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Tan B, Chen L, Yan S, Pan H, Zhang J, Wei H. Risk of stress cardiomyopathy associated with selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors: a real-world pharmacovigilance analysis. Sci Rep 2024; 14:15167. [PMID: 38956425 PMCID: PMC11220088 DOI: 10.1038/s41598-024-66155-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024] Open
Abstract
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are reported to cause stress cardiomyopathy (SC). This study evaluated the association between SSRI/SNRI use and the occurrence of cardiomyopathy in the publicly available U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. Disproportionate analysis and likelihood ratio tests were used to identify risk associated with SSRIs or SNRIs and the incidence of SC, using data from between from 2012 to 2022 acquired from the FAERS database. The study identified 132 individual case safety reports (ICSRs) of SC associated with SSRIs or SNRIs. Venlafaxine (48%) and fluoxetine (27%) were the most common antidepressants of the ICSRs. Approximately 80% of SC cases were reported in females, with individuals aged 45-65 years identified as a high-risk population. Both venlafaxine (ratio-scale information component [RSIC] 2.54, 95% CI 2.06-3.04) and fluoxetine (RSIC 3.20, 95% CI 2.31-4.47) were associated with SC, with likelihood ratio estimates of 3.55 (p = 0.02) for venlafaxine and 4.82 (p = 0.008) for fluoxetine. The median time to cardiomyopathy onset was 20 days, with hospitalization reported in 48.33% of patients. Venlafaxine and fluoxetine were associated with SC risk, particularly in middle-aged women. Caution should be exercised when using SSRIs or SNRIs combined with other serotonergic medications.
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Affiliation(s)
- Boyu Tan
- Department of Pharmacy, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Department of Pharmacy, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, People's Republic of China
| | - Li Chen
- Department of Pharmacy, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, People's Republic of China
| | - Sulan Yan
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, People's Republic of China
| | - Huijie Pan
- Department of Pharmacy, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Jingxian Zhang
- Department of Pharmacy, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Hongyan Wei
- Department of Pharmacy, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.
- Institute of I Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People's Republic of China.
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Moreno V, Dévora S, Abdala-Kuri S, Oliva A. Trends in the Consumption of Antidepressant Drugs before and during the COVID-19 Pandemic in the Canary Islands, Spain: The Case of the Province of Las Palmas. Healthcare (Basel) 2023; 11:healthcare11101425. [PMID: 37239712 DOI: 10.3390/healthcare11101425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
The use of antidepressants (ADs) has increased significantly as a result of COVID-19 and its consequences. However, there are some notable differences in the relative levels of use between geographical areas and population groups. The aim of this work is to assess the impact of COVID-19 on the consumption of ADs in the Canary Islands, focusing on the islands of Gran Canaria, Fuerteventura and Lanzarote, by analyzing the trends in prescriptions of ADs during the pandemic period (2020) compared to the pre-pandemic period (2016-2020). Data were extracted from the community pharmacy wholesaler at a population level. Consumption patterns are expressed as the number of defined daily doses per 1000 inhabitant/day. The overall consumption of DIDs was higher in Gran Canaria, mainly in urban areas and the capital. It was similar in both Lanzarote and Fuerteventura, but particularly localized in the capital, which are considered semi-urban areas. Lanzarote and Fuerteventura present the same pattern of prescription ADs use, whereas Gran Canaria is notably different. This finding was also observed in the more consumed active pharmaceutical ingredients, although small inter-island variations in the ranking and percentages were observed. Sertraline and escitalopram are two of the most prescribed N06AB ADs, whereas the most recent N06AX ADs such as venlafaxine, mirtazapine and desvenlafaxine are more commonly prescribed. These differences in prescription ADs can be explained by demographical characteristics, population size, the fact of living in an urban area and general medical practice. In this context, the COVID-19 pandemic did not have an impact on the overall trend of the use of ADs between 2016 and 2020 in the islands under study.
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Affiliation(s)
- Vanessa Moreno
- Department of Physical Medicine and Pharmacology, Faculty of Pharmacy, University of La Laguna, 38200 Tenerife, Spain
| | - Sandra Dévora
- Department of Physical Medicine and Pharmacology, Faculty of Pharmacy, University of La Laguna, 38200 Tenerife, Spain
| | - Susana Abdala-Kuri
- Department of Physical Medicine and Pharmacology, Faculty of Pharmacy, University of La Laguna, 38200 Tenerife, Spain
| | - Alexis Oliva
- Department of Chemical Engineering and Pharmaceutical Technolgy, Faculty of Pharmacy, University of La Laguna, 38200 Tenerife, Spain
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Diaz-Camal N, Cardoso-Vera JD, Islas-Flores H, Gómez-Oliván LM, Mejía-García A. Consumption and ocurrence of antidepressants (SSRIs) in pre- and post-COVID-19 pandemic, their environmental impact and innovative removal methods: A review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 829:154656. [PMID: 35318057 DOI: 10.1016/j.scitotenv.2022.154656] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 06/14/2023]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are pharmaceuticals whose consumption has increased significantly. They are prescribed as first-line treatment in mental disorders such as depression, obsessive-compulsive disorder, phobias, and anxiety; also, they are indicated as adjuvants in diseases such as fibromyalgia and bulimia nervosa. In addition to being linked to the illegal market to be consumed as recreational drugs. The relevance of this review lies in the fact that worldwide consumption has increased significantly during the COVID-19 pandemic, due to the depression and anxiety that originated in the population. As a consequence of this increase in consumption, concentrations of SSRIs in the environment have increased, and these have become a relevant issue for toxicologists due to the effects that they could generate in different organisms, both aquatic and terrestrial. For this reason, the objective of this article was to do a critical evaluation of the existing data on the characteristics and physicochemical properties of SSRIs, consumption data during the COVID-19 pandemic, its occurrence in the environment and the reports of toxic effects that have been generated in different organisms; we also conclude with an updated review of different methods that have been used for their removal. With this analysis, it can be concluded that, despite SSRIs are pharmaceutical products widely studied since their launching to the market, still currently under investigation to clarify their mechanisms of action to understand the different effects on the organisms, adverse reactions, as well as possible toxicological effects on non-target organisms. On the other hand, it has been proven that although it is already possible to eliminate a significant percentage of SSRIs in the laboratory, due to their physicochemical characteristics and their behavior in complex mixtures in the environment, they have not yet been eradicated, showing a persistence in the soil, subsoil and surface waters of the entire planet that may represent a future risk.
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Affiliation(s)
- Nidya Diaz-Camal
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico
| | - Jesús Daniel Cardoso-Vera
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico
| | - Hariz Islas-Flores
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico.
| | - Leobardo Manuel Gómez-Oliván
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico
| | - Alejandro Mejía-García
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico
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Surging trends in prescriptions and costs of antidepressants in England amid COVID-19. Daru 2021; 29:217-221. [PMID: 33715138 PMCID: PMC7955799 DOI: 10.1007/s40199-021-00390-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/12/2021] [Indexed: 11/20/2022] Open
Abstract
The social restrictions amid coronavirus disease 2019 (COVID-19) pandemic have posed a serious threat to mental health and have implications in the use of medications for mental health including antidepressants (ADs). This study investigated the trends in prescriptions and costs of various ADs in England during COVID-19 pandemic. National prescribing rates and net ingredient costs (NIC) of all ADs prescriptions during 2016 to 2020 were analyed. The total number of ADs prescriptions dispensed during COVID-19 pandemic (January to December 2020) were 78 million, 4 million more than in 2019 that costed NHS England £ 139 million more than in 2019. Sertraline, an SSRI antidepressant drug, alone accounted for an extra £113 million during 2020 than in 2019. The peak dispensing for ADs was observed in March 2020 while the total costs for AD drugs peaked in April 2020. The rising prescription costs for ADs during COVID-19 pandemic is a potential cause of concern, in particular the increasing use in adolescents and younger adults needs attention, who are at a higher risk of life-threatening adverse drug reactions.
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Choi JW, Bediako JK, Zhao Y, Lin S, Sarkar AK, Han M, Song MH, Cho CW, Yun YS. Adsorptive removal of cationic tricyclic antidepressants using cation-exchange resin. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:24760-24771. [PMID: 31925694 DOI: 10.1007/s11356-019-06549-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/16/2019] [Indexed: 06/10/2023]
Abstract
This study aimed to select a high-performance cation-exchange resin (CER) and estimate its uptake of positively ionized tricyclic antidepressants (TCAs), i.e., amitriptyline (AMI), imipramine (IMI), clomipramine (CLO), and desipramine (DES), which are frequently used, and detected in wastewater treatment systems. For the selection of the resin, the one-point check test of AMI in distilled water was examined using several CERs. As a result, the strong-acid polystyrene CER, Dowex 50WX4-200, was selected on the basis of its outstanding uptake of AMI. The maximum adsorption capacities of Dowex 50WX4-200 for removal of the TCAs ranged from 2.53 ± 0.20 mmol/g to 3.76 ± 0.12 mmol/g, which are significantly higher when compared with those of previously reported adsorbents. This is likely because the combination of electrostatic and π-π interactions between the TCAs and Dowex 50WX4-200 may lead to high uptakes of the TCAs. Additionally, the removal efficiency of DES as a representative of the TCAs was tested in actual wastewater system containing activated sludge and miscellaneous cations. Consequently, the removal efficiencies of the DES in distilled water, aerobic wastewater, and filtered wastewater were 95.68%, 77.99%, and 56.66%, respectively. It is interesting to note that the activated sludge could also contribute to adsorption of the DES, leading to increased removability, while the cations present in the wastewater acted as competing ions, decreasing the removal efficiency.
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Affiliation(s)
- Jong-Won Choi
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea
| | - John Kwame Bediako
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea
| | - Yufeng Zhao
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea
| | - Shuo Lin
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea
| | - Amit Kumar Sarkar
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea
| | - Minhee Han
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea
| | - Myung-Hee Song
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea
| | - Chul-Woong Cho
- Department of Bioenergy Science and Technology, Chonnam National University, Yongbong-ro 77, Buk-gu, Gwangju, 61186, Republic of Korea.
| | - Yeoung-Sang Yun
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea.
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Study of antidepressant use in 5 European settings. Could economic, sociodemographic and cultural determinants be related to their use? J Affect Disord 2019; 249:278-285. [PMID: 30784725 DOI: 10.1016/j.jad.2019.01.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND We aimed at describing the trends in antidepressants use (AD) by age and sex, during 2007-2011, in 5 European settings (Sweden, Norway, Denmark, Catalonia and Veneto), and to assess whether the differences found across settings could be related to economic, social and cultural determinants. METHODS We collected data of AD use expressed in defined daily doses (DDD). Data were retrieved from population-based databases. We calculated DDD/1000 inhabitants/day. We analysed which economic, social, and cultural covariates determined between-settings differences in AD consumption. RESULTS The use of AD showed an increasing trend during the study period, being Selective Serotonin Reuptake Inhibitors the most consumed, followed "others AD". Women and the elderly showed the highest AD consumption. Between-settings variability in AD consumption showed a positive correlation with pharmaceutical expenditure and a negative one with general practitioner's rate. After adjusting by pharmaceutical expenditure and general practitioners rate Masculinity, Long-Term Orientation and Individualism cultural dimensions were associated with AD use by using the Hofstede´s cultural dimensions model. LIMITATIONS This study has been conducted in administrative databases, with no information on AD use by indication; differences among AD use could be related to their prescription for other disorders. Analyses were based on a small dataset and none of the results reached statistical significance. CONCLUSIONS AD use increased through 2007-2011. Pharmaceutical expenditure and General Practitioners rate, Masculinity, Long-Term Orientation and Individualism explained the differences in AD use between countries. People's attitude should be considered when designing national campaigns to improve antidepressant use.
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González-López MC, Rodríguez-López CM, Parrón-Carreño T, Luna JD, Del Pozo E. Trends in the dispensation of antidepressant drugs over the past decade (2000-2010) in Andalusia, Spain. Soc Psychiatry Psychiatr Epidemiol 2015; 50:705-12. [PMID: 25527208 DOI: 10.1007/s00127-014-0995-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 12/14/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To study antidepressant drug dispensation in the Spanish region of Andalusia and in the Almeria Health Area (AHA) over the past decade, analyzing the variability, trends, and influential factors. METHODS We conducted an observational ecological study of antidepressant drug dispensation between 2000 and 2010 in Andalusia. Dispensation was measured as Defined Daily Dose (DDD) per 1,000 inhabitants per day. A multilevel analysis (STATA 11.1) was performed to determine the variability among the basic health zones (BHZs) (2004-2010) and influential factors. RESULTS Between 2000 and 2010, the total dispensation of antidepressant drugs increased by more than 100 % in Andalusia and in the AHA. This increase was primarily caused by the greater dispensation of selective serotonin reuptake inhibitors (ATC-N06AB) and other antidepressants (ATC-N06AX). Multilevel analysis revealed a wide variability in the levels and trends of antidepressant dispensation among BHZs. Urbanicity and the percentage of immigrants in the BHZ were negatively associated with their dispensation, which was positively influenced by a higher proportion of women and over 65-year-olds in the population. CONCLUSIONS The elevated dispensation of several groups of antidepressant drugs in this study population indicates the need for health policies to rationalize their use. Further research is required into the differences in antidepressant dispensations between immigrant and native populations and the implications for public health policies.
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Antidepressant use and the risk of suicide: a population-based cohort study. J Affect Disord 2015; 174:479-84. [PMID: 25553409 DOI: 10.1016/j.jad.2014.12.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 12/09/2014] [Accepted: 12/10/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND The existing literature provides contradictory evidence on antidepressant use and risk of suicide. Some studies have shown that the use of Selective Serotonin Reuptake Inhibitors (SSRIs) is associated with an increased risk of suicide, especially during the first months of treatment, whereas other studies did not confirm this association. For this reason, our objective was to investigate the association between antidepressant use and risk of suicide in incident antidepressant users in relation to time since starting therapy. METHODS We conducted a population-based cohort study within the Dutch Integrated Primary Care Information (IPCI) database, in incident users of antidepressant therapy between 1994 and 2012 (n=27,712). Cox proportional hazard models were used to study the association between current use of SSRIs, tricyclic antidepressants (TCA) and other antidepressants and risk of suicide or attempted suicide. RESULTS During follow-up, a total of 280 incident antidepressant users attempted or committed suicide. Current use of SSRIs (hazard ratio (HR): 0.78, 95% CI: 0.57-1.07), TCAs (HR: 0.82, 95% CI: 0.48-1.42) or other antidepressants (HR: 0.75, 95% CI: 0.47-1.18) was not statistically significantly associated with suicide compared to past use of any of the antidepressants. LIMITATIONS Although a large healthcare database was used, the number of reported cases of suicide (attempt) was low. CONCLUSIONS This study did not indicate an increase in risk of suicide after starting treatment with SSRIs, TCAs or other antidepressants compared with past antidepressant use.
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Sempere Verdú E, Salazar Fraile J, Palop Larrea V, Vicens Caldentey C. [Evolution of the use of antidepressants, anxiolytics and hypnotics in Valencia. Period 2000-2010]. Aten Primaria 2014; 46:416-25. [PMID: 24559729 PMCID: PMC6983638 DOI: 10.1016/j.aprim.2013.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 11/11/2013] [Accepted: 11/24/2013] [Indexed: 11/30/2022] Open
Abstract
Objetivo Conocer la evolución de la utilización de antidepresivos (AD), ansiolíticos(A) e hipnóticos (H) en la Comunidad Valenciana (CV) entre los años 2000 y2010, su importe y el coste por dosis diaria definida (DDD). Diseño Estudio observacional retrospectivo. Emplazamiento Recetas dispensadas cargo del sistema público de salud de la CV durante los años 2000 a 2010. Mediciones Consumo de los principios activos pertenecientes a los grupos terapéuticos N05B (A), N05C (H) y N06A (AD) obtenidos a partir de la base de datos de farmacia de la Agencia Valenciana de Salud medido en dosis habitante día. Resultados Durante el período estudiado, el consumo de AD aumentó el 81,2% y el de A e H el 11,7%. Los inhibidores selectivos de la recaptación de serotonina fueron los AD más prescritos y los inhibidores de la recaptación de serotonina y noradrenalina los de mayor crecimiento (386,8%). Escitalopram aumentó el 1.013%. Lorazepam, alprazolam y diacepam, suman el 80,4% de los ansiolíticos prescritos, y lormetazepam y zolpidem el 88,7% de los hipnóticos. El importe de los AD aumentó el 78,2% y el de los A e H el 14,5%; el coste por DDD de ambos grupo descendió el 29%. Conclusiones La utilización de AD en la CV ha experimentado un gran incremento entre 2000-2010, mientras que el de A e H ha sido moderado, aunque su consumo todavía está por encima del de AD. A pesar de la reducción en el coste de la DDD en ambos grupos, el importe global de la factura en antidepresivos en la CV sigue en aumento.
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Affiliation(s)
| | | | - Vicente Palop Larrea
- Médico de familia, Subdirección Asistencial Departamento de Salud de la Ribera, Alzira, Valencia, España
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Alameda-Palacios J, Ruiz-Ramos M, García-Robredo B. [Suicide, antidepressant prescription and unemployment in Andalusia (Spain)]. GACETA SANITARIA 2014; 28:309-12. [PMID: 24552969 DOI: 10.1016/j.gaceta.2013.12.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/15/2013] [Accepted: 12/16/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To analyze the trend in suicide mortality in Andalusia from 1975 to 2012 and its relationship with unemployment and the use of antidepressants. METHODS Poisson's segmented regression models were used to estimate changes over time. The association between suicide and the factors examined was measured using Spearman's correlation coefficient. RESULTS Suicide mortality patterns in men and women are rising. The largest increase was found in people aged from 15 to 44 years, with an annual percentage rate change of 1.21 (95%CI: 0.7-1.7) for men and 0.93 (95%CI: 0.4-1.4) for women. CONCLUSIONS Mortality by suicide has increased in Andalusia since 1975 in all age and gender groups except for women aged 65 years or above. During the last few decades, an upward trend has been observed in young people and a stable or falling trend in the remaining population. Temporary variations in suicide rates are not associated with unemployment rates or with changes in antidepressant prescription.
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Affiliation(s)
- José Alameda-Palacios
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Virgen Macarena, Servicio Andaluz de Salud, Sevilla, España.
| | - Miguel Ruiz-Ramos
- Servicio de Información y Evaluación, Consejería de Salud de la Junta de Andalucía, Sevilla, España
| | - Beatriz García-Robredo
- Servicio de Promoción del Uso Racional del Medicamento, Dirección General de Asistencia Sanitaria y Resultados en Salud, Servicio Andaluz de Salud, Sevilla, España
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Trend in SSRI-SNRI antidepressants prescription over a 6-year period and predictors of poor adherence. Eur J Clin Pharmacol 2013; 69:2095-101. [PMID: 23904053 DOI: 10.1007/s00228-013-1567-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To describe antidepressant (AD) use in the Emilia-Romagna Region (Italy) and to evaluate adherence to treatment with selective serotonin receptor inhibitors or selective noradrenaline receptor inhibitors (SSRI-SNRI). METHODS Reimbursed prescriptions of AD were retrieved from the Emilia-Romagna Regional Health Authority Database. The overall AD consumption from the 2006-2011 period was expressed in terms of prevalence and amount of use. Adherence to treatment was assessed in a cohort of patients who received SSRI-SNRI, and was followed throughout a 6-month period from the start of each treatment episode. Adherence was considered according to three parameters: duration of treatment ≥ 120 days, prescription coverage ≥ 80 %, and gaps between prescriptions < 3 months. Determinants of non-adherent regimen, including sociodemographic and clinical variables, were identified by multivariate logistic regression by calculating adjusted Odds Ratio (adjOR) and the relevant 95 % confidence interval (95CI). RESULTS From 2006 to 2011, the prevalence of use of AD increased by 5 % (from 86 to 90 per 1,000 inhabitants) and the amount of antidepressant consumption increased by 20 % (from 43 to 51 defined daily dose per thousand inhabitants per day [DDD/TID]), with a 14 % rise in the intensity of drug use (from 182 to 208 DDD per patient). Out of 347,615 SSRI-SNRI treatment episodes, only 23.8 % were adherent. Comorbidity (adjOR:0.69; 95CI:0.67-0.72) and recurrence of AD treatment in the previous year (0.91; 0.89-0.92) were associated with better adherence. Moreover, patients treated with duloxetine (0.58; 0.55-0.60), escitalopram (0.64; 0.62-0.66) or sertraline (0.65; 0.64-0.67) showed better adherence in comparison with paroxetine. CONCLUSIONS Clinical variables resulting in improved adherence seem to identify patients with more severe disorders and who actually need a pharmacological approach, whereas differences in adherence among ADs could in part be caused by channeling and sponsorship bias. Initiatives addressed at improving cooperation between primary care and psychiatrists could decrease AD prescription for cases of sub-threshold or mild depression that easily drop out because of rapid symptom relief or side effects.
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D'Incau P, Lapeyre-Mestre M, Carvajal A, Donati M, Salado I, Rodriguez L, Sáinz M, Escudero A, Conforti A. No differences between men and women in adverse drug reactions related to psychotropic drugs: a survey from France, Italy and Spain. Fundam Clin Pharmacol 2013; 28:342-8. [DOI: 10.1111/fcp.12032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 02/03/2013] [Accepted: 03/15/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Paola D'Incau
- Dipartimento di Sanità Pubblica e Medicina di Comunità; Sezione di Farmacologia; Università di Verona; Verona Italy
| | - Maryse Lapeyre-Mestre
- Equipe de Pharmacoépidémiologie; INSERM 1027; Université Paul Sabatier; Toulouse France
- Centre Midi-Pyrénées de Pharmacovigilance et d'Information sur le Médicament; Service de Pharmacologie Clinique; Centre Hospitalier Universitaire; Toulouse France
| | - Alfonso Carvajal
- Centro de Estudios sobre la Seguridad de los Medicamentos; Universidad de Valladolid; Valladolid Spain
| | - Monia Donati
- Dipartimento di Sanità Pubblica e Medicina di Comunità; Sezione di Farmacologia; Università di Verona; Verona Italy
| | - Inés Salado
- Centro de Estudios sobre la Seguridad de los Medicamentos; Universidad de Valladolid; Valladolid Spain
| | - Lauriane Rodriguez
- Equipe de Pharmacoépidémiologie; INSERM 1027; Université Paul Sabatier; Toulouse France
| | - María Sáinz
- Centro de Estudios sobre la Seguridad de los Medicamentos; Universidad de Valladolid; Valladolid Spain
| | - Antonio Escudero
- Centro de Estudios sobre la Seguridad de los Medicamentos; Universidad de Valladolid; Valladolid Spain
| | - Anita Conforti
- Dipartimento di Sanità Pubblica e Medicina di Comunità; Sezione di Farmacologia; Università di Verona; Verona Italy
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Silva LJG, Lino CM, Meisel LM, Pena A. Selective serotonin re-uptake inhibitors (SSRIs) in the aquatic environment: an ecopharmacovigilance approach. THE SCIENCE OF THE TOTAL ENVIRONMENT 2012; 437:185-95. [PMID: 22940043 DOI: 10.1016/j.scitotenv.2012.08.021] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 08/06/2012] [Accepted: 08/06/2012] [Indexed: 05/21/2023]
Abstract
Selective serotonin re-uptake inhibitors (SSRIs) antidepressants are among the most prescribed pharmaceutical active substances throughout the world. The occurrence of these widely used compounds in different environmental compartments (wastewaters, surface, ground and drinking waters, and sediments), justify the growing concern about these emerging environmental pollutants. Viewing an ecopharmacovigilance approach, a comprehensive discussion of the state of the art regarding different contamination sources, fate, degradation and occurrence is presented. Information on the current distribution levels and fate in different environmental matrices continues to be sparse and measures are imperative to improve awareness and encourage precautionary actions to minimize SSRIs' environmental impact.
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Affiliation(s)
- Liliana J G Silva
- Group of Health Surveillance, Center of Pharmaceutical Studies, Faculty of Pharmacy, University of Coimbra, Polo III, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal.
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Ilyas S, Moncrieff J. Trends in prescriptions and costs of drugs for mental disorders in England, 1998-2010. Br J Psychiatry 2012; 200:393-8. [PMID: 22442100 DOI: 10.1192/bjp.bp.111.104257] [Citation(s) in RCA: 204] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Increasing rates of prescriptions for antidepressants, antipsychotics and stimulants have been reported from various countries. AIMS To examine trends in prescriptions and the costs of all classes of psychiatric medication in England. METHOD Data from the Prescription Cost Analysis 1998-2010 was examined, using linear regression analysis to examine trends. RESULTS Prescriptions of drugs used for mental disorders increased by 6.8% (95% CI 6.3-7.4) per year on average, in line with other drugs, but made up an increasing proportion of all prescription drug costs (P = 0.001). There were rising trends in prescriptions of all classes of psychiatric drugs, except anxiolytics and hypnotics (which did not change). Antidepressant prescriptions increased by 10% (95% CI 9.0-11) per year on average, and antipsychotics by 5.1% (95% CI 4.3-5.9). Antipsychotics overtook antidepressants as the most costly class of psychiatric medication, with costs rising 22% (95% CI 17-27) per year. CONCLUSIONS Rising prescriptions may be partly explained by longer-term treatment and increasing population. Nevertheless, it appears that psychiatric drugs make an increasing contribution to total prescription drug costs, with antipsychotics becoming the most costly. Low-dose prescribing of some antipsychotics is consistent with other evidence that their use may not be restricted to those with severe mental illness.
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Affiliation(s)
- Stephen Ilyas
- General Adult Psychiatry, Tower Hamlets Centre for Mental Health, East London NHS Foundation Trust, London
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15
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Carvajal A, Ortega S, Del Olmo L, Vidal X, Aguirre C, Ruiz B, Conforti A, Leone R, López-Vázquez P, Figueiras A, Ibáñez L. Selective serotonin reuptake inhibitors and gastrointestinal bleeding: a case-control study. PLoS One 2011; 6:e19819. [PMID: 21625637 PMCID: PMC3097219 DOI: 10.1371/journal.pone.0019819] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 04/17/2011] [Indexed: 11/18/2022] Open
Abstract
Background Selective serotonin reuptake inhibitors (SSRIs) have been associated with upper gastrointestinal (GI) bleeding. Given their worldwide use, even small risks account for a large number of cases. This study has been conducted with carefully collected information to further investigate the relationship between SSRIs and upper GI bleeding. Methods We conducted a case-control study in hospitals in Spain and in Italy. Cases were patients aged ≥18 years with a primary diagnosis of acute upper GI bleeding diagnosed by endoscopy; three controls were matched by sex, age, date of admission (within 3 months) and hospital among patients who were admitted for elective surgery for non-painful disorders. Exposures to SSRIs, other antidepressants and other drugs were defined as any use of these drugs in the 7 days before the day on which upper gastrointestinal bleeding started (index day). Results 581 cases of upper GI bleeding and 1358 controls were considered eligible for the study; no differences in age or sex distribution were observed between cases and controls after matching. Overall, 4.0% of the cases and 3.3% of controls used an SSRI antidepressant in the week before the index day. No significant risk of upper GI bleeding was encountered for SSRI antidepressants (adjusted odds ratio, 1.06, 95% CI, 0.57–1.96) or for whichever other grouping of antidepressants. Conclusions The results of this case-control study showed no significant increase in upper GI bleeding with SSRIs and provide good evidence that the magnitude of any increase in risk is not greater than 2.
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Affiliation(s)
- Alfonso Carvajal
- Instituto de Farmacoepidemiología, Universidad de Valladolid, Valladolid, Spain.
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Päären A, von Knorring L, Jonsson U, Bohman H, Olsson G, von Knorring AL. Drug prescriptions of adults with adolescent depression in a community sample. Pharmacoepidemiol Drug Saf 2011; 21:130-6. [PMID: 21523852 DOI: 10.1002/pds.2120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 01/21/2011] [Accepted: 02/07/2011] [Indexed: 11/07/2022]
Abstract
PURPOSE The prescription drugs have, to our knowledge, not been much studied in epidemiological samples with long-term follow-up. Accordingly, our purpose was to analyze the use of prescription drugs in adults with adolescent depression. METHODS A population-based cohort of adolescents (n = 2465) was screened for the presence of depressive symptoms and diagnosed according to a structured interview. Totally, 362 individuals were identified as depressed and compared with 250 non-depressed controls. The prescription drugs were evaluated at the age of 29-31 years from a register kept by the National Health and Welfare Board. RESULTS The formerly depressed females received significantly more prescription drugs, such as antidepressants, antiepileptics, antibacterials, antimycotics, and antihistamines for systemic use as well as other drugs, compared with controls (15.6 ± 27.4 vs 8.2 ± 7.4 recipes, p < 0.001). Formerly depressed males did not differ from controls regarding prescription drugs. CONCLUSIONS The females but not males with adolescent depression subsequently received more prescription drugs than non-depressed peers. Depressed female adolescents received more psychotropic and non-psychotropic drugs later in life compared to the non-depressed. This might be as a result of physical illnesses, different treatment-seeking behaviors, or somatizing reactions.
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Affiliation(s)
- Aivar Päären
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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