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Lam MK, Lam LT, Butler-Henderson K, King J, Clark T, Slocombe P, Dimarco K, Cockshaw W. Prescribing behavior of antidepressants for depressive disorders: A systematic review. Front Psychiatry 2022; 13:918040. [PMID: 36159914 PMCID: PMC9501861 DOI: 10.3389/fpsyt.2022.918040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/12/2022] [Indexed: 12/01/2022] Open
Abstract
Objective Guidelines for the prescription of antidepressants for Depressive Disorders (DD) have been in place for a long time. However, there is a lack of systematic information on the prescribing behavior of antidepressants in evidence-based clinical practice in psychopharmacotherapy of depressive disorders. This may suggest a lack of implementation of clinical guidelines by clinicians. Existing literature mainly focuses on specific issues or medications. To provide general information on the prescribing behavior of antidepressants for depressive disorders, a systematic review of available studies since 2013 was conducted. Methods and materials To ensure a structured and systematic approach for the literature search and subsequent review process, the PRISMA guidelines for systematic reviews were followed. Major medical and health and psychological databases were used for the literature search. These included Ebsco Host, OVID, PubMed, Science Direct, Scopus, and Web of Science. The online application "Covidence" was employed to manage the titles collected and the full articles retrieved from the initial literature search. Upon finalizing the list of selected studies, data extraction was then conducted using a build-in function of the Covidence platform with the required information pre-set on a template for data extraction. The extracted information was tabulated and summarized in a table. Results Forty-one studies were identified after an extensive search of the literature following the PRISMA guidelines. Of these, 37 quantitative studies providing useful information were systematically reviewed and information extracted. There was a high level of heterogeneity among these studies with different foci or characteristics. Most studies were conducted in or utilized data obtained from hospital and primary healthcare settings. SSRIs were the most commonly prescribed type of antidepressant in the past decade, particularly among younger patients. Among these studies, antidepressants were mainly prescribed by psychiatrists with some by other physicians and general practitioners. This might reflect differences in legislation regarding professional requirements for prescribers or clinical practices. Conclusions A few themes that would be considered important in terms of the effect of prescription behavior on depression, specifically children/adolescents, special target populations, and off-label prescription. The results highlighted the need for more studies on a community-based approach and the role of GPs in the treatment of DD.
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Affiliation(s)
- Mary K. Lam
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Lawrence T. Lam
- Faculty of Medicine, Macau University of Science and Technology, Macau, Macau SAR, China
- Specialty of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Jonathan King
- Lysn (A Danewell Health Company), Sydney, NSW, Australia
| | - Tahnee Clark
- Lysn (A Danewell Health Company), Sydney, NSW, Australia
| | - Peta Slocombe
- Lysn (A Danewell Health Company), Sydney, NSW, Australia
| | - Katherine Dimarco
- Lysn (A Danewell Health Company), Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Wendell Cockshaw
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
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Chen W, Faris MAIE, Bragazzi NL, AlGahtani HMS, Saif Z, Jahrami A, Shivappa N, Hebert JR, Jahrami H. Diet-Related Inflammation is Associated with Major Depressive Disorder in Bahraini Adults: Results of a Case-Control Study Using the Dietary Inflammatory Index. J Inflamm Res 2021; 14:1437-1445. [PMID: 33883920 PMCID: PMC8055288 DOI: 10.2147/jir.s306315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/26/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE This case-control study aimed to examine the association between the inflammation potential of the diet and depression. PATIENTS AND METHODS Ninety-six patients with major depression disorder were matched with 96 age- and sex-matched healthy controls. Energy-adjusted DII (E-DIITM) scores were calculated based on the participants' responses to a detailed nutritional assessment using a quantitative food frequency questionnaire. Descriptive results were reported. Logistic regression was used to estimate odds ratios and 95% confidence intervals associated with E-DII scores and depression adjusting for covariates including age, sex, body mass index, comorbidities, level of education, and employment. RESULTS The mean E-DII score of participants in the study was 1.32±1.08, indicating a generally pro-inflammatory diet. Patients with depression had elevated E-DII scores compared to age- and sex-matched controls with E-DII scores of 1.72± 1.09 vs 0.90±0.90, respectively (P=0.001). Results of logistic regression analysis revealed that patients with depression were nearly three times more likely to be in the extreme ends of pro-inflammatory diet (OR 2.75; 95% CI 1.82-4.15). CONCLUSION Adult Bahraini patients with depression have higher dietary inflammation potential compared to the general population controls. Further research is needed to confirm these results and provide effective interventions to reduce the burden of this dietary inflammation.
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Affiliation(s)
- Wen Chen
- Department of Psychiatry, Xiamen Xianyue Hospital, Xiamen, 361000, People’s Republic of China
| | - Mo’ez Al-Islam E Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute for Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Haifa M S AlGahtani
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Renewal and Reward Center, Dammam, Saudi Arabia
| | | | - Ahmed Jahrami
- Bahraini Association for Intellectual Disabilities and Autism, Sanad, Bahrain
| | - Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - James R Hebert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Haitham Jahrami
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Ministry of Health, Manama, Bahrain
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Nguyen ML, Sunderland B, Lim S, Hattingh L, Chalmers L. A qualitative exploration of factors contributing to non-guideline adherent antipsychotic polypharmacy. Res Social Adm Pharm 2021; 18:2457-2467. [PMID: 33840621 DOI: 10.1016/j.sapharm.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antipsychotic polypharmacy ("polypharmacy") involves the concurrent prescribing of two or more antipsychotics for managing schizophrenia. It occurs frequently despite there being limited clinical evidence for this practice and an increased risk of adverse events. Little is understood about why it occurs outside of treatment guidelines, highlighting a current research gap. OBJECTIVE To explore the factors contributing to non-evidence based polypharmacy practice and possible strategies for addressing these factors. METHODS Three focus groups were conducted between June and August 2018 with doctors and nurses employed at a mental health unit of a Western Australian public hospital. Participants were asked about their perceptions of polypharmacy, why it occurred and what could limit its prevalence. Thematic inductive analysis was mapped to the Theoretical Domains Framework to identify key underlying themes and to establish potential enablers and barriers for practice change. RESULTS Participants understood the risks of polypharmacy and perceived it to largely be perpetuated by external factors, out of which two key themes emerged: system-related issues (e.g.: communication failures whereby de-prescribing plans are not actioned); and patient-related issues (e.g.: misinformed views translating to medication-seeking behaviour). This led to the third theme: a disconnect between clinicians' knowledge and their practices (i.e.: being aware of Australian evidence-based guideline recommendations yet acknowledging polypharmacy still occurred due to the aforementioned issues). Strategies suggested to address these issues included developing medication management plans to bridge communication gaps and managing patients' medication expectations with education. CONCLUSIONS Management of schizophrenia is complex, requiring consideration of many patient-related and systemic factors. Polypharmacy has a place in certain contexts, however, must be well considered and closely monitored to allow for early identification of opportunities to rationalise (i.e.: de-prescribe) therapy, where appropriate. Future research objectives will centre on implementing strategies identified from these focus groups to optimise patient outcomes.
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Affiliation(s)
- My Linh Nguyen
- Curtin Medical School, Curtin University, Bentley, Western Australia, 6102, Australia; Pharmacy Department, Armadale Kalamunda Group, Mount Nasura, Western Australia, 6112, Australia.
| | - Bruce Sunderland
- Curtin Medical School, Curtin University, Bentley, Western Australia, 6102, Australia
| | - Stephen Lim
- Curtin Medical School, Curtin University, Bentley, Western Australia, 6102, Australia
| | - Laetitia Hattingh
- Curtin Medical School, Curtin University, Bentley, Western Australia, 6102, Australia; Gold Coast Health, Gold Coast, Queensland, 4215, Australia; School of Pharmacy and Pharmacology, Griffith University, Gold Coast, Queensland, 4222, Australia
| | - Leanne Chalmers
- Curtin Medical School, Curtin University, Bentley, Western Australia, 6102, Australia
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Hattab S, Qasarweh L, Ahmaro M, Atatre Y, Tayem Y, Ali M, Jahrami H. Prescribing patterns of psychotropic medications in psychiatric disorders: a descriptive study from Palestine. Int J Clin Pharm 2021; 43:1101-1108. [PMID: 33411103 DOI: 10.1007/s11096-020-01223-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
Background The practice patterns of psychiatrists have changed over the last two decades. Objectives This study describes the pattern of prescribing psychotropic drugs in treating common psychiatric disorders, and investigates the rate of polypharmacy and potential drug-drug interactions. Setting Psychiatry governmental outpatient clinic in the north of West Bank, Palestine. Methods Cross-sectional study that included all prescriptions which were issued over the period October 2018 to January 2019, for patients diagnosed with schizophrenia, depression, anxiety, bipolar disorder and schizoaffective disorders, and checked for the presence and the grade of potential drug-drug interactions using "Medscape drug interactions checker". Main outcome measure Prescribing patterns of psychotropic drugs. Results A total of 1045 prescriptions were examined. The mean age of the patients was 47.3 years (SD = 13.6), two-thirds of the patients (64.5%) were males. Fifty-two percent of the patients were diagnosed with schizophrenia while 15.2% were diagnosed with depression. The later third was diagnosed with bipolar disorder, schizoaffective and anxiety disorders (15.8%, 11.1% and 5.1% respectively). The most commonly prescribed drugs were typical antipsychotics for schizophrenia, bipolar and schizoaffective disorders, selective serotonin reuptake inhibitors for depression and tricyclic anti-depressants for anxiety. Polypharmacy was found in 877 prescriptions (84%), and drug-drug interactions (DDIs) were identified in 823 (94%) prescriptions. The DDIs were classified as minor (4, 0.5%), significant (418, 50.8%) and serious (401, 48.7%). Conclusions Our results suggest that the pharmacotherapy of psychiatric disorders in Palestine may not be in accordance to international guidelines and the incidence of polypharmacy and DDIs is high.
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Affiliation(s)
- Suhaib Hattab
- Department of Biomedical Sciences, Physiology, Pharmacology and Toxicology Division, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| | - Layth Qasarweh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Malek Ahmaro
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Yazid Atatre
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Yasin Tayem
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Mazen Ali
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Haitham Jahrami
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
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