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Alderman BL, Perdue HM, Sarwani AH. Exercise for the Prevention and Treatment of Depression. Curr Top Behav Neurosci 2024. [PMID: 39042248 DOI: 10.1007/7854_2024_496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Depression is among the world's leading causes of disability and accounts for a significant loss of life. Despite large investments in research for antidepressants and psychotherapies, non-response, partial response, and small effects remain significant problems. Exercise and physical activity are two lifestyle behaviors that have been studied for well over half a century for the prevention and treatment of depression. The aim of this chapter is to summarize the current evidence base supporting the efficacy of exercise and physical activity in the prevention and treatment of depression, including evidence supporting exercise as a monotherapy and adjunct to antidepressant medication and psychotherapies. We conclude the chapter by outlining challenges to prescribing exercise for depression and general recommendations for encouraging behavioral adoption for individuals suffering from depression.
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Affiliation(s)
- Brandon L Alderman
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA.
| | - Hannah M Perdue
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA
| | - Amber H Sarwani
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA
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Kwon Y, Lauffenburger JC. Antidepressant discontinuation patterns and characteristics across sociodemographic groups in the United States. J Affect Disord 2024; 355:82-85. [PMID: 38554879 DOI: 10.1016/j.jad.2024.03.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND While antidepressants are frequently used, less is known about contemporary discontinuation patterns, especially across different sociodemographic populations. METHODS Patients 16-84 years initiating antidepressants between 2016 and 2019 within a large US health insurer were identified. The association between patient characteristics and time until antidepressant discontinuation was evaluated using adjusted Cox proportional hazard regression. RESULTS Across 1,365,576 patients, mean time to discontinuation was 168.1 days (SD: 223.6). Men were more likely to discontinue than women (HR: 0.94, 95%CI: 0.94-0.94). Younger patients (16-24 years) were more likely to discontinue than older patients. Patients who were non-White (Asian HR: 1.33, 95%CI: 1.31-1.34; Black HR: 1.27, 95%CI: 1.27-1.28; Hispanic HR: 1.34, 95%:CI 1.34-1.35), with evidence of a substance use disorder (HR: 1.31, 95%CI: 1.27-1.35), or taking tricyclic antidepressants (HR:1.26, 95%CI: 1.25-1.27) were more likely to discontinue. LIMITATIONS Information on reasons for discontinuation was not available, and wide standard deviations for the primary outcome were reported. The results may not be generalized to non-commercially insured beneficiaries. CONCLUSIONS Discontinuation is common within the first 6 months of treatment but varies across populations, highlighting patients who may benefit from potential intervention.
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Affiliation(s)
- Yoojung Kwon
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, United States of America; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, United States of America
| | - Julie C Lauffenburger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, United States of America.
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Del Pino-Sedeño T, Infante-Ventura D, Hernández-González D, González-Hernández Y, González de León B, Rivero-Santana A, Hurtado I, Acosta Artiles FJ. Sociodemographic and clinical predictors of adherence to antidepressants in depressive disorders: a systematic review with a meta-analysis. Front Pharmacol 2024; 15:1327155. [PMID: 38318137 PMCID: PMC10839896 DOI: 10.3389/fphar.2024.1327155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction: Current evidence reveals concerning rates of non-adherence to antidepressant treatment, possibly influenced by various relevant determinants such as sociodemographic factors or those related to the health system and their professionals. The aim of this paper is to review the scientific evidence on sociodemographic and clinical predictors of adherence to pharmacological treatment in patients diagnosed with a depressive disorder. Methods: a systematic review (SR) was conducted. The search for a previous SR was updated and de novo searches were performed in Medline, EMBASE, Web of Science (WoS) and PsycInfo (last 10 years). The risk of bias was assessed using the Cochrane tool for non-randomized studies-of Exposure (ROBINS-E). Meta-analyses were conducted. Results: Thirty-nine studies (n = 2,778,313) were included, 24 of them in the meta-analyses. In the initiation phase, no association of adherence was found with any of the predictors studied. In the implementation and discontinuation phases, middle-aged and older patients had better adherence rates and lower discontinuation rates than younger ones. White patients adhered to treatment better than African-American patients. Discussion: Age and ethnicity are presented as the predictive factors of pharmacological adherence. However, more research is needed in this field to obtain more conclusive results on other possible factors. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023414059], identifier [CRD42023414059].
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Affiliation(s)
- Tasmania Del Pino-Sedeño
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Tenerife, Spain
- Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, Spain
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, Tenerife, Spain
| | - Diego Infante-Ventura
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, Tenerife, Spain
| | | | - Yadira González-Hernández
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
| | - Beatriz González de León
- Multiprofessional Teaching Unit of Family and Community Care La Laguna-Tenerife Norte, Management of Primary Care of Tenerife, Santa Cruz de Tenerife, Spain
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Tenerife, Spain
| | - Isabel Hurtado
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Tenerife, Spain
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain
| | - Francisco Javier Acosta Artiles
- Department of Mental Health, General Management of Health care Programs, Canary Islands Health Service, Las Palmas de Gran Canaria, Spain
- Department of Psychiatry, Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
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Pillinger T, Howes OD, Correll CU, Leucht S, Huhn M, Schneider-Thoma J, Gaughran F, Jauhar S, McGuire PK, Taylor DM, Young AH, McCutcheon RA. Antidepressant and antipsychotic side-effects and personalised prescribing: a systematic review and digital tool development. Lancet Psychiatry 2023; 10:860-876. [PMID: 37774723 PMCID: PMC10878984 DOI: 10.1016/s2215-0366(23)00262-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Side-effects of psychiatric medication impair quality of life and functioning. Furthermore, they contribute to morbidity, mortality, stigma, and poor treatment concordance resulting in relapse of psychiatric illness. Guidelines recommend discussing side-effects with patients when making treatment decisions, but a synthesis of antidepressant and antipsychotic side-effects to guide this process is missing, and considering all side-effects is a complex, multidimensional process. We aimed to create comprehensive databases of antipsychotic and antidepressant side-effects, and a digital tool to support database navigation. METHODS To create the databases, we did an umbrella review of Embase, PsycINFO, and MEDLINE from database inception to June 26, 2023. We included meta-analyses of randomised controlled trials examining antipsychotic monotherapy in the treatment of schizophrenia or antidepressant monotherapy in the treatment of major depressive disorder. We included meta-analyses in adults (aged ≥18 years) that assessed drugs with a common comparator. The search was complemented by a review of national and international guidelines and consensus statements for the treatment of major depressive disorder and schizophrenia in adults. Effect sizes for antipsychotic and antidepressant side-effects were extracted from meta-analyses examining the largest number of drugs. In cases of incomplete meta-analytic coverage, data were imputed on the basis of guideline-derived ordinal rankings or, if imputation was not possible, ordinal scores were extracted. Both meta-analytic and ordinal outcomes were normalised to provide values between 0 and 1. We then constructed a digital tool, the Psymatik Treatment Optimizer, to combine the side-effect databases with side-effect concerns of an individual user, to enable users to select side-effects of concern and the relative degree of concern for each side-effect. Concern weightings and the side-effect databases are synthesised via a multicriteria decision analysis method (technique for order of preference by similarity to ideal situation, or TOPSIS). FINDINGS Of 3724 citations, 14 articles containing 68 meta-analyses of individual side-effects met inclusion criteria. After review of 19 guidelines, seven provided ordinal data. Antipsychotic data were extracted from five studies (11 meta-analyses, n=65 594 patients) and four guidelines, and antidepressant data were extracted from three guidelines. The resultant databases included data on 32 antipsychotics (14 side-effects) and 37 antidepressants (nine side-effects). The databases highlighted the clinical dilemma associated with balancing side-effects, with avoidance of one side-effect (eg, weight gain for antipsychotics) increasing the risk of others (eg, akathisia). To aid with this dilemma, the Psymatik Treatment Optimizer synthesises the side-effect databases with individual user-defined concern weights. After computing up to 5851 pairwise comparisons for antidepressants and 5142 pairwise comparisons for antipsychotics, Psymatik ranks treatments in order of preference for the individual user, with the output presented in a heatmap. INTERPRETATION By facilitating collaborative, personalised, and evidence-based prescribing decisions, the side-effect databases and digital application supports care delivery that is consistent with international regulatory guidance for the treatment of schizophrenia and depression, and it therefore has promise for informing psychiatric practice and improving outcomes. FUNDING National Institute for Health and Care Research, Maudsley Charity, Wellcome Trust, Medical Research Council.
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Affiliation(s)
- Toby Pillinger
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Imperial College London, London, UK.
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Maximilian Huhn
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Sameer Jauhar
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Philip K McGuire
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - David M Taylor
- Pharmacy Department, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK; Institute of Pharmaceutical Science, King's College London, London, UK
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Robert A McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
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Alemi F, Min H, Yousefi M, Becker LK, Hane CA, Nori VS, Crown WH. Procedure for Organizing a Post-FDA-approval Evaluation of Antidepressants. Cureus 2022; 14:e29884. [PMID: 36348913 PMCID: PMC9629984 DOI: 10.7759/cureus.29884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose: The study reports the construction of a cohort used to study the effectiveness of antidepressants. Methods: The cohort includes experiences of 3,678,082 patients with depression in the United States on antidepressants between January 1, 2001, and December 31, 2018. A total of 10,221,145 antidepressant treatment episodes were analyzed. Patients who had no utilization of health services for at least two years, or who had died, were excluded from the analysis. Follow-up was passive, automatic, and collated from fragmented clinical services of diverse providers. Results: The average follow-up was 2.93 years, resulting in 15,096,055 person-years of data. The mean age of the cohort was 46.54 years (standard deviation of 17.48) at first prescription of antidepressant, which was also the enrollment event (16.92% were over 65 years), and most were female (69.36%). In 10,221,145 episodes, within the first 100 days of start of the episode, 4,729,372 (46.3%) continued their treatment, 1,306,338 (12.8%) switched to another medication, 3,586,156 (35.1%) discontinued their medication, and 599,279 (5.9%) augmented their treatment. Conclusions: We present a procedure for constructing a cohort using claims data. A surrogate measure for self-reported symptom remission based on the patterns of use of antidepressants has been proposed to address the absence of outcomes in claims. Future studies can use the procedures described here to organize studies of the comparative effectiveness of antidepressants.
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John D, Montvida O, Chin KL, Khunti K, Paul SK. Antidepressant prescriptions and therapy intensification in men and women newly diagnosed with depression in the UK. J Psychiatr Res 2022; 154:167-174. [PMID: 35944378 DOI: 10.1016/j.jpsychires.2022.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/17/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Evidence on therapeutic interventions and factors driving treatment intensification (TI) in people with incident depression in UK are scarce. AIMS To explore antidepressant prescribing patterns and factors influencing TI. DESIGN and setting: Retrospective cohort study of adults with incident depression diagnosed between 2006 and 2017 using UK primary care database. METHODS Patterns of antidepressant prescriptions, and factors influencing TI were evaluated by sex. RESULTS In 931,302 people with depression (90% initiating antidepressants), mean age was 39 years, 41% were male, 14% had cardiometabolic multimorbidity (CMM), and 54% were diagnosed at < 40 years. Being the most prescribed first-line antidepressant (62%), SSRI prescribing rate increased from 66 per 1000 person-years to 170 per 1000 person-years; 24% (2% dose escalation, 4% adding, 18% switching) of first-line antidepressant initiators intensified with 13 months median time to TI. Compared to 60-70 years, younger adults had significantly higher TI risk (range of hazards ratio, HR: 1.08-1.42). CMM and anxiety were associated with 15-24% and 39-49% significantly higher TI risks respectively. First-line antidepressant and deprivation status influenced TI differently by gender. CONCLUSIONS Men and women with depression in UK have different antidepressant prescription patterns in real-world. Age at diagnosis, deprivation status and cardiometabolic multimorbidity are the major sociodemographic and non-psychiatric risk factors for therapeutic changes.
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Affiliation(s)
- Dibato John
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Olga Montvida
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Ken L Chin
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia; Melbourne Medical School, The University of Melbourne, Parkville, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK; Leicester NIHR Biomedical Research Centre, UK
| | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia; Recently Employee of AstraZeneca PLC, United Kingdom.
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7
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Kennedy SH. Beyond Response: Aiming for Quality Remission in Depression. Adv Ther 2022; 39:20-28. [PMID: 35247185 PMCID: PMC9015986 DOI: 10.1007/s12325-021-02030-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022]
Abstract
To define treatment response in depression as at least a 50% reduction in total symptom severity is to accept that up to half of patients will continue to have residual symptoms, most commonly low mood/loss of interest, cognitive problems, lack of energy, and difficulty sleeping. In fact, patients' goals for treatment are to return to premorbid levels of functioning. This highlights the importance of assessing both functional outcomes and symptom improvement when evaluating the efficacy of antidepressant medication. Not all patients who achieve symptomatic response/remission will achieve a functional response/remission. In two studies (one with agomelatine and one with escitalopram), 54% of patients receiving agomelatine and 47% of those receiving escitalopram achieved a symptomatic response, and 53% of patients in each study achieved a functional response. However, 42% of patients receiving agomelatine and 35% of those receiving escitalopram had both a symptomatic and a functional response. The four symptoms of depression with the most marked effect on function are sad mood, impaired concentration, fatigue, and loss of interest. Low energy is particularly associated with poor occupational functioning, highlighting the importance of ongoing assessment of patients with depression, focusing particular attention on the symptoms that affect their ability to function, such as fatigue. Depending on the type of residual symptoms, some patients may benefit from combination therapy, such as adding dopamine modulator therapy. Antidepressant therapy is only effective if patients continue to take their medication, and high rates of early discontinuation have been reported. Therefore, when selecting treatment for depression, physicians can maximize the likelihood of adherence and persistence by taking into account both the antidepressant efficacy of treatment, its adverse effects and acceptability to patients.
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Affiliation(s)
- Sidney H Kennedy
- Centre for Depression and Suicide Studies, St Michael's Hospital, University of Toronto, 193 Yonge Street, Suite 6-001A, Toronto, ON, M5B 1M4, Canada.
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Larson S, Nemoianu A, Lawrence DF, Troup MA, Gionfriddo MR, Pousti B, Sun H, Riaz F, Wagner ES, Chrones L, Touya M. Characterizing primary care for patients with major depressive disorder using electronic health records of a US-based healthcare provider. J Affect Disord 2022; 300:377-384. [PMID: 34953925 DOI: 10.1016/j.jad.2021.12.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is predominantly managed in primary care. However, primary care providers (PCPs) may not consistently follow evidence-based treatment algorithms, leading to variable patient management that can impact outcomes. METHODS We retrospectively analyzed adult patients with MDD seen at Geisinger, an integrated health system. Utilizing electronic health record (EHR) data, we classified patients as having MDD based on International Classification of Disease (ICD)-9/10 codes or a Patient Health Questionnaire (PHQ)-9 score ≥5. Outcomes assessed included time to first visit with a PCP or behavioral health specialist following diagnosis, antidepressant medication switching, persistence, healthcare resource utilization (HRU), and treatment costs. RESULTS Among the 38,321 patients with MDD managed in primary care in this study, significant delays between diagnosis with antidepressant prescribing and follow-up PCP visits were observed. There was also considerable variation in care following diagnosis. Overall, 34.9% of patients with an ICD-9/10 diagnosis of MDD and 41.3% with a PHQ-9 score ≥15 switched antidepressants. An ICD-9/10 diagnosis, but not moderately severe to severe depression, was associated with higher costs and HRU. More than 75% of patients with MDD discontinued antidepressant medication within 6 months. LIMITATIONS The study population was comparable with other real-world studies of MDD, but study limitations include its retrospective nature and reliance on the accuracy of EHRs. CONCLUSIONS Management of patients with MDD in a primary care setting is variable. Addressing these gaps will have important implications for ensuring optimal patient management, which may reduce HRU and treatment medication costs, and improve treatment persistence.
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Affiliation(s)
- Sharon Larson
- Main Line Health Center for Population Research at the Lankenau Institute for Medical Research, Wynnewood, PA, and Thomas Jefferson University College of Population Health, Philadelphia, PA, United States.
| | | | - Debra F Lawrence
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | | | | | - Bobak Pousti
- Geisinger Health System, Danville, PA, United States
| | - Haiyan Sun
- Geisinger Health System, Danville, PA, United States
| | - Faisal Riaz
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Eric S Wagner
- Geisinger Health System, Danville, PA, United States
| | - Lambros Chrones
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
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Lampela P, Tanskanen A, Lähteenvuo M, Tiihonen J, Taipale H. Switches and early discontinuations of antidepressant medication in young adults with depression. J Affect Disord 2021; 295:1474-1481. [PMID: 34565589 DOI: 10.1016/j.jad.2021.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/23/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Receiving treatment for depression is increasingly common among young adults. Antidepressants (AD) are important in depression treatment and modification of medication is common. We examined switches and discontinuations of ADs among young Finnish adults aged 18-29 years. METHODS All persons diagnosed with depression in inpatient or specialized outpatient care or having received sickness absence or disability pension due to depression at age of 18-29 years during 2004-17 were included (N = 110761). Among them, we focused on incident AD users (N = 52855, 47.7%) who were identified with a 6 month washout before AD initiation. The follow-up was 2 years. RESULTS The majority (76.3%) initiated with selective serotonin reuptake inhibitors (SSRIs). The initial AD was switched in 17.4% of cases. Switching was most common when treatment was initiated with tricyclic antidepressants (TCA) or polytherapy, and least common when initiated with SSRIs or serotonin-noradrenaline reuptake inhibitors. Factors associated with switch included initiation with polytherapy, TCA or mirtazapine, and use of benzodiazepines or Z-drugs at baseline. During the first 3 months, 27.6% discontinued AD use, and only 14.1% used AD for 2 years. Factors associated with discontinuation included substance abuse, ADHD, previous suicide attempt and initiation with mirtazapine. SSRIs had the longest time to discontinuation (median 144 days, IQR 64-302). LIMITATIONS Our data sources lack those treated in primary care only, without receiving a sick leave of ≥2 weeks. In addition, we do not have data on severity of depression, social factors or psychotherapy. CONCLUSIONS Special emphasis should be paid to persons with increased risk of discontinuation, including those with previous self-harm/suicide attempt or substance abuse.
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Affiliation(s)
- Pasi Lampela
- Finnish Student Health Service, Helsinki, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
| | - Antti Tanskanen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Heidi Taipale
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Paulus MP, Kuplicki R, Victor TA, Yeh HW, Khalsa SS. Methylphenidate augmentation of escitalopram to enhance adherence to antidepressant treatment: a pilot randomized controlled trial. BMC Psychiatry 2021; 21:582. [PMID: 34798853 PMCID: PMC8603485 DOI: 10.1186/s12888-021-03583-7] [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: 04/23/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adherence to treatment, i.e. the extent to which a patient's therapeutic engagement coincides with the prescribed treatment, is among the most important problems in mental health care. The current study investigated the influence of pairing an acute positive reinforcing dopaminergic/noradrenergic effect (methylphenidate, MPH) with a standard antidepressant on the rates of adherence to medication treatment. The primary objective of this study was to determine whether MPH + escitalopram resulted in higher rates of medication adherence relative to placebo + escitalopram. METHODS Twenty participants with moderate to severe depression were 1-1 randomized to either (1) 5 mg MPH + 10 mg escitalopram or (2) placebo + 10 mg escitalopram with the possibility for a dose increase at 4 weeks. A Bayesian analysis was conducted to evaluate the outcomes. RESULTS First, neither percent Pill count nor Medication Electronic Monitoring System adherence showed that MPH was superior to placebo. In fact, placebo showed slightly higher adherence rates on the primary (7.82% better than MPH) and secondary (7.07% better than MPH) outcomes. There was a less than 25% chance of MPH augmentation showing at least as good or better adherence than placebo. Second, both groups showed a significant effect of treatment on the QIDS-SR with a median effect of an 8.6-point score reduction. Third, neither subjective measures of adherence attitudes nor socio-demographic covariates had a significant influence on the primary or secondary outcome variables. CONCLUSIONS These data do not support the use of MPH to increase adherence to antidepressant medication in individuals with moderate to severe depression. CLINICALTRIALS. GOV IDENTIFIER NCT03388164 , registered on 01/02/2018.
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Affiliation(s)
- Martin P. Paulus
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326 USA ,grid.267360.60000 0001 2160 264XOxley College of Health Sciences, The University of Tulsa, Tulsa, OK USA
| | - Rayus Kuplicki
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326 USA
| | - Teresa A. Victor
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326 USA
| | - Hung-Wen Yeh
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326 USA ,grid.239559.10000 0004 0415 5050Health Services & Outcomes Research, Children’s Mercy Hospital, Kansas City, MO USA
| | - Sahib S. Khalsa
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326 USA ,grid.267360.60000 0001 2160 264XOxley College of Health Sciences, The University of Tulsa, Tulsa, OK USA
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Colzato L, Zhang W, Walter H, Beste C, Stock AK. An Oppositional Tolerance Account for Potential Cognitive Deficits Caused by the Discontinuation of Antidepressant Drugs. PHARMACOPSYCHIATRY 2021; 54:252-260. [PMID: 34293810 PMCID: PMC8575552 DOI: 10.1055/a-1520-4784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/26/2021] [Indexed: 10/24/2022]
Abstract
Depression is the leading cause of disability worldwide, making antidepressant drugs the most used psychiatric drugs in the USA. Withdrawal effects and rebound symptoms frequently occur after the reduction and/or discontinuation of these drugs. Although these phenomena have been investigated with respect to the clinical symptomatology, no studies have systematically investigated the effects of withdrawal/rebound on general cognition. We present a novel framework based on the idea of allostatic adaptation, which allows to predict how different antidepressants likely impair different cognitive processes as a result of withdrawal and rebound effects. This framework relies on the assumptions that the type of cognitive impairments evoked by an antidepressant is determined by the targeted neurotransmitter systems, while the severity of deficits depends on its half-life. Our model predicts that the severity of detrimental cognitive withdrawal and rebound effects increases with a shorter half-life of the discontinued antidepressant drug. It further proposes drug-specific effects: antidepressants mainly targeting serotonin should primarily impair aversive and emotional processing, those targeting norepinephrine should impair the processing of alerting signals, those targeting dopamine should impair motivational processes and reward processing, and those targeting acetylcholine should impair spatial learning and memory. We hope that this framework will motivate further research to better understand and explain cognitive changes as a consequence of antidepressant discontinuation.
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Affiliation(s)
- Lorenza Colzato
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Wenxin Zhang
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Henrik Walter
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Ann-Kathrin Stock
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
- Biopsychology, Faculty of Psychology, TU Dresden, Dresden, Germany
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12
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Lunghi C, Antonazzo IC, Burato S, Raschi E, Zoffoli V, Forcesi E, Sangiorgi E, Menchetti M, Roberge P, Poluzzi E. Prevalence and Determinants of Long-Term Utilization of Antidepressant Drugs: A Retrospective Cohort Study. Neuropsychiatr Dis Treat 2020; 16:1157-1170. [PMID: 32440131 PMCID: PMC7213896 DOI: 10.2147/ndt.s241780] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/09/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Antidepressant consumption has risen in recent years, driven by longer treatment duration. The objective of this study was to measure the prevalence of antidepressant long-term and chronic use in the Bologna area, Italy, and to identify their main determinants. MATERIALS AND METHODS We conducted a retrospective claims-based cohort study by using the Bologna Local Health Authority data. A cohort of 18,307 incident users of antidepressant drugs in 2013 was selected, and subjects were followed for three years. A long-term utilization was defined as having at least one prescription claimed during each year of follow-up, while chronic utilization was defined as claiming at least 180 defined daily doses per year. Factors associated with chronic and long-term use were identified by univariate and multivariate logistic regressions. RESULTS In our cohort, 5448 (29.8%) and 1817 (9.9%) subjects were dispensed antidepressants for a long-term course and in a chronically way, respectively. Older age, antidepressant polytherapy, polypharmacy, and being prescribed the first antidepressant by a hospital physician were all factors independently associated with chronic and long-term prescriptions of antidepressant drugs. Results were reported separately for men and women. CONCLUSION Antidepressant long-term and chronic prescriptions are common in the Bologna area. Because longer treatment should be clinically motivated, these results strongly prompt the need to evaluate the actual relevance, as they may indicate potentially inappropriate prescription patterns.
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Affiliation(s)
- Carlotta Lunghi
- Department of Health Sciences, Université Du Québec À Rimouski, Lévis, Québec, Canada.,Department of Medical and Surgical Sciences, Pharmacology Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Groupe De Recherche PRIMUS, Centre De Recherche Du CHUS, Université De Sherbrooke, Sherbrooke, Canada
| | - Ippazio Cosimo Antonazzo
- Department of Medical and Surgical Sciences, Pharmacology Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Sofia Burato
- Department of Medical and Surgical Sciences, Pharmacology Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences, Pharmacology Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Violetta Zoffoli
- Department of Medical and Surgical Sciences, Pharmacology Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Emanuele Forcesi
- Department of Medical and Surgical Sciences, Pharmacology Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Elisa Sangiorgi
- Drug Policy Service, Emilia Romagna Region Health Authority, Bologna, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Pasquale Roberge
- Groupe De Recherche PRIMUS, Centre De Recherche Du CHUS, Université De Sherbrooke, Sherbrooke, Canada.,Faculty of Medicine and Health Sciences, Université De Sherbrooke, Sherbrooke, Québec, Canada
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, Pharmacology Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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13
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Webb CA, Trivedi MH, Cohen ZD, Dillon DG, Fournier JC, Goer F, Fava M, McGrath PJ, Weissman M, Parsey R, Adams P, Trombello JM, Cooper C, Deldin P, Oquendo MA, McInnis MG, Huys Q, Bruder G, Kurian BT, Jha M, DeRubeis RJ, Pizzagalli DA. Personalized prediction of antidepressant v. placebo response: evidence from the EMBARC study. Psychol Med 2019; 49:1118-1127. [PMID: 29962359 PMCID: PMC6314923 DOI: 10.1017/s0033291718001708] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a highly heterogeneous condition in terms of symptom presentation and, likely, underlying pathophysiology. Accordingly, it is possible that only certain individuals with MDD are well-suited to antidepressants. A potentially fruitful approach to parsing this heterogeneity is to focus on promising endophenotypes of depression, such as neuroticism, anhedonia, and cognitive control deficits. METHODS Within an 8-week multisite trial of sertraline v. placebo for depressed adults (n = 216), we examined whether the combination of machine learning with a Personalized Advantage Index (PAI) can generate individualized treatment recommendations on the basis of endophenotype profiles coupled with clinical and demographic characteristics. RESULTS Five pre-treatment variables moderated treatment response. Higher depression severity and neuroticism, older age, less impairment in cognitive control, and being employed were each associated with better outcomes to sertraline than placebo. Across 1000 iterations of a 10-fold cross-validation, the PAI model predicted that 31% of the sample would exhibit a clinically meaningful advantage [post-treatment Hamilton Rating Scale for Depression (HRSD) difference ⩾3] with sertraline relative to placebo. Although there were no overall outcome differences between treatment groups (d = 0.15), those identified as optimally suited to sertraline at pre-treatment had better week 8 HRSD scores if randomized to sertraline (10.7) than placebo (14.7) (d = 0.58). CONCLUSIONS A subset of MDD patients optimally suited to sertraline can be identified on the basis of pre-treatment characteristics. This model must be tested prospectively before it can be used to inform treatment selection. However, findings demonstrate the potential to improve individual outcomes through algorithm-guided treatment recommendations.
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Affiliation(s)
| | | | | | | | | | | | - Maurizio Fava
- Harvard Medical School – Massachusetts General Hospital, Boston, MA
| | - Patrick J. McGrath
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Myrna Weissman
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | | | - Phil Adams
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | | | - Crystal Cooper
- University of Texas, Southwestern Medical Center, Dallas, TX
| | | | | | | | | | - Gerard Bruder
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Benji T. Kurian
- University of Texas, Southwestern Medical Center, Dallas, TX
| | - Manish Jha
- University of Texas, Southwestern Medical Center, Dallas, TX
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14
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Castelpietra G, Bortolussi L, Gobbato M, Arnoldo L, Balestrieri M, Wettermark B. Discontinuation of antidepressants in suicides findings from the Friuli Venezia Giulia Region, Italy, 2005‐2014. Basic Clin Pharmacol Toxicol 2018; 124:312-320. [DOI: 10.1111/bcpt.13140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/19/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Giulio Castelpietra
- Primary Care Services Area Central Health Directorate, Friuli Venezia Giulia Region Trieste Italy
- Department of Medicine, Surgery and Health Sciences University of Trieste Trieste Italy
| | - Luca Bortolussi
- Department of Mathematics and Geosciences University of Trieste Trieste Italy
| | - Michele Gobbato
- Epidemiological Service Trust for the Centralised Management of Shared Services (EGAS) Udine Italy
| | - Luca Arnoldo
- Department of Medical and Biological Sciences University of Udine Udine Italy
| | - Matteo Balestrieri
- Department of Medical and Biological Sciences University of Udine Udine Italy
| | - Bjorn Wettermark
- Department of Medicine Centre for Pharmacoepidemiology Karolinska Institutet Stockholm Sweden
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15
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Wei YJ, Simoni-Wastila L, Albrecht JS, Huang TY, Moyo P, Khokhar B, Harris I, Langenberg P, Netzer G, Lehmann SW. The association of antidepressant treatment with COPD maintenance medication use and adherence in a comorbid Medicare population: A longitudinal cohort study. Int J Geriatr Psychiatry 2018; 33:e212-e220. [PMID: 28833488 PMCID: PMC6362976 DOI: 10.1002/gps.4772] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/12/2017] [Indexed: 11/10/2022]
Abstract
UNLABELLED The effect of treating comorbid depression to achieve optimal management of chronic obstructive pulmonary disease (COPD) has not yet empirically tested. We examined the association between antidepressant treatment and use of and adherence to COPD maintenance medications among patients with new-onset COPD and comorbid depression. METHODS Using 2006-2012 Medicare data, this retrospective cohort study identified patients with newly diagnosed COPD and new-onset major depression. Two exposures-antidepressant use (versus non-use) and adherence measured by proportion of days covered (PDC) (PDC ≥0.8 versus <0.8)-were assessed quarterly. We used marginal structural models to estimate the effects of prior antidepressant use and adherence on subsequent COPD maintenance inhaler use and adherence outcomes, accounting for time-varying confounders. RESULTS A total of 25 458 COPD-depression patients, 82% with antidepressant treatment, were followed for a median of 2.5 years. Nearly half (48%) used at least 1 COPD maintenance inhaler in any given quarter; among users, 3 in 5 (61%) had a PDC of <0.8. Compared to patients with no antidepressant treatment, those with antidepressant use were more likely to use (relative ratio [RR] = 1.15, 95% confidence interval [CI] = 1.12- 1.17) and adhere to (RR = 1.08, 95% = 1.03-1.14) their COPD maintenance inhalers. Patients who adhered to antidepressant treatment were more likely to use and adhere to COPD maintenance inhalers. CONCLUSION Regularly treated depression may increase use of and adherence to necessary maintenance medications for COPD. Antidepressant treatment may be a key determinant to improving medication-taking behaviors among COPD patients comorbid with depression.
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Affiliation(s)
- Yu-Jung Wei
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Jennifer S. Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ting-Ying Huang
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Patience Moyo
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Bilal Khokhar
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Ilene Harris
- IMPAQ International LLC, Columbia, Maryland, USA
| | - Patricia Langenberg
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Giora Netzer
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Susan W. Lehmann
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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16
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Herzog DP, Wagner S, Ruckes C, Tadic A, Roll SC, Härter M, Lieb K. Guideline adherence of antidepressant treatment in outpatients with major depressive disorder: a naturalistic study. Eur Arch Psychiatry Clin Neurosci 2017; 267:711-721. [PMID: 28421334 DOI: 10.1007/s00406-017-0798-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
Abstract
Little is known about guideline adherence of naturalistic antidepressant drug therapy in outpatients with major depressive disorder (MDD). The aim of the study was to analyze guideline adherence, especially regarding treatment length, treatment evaluation and medication change strategies. We investigated 889 patients with MDD who had been admitted for inpatient treatment and were enrolled in the early medication change trial (ClinicalTrials.gov NCT00974155). We investigated all patients at screening visit regarding previous outpatient drug treatment in the index episode, which was assessed by structured interviews. Demographic variables were obtained from patients and patients' records. 51.0% of the patients had received previous drug treatment in the index episode, 56.6% were females, and their mean age was 40.0 years. In the 153 patients who were pharmacologically treated at least 8 weeks, medication was not changed in 129 (84.3%) patients. Patients who had a medication change in their index episode (n = 24, 15.7%) waited 71.1 weeks (±110.4) for their treatment optimization. Only 5 of those 153 patients (3.3%) had a dose increase, whereas 132 patients (86.3%) had no dose adaption at all. Antidepressant blood levels were measured in 46 patients (30.1%). We conclude that a large proportion of patients with MDD is not treated in adherence to treatment guidelines recommending treatment evaluation (e.g. therapeutic drug monitoring) and treatment change after 4 to 8 weeks in non-responders. Earlier treatment optimization may prevent long-term suffering of patients and may avoid inpatient treatment.
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Affiliation(s)
- David P Herzog
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany.
| | - Stefanie Wagner
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Centre for Clinical Trials (IZKS), University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - André Tadic
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, Agaplesion Elisabethenstift gGmbH, 64287, Darmstadt, Germany
| | - Sibylle C Roll
- Hospital for Psychiatry and Psychotherapy, Vitos Rheingau, Kloster-Eberbach-Straße 4, 65346, Eltville, Germany
| | - Martin Härter
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany.
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Increased Post-procedural Non-gastrointestinal Adverse Events After Outpatient Colonoscopy in High-risk Patients. Clin Gastroenterol Hepatol 2017; 15:883-891.e9. [PMID: 28017846 DOI: 10.1016/j.cgh.2016.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/12/2016] [Accepted: 12/12/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The incidence and predictors of non-gastrointestinal (GI) adverse events (AEs) after colonoscopy are not well-understood. We studied the effects of antithrombotic agents, cardiopulmonary comorbidities, and age on risk of non-GI AEs after colonoscopy. METHODS We performed a retrospective longitudinal analysis to assess the diagnosis, procedure, and prescription drug codes in a United States commercial claims database (March 2010-March 2012). Data from patients at increased risk (n = 82,025; defined as patients with pulmonary comorbidities or cardiovascular disease requiring antithrombotic medications) were compared with data from 398,663 average-risk patients. In a 1:1 matched analysis, 51,932 patients at increased risk, examined by colonoscopy, were compared with 51,932 matched (on the basis of age, sex, and comorbidities) patients at increased risk who did not undergo colonoscopy. We tracked cardiac, pulmonary, and neurovascular events 1-30 days after colonoscopy. RESULTS Thirty days after outpatient colonoscopy, non-GI AEs were significantly higher in patients taking antithrombotic medications (7.3%; odds ratio [OR], 10.75; 95% confidence interval, 10.13-11.42) or those with pulmonary comorbidities (1.8%; OR, 2.44; 95% confidence interval, 2.27-2.62) vs average-risk patients (0.7%) and in patients 60-69 years old (OR, 2.21; 95% confidence interval, 2.01-2.42) or 70 years or older (OR, 6.45; 95% confidence interval, 5.89-7.06), compared with patients younger than 50 years. The 30-day incidence of non-GI AEs in patients at increased risk who underwent colonoscopy was also significantly higher than in matched patients at increased risk who did not undergo colonoscopy in the anticoagulant group (OR, 2.31; 95% confidence interval, 2.01-2.65) and in the chronic obstructive pulmonary disease group (OR, 1.33; 95% confidence interval, 1.13-1.56). CONCLUSIONS Increased number of comorbidities and older age (older than 60 years) are associated with increased risk of non-GI AEs after colonoscopy. These findings indicate the importance of determining comorbid risk and evaluating antithrombotic management before colonoscopy.
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18
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Mars B, Heron J, Gunnell D, Martin RM, Thomas KH, Kessler D. Prevalence and patterns of antidepressant switching amongst primary care patients in the UK. J Psychopharmacol 2017; 31:553-560. [PMID: 28460603 DOI: 10.1177/0269881117693748] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Non-response to antidepressant treatment is a substantial problem in primary care, and many patients with depression require additional second-line treatments. This study aimed to examine the prevalence and patterns of antidepressant switching in the UK, and identify associated demographic and clinical factors. METHOD Cohort analysis of antidepressant prescribing data from the Clinical Practice Research Datalink, a large, anonymised UK primary care database. The sample included 262,844 patients who initiated antidepressant therapy between 1 January 2005 and 31 June 2011. RESULTS 9.3% of patients switched to a different antidepressant product, with most switches (60%) occurring within 8 weeks of the index date. The proportion switching was similar for selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants and other antidepressants (9.3%, 9.8% and 9.2%, respectively). Most switches were to an SSRI (64.5%), and this was the preferred option regardless of initial antidepressant class. Factors predictive of switching included male gender, age, and history of self-harm and psychiatric illness. CONCLUSION Over one in every 11 patients who initiates antidepressant therapy will switch medication, suggesting that initial antidepressant treatment has been unsatisfactory. Evidence to guide choice of second-line treatment for individual patients is currently limited. Additional research comparing different pharmacological and psychological second-line treatment strategies is required in order to inform guidelines and improve patient outcomes.
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Affiliation(s)
- Becky Mars
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jon Heron
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kyla H Thomas
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Antidepressant use in suicides: a case-control study from the Friuli Venezia Giulia Region, Italy, 2005-2014. Eur J Clin Pharmacol 2017; 73:883-890. [PMID: 28342066 PMCID: PMC5486927 DOI: 10.1007/s00228-017-2236-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/08/2017] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare the use of antidepressant (AD) classes and compounds in individuals who committed suicide and in controls from the general population and to assess to what extent adherence and current use of different AD classes can affect the risk of committing suicide. METHODS Individual data on suicide, diagnoses and AD use in Friuli Venezia Giulia from 2005 to 2014 were obtained from the Regional Social and Health Information System. All suicides that had at least one prescription of AD in the 730 days before death (N = 876) were included as cases. Each case was matched with regard to age and sex with five controls from the general population. The association between suicide and AD use was assessed using conditional logistic regression analysis. RESULTS Almost 70% of all suicides occurring in the10-year period had been prescribed AD. Selective serotonin reuptake inhibitors (SSRIs) accounted for more than the 90% of the prescriptions, with paroxetine the most prescribed AD. All AD compounds and classes were not associated with a higher suicide risk, with the exception of SSRI (OR = 1.6). A decreasing trend in suicide risk was observed when adherent subjects or current AD users were compared to the others. CONCLUSIONS AD treatment is an important factor for preventing suicide, since the use of AD at adequate dosage and for a proper duration was associated with a lower suicide risk. The proper use of AD should be ascertained by physicians, particularly in a primary care context.
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20
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Braunstein D, Hardy A, Boucherie Q, Frauger E, Blin O, Gentile G, Micallef J. Antidepressant adherence patterns in older patients: use of a clustering method on a prescription database. Fundam Clin Pharmacol 2017; 31:226-236. [PMID: 27862243 DOI: 10.1111/fcp.12252] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/04/2016] [Accepted: 11/10/2016] [Indexed: 01/11/2023]
Abstract
According to the World Health Organization, depression will become the second most important cause of disability worldwide by 2020. Our objective was to identify patterns of adherence to antidepressant treatments in older patients using several indicators of adherence and to characterize these patterns in terms of medication exposure. We conducted a retrospective cohort study using the French National Health Insurance reimbursement database. Incident antidepressant users aged more than 65 were included from July 1, 2010, to June 30, 2011, and followed up for 18 months. Antidepressant and other psychotropic drugs (opioids, benzodiazepines, antipsychotics, anti-epileptics) were recorded. Adherence to antidepressant treatment was assessed by several measures including proportion of days covered, discontinuation periods, persistence of treatment, and doses dispensed. Patients were classified according to their adherence patterns using a mixed clustering method. We identified five groups according to antidepressant adherence. One group (n = 7505, 26.9%) was fully adherent with regard to guidelines on antidepressant use. Two patterns of nonadherent users were identified: irregular but persistent users (n = 5131, 18.4%) and regular but nonpersistent users (n = 9037, 32.4%). Serotonin reuptake inhibitors were the most frequently dispensed antidepressant class (70.6%), followed by other antidepressants (43.3%, mainly serotonin-norepinephrine reuptake inhibitors and tianeptine) and tricyclic antidepressants (TCAs) (13.4%). Nonadherent users more frequently had a dispensing of TCA, opioid, and anti-epileptic medication than adherent users. Health policies to improve adherence to antidepressant treatment may require better training of physicians and pharmacists, insisting on the important role of the continuation period of antidepressant treatment.
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Affiliation(s)
- David Braunstein
- Service de Pharmacologie clinique et pharmacovigilance, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille (AP-HM), Pharmacologie Intégrée & Interface Clinique et Industrielle, Aix Marseille Université, Institut de Neurosciences de la Timone UMR 7289 CNRS, 264 rue Saint-Pierre, Marseille, 13385, France
| | - Amélie Hardy
- Département universitaire de Médecine générale, Faculté de Médecine de la Timone, Aix-Marseille Université, 27 boulevard Jean Moulin, Marseille, 13005, France
| | - Quentin Boucherie
- Service de Pharmacologie clinique et pharmacovigilance, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille (AP-HM), Pharmacologie Intégrée & Interface Clinique et Industrielle, Aix Marseille Université, Institut de Neurosciences de la Timone UMR 7289 CNRS, 264 rue Saint-Pierre, Marseille, 13385, France
| | - Elisabeth Frauger
- Service de Pharmacologie clinique et pharmacovigilance, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille (AP-HM), Pharmacologie Intégrée & Interface Clinique et Industrielle, Aix Marseille Université, Institut de Neurosciences de la Timone UMR 7289 CNRS, 264 rue Saint-Pierre, Marseille, 13385, France
| | - Olivier Blin
- Service de Pharmacologie clinique et pharmacovigilance, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille (AP-HM), Pharmacologie Intégrée & Interface Clinique et Industrielle, Aix Marseille Université, Institut de Neurosciences de la Timone UMR 7289 CNRS, 264 rue Saint-Pierre, Marseille, 13385, France
| | - Gaétan Gentile
- Département universitaire de Médecine générale, Faculté de Médecine de la Timone, Aix-Marseille Université, 27 boulevard Jean Moulin, Marseille, 13005, France
| | - Joëlle Micallef
- Service de Pharmacologie clinique et pharmacovigilance, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille (AP-HM), Pharmacologie Intégrée & Interface Clinique et Industrielle, Aix Marseille Université, Institut de Neurosciences de la Timone UMR 7289 CNRS, 264 rue Saint-Pierre, Marseille, 13385, France
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Kjosavik SR, Gillam MH, Roughead EE. Average duration of treatment with antidepressants among concession card holders in Australia. Aust N Z J Psychiatry 2016; 50:1180-1185. [PMID: 26671459 DOI: 10.1177/0004867415621392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyse the average treatment duration with antidepressants that are reimbursed for concession card holders under the Pharmaceutical Benefits Scheme in Australia. METHOD This pharmacoepidemiological study was based on a representative 10% sample of patients receiving Pharmaceutical Benefits Scheme prescriptions. Antidepressants redeemed by concession card holders in the period from 2010 to 2013 were analysed. A 5-year baseline period was used to exclude prevalent users from incident users. Estimation of treatment duration was based on the epidemiological equation: prevalence/incidence = average duration. The mean value for prevalence and incidence over the studied period was used in the equation. RESULTS The number of prevalent and incident users increased from 90,475 to 103,305 and from 25,006 to 26,289, respectively. The epidemiological average treatment duration in the period was about 4 years. When considered by age-bands, average treatment duration was 2 years in patients under 24 years, 3 years in patients 35 to 44 years and up to 5 years in the 55 to 64 year age group. Of new users of antidepressants reimbursed under the Pharmaceutical Benefits Scheme, 86% received their first prescription from general practitioners, 4.3% from psychiatrists and 9.7% from other physicians. CONCLUSION While recommendations have underlined the importance of giving antidepressants for a sufficient period of time, the results from this study show that it is as important to remind general practitioners to review patients on antidepressant treatment regularly, and try to cease drug treatment when timely.
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Affiliation(s)
- Svein Reidar Kjosavik
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia, Adelaide, SA, Australia
- Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
- Research Unit for General Practice in Bergen, Uni Research Health, Bergen, Norway
| | - Marianne Hansen Gillam
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia, Adelaide, SA, Australia
| | - Elisabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia, Adelaide, SA, Australia
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Explaining the variation between practices in the duration of new antidepressant treatment: a database cohort study in primary care. Br J Gen Pract 2016; 65:e114-20. [PMID: 25624307 DOI: 10.3399/bjgp15x683557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Practices vary in the duration of newly initiated antidepressant treatment, even after adjusting for patient characteristics. It was hypothesised that this may be because of differences between practices in demographic (practice deprivation and antidepressant prescribing rates), organisational (practice size and proportion of female GPs), and clinical factors (proportion of new episodes of depression coded). AIM To examine the effect of practice characteristics on the duration of new selective serotonin reuptake inhibitor antidepressant treatment in primary care. DESIGN AND SETTING Database cohort study of 28 027 patients from 237 GP practices in Scotland. METHOD Prescription data were used to estimate duration of treatment for individual patients beyond three time points: 30, 90, and 180 days. Data at patient and practice level were analysed by multilevel logistic regression to quantify the variation between practices. RESULTS The mean rate of diagnostic coding for depression in patients beginning a course of treatment was 29% (range 0-80%). Practice-level deprivation and rate of new antidepressant prescribing were not associated with duration of treatment. The practice level factor most strongly associated with duration of treatment at practice level was the proportion of patients coded as having depression: odds ratio for continuing beyond 30 days was 1.54 (95% confidence interval [CI] = 1.22 to 1.94); beyond 90 days, 1.37 (95% CI = 1.09 to 1.71); and beyond 180 days 1.41 (95% CI = 1.10 to 1.82). CONCLUSION Encouraging coding and structured follow-up at the onset of treatment of depression is likely to reduce early discontinuation of antidepressant treatment and improve outcomes.
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Hashimoto T, Shiina A, Hasegawa T, Kimura H, Oda Y, Niitsu T, Ishikawa M, Tachibana M, Muneoka K, Matsuki S, Nakazato M, Iyo M. Effect of mirtazapine versus selective serotonin reuptake inhibitors on benzodiazepine use in patients with major depressive disorder: a pragmatic, multicenter, open-label, randomized, active-controlled, 24-week trial. Ann Gen Psychiatry 2016; 15:27. [PMID: 27777607 PMCID: PMC5070072 DOI: 10.1186/s12991-016-0115-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/19/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study aimed to evaluate whether selecting mirtazapine as the first choice for current depressive episode instead of selective serotonin reuptake inhibitors (SSRIs) reduces benzodiazepine use in patients with major depressive disorder (MDD). We concurrently examined the relationship between clinical responses and serum mature brain-derived neurotrophic factor (BDNF) and its precursor, proBDNF. METHODS We conducted an open-label randomized trial in routine psychiatric practice settings. Seventy-seven MDD outpatients were randomly assigned to the mirtazapine or predetermined SSRIs groups, and investigators arbitrarily selected sertraline or paroxetine. The primary outcome was the proportion of benzodiazepine users at weeks 6, 12, and 24 between the groups. We defined patients showing a ≥50 % reduction in Hamilton depression rating scale (HDRS) scores from baseline as responders. Blood samples were collected at baseline, weeks 6, 12, and 24. RESULTS Sixty-five patients prescribed benzodiazepines from prescription day 1 were analyzed for the primary outcome. The percentage of benzodiazepine users was significantly lower in the mirtazapine than in the SSRIs group at weeks 6, 12, and 24 (21.4 vs. 81.8 %; 11.1 vs. 85.7 %, both P < 0.001; and 12.5 vs. 81.8 %, P = 0.0011, respectively). No between-group difference was observed in HDRS score changes. Serum proBDNF levels were significantly decreased (χ2 = 8.5, df = 3, P = 0.036) and serum mature BDNF levels were temporarily significantly decreased (F = 3.5, df = 2.4, P = 0.027) in the responders of both groups at week 24. CONCLUSION This study demonstrated mirtazapine as the first-choice antidepressant for current depressive episodes may reduce benzodiazepine use in patients with MDD. Trial registration UMIN000004144. Registered 2nd September 2010. The date of enrolment of the first participant to the trial was 24th August 2010. This study was retrospectively registered 9 days after the first participant was enrolled.
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Affiliation(s)
- Tasuku Hashimoto
- Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
- Sodegaura Satsukidai Hospital, 5-21 Nagauraekimae, Sodegaura-shi, 299-0246 Japan
| | - Akihiro Shiina
- Department of Psychiatry, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856 Japan
- Kokoronokenko Tsudanuma Clinic, 2-13-13 Maebaranishi, Funabashi-shi, Chiba, 274-0825 Japan
| | - Tadashi Hasegawa
- Department of Psychiatry, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856 Japan
- Kokoronokenko Tsudanuma Clinic, 2-13-13 Maebaranishi, Funabashi-shi, Chiba, 274-0825 Japan
| | - Hiroshi Kimura
- Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
- Kokoronokaze Funabashi Clinic, 1-26-2 Motomachi, Funabashi-shi, Chiba, 273-0005 Japan
| | - Yasunori Oda
- Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
| | - Tomihisa Niitsu
- Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
- Fujita Hospital, 3292-Ho Yokaichiba, Sosa-shi, Chiba, 289-2146 Japan
| | - Masatomo Ishikawa
- Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
| | - Masumi Tachibana
- Fujita Hospital, 3292-Ho Yokaichiba, Sosa-shi, Chiba, 289-2146 Japan
| | | | - Satoshi Matsuki
- Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
- Kisarazu Hospital, 2-3-1 Iwane, Kisarazu-shi, Chiba, 292-0061 Japan
| | - Michiko Nakazato
- Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
- Kokoronokaze Funabashi Clinic, 1-26-2 Motomachi, Funabashi-shi, Chiba, 273-0005 Japan
| | - Masaomi Iyo
- Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
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Salamone JD, Correa M, Yohn S, Lopez Cruz L, San Miguel N, Alatorre L. The pharmacology of effort-related choice behavior: Dopamine, depression, and individual differences. Behav Processes 2016; 127:3-17. [PMID: 26899746 DOI: 10.1016/j.beproc.2016.02.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/08/2016] [Accepted: 02/12/2016] [Indexed: 12/22/2022]
Abstract
This review paper is focused upon the involvement of mesolimbic dopamine (DA) and related brain systems in effort-based processes. Interference with DA transmission affects instrumental behavior in a manner that interacts with the response requirements of the task, such that rats with impaired DA transmission show a heightened sensitivity to ratio requirements. Impaired DA transmission also affects effort-related choice behavior, which is assessed by tasks that offer a choice between a preferred reinforcer that has a high work requirement vs. less preferred reinforcer that can be obtained with minimal effort. Rats and mice with impaired DA transmission reallocate instrumental behavior away from food-reinforced tasks with high response costs, and show increased selection of low reinforcement/low cost options. Tests of effort-related choice have been developed into models of pathological symptoms of motivation that are seen in disorders such as depression and schizophrenia. These models are being employed to explore the effects of conditions associated with various psychopathologies, and to assess drugs for their potential utility as treatments for effort-related symptoms. Studies of the pharmacology of effort-based choice may contribute to the development of treatments for symptoms such as psychomotor slowing, fatigue or anergia, which are seen in depression and other disorders.
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Affiliation(s)
- John D Salamone
- Dept. of Psychology Sciences, University of Connecticut, Storrs, CT 06269-1020, USA.
| | - Merce Correa
- Dept. of Psychology Sciences, University of Connecticut, Storrs, CT 06269-1020, USA; Area de Psicobiol., Dept. Psic., Universitat de Jaume I, Castelló 12071, Spain
| | - Samantha Yohn
- Dept. of Psychology Sciences, University of Connecticut, Storrs, CT 06269-1020, USA
| | - Laura Lopez Cruz
- Dept. of Psychology Sciences, University of Connecticut, Storrs, CT 06269-1020, USA; Area de Psicobiol., Dept. Psic., Universitat de Jaume I, Castelló 12071, Spain
| | - Noemi San Miguel
- Dept. of Psychology Sciences, University of Connecticut, Storrs, CT 06269-1020, USA; Area de Psicobiol., Dept. Psic., Universitat de Jaume I, Castelló 12071, Spain
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Yohn SE, Thompson C, Randall PA, Lee CA, Müller CE, Baqi Y, Correa M, Salamone JD. The VMAT-2 inhibitor tetrabenazine alters effort-related decision making as measured by the T-maze barrier choice task: reversal with the adenosine A2A antagonist MSX-3 and the catecholamine uptake blocker bupropion. Psychopharmacology (Berl) 2015; 232:1313-23. [PMID: 25323625 DOI: 10.1007/s00213-014-3766-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 10/03/2014] [Indexed: 01/28/2023]
Abstract
RATIONALE Depressed people show effort-related motivational symptoms, such as anergia, retardation, lassitude, and fatigue. Animal tests can model these motivational symptoms, and the present studies characterized the effort-related effects of the vesicular monoamine transport (VMAT-2) inhibitor tetrabenazine. Tetrabenazine produces depressive symptoms in humans and, at low doses, preferentially depletes dopamine. OBJECTIVES The current studies investigated the effects of tetrabenazine on effort-based decision making using the T-maze barrier task. METHODS Rats were tested in a T-maze in which the choice arms of the maze contain different reinforcement densities, and under some conditions, a vertical barrier was placed in the high-density arm to provide an effort-related challenge. The first experiment assessed the effects of tetrabenazine under different maze conditions: a barrier in the arm with 4 food pellets and 2 pellets in the no barrier arm (4-2 barrier), 4 pellets in one arm and 2 pellets in the other with no barrier in either arm (no barrier), and 4 pellets in the barrier arm with no pellets in the other (4-0 barrier). RESULTS Tetrabenazine (0.25-0.75 mg/kg IP) decreased selection of the high cost/high reward arm when the barrier was present, but had no effect on choice under the no barrier and 4-0 barrier conditions. The effects of tetrabenazine on barrier climbing in the 4-2 condition were reversed by the adenosine A2A antagonist MSX-3 and the catecholamine uptake inhibitor and antidepressant bupropion. CONCLUSIONS These studies have implications for the development of animal models of the motivational symptoms of depression and other disorders.
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Affiliation(s)
- Samantha E Yohn
- Division of Behavioral Neuroscience, Department of Psychology, University of Connecticut, Storrs, CT, 06269-1020, USA
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Albrecht JS, Kiptanui Z, Tsang Y, Khokhar B, Smith GS, Zuckerman IH, Simoni-Wastila L. Patterns of Depression Treatment in Medicare Beneficiaries with Depression after Traumatic Brain Injury. J Neurotrauma 2015; 32:1223-9. [PMID: 25526613 DOI: 10.1089/neu.2014.3651] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There are no clinical guidelines addressing the management of depression after traumatic brain injury (TBI). The objectives of this study were to (1) describe depression treatment patterns among Medicare beneficiaries with a diagnosis of depression post-TBI; (2) compare them with depression treatment patterns among beneficiaries with a diagnosis of depression pre-TBI; and (3) quantify the difference in prevalence of use. We conducted a retrospective analysis of Medicare beneficiaries hospitalized with TBI during 2006-2010. We created two cohorts: beneficiaries with a new diagnosis of depression pre-TBI (n=4841) and beneficiaries with a new diagnosis of depression post-TBI (n=4668). We searched for antidepressant medications in Medicare Part D drug event files and created variables indicating antidepressant use in each 30-day period after diagnosis of depression. We used provider specialty and current procedural terminology to identify psychotherapy in any location. We used generalized estimating equations to quantify the effect of TBI on receipt of depression treatment during the year after diagnosis of depression. Average monthly prevalence of antidepressant use was 42% among beneficiaries with a diagnosis of depression pre-TBI and 36% among those with a diagnosis post-TBI (p<0.001). Beneficiaries with a diagnosis of depression post-TBI were less likely to receive antidepressants compared with a depression diagnosis pre-TBI (adjusted odds ratio [OR] 0.87; 95% confidence interval [CI] 0.82, 0.92). There was no difference in receipt of psychotherapy between the two groups (OR 1.08; 95% CI 0.93, 1.26). Depression after TBI is undertreated among older adults. Knowledge about reasons for this disparity and its long-term effects on post-TBI outcomes is limited and should be examined in future work.
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Affiliation(s)
- Jennifer S Albrecht
- 1 Department of Epidemiology and Public Health, University of Maryland School of Medicine , Baltimore, Maryland
| | | | - Yuen Tsang
- 3 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, Maryland
| | - Bilal Khokhar
- 3 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, Maryland
| | - Gordon S Smith
- 4 Shock, Trauma and Anesthesiology Research (STAR)-Organized Research Center, National Study Center for Trauma and Emergency Medical Services, University of Maryland , Baltimore, Maryland
| | - Ilene H Zuckerman
- 2 IMPAQ International , LLC, Columbia, Maryland.,3 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, Maryland
| | - Linda Simoni-Wastila
- 3 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, Maryland
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Randall PA, Lee CA, Podurgiel SJ, Hart E, Yohn SE, Jones M, Rowland M, López-Cruz L, Correa M, Salamone JD. Bupropion increases selection of high effort activity in rats tested on a progressive ratio/chow feeding choice procedure: implications for treatment of effort-related motivational symptoms. Int J Neuropsychopharmacol 2015; 18:pyu017. [PMID: 25575584 PMCID: PMC4368885 DOI: 10.1093/ijnp/pyu017] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Depression and related disorders are characterized by deficits in behavioral activation, exertion of effort, and other psychomotor/motivational dysfunctions. Depressed patients show alterations in effort-related decision making and a bias towards selection of low effort activities. It has been suggested that animal tests of effort-related decision making could be useful as models of motivational dysfunctions seen in psychopathology. METHODS Because clinical studies have suggested that inhibition of catecholamine uptake may be a useful strategy for treatment of effort-related motivational symptoms, the present research assessed the ability of bupropion to increase work output in rats responding on a test of effort-related decision-making (ie, a progressive ratio/chow feeding choice task). With this task, rats can choose between working for a preferred food (high-carbohydrate pellets) by lever pressing on a progressive ratio schedule vs obtaining a less preferred laboratory chow that is freely available in the chamber. RESULTS Bupropion (10.0-40.0 mg/kg intraperitoneal) significantly increased all measures of progressive ratio lever pressing, but decreased chow intake. These effects were greatest in animals with low baseline levels of work output on the progressive ratio schedule. Because accumbens dopamine is implicated in effort-related processes, the effects of bupropion on markers of accumbens dopamine transmission were examined. Bupropion elevated extracellular dopamine levels in accumbens core as measured by microdialysis and increased phosphorylated dopamine and cyclic-AMP related phosphoprotein 32 kDaltons (pDARPP-32) immunoreactivity in a manner consistent with D1 and D2 receptor stimulation. CONCLUSION The ability of bupropion to increase exertion of effort in instrumental behavior may have implications for the pathophysiology and treatment of effort-related motivational symptoms in humans.
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Kato M, Kimura T, Kimura T, Hara T. Safety and effectiveness of controlled-release paroxetine in routine clinical practice: results of a postmarketing surveillance study of patients with depression. Neuropsychiatr Dis Treat 2015; 11:435-52. [PMID: 25759586 PMCID: PMC4345990 DOI: 10.2147/ndt.s77542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Selective serotonin reuptake inhibitors are commonly used in the pharmacotherapy of depression. However, adverse events can lead to their early discontinuation. This study evaluated the safety and effectiveness of paroxetine controlled-release (CR) tablets in Japanese patients with depression/depressive state (hereafter referred to as depression) in routine clinical practice in Japan. PATIENTS AND METHODS This was an open-label, noninterventional, prospective, postmarketing surveillance study. A total of 3,213 patients aged 12-92 years with depression were prescribed paroxetine CR for 8 weeks at the physician's discretion. Safety was evaluated on the basis of the reporting of adverse drug reactions. Effectiveness was evaluated on the basis of the physician's assessment using the Clinical Global Impression-Global Improvement (CGI-GI) and the Clinical Global Impression-Severity of Illness (CGI-SI) scales, as well as on the basis of the patients' self-reported satisfaction. The primary effectiveness outcome was the improvement rate based on the physician's assessment using the CGI-GI. RESULTS The incidence of adverse drug reactions was 11.2% (359/3,213; 95% confidence interval [CI]: 10.1%-12.3%). The common adverse drug reactions that accounted for 1.0% or more of the incidence were nausea (3.5%) and somnolence (2.7%). The proportion of patients who continued paroxetine CR at week 8 was 80.2% (2,577/3,213; 95% CI: 78.8%-81.6%). The improvement rate at week 8 (last observation carried forward) was 72.8% (2,132/2,927; 95% CI: 71.2%-74.4%). The proportion of patients with CGI-SI scores of moderately or severely ill decreased from 63.6% at baseline to 17.9% at week 8. The proportion of patients who were satisfied with paroxetine CR treatment was 69.8% (2,040/2,921; 95% CI: 68.1%-71.5%). CONCLUSION The results of this study suggest that paroxetine CR is a well-tolerated and efficacious treatment for depression in routine clinical practice.
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Affiliation(s)
- Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Moriguchi-shi, Osaka, Japan
| | | | - Takeshi Kimura
- Clinical Safety and PMS, Development and Medical Affairs Division, GlaxoSmithKline K.K., Shibuya-ku, Tokyo, Japan
| | - Terufumi Hara
- Clinical Safety and PMS, Development and Medical Affairs Division, GlaxoSmithKline K.K., Shibuya-ku, Tokyo, Japan
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Salamone JD, Pardo M, Yohn SE, López-Cruz L, SanMiguel N, Correa M. Mesolimbic Dopamine and the Regulation of Motivated Behavior. Curr Top Behav Neurosci 2015; 27:231-57. [PMID: 26323245 DOI: 10.1007/7854_2015_383] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
It has been known for some time that nucleus accumbens dopamine (DA) is involved in aspects of motivation , but theoretical approaches to understanding the functions of DA have continued to evolve based upon emerging data and novel concepts. Although it has become traditional to label DA neurons as "reward" neurons, the actual findings are more complicated than that, because they indicate that DA neurons can respond to a variety of motivationally significant stimuli. Moreover, it is important to distinguish between aspects of motivation that are differentially affected by dopaminergic manipulations. Studies that involve nucleus accumbens DA antagonism or depletion indicate that accumbens DA does not mediate primary food motivation or appetite. Nevertheless, DA is involved in appetitive and aversive motivational processes including behavioral activation , exertion of effort, sustained task engagement, and Pavlovian-to-instrumental transfer. Interference with accumbens DA transmission affects instrumental behavior in a manner that interacts with the response requirements of the task and also shifts effort-related choice behavior, biasing animals toward low-effort alternatives. Dysfunctions of mesolimbic DA may contribute to motivational symptoms seen in various psychopathologies, including depression , schizophrenia, parkinsonism, and other disorders.
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Affiliation(s)
- John D Salamone
- Department of Psychology, University of Connecticut, Storrs, CT, 06269-1020, USA.
| | - Marta Pardo
- Àrea de Psicobiologia, Universitat Jaume I, 12071, Castelló, Spain
| | - Samantha E Yohn
- Department of Psychology, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Laura López-Cruz
- Àrea de Psicobiologia, Universitat Jaume I, 12071, Castelló, Spain
| | - Noemí SanMiguel
- Àrea de Psicobiologia, Universitat Jaume I, 12071, Castelló, Spain
| | - Mercè Correa
- Department of Psychology, University of Connecticut, Storrs, CT, 06269-1020, USA.,Àrea de Psicobiologia, Universitat Jaume I, 12071, Castelló, Spain
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Randall PA, Lee CA, Nunes EJ, Yohn SE, Nowak V, Khan B, Shah P, Pandit S, Vemuri VK, Makriyannis A, Baqi Y, Müller CE, Correa M, Salamone JD. The VMAT-2 inhibitor tetrabenazine affects effort-related decision making in a progressive ratio/chow feeding choice task: reversal with antidepressant drugs. PLoS One 2014; 9:e99320. [PMID: 24937131 PMCID: PMC4061002 DOI: 10.1371/journal.pone.0099320] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 05/13/2014] [Indexed: 01/13/2023] Open
Abstract
Behavioral activation is a fundamental feature of motivation, and organisms frequently make effort-related decisions based upon evaluations of reinforcement value and response costs. Furthermore, people with major depression and other disorders often show anergia, psychomotor retardation, fatigue, and alterations in effort-related decision making. Tasks measuring effort-based decision making can be used as animal models of the motivational symptoms of depression, and the present studies characterized the effort-related effects of the vesicular monoamine transport (VMAT-2) inhibitor tetrabenazine. Tetrabenazine induces depressive symptoms in humans, and also preferentially depletes dopamine (DA). Rats were assessed using a concurrent progressive ratio (PROG)/chow feeding task, in which they can either lever press on a PROG schedule for preferred high-carbohydrate food, or approach and consume a less-preferred lab chow that is freely available in the chamber. Previous work has shown that the DA antagonist haloperidol reduced PROG work output on this task, but did not reduce chow intake, effects that differed substantially from those of reinforcer devaluation or appetite suppressant drugs. The present work demonstrated that tetrabenazine produced an effort-related shift in responding on the PROG/chow procedure, reducing lever presses, highest ratio achieved and time spent responding, but not reducing chow intake. Similar effects were produced by administration of the subtype selective DA antagonists ecopipam (D1) and eticlopride (D2), but not by the cannabinoid CB1 receptor neutral antagonist and putative appetite suppressant AM 4413, which suppressed both lever pressing and chow intake. The adenosine A2A antagonist MSX-3, the antidepressant and catecholamine uptake inhibitor bupropion, and the MAO-B inhibitor deprenyl, all reversed the impairments induced by tetrabenazine. This work demonstrates the potential utility of the PROG/chow procedure as a rodent model of the effort-related deficits observed in depressed patients.
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Affiliation(s)
- Patrick A. Randall
- Department of Psychology, University of Connecticut, Storrs, Connecticut, United States of America
| | - Christie A. Lee
- Department of Psychology, University of Connecticut, Storrs, Connecticut, United States of America
| | - Eric J. Nunes
- Department of Psychology, University of Connecticut, Storrs, Connecticut, United States of America
| | - Samantha E. Yohn
- Department of Psychology, University of Connecticut, Storrs, Connecticut, United States of America
| | - Victoria Nowak
- Department of Psychology, University of Connecticut, Storrs, Connecticut, United States of America
| | - Bilal Khan
- Department of Psychology, University of Connecticut, Storrs, Connecticut, United States of America
| | - Priya Shah
- Department of Psychology, University of Connecticut, Storrs, Connecticut, United States of America
| | - Saagar Pandit
- Department of Psychology, University of Connecticut, Storrs, Connecticut, United States of America
| | - V. Kiran Vemuri
- Center for Drug Discovery, Northeastern University, Boston, Massachusetts, United States of America
| | - Alex Makriyannis
- Center for Drug Discovery, Northeastern University, Boston, Massachusetts, United States of America
| | - Younis Baqi
- Pharma-Zentrum Bonn, Pharmazeutisches Institut, Pharmazeutische Chemie, Universität Bonn, Bonn, Germany
- Department of Chemistry, Faculty of Science, Sultan Qaboos University, Muscat, Oman
| | - Christa E. Müller
- Pharma-Zentrum Bonn, Pharmazeutisches Institut, Pharmazeutische Chemie, Universität Bonn, Bonn, Germany
| | - Merce Correa
- Department of Psychology, University of Connecticut, Storrs, Connecticut, United States of America
- Àrea de Psicobiologia, Campus de Riu Sec, Universitat Jaume I, Castelló, Spain
| | - John D. Salamone
- Department of Psychology, University of Connecticut, Storrs, Connecticut, United States of America
- * E-mail:
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Kornstein SG, McIntyre RS, Thase ME, Boucher M. Desvenlafaxine for the treatment of major depressive disorder. Expert Opin Pharmacother 2014; 15:1449-63. [DOI: 10.1517/14656566.2014.923403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Párraga Martínez I, López-Torres Hidalgo J, del Campo del Campo JM, Villena Ferrer A, Morena Rayo S, Escobar Rabadán F. [Adherence to patients antidepressant treatment and the factors associated of non-compiance]. Aten Primaria 2014; 46:357-66. [PMID: 24704196 PMCID: PMC6983598 DOI: 10.1016/j.aprim.2013.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 11/03/2013] [Accepted: 11/23/2013] [Indexed: 01/08/2023] Open
Abstract
Objetivo Conocer la adherencia al tratamiento en pacientes que inician fármacos antidepresivos y analizar los factores asociados al incumplimiento, tanto clínicos como sociodemográficos. Diseño Estudio observacional longitudinal prospectivo. Emplazamiento Consultas de atención primaria y de salud mental de tres áreas sanitarias de Castilla-La Mancha. Participantes Un total de 185 pacientes mayores de 18 años que iniciaron tratamiento antidepresivo. Mediciones principales Cumplimiento terapéutico (test Haynes-Sackett, Morisky-Green, recuento de comprimidos y MEMS), efectos adversos, intensidad de los síntomas depresivos, características sociodemográficas y otras características relacionadas con los antidepresivos o con los participantes. Resultados Tras 6 meses del inicio del tratamiento antidepresivo, el 46,9% (IC 95%: 36,5-57,3) mostró un cumplimiento inadecuado mediante el método de recuento de comprimidos, y el 28,6% (IC 95%: 19,1-38,0) con el cuestionario de Morisky-Green. A los 15 días la falta de adherencia fue del 48,5% (IC 95%: 40,6-56,4) y del 33,5% (IC 95%: 26,1-41,0), respectivamente. El 38,4% (IC 95%: 31,1-45,7) manifestó algún efecto secundario durante el seguimiento. Mediante un modelo de riesgos proporcionales de Cox las variables relacionadas con incumplimiento fueron menor edad, nivel de instrucción inferior a enseñanza secundaria, prestación farmacéutica como pensionista, no recibir tratamiento psicoterápico, consumir menor número de fármacos no antidepresivos y frecuentación ≤ 3 visitas al médico de familia los 3 meses previos al inicio del estudio. Conclusiones El incumplimiento del tratamiento antidepresivo es elevado en atención primaria desde las primeras semanas tras iniciarlo. Constituyen factores condicionantes del mismo los relacionados con características sociodemográficas y con otras características de los pacientes como tipo de financiación de prestación farmacéutica y frecuentación a las consultas.
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Affiliation(s)
| | - Jesús López-Torres Hidalgo
- Centro de Salud Zona IV de Albacete, Servicio de Salud de Castilla-La Mancha, Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Albacete, España
| | | | - Alejandro Villena Ferrer
- Centro de Salud de San Clemente, Servicio de Salud de Castilla-La Mancha, San Clemente, Cuenca, España
| | - Susana Morena Rayo
- Centro de Salud de Hellín 2, Servicio de Salud de Castilla-La Mancha, Hellín, Albacete, España
| | - Francisco Escobar Rabadán
- Centro de Salud Zona IV de Albacete, Servicio de Salud de Castilla-La Mancha, Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Albacete, España
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What happens next?: a claims database study of second-line pharmacotherapy in patients with major depressive disorder (MDD) who initiate selective serotonin reuptake inhibitor (SSRI) treatment. Ann Gen Psychiatry 2014; 13:8. [PMID: 24645830 PMCID: PMC3994945 DOI: 10.1186/1744-859x-13-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/06/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The objective of this research was to examine treatment patterns and health-care costs associated with second-step pharmacotherapy in patients with major depressive disorder (MDD) who initiated monotherapy with a selective serotonin reuptake inhibitor (SSRI) in 2010. METHODS This claims database study analyzed patients diagnosed with MDD who were prescribed a monotherapy SSRI, with the first prescription identified as the index date. Patients were required to be ≥18 years old, to have continuous insurance coverage from 1 year prior (pre-index) through 1 year post (post-index) from the index date, and to have not received an antidepressant in the pre-index period. The analyses are descriptive of the patient characteristics, initial SSRI prescribed, most commonly prescribed second-step therapies, and annualized health-care costs. RESULTS The identified patients (N = 5,012) were predominantly female (65.2%) with a mean age of 41.9 years. The most frequent index SSRIs were citalopram (30.1%) and sertraline (27.5%), and 52.9% of patients were prescribed a second-step pharmacotherapy during the post-index period. Add-on therapy occurred twice more frequently than switching treatments, with either anxiolytics (40.2%) or antidepressants (37.1%) as the most common classes of add-on pharmacological therapies. Patients who added a second medication or switched therapies had higher annualized medical costs compared with patients who continued their index SSRI or discontinued treatment. CONCLUSIONS For patients who were initially treated with an SSRI therapy, approximately half were prescribed a second-step treatment. In this comprehensive claims analysis, many of these patients experienced the addition of second medication, rather than switching to a new therapy. Given the type of medications used, it is possible that second-step interventions were targeted toward resolution of residual symptoms; however, this work is limited by the use of claims data without information on dosing or clinical symptoms, side effects, or response. Findings from this study set the expectation that physicians and patients will most likely need to partner for additional interventions in order to achieve remission.
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Early improvement in depressive symptoms with desvenlafaxine 50 mg/d as a predictor of treatment success in patients with major depressive disorder. J Clin Psychopharmacol 2014; 34:57-65. [PMID: 24346751 DOI: 10.1097/jcp.0000000000000049] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This post hoc analysis assessed the predictive value of improvement in depressive scores at early time points for treatment outcomes at week 8 in patients with major depressive disorder treated with desvenlafaxine 50 mg/d or placebo. METHODS Pooled data from 6 double-blind, fixed-dose studies in adult patients with major depressive disorder. Patients were randomly assigned to desvenlafaxine or placebo. Primary end point was change in 17-item Hamilton Rating Scale for Depression (HAM-D17) scores from baseline to week 8 (or last observation carried forward). Optimal thresholds of improvement (percent change from baseline HAM-D17) at weeks 2 and 3 for predicting 4 levels of treatment success (≥ 45%, ≥ 50%, and ≥ 65% decrease from baseline HAM-D17, HAM-D17 ≤ 7) at week 8 (last observation carried forward) were determined using receiver operating characteristic analysis. Odds ratios of the predictability of improvement thresholds were computed from a logistic regression model adjusting for significant baseline predictors. RESULTS Desvenlafaxine 50 mg/d (n = 1207) had significantly greater rates of treatment success for each level of treatment success at 8 weeks compared with placebo (n = 1067). Optimal early improvement thresholds for weeks 2 (20%-30%) and 3 (28%-41%) were highly predictive of all 4 levels of treatment success after adjusting for significant baseline predictors (odds ratios, 0.951-0.960; all P < 0.0001). Negative predictive value of early improvement increased, and positive predictive value decreased, for increasingly stringent definitions of treatment success at week 8. CONCLUSIONS Clinical observations of patients' early response to desvenlafaxine 50 mg/d may have clinical value in predicting treatment success and guiding patient management.
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Nunes EJ, Randall PA, Hart EE, Freeland C, Yohn SE, Baqi Y, Müller CE, López-Cruz L, Correa M, Salamone JD. Effort-related motivational effects of the VMAT-2 inhibitor tetrabenazine: implications for animal models of the motivational symptoms of depression. J Neurosci 2013; 33:19120-30. [PMID: 24305809 PMCID: PMC3850037 DOI: 10.1523/jneurosci.2730-13.2013] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/11/2013] [Accepted: 10/15/2013] [Indexed: 11/21/2022] Open
Abstract
Motivated behaviors are often characterized by a high degree of behavioral activation, and work output and organisms frequently make effort-related decisions based upon cost/benefit analyses. Moreover, people with major depression and other disorders often show effort-related motivational symptoms such as anergia, psychomotor retardation, and fatigue. It has been suggested that tasks measuring effort-related choice behavior could be used as animal models of the motivational symptoms of depression, and the present studies characterized the effort-related effects of the vesicular monoamine transport (VMAT) inhibitor tetrabenazine. Tetrabenazine produces depressive symptoms in humans and, because of its selective inhibition of VMAT-2, it preferentially depletes dopamine (DA). Rats were assessed using a concurrent fixed-ratio 5/chow feeding choice task that is known to be sensitive to dopaminergic manipulations. Tetrabenazine shifted response choice in rats, producing a dose-related decrease in lever pressing and a concomitant increase in chow intake. However, it did not alter food intake or preference in parallel free-feeding choice studies. The effects of tetrabenazine on effort-related choice were reversed by the adenosine A2A antagonist MSX-3 and the antidepressant bupropion. A behaviorally active dose of tetrabenazine decreased extracellular DA in nucleus accumbens and increased expression of DARPP-32 in accumbens medium spiny neurons in a pattern indicative of reduced transmission at both D1 and D2 DA receptors. These experiments demonstrate that tetrabenazine, which is used in animal models to produce depression-like effects, can alter effort-related choice behavior. These studies have implications for the development of animal models of the motivational symptoms of depression and related disorders.
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Affiliation(s)
- Eric J. Nunes
- Department of Psychology, University of Connecticut, Storrs, Connecticut 06269-1020
| | - Patrick A. Randall
- Department of Psychology, University of Connecticut, Storrs, Connecticut 06269-1020
| | - Evan E. Hart
- Department of Psychology, University of Connecticut, Storrs, Connecticut 06269-1020
| | - Charlotte Freeland
- Department of Psychology, University of Connecticut, Storrs, Connecticut 06269-1020
| | - Samantha E. Yohn
- Department of Psychology, University of Connecticut, Storrs, Connecticut 06269-1020
| | - Younis Baqi
- Universität Bonn, Pharma-Zentrum Bonn, Pharmazeutisches Institut, Pharmazeutische Chemie, 53121 Bonn, Germany, and
| | - Christa E. Müller
- Universität Bonn, Pharma-Zentrum Bonn, Pharmazeutisches Institut, Pharmazeutische Chemie, 53121 Bonn, Germany, and
| | - Laura López-Cruz
- Àrea de Psicobiologia, Campus de Riu Sec, Universitat Jaume I, 12071 Castelló, Spain
| | - Mercè Correa
- Department of Psychology, University of Connecticut, Storrs, Connecticut 06269-1020
- Àrea de Psicobiologia, Campus de Riu Sec, Universitat Jaume I, 12071 Castelló, Spain
| | - John D. Salamone
- Department of Psychology, University of Connecticut, Storrs, Connecticut 06269-1020
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Andersson Sundell K, Petzold MG, Wallerstedt SM. Factors associated with switching and combination use of antidepressants in young Swedish adults. Int J Clin Pract 2013; 67:1302-10. [PMID: 24118600 PMCID: PMC4282276 DOI: 10.1111/ijcp.12263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 07/04/2013] [Accepted: 07/21/2013] [Indexed: 11/02/2022] Open
Abstract
AIMS Little is known on factors associated with switching and combination use of antidepressants. Our aim was to describe such use and to analyse the association with socioeconomic factors and level of care in Swedish adults aged 20-34 years. METHODS Individuals, aged 20-34 years, who purchased an antidepressant in January-June 2006, and who had not purchased any antidepressant in the preceding 6 months (n = 24,897) were followed from 6 up to 12 months. Among those who purchased ≥ 2 antidepressant substances, switchers were defined as those who did not fulfil the requirements for combination use. Data on purchased antidepressants and socioeconomic characteristics were obtained from the Swedish Prescribed Drug Register and Statistics Sweden. The association between (i) ≥ 2 antidepressants or (ii) switching, respectively, and socioeconomic factors as well as level of care was analysed with multiple logistic regression. RESULTS A total of 4254 individuals (17%) purchased ≥ 2 antidepressant substances, and the remaining 20,643 (83%) purchased one antidepressant. The adjusted odds ratio (OR) for purchase of ≥ 2 antidepressants (vs. purchase of one antidepressant only) was higher among those who started on mirtazapine compared with selective serotonin re-uptake inhibitors: 2.23 (95% confidence interval: 1.93-2.57), and lower in individuals with high education: 0.64 (0.54-0.75), and shorter length of follow-up: 0.73 (0.62-0.85). Among those with ≥ 2 antidepressants, 71.6% were classified as switchers. The adjusted OR for switching (vs. combination use) were higher among divorced/widows/widowers: 1.61 (1.05-2.49), and lower among individuals with short university education: 0.58 (0.43-0.78), those starting on mirtazapine: 0.78 (0.62-0.97), and when treatment was initiated in psychiatric care: 0.75 (0.63-0.88). CONCLUSIONS One of six new users purchased at least two antidepressants, the majority were classified as switchers. Purchase patterns were associated with socioeconomic characteristics, in particular level of education, type of first purchased antidepressant, and level of care initiating treatment.
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Affiliation(s)
- K Andersson Sundell
- Nordic School of Public HealthGothenburg, Sweden
- Section of Social Medicine, Sahlgrenska Academy, University of GothenburgGothenburg, Sweden
| | - M G Petzold
- Nordic School of Public HealthGothenburg, Sweden
- Akademistatistik – Centre for Applied Biostatistics, Sahlgrenska Academy, University of GothenburgGothenburg, Sweden
| | - S M Wallerstedt
- Department of Clinical Pharmacology, Sahlgrenska University HospitalGothenburg, Sweden
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Associations of depression diagnosis and antidepressant treatment with mortality among young and disabled Medicare beneficiaries with COPD. Gen Hosp Psychiatry 2013; 35:612-8. [PMID: 23871313 DOI: 10.1016/j.genhosppsych.2013.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 05/28/2013] [Accepted: 06/12/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Depression is prevalent in chronic obstructive pulmonary disease (COPD) patients and a risk factor for COPD exacerbation and death. The objective of this study was to determine the associations of depression diagnosis and antidepressant treatment with mortality among Social Security Disability Insurance (SSDI)-eligible (age <65 years who had permanent physical or mental disabilities) Medicare beneficiaries with COPD. METHOD This retrospective cohort study used a 5% random sample of SSDI-eligible Medicare beneficiaries with COPD in stand-alone Part D plans during 2006-2008 (n=17,320). COPD and depression diagnoses were assessed during 2006. Evidence of antidepressant treatment was measured in 2006-2008. All-cause mortality was measured in 2007-2008. Cox proportional hazards models were used to examine the associations of depression diagnosis with mortality and, among depressed beneficiaries, antidepressant treatment (time dependent) with mortality after controlling for covariates. RESULTS More than one third (37.3%) of SSDI-eligible beneficiaries with COPD had a baseline depression diagnosis; of those, 86.8% had evidence of antidepressant treatment. Baseline depression diagnosis was an independent risk factor for 2-year mortality [hazard ratio (HR)=1.21; 99% confidence interval (CI)=1.07-1.37]. Among depressed beneficiaries, receiving antidepressant treatment was associated with significantly lower mortality (HR=0.55; 99% CI=0.44-0.68). CONCLUSION Proactive antidepressant treatment should be considered as an intervention to reduce mortality for this young and disabled Medicare population.
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Mood-altering drugs in the trauma population: hidden dangers, deadly combinations. J Trauma Nurs 2013; 20:117-24. [PMID: 23722223 DOI: 10.1097/jtn.0b013e318295ffbd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Depression is on the rise, and as a result, there is an increased use of psychotropic medications. Also, nonreversible anticoagulants have entered the market and are increasing in use. In combination, these developments have created new risk factors for trauma patients. Our study examined the occurrence of trauma patients who present with a history of psychotropic medication, and we also sought to determine the rate of psychotropic medication and blood thinner use in the older adults. Because these drugs may play a role in causing injury and worsening outcomes, prescribers need to be aware of the patients' medication history and the potential risks.
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Wu CS, Shau WY, Chan HY, Lai MS. Persistence of antidepressant treatment for depressive disorder in Taiwan. Gen Hosp Psychiatry 2013; 35:279-85. [PMID: 23415578 DOI: 10.1016/j.genhosppsych.2012.12.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 12/06/2012] [Accepted: 12/11/2012] [Indexed: 01/12/2023]
Abstract
OBJECT We sought to explore factors associated with persistence of antidepressant treatment in Taiwan and to compare persistence rates across various antidepressants. METHOD This was a retrospective cohort study using medical claims in Taiwan. We collected data of all new antidepressant users with depressive disorder, aged 18 years or older, during the study period from January 1, 1998, to July 4, 2009. Overall antidepressant treatment persistence was defined as undergoing treatment for 180 days without exceeding a 30-day gap. We also assess the cause of treatment change of initial monotherapy, including discontinuation, switching or combination. The competing risks method was used to estimate cause-specific cumulative incidence and to determine associated factors. RESULTS Only 17.4% of patients continued overall antidepressant treatment and 7.6% continued initial antidepressant monotherapy for 180 days or more. Most patients change initial monotherapy through discontinuation, followed by switching and combination. Male gender, older age, comorbidity with anxiety or sleep disorders, and more concomitant use of drugs were associated with lower discontinuation rate. In terms of antidepressant comparisons, we found that patients treated with selective serotonin reuptake inhibitors are less likely to change initial monotherapy. CONCLUSION The overall persistence of antidepressant treatment in Taiwan was lower than in other countries.
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Affiliation(s)
- Chi-Shin Wu
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Qian J, Simoni-Wastila L, Langenberg P, Rattinger GB, Zuckerman IH, Lehmann S, Terrin M. Effects of depression diagnosis and antidepressant treatment on mortality in Medicare beneficiaries with chronic obstructive pulmonary disease. J Am Geriatr Soc 2013; 61:754-61. [PMID: 23617752 PMCID: PMC3656143 DOI: 10.1111/jgs.12220] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To estimate the effects of depression diagnosis and antidepressant treatment on 2-year all-cause mortality in Medicare beneficiaries with chronic obstructive pulmonary disease (COPD) and determine whether Social Security Disability Insurance (SSDI) eligibility modifies these relationships. DESIGN Retrospective cohort study. SETTING A 5% random sample of Medicare beneficiaries aged 65 and older in stand-alone Part D plans in 2006 to 2008. PARTICIPANTS Beneficiaries diagnosed with COPD and continuously enrolled in Medicare Parts A, B, and D (N = 75,699). MEASUREMENTS Depression diagnosis was assessed at baseline (2006). Evidence of antidepressant treatment was measured across time. Covariates included baseline characteristics, comorbidities, and disease severity. Survival analyses using Cox proportional hazards models estimated 2-year mortality associated with depression diagnosis or antidepressant treatment (in beneficiaries with depression). Interaction terms of SSDI eligibility with baseline depression and time-dependent antidepressant treatment were tested. RESULTS More than one-fifth (21.6%) of beneficiaries with COPD had a depression diagnosis at baseline, and 82.1% of those received antidepressants. Nearly one-sixth (16.3%) of the sample were SSDI eligible. Baseline depression heightened risk of death (hazard ratio = 1.13, 95% confidence interval = 1.09-1.18) in beneficiaries who were not eligible for SSDI. In beneficiaries with depression, the association between antidepressant treatment and lower mortality was different according to SSDI eligibility status. CONCLUSION Social Security Disability Insurance eligibility modifies the effects of depression and antidepressant treatment on mortality in Medicare beneficiaries with COPD. These data suggest that clinicians should identify and treat depression in individuals with COPD, but further studies are needed to determine the effect of these interventions.
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Affiliation(s)
- Jingjing Qian
- Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, Auburn, Alabama 36849, USA.
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Saragoussi D, Chollet J, Bineau S, Chalem Y, Milea D. Antidepressant switching patterns in the treatment of major depressive disorder: a General Practice Research Database (GPRD) Study. Int J Clin Pract 2012; 66:1079-87. [PMID: 23067031 DOI: 10.1111/j.1742-1241.2012.03015.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AIMS To investigate switching patterns of major antidepressant treatments and associated factors in a primary care adult population with major depressive disorder (MDD) using data from the General Practitioner Research Database (GPRD). METHODS A retrospective cohort study was conducted using the GPRD. The study included patients with MDD, aged [18-70], with a new prescription for amitriptyline, citalopram, escitalopram, fluoxetine, paroxetine, sertraline or venlafaxine between January 1, 2001 and September 30, 2003 and having no antidepressant prescription in the 6 months preceding index date. Switching of antidepressant treatment was defined as a prescription of a different antidepressant among all available marketed antidepressant treatment at this time (no restriction of compound) from 1 month before up to 2 months after the calculated end of the previous antidepressant treatment. Survival analysis techniques were used to describe switching of antidepressant and time to switch. Profiles of switchers were described and by-treatment analyses performed. RESULTS Data from over 59,000 patients showed that 16% switched antidepressants. Seventy-two per cent of switches appeared within 3 months after treatment initiation. Within switchers, median time to switch was 53 days. Switching patients had generally a more severe psychiatric profile, including more previous episodes of depression or other psychiatric disorders. They also had a higher proportion of concurrent psychiatric disorders (especially anxiety) and concomitant prescription of anxiolytics or hypnotics. Patients initially prescribed amitriptyline were almost twice as likely to switch (27%) as patients prescribed venlafaxine (17%) or an SSRI (15%). CONCLUSIONS This population-based study confirmed that antidepressant switch is more likely to occur within the first 3 months of treatment and in patients with a more severe psychiatric profile. A particular attention paid to these patients within the early phase of treatment may therefore help to improve their management.
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Affiliation(s)
- D Saragoussi
- Lundbeck SAS, Global Outcome Research, Issy Les Moulineaux, France.
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Zucker I, Chodick G, Grunhaus L, Raz R, Shalev V. Adherence to treatment with selective serotonin reuptake inhibitors and the risk for fractures and bone loss: a population-based cohort study. CNS Drugs 2012; 26:537-47. [PMID: 22612695 DOI: 10.2165/11633300-000000000-00000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are suspected of increasing the risk of bone loss and osteoporotic fractures. OBJECTIVE The aim of this study was to investigate the association between adherence to SSRI treatment and the risk of bone loss-related events. METHODS The data used in this retrospective cohort study are part of the ongoing medical documentation routinely collected in a large health maintenance organization in Israel. Specifically, we used the information collected between January 2004 and April 2010. The study cohort included 10 621 women who were new users of SSRIs. Bone loss-related events were defined as fractures or initiation of bisphosphonate treatment. Adherence level was assessed by calculating the proportion of days covered (PDC) with an SSRI from the date of first dispensed SSRI (index date) to the end of follow-up and was categorized as low (PDC ≤20%), intermediate (PDC 21-79%) and high (PDC ≥80%). To validate the study model, we conducted a similar analysis on patients using antiepileptic drugs, which are known to be positively associated with an increased risk of osteoporotic fractures. RESULTS Higher adherence to SSRI treatment was significantly associated with an increased risk of bone loss-related events in a dose-response manner. The adjusted hazard ratio for bone loss-related events adjusted for age, physician visits and body mass index in patients who were covered with an SSRI for 21-79% of the time and 80% or more of the time was 1.15 (95% CI 0.97, 1.37) and 1.40 (95% CI 1.14, 1.73) compared with patients who were covered for less than 21% of the follow-up period. CONCLUSION Exposure to SSRI treatment is associated with an increased risk of bone loss-related events. Further studies are required to determine the causality of the association and its relevance to the clinical use of SSRIs.
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Affiliation(s)
- Inbar Zucker
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel.
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Cruz I, Serna C, Rué M, Real J, Soler-Gonzalez J, Galván L. Duration and compliance with antidepressant treatment in immigrant and native-born populations in Spain: a four year follow-up descriptive study. BMC Public Health 2012; 12:256. [PMID: 22469197 PMCID: PMC3350418 DOI: 10.1186/1471-2458-12-256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 04/02/2012] [Indexed: 11/24/2022] Open
Abstract
Background Non-compliance with antidepressant treatment continues to be a complex problem in mental health care. In immigrant populations non-compliance is one of several barriers to adequate management of mental illness; some data suggest greater difficulties in adhering to pharmacological treatment in these groups and an increased risk of therapeutic failure. The aim of this study is to assess differences in the duration and compliance with antidepressant treatment among immigrants and natives in a Spanish health region. Methods Population-based (n=206,603), retrospective cohort study including all subjects prescribed ADT between 2007 and 2009 and recorded in the national pharmacy claims database. Compliance was considered adequate when the duration was longer than 4months and when patients withdrew more than 80% of the packs required. Results 5334 subjects (8.5% of them being immigrants) initiated ADT. Half of the immigrants abandoned treatment during the second month (median for natives=3months). Of the immigrants who continued, only 29.5% presented good compliance (compared with 38.8% in natives). The estimated risk of abandoning/ending treatment in the immigrant group compared with the native group, adjusted for age and sex, was 1.28 (95%CI 1.16-1.42). Conclusions In the region under study, immigrants of all origins present higher percentages of early discontinuation of ADT and lower median treatment durations than the native population. Although this is a complex, multifactor situation, the finding of differences between natives and immigrants in the same region suggests the need to investigate the causes in greater depth and to introduce new strategies and interventions in this population group.
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Affiliation(s)
- Inés Cruz
- Primary Care Research Institute IDIAP J Gol, Catalan Institute of Health, Rambla de Ferran 44, 3, 25007 Lleida, Spain.
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Conti V, Lora A, Cipriani A, Fortino I, Merlino L, Barbui C. Persistence with pharmacological treatment in the specialist mental healthcare of patients with severe mental disorders. Eur J Clin Pharmacol 2012; 68:1647-55. [PMID: 22573134 DOI: 10.1007/s00228-012-1298-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 04/18/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to measure persistence with pharmacological treatment in the specialist mental healthcare of patients with schizophrenia, bipolar disorder, and unipolar depression in Lombardy, a region of 10 million inhabitants located in the northernmost part of Italy. METHODS The data concerning psychiatric care used in this study were retrieved from the regional Psychiatric Information System, while information on drug treatment was retrieved from the regional administrative database. Time to lack of persistence with initial pharmacological treatment was the outcome measure. RESULTS A total of 11,797 patients, followed in the specialist mental healthcare system, started a new pharmacological treatment for depression, schizophrenia, or bipolar disorder during 2007. Overall, 8,500 patients (72.1%) discontinued treatment during the 12 month follow-up, with a median duration of 101 days. Very similar discontinuation rates were observed in patients with unipolar depression, schizophrenia, and bipolar disorder. In the multivariate analysis, operational definitions of continuity and intensity of care were the most robust determinants of persistence with drug treatment in each of the three cohorts of psychiatric diagnoses. CONCLUSIONS High rates of treatment discontinuation were found in a population of patients with severe mental disorders followed in the specialist mental healthcare system of an Italian region, with no differences among patients with unipolar major depression, schizophrenia, and bipolar disorder. These findings corroborate the notion that the problem of treatment discontinuation in psychiatric disorders is a factor related to the capacity of the mental health system to assure and maintain continuity and intensity of care.
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Affiliation(s)
- Valentino Conti
- Regional Centre for Pharmacovigilance, Lombardy Region, via Rosellini 17, 20124, Milan, Italy.
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Hansen RA, Dusetzina SB, Ellis AR, Stürmer T, Farley JF, Gaynes BN. Risk of adverse events in treatment-resistant depression: propensity-score-matched comparison of antidepressant augment and switch strategies. Gen Hosp Psychiatry 2012; 34:192-200. [PMID: 22079151 DOI: 10.1016/j.genhosppsych.2011.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 10/03/2011] [Accepted: 10/05/2011] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The objective was to assess differences in adverse events between major depressive patients augmented with a second medication and patients switched to an alternative monotherapy after failing first-step treatment with citalopram. METHOD Adverse event profiles for second-step switch and augment medication strategies were compared using public data files from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. In the STAR*D trial, participants failing citalopram selected acceptable next-step strategies and were randomized within acceptable strategies. This design resulted in clinically important differences when comparing across strategies, so a propensity-score-matched sample was created to compare switch (n=269) and augment (n=269) strategies. RESULTS Incidence proportions of any adverse event and specific adverse events were similar between the augment and switch groups. The overall incidence proportion of any distressing event was 0.78 [95% confidence interval (CI) 0.72-0.84] in the augment group and 0.80 (95% CI 0.74-0.85) in the switch group. This contrasts unmatched analyses where distressing adverse events were less common in the augment group than the switch group (risk ratio 0.85, 95% CI 0.81-0.90). CONCLUSION After adjusting for selection bias inherent in the STAR*D comparison of augment with switch, clinically meaningful differences in the adverse event profiles between these treatment strategies were not observed.
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Affiliation(s)
- Richard A Hansen
- Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, 207 Dunstan Hall, Auburn, AL 36849-5506, USA.
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Sundell KA, Waern M, Petzold M, Gissler M. Socio-economic determinants of early discontinuation of anti-depressant treatment in young adults. Eur J Public Health 2011; 23:433-40. [DOI: 10.1093/eurpub/ckr137] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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