenomic testing for treatment resistant depression". Mental Health Clinician 4, nr 5 (1.09.2014): 236–39. http://dx.doi.org/10.9740/mhc.n207183.
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The percentage of patients who have failed to completely or partially respond to multiple trials of antidepressants at adequate doses and for an adequate duration of therapy has varied in the literature and is considered substantial. Numerous strategies exist to treat poor antidepressant response, but often medications are selected on a “trial and error” basis. Genetic factors may play a role in poor response or intolerance to treatment with antidepressants which lead to treatment failures. Currently, available genetic testing as well as genetic testing currently under research may help guide clinicians with proper medication and dose selection.
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Colman, Ian, Michael E. J. Wadsworth, Tim J. Croudace i Peter B. Jones. "Three decades of antidepressant, anxiolytic and hypnotic use in a national population birth cohort". British Journal of Psychiatry 189, nr 2 (sierpień 2006): 156–60. http://dx.doi.org/10.1192/bjp.bp.105.017434.
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BackgroundPsychotropic medication use is common and increasing. Use of such drugs at the individual level over long periods has not been reported.AimsTo describe antidepressant, anxiolytic and hypnotic drug use, and associations between such medication use and common mental disorder, over a 22-year period.MethodQuestions about psychotropic medication use and symptoms of common mental disorder were asked of more than 3000 members of the 1946 British birth cohort at multiple time points between ages 31 and 53 years.ResultsPrevalence of any antidepressant, anxiolytic or hypnotic use increased significantly from 1977 (30.6 per 1000) to 1999 (59.1 per 1000) as the cohort aged. Less than 30% with mental disorder used antidepressants, anxiolytics or hypnotics. Previous use of antidepressant, anxiolytic or hypnotic was a strong predictor of future use during an episode of mental disorder (odds ratios 3.0–8.4); this association became weaker over time.ConclusionsPharmacotherapy is infrequently used by individuals with common mental disorder in Britain; this has not changed in the past three decades.
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Cetin, K., K. L. Johnson, D. M. Ehde, C. M. Kuehn, D. Amtmann i G. H. Kraft. "Antidepressant use in multiple sclerosis: epidemiologic study of a large community sample". Multiple Sclerosis Journal 13, nr 8 (10.07.2007): 1046–53. http://dx.doi.org/10.1177/1352458507077864.
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Depressive symptoms and disorders among individuals with multiple sclerosis (MS) are more common when compared to other chronic illnesses and the general population, but relatively little is known about the use of antidepressant medication in this population. In this cross-sectional study of 542 community-dwelling adults with MS, we examined the prevalence of antidepressant use and employed multivariate logistic regression modeling to identify factors significantly associated with antidepressant use. Thirty-five percent of the sample reported currently using at least one antidepressant medication. Gender, marital status, insurance status, fatigue, and use of disease modifying therapies were all significantly associated with antidepressant use. Just over half of the sample endorsed a clinically significant level of depressive symptoms, and the majority of this group was not currently taking an antidepressant. Conversely, 41% of those with depressive symptoms reported taking at least one antidepressant medication. More research is needed to better understand why people with MS and depressive symptoms use or do not use antidepressant medications and to further explore the possibility of an under-treatment of depressive disorder in this population. Rigorous studies testing the feasibility, acceptability, and efficacy of currently available therapies for depression in the MS population should also be conducted. Multiple Sclerosis 2007; 13: 1046—1053. http://msj.sagepub.com
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Jeschke, Elke, Thomas Ostermann, Horst C. Vollmar, Manuela Tabali i Harald Matthes. "Depression, Comorbidities, and Prescriptions of Antidepressants in a German Network of GPs and Specialists with Subspecialisation in Anthroposophic Medicine: A Longitudinal Observational Study". Evidence-Based Complementary and Alternative Medicine 2012 (2012): 1–8. http://dx.doi.org/10.1155/2012/508623.
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Background. Depression is a major reason for counselling in primary care. Our study aims at evaluating pharmacological treatment strategies among physicians specialised in anthroposophic medicine (AM).Methods. From 2004 to 2008, twenty-two German primary care AM-physicians participated in this prospective, multicentre observational study. Multiple logistic regression was used to determine factors associated with a prescription of any antidepressant medication.Results. A total of 2444 patients with depression were included (mean age: 49.1 years (SD: 15.4); 77.3% female). 2645 prescriptions of antidepressants for 833 patients were reported. Phytotherapeutic preparations fromHypericum perforatumwere the most frequently prescribed antidepressants over all (44.6% of all antidepressants), followed by amitriptyline (16.1%). The likelihood of receiving an antidepressant medication did not depend on comorbidity after controlling for age, gender, physician specialisation, and type of depression (adjusted OR(AOR)=1.01; CI: 0.81–1.26). Patients who had cancer were significantly less likely to be prescribed an antidepressant medication than those who had no cancer (AOR=0.75; CI: 0.57–0.97).Conclusion. This study provides a comprehensive analysis of everyday practice for the treatment of depression in AM -physicians. Further analysis regarding the occurrence of critical combinations is of high interest to health services research.
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Marasine, Nirmal Raj, Sabina Sankhi, Rajendra Lamichhane, Nabin Raj Marasini i Nim Bahadur Dangi. "Self-Reported Antidepressant Drug Side Effects, Medication Adherence, and Its Associated Factors among Patients Diagnosed with Depression at the Psychiatric Hospital of Nepal". Depression Research and Treatment 2020 (17.10.2020): 1–7. http://dx.doi.org/10.1155/2020/7024275.
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Objective. The present study is aimed at evaluating the side effects of antidepressant drugs, medication adherence (MA), and associated factors among patients diagnosed with depression at a psychiatric hospital in western Nepal. Methods. A prospective cross-sectional study was conducted among 174 patients visiting the outpatient clinic of a psychiatric hospital. The antidepressant side effect checklist (ASEC) was used to classify the reported antidepressant drug side effects into mild, moderate, and severe types. The Naranjo adverse drug reaction (ADR) probability scale was employed to assess the ADRs, and the Morisky Green Levine Adherence (MGLA) score was employed to determine the rate of medication adherence. Descriptive statistics and bivariate analysis were used, and a P value < 0.05 was taken as statistically significant in the multivariate analysis. Results. The patients were mostly female (55.74%), with a median (IQR) age of 32 (20) years. Approximately 74.13% of the patients experienced antidepressant side effects, where insomnia (17.05%) and anxiety (17.05%) were the most common. More than half of the patients (52.29%) had a low level of adherence. Females were 1.01 times more likely to be nonadherent to their antidepressant medications compared to males, adjusted odds ratio (AOR): 1.001 (0.31-1.63). Similarly, illiterate patients tended to be more nonadherent compared to literates, AOR: 1.342 (0. 93-2.82), and unemployed individuals were 1.5 times more likely to be nonadherent to their medications compared to employed individuals, AOR: 1.46 (1.16-4.13). Likewise, patients with severe side effects were more prone to develop nonadherence than those with moderate side effects, AOR: 1.173 (0.42-3.25). A significant association was found between the Naranjo score and medication adherence. Conclusions. This study suggests that antidepressant drug side effects were more prevalent and medication adherence was extremely poor among depressive patients in psychiatric hospitals. Factors such as gender, occupation, education, side effects, and ADRs attributed to poor medication adherence in patients.
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Gadde, Sumana, Carl Brown, Amy Shah i Rif S. El-Mallakh. "Long-term prospective mood self-rating and antidepressant treatment". Irish Journal of Psychological Medicine 28, nr 4 (grudzień 2011): 227–29. http://dx.doi.org/10.1017/s0790966700011721.
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AbstractThe use of antidepressants in bipolar illness remains controversial. This controversy continues to be fuelled by short-term studies that inconsistently report efficacy or no benefit. However, long-term studies have been consistently unfavourable, suggesting that understanding the long-term course of the illness in the setting of antidepressant treatment is important. This is an extraordinary case in which prospectively collected daily mood ratings were available in a type I bipolar individual who had experienced minimal medication changes over a 21-year period was reviewed. Data regarding the number of euthymic days in the setting of antidepressant use and after antidepressant discontinuation were collected.Induction of cycling and increase in the number of depressed days occurred after five years of continuous serotonergic antidepressant administration. Discontinuation of antidepressants after 11 years of continuous use was associated with only a partial improvement which had a delayed onset. Cycling and increase in depression was noted after years of continuous use of serotonergic antidepressant treatment. Antidepressant-associated destabilisation may occur after long-term exposure and may be associated with prolonged worsening even after antidepressant discontinuation.
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Bauer, Michael, Brigitta U. Monz, Angel L. Montejo, Deborah Quail, Nicolas Dantchev, Koen Demyttenaere, Ana Garcia-Cebrian i in. "Prescribing patterns of antidepressants in Europe: Results from the Factors Influencing Depression Endpoints Research (FINDER) study". European Psychiatry 23, nr 1 (styczeń 2008): 66–73. http://dx.doi.org/10.1016/j.eurpsy.2007.11.001.
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AbstractAntidepressant prescribing patterns and factors influencing the choice of antidepressant for the treatment of depression were examined in the Factors Influencing Depression Endpoints Research (FINDER) study, a prospective, observational study in 12 European countries of 3468 adults about to start antidepressant medication for their first episode of depression or a new episode of recurrent depression. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed antidepressant (63.3% patients), followed by serotonin-norepinephrine reuptake inhibitors (SNRIs, 13.6%), but there was considerable variation across countries. Notably, tricyclic and tetracyclic antidepressants (TCAs) were prescribed for 26.5% patients in Germany. The choice of the antidepressant prescribed was strongly influenced by the previous use of antidepressants, which was significantly associated with the prescription of a SSRI (OR 0.64; 95% CI 0.54, 0.76), a SNRI (OR 1.49; 95% CI 1.18, 1.88) or a combination of antidepressants (OR 2.78; 95% CI 1.96, 3.96). Physician factors (age, gender, speciality) and patient factors (severity of depression, age, education, smoking, number of current physical conditions and functional syndromes) were associated with initial antidepressant choice in some models. In conclusion, the prescribing of antidepressants varies by country, and the type of antidepressant chosen is influenced by physician- as well as patient-related factors.
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Grover, Sandeep, Natasha Kate, Eepsita Mishra i Ajit Avasthi. "Prevalence and Type of Sexual Dysfunction in Female Patients Receiving Antidepressant Medications". Journal of Psychosexual Health 2, nr 2 (kwiecień 2020): 158–64. http://dx.doi.org/10.1177/2631831820937523.
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Aim: To assess the prevalence and typology of sexual dysfunction in female patients receiving antidepressant medications using the Arizona Sexual Experience Scale (ASEX). Method: A cross-sectional design was employed. A total of 71 married women with various psychiatric disorders receiving antidepressants for at least 3 months’ were evaluated on ASEX, Brief Adherence Rating Scale, Medication Adherence Questionnaire, and Global Assessment of Functioning (GAF) scale. Subjects with a history of sexual dysfunction prior to psychotropic intake, menopause, severe interpersonal relationship problems with spouse, or chronic medical illness were excluded. Results: The study sample had the mean age of 37.35 (SD: 6.82) years. More than four-fifth (80.2%) of patients had sexual dysfunction as per the ASEX. Using a cutoff score of 4 or more to define sexual dysfunction in various domains, decreased desire was seen in 81.7%, reduced arousal was seen in 80.3%, poor vaginal lubrication was seen in 76.1%, reduced satisfaction was seen in 57.7%, and reduced ability to reach orgasm was seen in 50.7%. Despite this, few patients (13.3%) discussed their sexual dysfunction with their treating psychiatrist. Sexual dysfunction did not influence the medication adherence. Conclusions: Sexual dysfunction is quite prevalent in female patients receiving antidepressant medications; however, this is not adequately discussed by the patient or the treating psychiatrist.
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Shasha, Michelle, John S. Lyons, Michael T. O'Mahoney, Sheldon I. Miller, Kenneth I. Howard i Alan Rosenberg. "Serotonin Reuptake Inhibitors and the Adequacy of Antidepressant Treatment". International Journal of Psychiatry in Medicine 27, nr 2 (czerwiec 1997): 83–92. http://dx.doi.org/10.2190/yvbe-mxaf-q09q-y02q.
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Objective: To determine whether the use of serotonin reuptake inhibitors (SSRIs) improves antidepressant medication prescribing patterns for both psychiatric and non-psychiatric physicians. Data Sources/Setting: Drug utilization review of 4,103 prescriptions for antidepressant medications with patients diagnosed with depressive disorders over an eighteen-month period from the formulary records of a large insurance company. Design: Using standards developed for clinical guidelines, variation in trial and treatment adequacy between drug types and physician specialty was studied. Principal Findings: Thirty-five percent of initial antidepressant trials were not prescribed for an adequate duration or at an adequate dosage level. SSRIs were more likely to be prescribed adequately than any other antidepressant reviewed. Psychiatrists were more likely to prescribe antidepressants at an adequate dosage level, whereas non-psychiatric physicians were more likely to attain adequate duration of treatment. Conclusions: A greater reliance on SSRIs may increase the likelihood of maintaining adequacy in antidepressant treatments. Although higher in cost than other treatment choices, their lower side effect profile is likely to maximize patient satisfaction and physician and patient adherence to guidelines. In order to ensure effective and efficient antidepressant usage, such patterns must be identified and appropriate performance improvement strategies (e.g., Total Quality Improvement, critical pathways) may be employed.
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Duffy, Larisa, Caroline S. Clarke, Gemma Lewis, Louise Marston, Nick Freemantle, Simon Gilbody, Rachael Hunter i in. "Antidepressant medication to prevent depression relapse in primary care: the ANTLER RCT". Health Technology Assessment 25, nr 69 (listopad 2021): 1–62. http://dx.doi.org/10.3310/hta25690.
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Background There has been a steady increase in the number of primary care patients receiving long-term maintenance antidepressant treatment, despite limited evidence of a benefit of this treatment beyond 8 months. Objective The ANTidepressants to prevent reLapse in dEpRession (ANTLER) trial investigated the clinical effectiveness and cost-effectiveness of antidepressant medication in preventing relapse in UK primary care. Design This was a Phase IV, double-blind, pragmatic, multisite, individually randomised parallel-group controlled trial, with follow-up at 6, 12, 26, 39 and 52 weeks. Participants were randomised using minimisation on centre, type of antidepressant and baseline depressive symptom score above or below the median using Clinical Interview Schedule – Revised (two categories). Statisticians were blind to allocation for the outcome analyses. Setting General practices in London, Bristol, Southampton and York. Participants Individuals aged 18–74 years who had experienced at least two episodes of depression and had been taking antidepressants for ≥ 9 months but felt well enough to consider stopping their medication. Those who met an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis of depression or with other psychiatric conditions were excluded. Intervention At baseline, participants were taking citalopram 20 mg, sertraline 100 mg, fluoxetine 20 mg or mirtazapine 30 mg. They were randomised to either remain on their current medication or discontinue medication after a tapering period. Main outcome measures The primary outcome was the time, in weeks, to the beginning of the first depressive episode after randomisation. This was measured by a retrospective Clinical Interview Schedule – Revised that assessed the onset of a depressive episode in the previous 12 weeks, and was conducted at 12, 26, 39 and 52 weeks. The depression-related resource use was collected over 12 months from medical records and patient-completed questionnaires. Quality-adjusted life-years were calculated using the EuroQol-5 Dimensions, five-level version. Results Between 9 March 2017 and 1 March 2019, we randomised 238 participants to antidepressant continuation (the maintenance group) and 240 participants to antidepressant discontinuation (the discontinuation group). The time to relapse of depression was shorter in the discontinuation group, with a hazard ratio of 2.06 (95% confidence interval 1.56 to 2.70; p < 0.0001). By 52 weeks, relapse was experienced by 39% of those who continued antidepressants and 56% of those who discontinued antidepressants. The secondary analysis revealed that people who discontinued experienced more withdrawal symptoms than those who remained on medication, with the largest difference at 12 weeks. In the discontinuation group, 37% (95% confidence interval 28% to 45%) of participants remained on their randomised medication until the end of the trial. In total, 39% (95% confidence interval 32% to 45%) of participants in the discontinuation group returned to their original antidepressant compared with 20% (95% confidence interval 15% to 25%) of participants in maintenance group. The health economic evaluation demonstrated that participants randomised to discontinuation had worse utility scores at 3 months (–0.037, 95% confidence interval –0.059 to –0.015) and fewer quality-adjusted life-years over 12 months (–0.019, 95% confidence interval –0.035 to –0.003) than those randomised to continuation. The discontinuation pathway, besides giving worse outcomes, also cost more [extra £2.71 per patient over 12 months (95% confidence interval –£36.10 to £37.07)] than the continuation pathway, although the cost difference was not significant. Conclusions Patients who discontinue long-term maintenance antidepressants in primary care are at increased risk of relapse and withdrawal symptoms. However, a substantial proportion of patients can discontinue antidepressants without relapse. Our findings will give patients and clinicians an estimate of the likely benefits and harms of stopping long-term maintenance antidepressants and improve shared decision-making. The participants may not have been representative of all people on long-term maintenance treatment and we could study only a restricted range of antidepressants and doses. Identifying patients who will not relapse if they discontinued antidepressants would be clinically important. Trial registration Current Controlled Trials ISRCTN15969819 and EudraCT 2015-004210-26. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 69. See the NIHR Journals Library website for further project information.
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Keen, Claire, James A. Foulds, Melissa Willoughby, Giles Newton-Howes, Josh Knight, Seena Fazel, Rohan Borschmann, Stuart A. Kinner i Jesse T. Young. "Antidepressant use and interpersonal violence perpetration: a protocol for a systematic review and meta-analysis". BMJ Open 11, nr 1 (styczeń 2021): e043306. http://dx.doi.org/10.1136/bmjopen-2020-043306.
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IntroductionThere are conflicting perspectives as to whether antidepressant medication increases, decreases or has no effect on violence perpetration, impulsivity and aggressive behaviour. This is an important question given the widespread use of antidepressant medication and the significant medical, social, legal and health consequences of violence. We aim to: (1) systematically identify observational studies and randomised controlled trials that quantify the relationship between antidepressant use and interpersonal violence; (2) assess the quality of studies that quantify the relationship between antidepressant use and interpersonal violence and (3) estimate the pooled prevalence and measure of effect for the relationship between antidepressant use and interpersonal violence.Methods and analysisWe will search MEDLINE, EMBASE, CINAHL, PsycINFO, PubMed and the Cochrane Library for relevant peer-reviewed literature. Our primary outcome is the perpetration of violent acts directed at others. Our secondary outcome is physical, interpersonal aggression measured through validated surveys. We will include randomised controlled trials, cohort studies and case–control studies that examine the association between the use of antidepressants and violence perpetration and/or physical aggression. No restrictions will be placed on the population. We will use the Methodological Standard for Epidemiological Research scale to assess the quality of included studies. We will provide an overview of the included studies and assess heterogeneity and publication bias. If there are sufficient studies, we will conduct meta-analyses to examine the possible association between antidepressants and violence, and undertake meta-regression to examine the effect of antidepressant class, length of follow-up, age of participants and population subgroups on the association between antidepressants and violence.Ethics and disseminationNo ethics approval is required. Our findings will be disseminated through a peer-reviewed journal article and conference presentations.PROSPERO registration detailsCRD42020175474.
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Parker, Gordon. "Managing melancholic depression: a personal perspective". Australasian Psychiatry 25, nr 1 (11.07.2016): 25–27. http://dx.doi.org/10.1177/1039856216657697.
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Objectives: The objective of this article is to offer a personal perspective on managing melancholia by interpreting both the limited salient evidence base and offering clinical observations. Conclusions: It is suggested that medication needs to be prioritised, that not all antidepressants are equally potent for those with melancholia and that as response to a single antidepressant alone (especially a narrow-spectrum one) is low, management commonly requires broader-spectrum antidepressant drugs and augmentation strategies.
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Li, Hui Hui, Nita Williams, Nidhi Sharma, Yvonne A. Efebera, Ashley E. Rosko, Don M. Benson i Craig C. Hofmeister. "Anti-Depressant Use in Patients with Multiple Myeloma Less Common Than Expected". Blood 128, nr 22 (2.12.2016): 2420. http://dx.doi.org/10.1182/blood.v128.22.2420.2420.
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Abstract Background: Depression is more common in patients with multiple myeloma (30%) than in the general population (7%), similar to other patients with advanced cancer (PMID 27141015, 20187072). It may be more difficult to detect depression in cancer patients as psychiatric symptoms commonly overlap with medical symptoms from their disease or treatment. Additionally, it is difficult to discern differences between normal and pathologic reactions to such a serious diagnosis. Depressive symptoms, even mild presentations, have been shown to lower quality of life, affect medication compliance, and increase suicide risk, which increase all-cause mortality in the general population, and this is no different in cancer patients, including those with multiple myeloma (PMID 26029972, 23677523). Although depression has a significant impact on cancer patients, there have not been large studies to evaluate antidepressant use, including the frequency of its initiation after diagnosis. Methods: Patients included in this study were participants in the Ohio Myeloma Initiative (NCT01408225), an observational registry collected from patients in Ohio State University's myeloma clinic. Medications were collected and patients who took antidepressants were filtered into a list. The order date of the medications was compared to the patient's diagnosis date. Patients with order dates occurring after date of diagnosis were collected. Chart review was then performed to determine when the antidepressant was started and its indication. Results: Fourteen hundred eight-nine multiple myeloma patients were enrolled in the registry and their medications (35,390) compiled. Of those 1,489 patients, 207 (14%) had an antidepressant on their medication list. The most commonly prescribed antidepressants were duloxetine (14%), sertraline (13%), and citalopram (9%). There were 133 male patients and 74 female patients and the average age of diagnosis was 60.2 years. Although 148 patients (148/207, 71.4%) had documentation of antidepressant use after diagnosis. Of these patients, 106 patients (106/148) had the indication of depression with or without anxiety. Other common indications included neuropathy (24/148, 16.2%) and insomnia (13/148, 8.8%). Fibromyalgia, smoking cessation, anorgasmia, and dizziness were rare but documented indications. Only 32 patients (32/207, 22%) were initiated on an antidepressant with the indication of depression after their diagnosis. There were 25 male patients and 7 female patients. Sertraline (22%), citalopram (22%), and escitalopram (18.6%) were the most common antidepressants started for depression. Conclusions: Only 14% of our patients were on antidepressants despite an average 30% incidence of depressive symptoms reported in prior studies. Of those on antidepressant medications, it would appear that younger patients tended to initiate treatment for their depression, which is congruent with a study by Lamers et al. 2013, which found that younger patients showed the greatest interest in treating their depression. Multiple myeloma is a unique malignancy in that its treatments have side effects, most notably polyneuropathy, which benefit from administration of a SSRI or TCA. Therefore, physicians treating these patients may unconsciously prescribe these antidepressants for a "two birds with one stone" approach. Because documentation of anti-depressant use is often lacking, prospective registries will need to separately document the indications for psychotropic medications. Disclosures Hofmeister: Janssen: Pharmaceutical Companies of Johnson & Johnson: Research Funding; Incyte, Corp: Membership on an entity's Board of Directors or advisory committees; Signal Genetics, Inc.: Membership on an entity's Board of Directors or advisory committees; Celgene: Research Funding; Karyopharm Therapeutics: Research Funding; Arno Therapeutics, Inc.: Research Funding; Takeda Pharmaceutical Company: Research Funding; Teva: Membership on an entity's Board of Directors or advisory committees.
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Wong, Risa, Areej El-Jawahri, Kelly Irwin, Sara D'Arpino, Samantha M. C. Moran, Connor Johnson, Daniel Lage i in. "The importance of recognizing and addressing depression in patients with advanced cancer." Journal of Clinical Oncology 35, nr 15_suppl (20.05.2017): 10050. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.10050.
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10050 Background: Patients with cancer often experience depression, which is associated with worse outcomes, including longer hospital length of stay (LOS). Although antidepressant medication can improve depressive symptoms in patients with cancer, it is unclear whether their use translates into better outcomes. We sought to clarify the relationship between depressive symptoms, antidepressant medication, and hospital LOS in patients with advanced cancer. Methods: We enrolled hospitalized patients with advanced cancer from 9/2014 to 4/2016 as part of a longitudinal data repository. We examined patients’ medical records to obtain information about documented depressive symptoms in the 3 months prior to admission and use of antidepressant medication at the time of admission. Using descriptive statistics, we compared differences in patient characteristics and hospital LOS across these groups. We used linear regression to examine associations and moderation effects between depressive symptoms, use of antidepressant medication, and hospital LOS. Results: Of 1,036 enrolled patients (89.9% of approached), 126 (12.2%) had documented depressive symptoms in the 3 months prior to admission and 288 (27.8%) were taking an antidepressant medication at the time of admission. Patients with depressive symptoms were more likely to be on antidepressant medication at admission than those without depressive symptoms (48.4% vs 24.9%, p < .001). Patients taking antidepressant medication were younger (62.4 vs 64.4 years, p = .026) and more likely to be female (55.2% vs 47.2%, p = .021). Depressive symptoms were associated with longer hospital LOS (7.3 vs 6.1 days, p = .036), and antidepressant medication was a moderator of this relationship. Among patients not on antidepressant medication, depressive symptoms were associated with longer hospital LOS (7.9 vs 6.1 days, p = .025), but among those on antidepressant medication, depressive symptoms were not associated with hospital LOS (6.6 vs 6.2 days, p = .588). Conclusions: Antidepressant medication moderated the relationship between depressive symptoms and longer hospital LOS. Our results support the need to recognize and address depressive symptoms in patients with advanced cancer.