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Ikawa H, Takeda Y, Osawa R, Sato A, Mizuno H, Noda Y. A Retrospective Case-Control Study on the Differences in the Effectiveness of Theta-Burst Stimulation Therapy for Depression with and without Antidepressant Medication. J Clin Med 2024; 13:399. [PMID: 38256534 PMCID: PMC10816069 DOI: 10.3390/jcm13020399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Transcranial magnetic stimulation (TMS) therapy has few side effects and comparable therapeutic effects to antidepressant treatment, but few studies have introduced TMS therapy as an initial treatment for MDD. The objective of this study was to retrospectively compare the clinical outcomes between 50 MDD patients without antidepressants (i.e., TMS monotherapy) and 50 MDD patients with antidepressants plus TMS therapy, matched for age, sex, and depression severity. The presence or absence of antidepressant therapy in first-line treatment was determined via a detailed interview by psychiatrists. The study design was a retrospective observational case-control study using the TMS registry data. The key inclusion criteria were adult patients who met the diagnosis of MDD and received 20-30 sessions of intermittent theta-burst stimulation (iTBS) therapy to the left dorsolateral prefrontal cortex (DLPFC). In this study, the Montgomery-Åsberg Depression Rating Scale (MADRS) was used as the primary outcome measure. No significant group differences existed in the baseline MADRS total score between the unmedicated and medicated patient groups. Following TMS therapy, no significant group differences in response rate, remission rate, or relative total score change in the MADRS were observed. The main limitations were the retrospective design and the use of registry data as a source. Our findings suggest that TMS monotherapy may be as effective as TMS add-on therapy to antidepressants when used as the first-line therapy for MDD, but randomized controlled trials are needed.
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Affiliation(s)
- Haruki Ikawa
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | - Yuya Takeda
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | - Ryota Osawa
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | - Akiko Sato
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | | | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
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Han S, Kim SY, Jung YE, Kim W, Seo JS, Sohn I, Lee K, Lee JH, Chung SK, Lee SY, Hong JW, Yoon BH, Woo YS, Han C, Chang JG, Bahk WM, Song HR, Hong M. Patient's Perspective on Psychiatric Drugs: A Multicenter Survey-Based Study. Psychiatry Investig 2024; 21:28-36. [PMID: 38114066 PMCID: PMC10822732 DOI: 10.30773/pi.2023.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/17/2023] [Accepted: 09/15/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE We aimed to identify the expectations and preferences for medication and medical decision-making in patients with major psychiatric disorders. METHODS A survey was conducted among patients with major psychiatric disorders who visited psychiatric outpatient clinics at 15 hospitals between 2016 and 2018 in Korea. The survey consisted of 12 questions about demographic variables and opinions on their expectations for medication, important medical decision-makers, and preferred drug type. The most preferred value in each category in the total population was identified, and differences in the preference ratio of each item among the disease groups were compared. RESULTS A total of 707 participants were surveyed. In the total population, patients reported high efficacy (44.01%±21.44%) as the main wish for medication, themselves (37.39%±22.57%) and a doctor (35.27%±22.88%) as the main decision makers, and tablet/capsule (36.16%±30.69%) as the preferred type of drug. In the depressive disorders group, the preference ratio of high efficacy was significantly lower, and the preference ratio of a small amount was significantly higher than that of the psychotic disorder and bipolar disorder groups. The preference ratio of a doctor as an important decision maker in the bipolar disorder group was higher compared to the other groups. CONCLUSION This study revealed the preference for medications and showed differences among patients with psychiatric disorders. Providing personalized medicine that considers a patient's preference for the drug may contribute to the improvement of drug compliance and outcomes.
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Affiliation(s)
- Seoyun Han
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | | | - Young-Eun Jung
- Department of Psychiatry, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Won Kim
- Department of Psychiatry, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Jeong Seok Seo
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Inki Sohn
- Department of Psychiatry, Keyo Hospital, Uiwang, Republic of Korea
| | - Kwanghun Lee
- Department of Psychiatry, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Republic of Korea
| | - Jong Hun Lee
- Department of Psychiatry, College of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Sang-Keun Chung
- Department of Psychiatry, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Sang-Yeol Lee
- Department of Psychiatry, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Jung Wan Hong
- Department of Psychiatry, Iksan Hospital, Iksan, Republic of Korea
| | - Bo-Hyun Yoon
- Department of Psychiatry, Naju National Hospital, Naju, Republic of Korea
| | - Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Changwoo Han
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Jhin Goo Chang
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hoo Rim Song
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Minha Hong
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
- UNC Neuroscience Center, University of North Carolina, Chapel Hill, NC, USA
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Miller LG, Singh R, Eells SJ, Gillen D, McKinnell JA, Park S, Tjoa T, Chang J, Rashid S, Macias-Gil R, Heim L, Gombosev A, Kim D, Cui E, Lequieu J, Cao C, Hong SS, Peterson EM, Evans KD, Launer B, Tam S, Bolaris M, Huang SS. Chlorhexidine and Mupirocin for Clearance of Methicillin-Resistant Staphylococcus aureus Colonization After Hospital Discharge: A Secondary Analysis of the Changing Lives by Eradicating Antibiotic Resistance Trial. Clin Infect Dis 2023; 76:e1208-e1216. [PMID: 35640877 PMCID: PMC10169430 DOI: 10.1093/cid/ciac402] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The CLEAR Trial demonstrated that a multisite body decolonization regimen reduced post-discharge infection and hospitalization in methicillin-resistant Staphylococcus aureus (MRSA) carriers. Here, we describe decolonization efficacy. METHODS We performed a large, multicenter, randomized clinical trial of MRSA decolonization among adult patients after hospital discharge with MRSA infection or colonization. Participants were randomized 1:1 to either MRSA prevention education or education plus decolonization with topical chlorhexidine, oral chlorhexidine, and nasal mupirocin. Participants were swabbed in the nares, throat, axilla/groin, and wound (if applicable) at baseline and 1, 3, 6, and 9 months after randomization. The primary outcomes of this study are follow-up colonization differences between groups. RESULTS Among 2121 participants, 1058 were randomized to decolonization. By 1 month, MRSA colonization was lower in the decolonization group compared with the education-only group (odds ration [OR] = 0.44; 95% confidence interval [CI], .36-.54; P ≤ .001). A similar magnitude of reduction was seen in the nares (OR = 0.34; 95% CI, .27-.42; P < .001), throat (OR = 0.55; 95% CI, .42-.73; P < .001), and axilla/groin (OR = 0.57; 95% CI, .43-.75; P < .001). These differences persisted through month 9 except at the wound site, which had a relatively small sample size. Higher regimen adherence was associated with lower MRSA colonization (P ≤ .01). CONCLUSIONS In a randomized, clinical trial, a repeated post-discharge decolonization regimen for MRSA carriers reduced MRSA colonization overall and at multiple body sites. Higher treatment adherence was associated with greater reductions in MRSA colonization.
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Affiliation(s)
- Loren G Miller
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Raveena Singh
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Samantha J Eells
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Daniel Gillen
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - James A McKinnell
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Steven Park
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Tom Tjoa
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Justin Chang
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Syma Rashid
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Raul Macias-Gil
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Lauren Heim
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Adrijana Gombosev
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Diane Kim
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Eric Cui
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Jennifer Lequieu
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Chenghua Cao
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Suzie S Hong
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Ellena M Peterson
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Kaye D Evans
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Bryn Launer
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Steven Tam
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Michael Bolaris
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Susan S Huang
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
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Solmi M, Miola A, Croatto G, Pigato G, Favaro A, Fornaro M, Berk M, Smith L, Quevedo J, Maes M, Correll CU, Carvalho AF. How can we improve antidepressant adherence in the management of depression? A targeted review and 10 clinical recommendations. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2021; 43:189-202. [PMID: 32491040 PMCID: PMC8023158 DOI: 10.1590/1516-4446-2020-0935] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022]
Abstract
Adherence to antidepressants is crucial for optimal treatment outcomes when treating depressive disorders. However, poor adherence is common among patients prescribed antidepressants. This targeted review summarizes the main factors associated with poor adherence, interventions that promote antidepressant adherence, pharmacological aspects related to antidepressant adherence, and formulates 10 clinical recommendations to optimize antidepressant adherence. Patient-related factors associated with antidepressant non-adherence include younger age, psychiatric and medical comorbidities, cognitive impairment, and substance use disorders. Prescriber behavior-related factors include neglecting medical and family histories, selecting poorly tolerated antidepressants, or complex antidepressant regimens. Multi-disciplinary interventions targeting both patient and prescriber, aimed at improving antidepressant adherence, include psychoeducation and providing the patient with clear behavioral interventions to prevent/minimize poor adherence. Regarding antidepressant choice, agents with individually tailored tolerability profile should be chosen. Ten clinical recommendations include four points focusing on the patient (therapeutic alliance, adequate history taking, measurement of depressive symptoms, and adverse effects improved access to clinical care), three focusing on prescribing practice (psychoeducation, individually tailored antidepressant choice, simplified regimen), two focusing on mental health services (improved access to mental health care, incentivized adherence promotion and monitoring), and one relating to adherence measurement (adherence measurement with scales and/or therapeutic drug monitoring).
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Affiliation(s)
- Marco Solmi
- Dipartimento di Neuroscienze, Università di Padova, Padova, Italy
- Azienda Ospedale Università di Padova, Padova, Italy
| | - Alessandro Miola
- Dipartimento di Neuroscienze, Università di Padova, Padova, Italy
| | - Giovanni Croatto
- Dipartimento di Neuroscienze, Università di Padova, Padova, Italy
| | | | - Angela Favaro
- Dipartimento di Neuroscienze, Università di Padova, Padova, Italy
- Azienda Ospedale Università di Padova, Padova, Italy
| | - Michele Fornaro
- Dipartimento di psichiatria, Università Federico II, Napoli, Italy
- Polyedra, Teramo, Italy
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT Strategic Research Centre), School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, Orygen – The Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Joao Quevedo
- Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Neurociências, Unidade de Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Center of Excellence on Mood Disorders, McGovern Medical School, UTHealth, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
| | - Michael Maes
- IMPACT Strategic Research Centre, Barwon Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Christoph U. Correll
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - André F. Carvalho
- IMPACT Strategic Research Centre, Barwon Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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Shoji M, Fujiwara A, Onda M. Creation and validation of a semi-quantitative instrument to assess the confidence of pharmacists in medication consultation for patients with depression: The pharmacists' confidence scale about medication consultation for depressive patients (PCMCD). Pharm Pract (Granada) 2020; 17:1628. [PMID: 31897261 PMCID: PMC6935550 DOI: 10.18549/pharmpract.2019.4.1628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/20/2019] [Indexed: 11/14/2022] Open
Abstract
Objectives To develop a semi-quantitative instrument to assess pharmacists' confidence in medication counseling for patients with depression, The Pharmacists' Confidence scale about Medication Consultation for Depressive patients (PCMCD), and investigated its validity. Methods Following discussions with practicing pharmacists, we developed a 12-item questionnaire to assess pharmacists' confidence in medication counseling for patients with depression. We launched web-based cross-sectional survey during November and December 2018 to 77 pharmacists employed at drug chain stores in Kansai area. Factor analysis was performed to evaluate the configuration concept validity. The least-squares method was used for factor extraction, and the resulting factors were subjected to direct oblimin rotation, with a factor loading cut-off of 0.4. To assess internal consistency, Cronbach's alpha values were calculated for each of the extracted factors (subscales). A multiple regression analysis was performed using simultaneous forced entry, with the scores obtained for each subscale as dependent variables and responder attributes as independent variables in order to investigate the factors associated with each subscale. Results During the factor analysis procedure, four questions were excluded by the cut-off rule. Eventually, a model with three subscales was identified, with a cumulative sum of squared loadings being 61.9%. The subscales were termed "relationship building," "comprehension of condition," and "information provision" based on the nature of the questions relevant for each of them. The Cronbach's alpha values for these subscales were 0.92, 0.73, and 0.72, respectively. The average inter-item correlation was 0.378. In addition, multiple regression analysis revealed that there were significant correlations between pharmacist career and both relationship building and information provision. Conclusions The PCMCD model demonstrated a satisfactory construct validity and internal consistency. This model will provide an excellent tool for assessing pharmacists' confidence in depression care.
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Affiliation(s)
- Masaki Shoji
- PhD. Assistant Professor. Department of Social and Administrative Pharmacy, Osaka University of Pharmaceutical Sciences. Osaka (Japan).
| | - Atsuko Fujiwara
- BPharm. General manager of Division of Planning and management of pharmacists training. Apis Pharmacy. Osaka (Japan).
| | - Mitsuko Onda
- PhD. Professor. Department of Social and Administrative Pharmacy, Osaka University of Pharmaceutical Sciences. Osaka (Japan).
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Self-Reported Antidepressant Drug Side Effects, Medication Adherence, and Its Associated Factors among Patients Diagnosed with Depression at the Psychiatric Hospital of Nepal. DEPRESSION RESEARCH AND TREATMENT 2020; 2020:7024275. [PMID: 33133693 PMCID: PMC7593732 DOI: 10.1155/2020/7024275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/19/2020] [Accepted: 10/05/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The present study is aimed at evaluating the side effects of antidepressant drugs, medication adherence (MA), and associated factors among patients diagnosed with depression at a psychiatric hospital in western Nepal. METHODS A prospective cross-sectional study was conducted among 174 patients visiting the outpatient clinic of a psychiatric hospital. The antidepressant side effect checklist (ASEC) was used to classify the reported antidepressant drug side effects into mild, moderate, and severe types. The Naranjo adverse drug reaction (ADR) probability scale was employed to assess the ADRs, and the Morisky Green Levine Adherence (MGLA) score was employed to determine the rate of medication adherence. Descriptive statistics and bivariate analysis were used, and a P value < 0.05 was taken as statistically significant in the multivariate analysis. RESULTS The patients were mostly female (55.74%), with a median (IQR) age of 32 (20) years. Approximately 74.13% of the patients experienced antidepressant side effects, where insomnia (17.05%) and anxiety (17.05%) were the most common. More than half of the patients (52.29%) had a low level of adherence. Females were 1.01 times more likely to be nonadherent to their antidepressant medications compared to males, adjusted odds ratio (AOR): 1.001 (0.31-1.63). Similarly, illiterate patients tended to be more nonadherent compared to literates, AOR: 1.342 (0. 93-2.82), and unemployed individuals were 1.5 times more likely to be nonadherent to their medications compared to employed individuals, AOR: 1.46 (1.16-4.13). Likewise, patients with severe side effects were more prone to develop nonadherence than those with moderate side effects, AOR: 1.173 (0.42-3.25). A significant association was found between the Naranjo score and medication adherence. CONCLUSIONS This study suggests that antidepressant drug side effects were more prevalent and medication adherence was extremely poor among depressive patients in psychiatric hospitals. Factors such as gender, occupation, education, side effects, and ADRs attributed to poor medication adherence in patients.
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Smith KS, Greene MW, Babu JR, Frugé AD. Psychobiotics as treatment for anxiety, depression, and related symptoms: a systematic review. Nutr Neurosci 2019; 24:963-977. [PMID: 31858898 DOI: 10.1080/1028415x.2019.1701220] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective: Altering the gut microflora may produce health benefits in individuals suffering from mood disorders. The purpose of this review was to evaluate the efficacy of probiotics, prebiotics, or synbiotics as a potential treatment for symptoms of depression, anxiety, and stress (as psychobiotics).Methods: Google Scholar, PubMed, PsychINFO, and Web of Science were utilized to identify and evaluate studies through October 31, 2019. Studies were included if subjects were evaluated for altered mood or stress levels at start of the study and consumed probiotics, prebiotics, and/or synbiotics for intervention.Results: Search results yielded 142 articles, while only 12 studies met all inclusion criteria. Nine of the 12 studies identified evaluated the efficacy of various probiotic strains, while only two evaluated synbiotics and one evaluated prebiotics. Six out of 12 studies found probiotics to reduce depression, while two studies found probiotics to reduce anxiety.Discussion: Translational research in this field is limited and further investigation of the efficacy of psychobiotics in mood disorders is warranted.
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Affiliation(s)
- Kristen S Smith
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL, USA
| | - Michael W Greene
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL, USA
| | - Jeganathan Ramesh Babu
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL, USA
| | - Andrew D Frugé
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL, USA
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Matraszek-Gawron R, Chwil M, Terlecka P, Skoczylas MM. Recent Studies on Anti-Depressant Bioactive Substances in Selected Species from the Genera Hemerocallis and Gladiolus: A Systematic Review. Pharmaceuticals (Basel) 2019; 12:ph12040172. [PMID: 31775329 PMCID: PMC6958339 DOI: 10.3390/ph12040172] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/04/2019] [Accepted: 11/22/2019] [Indexed: 12/14/2022] Open
Abstract
Herbal therapy is a potential alternative applied to pharmacological alleviation of depression symptoms and treatment of this disorder, which is predicted by the World Health Organization (WHO) to be the most serious health problem worldwide over the next several years. It has been well documented that many herbs with psychotropic effects have far fewer side effects than a variety of pharmaceutical agents used by psychiatrists for the treatment of depression. This systematic review presents literature data on the antidepressant activity of representatives of the genera Hemerocallis (H. fulva and H. citrina Baroni, family Xanthorrhoeaceae) and Gladiolus (G. dalenii, family Iridaceae) and on biologically active compounds and their mechanisms of action to consider the application of herbal preparations supporting the treatment of depression.
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Affiliation(s)
- Renata Matraszek-Gawron
- Department of Botany and Plant Physiology, University of Life Sciences in Lublin, 15 Akademicka Street, 20-950 Lublin, Poland;
| | - Mirosława Chwil
- Department of Botany and Plant Physiology, University of Life Sciences in Lublin, 15 Akademicka Street, 20-950 Lublin, Poland;
- Correspondence: ; Tel.: +48-81-445-66-24
| | - Paulina Terlecka
- Chair and Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 8 Jaczewskiego Street, 20-090 Lublin, Poland;
| | - Michał M. Skoczylas
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University in Szczecin, 1 Unii Lubelskiej Street, 71-252 Szczecin, Poland;
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Kim MJ, Kim N, Shin D, Rhee SJ, Park CHK, Kim H, Cho SJ, Lee JW, Kim EY, Yang B, Ahn YM. The epidemiology of antidepressant use in South Korea: Does short-term antidepressant use affect the relapse and recurrence of depressive episodes? PLoS One 2019; 14:e0222791. [PMID: 31553786 PMCID: PMC6760791 DOI: 10.1371/journal.pone.0222791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/06/2019] [Indexed: 02/01/2023] Open
Abstract
Background The duration of antidepressant use affects the treatment of depression. Using the National Health Insurance database, which covers almost the entire national population, we verified the factors associated with the inadequate short-term use of initially prescribed antidepressants and their effects on the relapse and recurrence of depressive episodes. Methods There were 752,190 patients included who had been newly prescribed antidepressants in 2012 with the diagnosis of depressive disorder. They were followed-up until December 31, 2015. They were classified as short-term and long-term antidepressant users depending on whether they used a specific initial antidepressant for at least four weeks. Sociodemographic, clinical, and medical utilization factors affecting the duration of antidepressant use were investigated. We also identified whether the duration of antidepressant use affected the risk of relapse and recurrence, which was defined by the restarting of antidepressants. Results Initial antidepressants were taken for less than 28 days by 458,057 (60.84%) patients. Tricyclic antidepressants were used as the initial antidepressant more frequently than selective serotonin reuptake inhibitors (64.5% versus 19.3%). The type of initial antidepressant, polypharmacy, psychiatric and medical comorbidities, type of insurance coverage, and type of medical institution visited were associated with short-term use. Short-term use marginally increased the risk of relapse and recurrence of depressive episodes (Hazard ratio: 1.06, 95% confidence intervals 1.048–1.075). Conclusions Short-term antidepressant use is widespread in Korea, and assessment in various aspects are necessary to set proper treatment plans.
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Affiliation(s)
- Min Ji Kim
- Department of Psychiatry, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Namwoo Kim
- Department of Psychiatry, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Daun Shin
- Department of Psychiatry, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Sang Jin Rhee
- Department of Psychiatry, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - C. Hyung Keun Park
- Department of Psychiatry, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- Department of Psychiatry and Behavioral Science, Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
- Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea
| | - Hyeyoung Kim
- Department of Psychiatry, Inha University Hospital, Inhang-ro, Jung-gu, Incheon, Republic of Korea
| | - Sung Joon Cho
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Won Lee
- Dept. of Psychiatry Seoul Metropolitan Eunpyeong Hospital, dept. of Psychiatry, Eunpyeong-gu, Seoul, Republic of Korea
| | - Eun Young Kim
- Mental Health Center, Seoul National University Health Care Center, Gwanak-gu, Seoul, Republic of Korea
- Department of Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
| | - Boram Yang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South-Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- Department of Psychiatry and Behavioral Science, Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
- * E-mail:
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Baziar S, Aqamolaei A, Khadem E, Mortazavi SH, Naderi S, Sahebolzamani E, Mortezaei A, Jalilevand S, Mohammadi MR, Shahmirzadi M, Akhondzadeh S. Crocus sativus L. Versus Methylphenidate in Treatment of Children with Attention-Deficit/Hyperactivity Disorder: A Randomized, Double-Blind Pilot Study. J Child Adolesc Psychopharmacol 2019; 29:205-212. [PMID: 30741567 DOI: 10.1089/cap.2018.0146] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders of childhood and adolescence. About 30% of patients do not respond to stimulants or cannot tolerate their side effects. Thus, alternative medication, like herbal medicine, should be considered. The aim of this trial is to compare the safety and efficacy of Crocus sativus (saffron) versus methylphenidate in improving symptoms of children with ADHD. METHODS In a 6-week randomized double-blind study, 54 patients (children 6-17 years old) with a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis of ADHD were randomly assigned to receive either 20-30 mg/d (20 mg/d for <30 kg and 30 mg/d for >30 kg) methylphenidate (MPH) or 20-30 mg/d saffron capsules depending on weight (20 mg/d for <30 kg and 30 mg/d for >30 kg). Symptoms were assessed using the Teacher and Parent Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV) at baseline and weeks 3 and 6. RESULTS Fifty patients completed the trial. General linear model repeated measures showed no significant difference between the two groups on Parent and Teacher Rating Scale scores (F = 0.749, df = 1.317, p = 0.425, and F = 0.249, df = 1.410, p = 0.701, respectively). Changes in Teacher and Parent ADHD Rating Scale scores from baseline to the study end were not significantly different between the saffron group and the MPH group (p = 0.731 and p = 0.883, respectively). The frequency of adverse effects was similar between saffron and MPH groups. CONCLUSION Short-term therapy with saffron capsule showed the same efficacy compared with methylphenidate. Nevertheless, larger controlled studies with longer treatment periods are necessary for future studies.
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Affiliation(s)
- Sara Baziar
- 1 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Aqamolaei
- 1 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Khadem
- 2 Department of Persian Medicine, Faculty of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Hosein Mortazavi
- 1 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Naderi
- 1 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Sahebolzamani
- 1 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhosein Mortezaei
- 1 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shakiba Jalilevand
- 1 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Mohammadi
- 1 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Shahmirzadi
- 1 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- 1 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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11
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A systematic review of measures of medication adherence in consumers with unipolar depression. Res Social Adm Pharm 2019. [DOI: 10.1016/j.sapharm.2018.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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12
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The Effect of Synbiotic as an Adjuvant Therapy to Fluoxetine in Moderate Depression: A Randomized Multicenter Trial. ARCHIVES OF NEUROSCIENCE 2018. [DOI: 10.5812/archneurosci.60507] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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13
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Olescowicz G, Neis VB, Fraga DB, Rosa PB, Azevedo DP, Melleu FF, Brocardo PS, Gil-Mohapel J, Rodrigues ALS. Antidepressant and pro-neurogenic effects of agmatine in a mouse model of stress induced by chronic exposure to corticosterone. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:395-407. [PMID: 28842257 DOI: 10.1016/j.pnpbp.2017.08.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/27/2017] [Accepted: 08/21/2017] [Indexed: 12/19/2022]
Abstract
Agmatine is an endogenous neuromodulator that has been shown to have beneficial effects in the central nervous system, including antidepressant-like effects in animals. In this study, we investigated the ability of agmatine (0.1mg/kg, p.o.) and the conventional antidepressant fluoxetine (10mg/kg, p.o.) to reverse the behavioral effects and morphological alterations in the hippocampus of mice exposed to chronic corticosterone (20mg/kg, p.o.) treatment for a period of 21days as a model of stress and depressive-like behaviors. Chronic corticosterone treatment increased the immobility time in the tail suspension test (TST), but did not cause anhedonic-like and anxiety-related behaviors, as assessed with the splash test and the open field test (OFT), respectively. Of note, the depressive-like behaviors induced by corticosterone were accompanied by a decrease in hippocampal cell proliferation, although no changes in hippocampal neuronal differentiation were observed. Our findings provide evidence that, similarly to fluoxetine, agmatine was able to reverse the corticosterone-induced depressive-like behaviors in the TST as well as the deficits in hippocampal cell proliferation. Additionally, fluoxetine but not agmatine, increased hippocampal differentiation. Agmatine, similar to fluoxetine, was capable of increasing both dendritic arborization and length in the entire dentate hippocampus, an effect more evident in the ventral portion of the hippocampus, as assessed with the modified Sholl analysis. Altogether, our results suggest that the increase in hippocampal proliferation induced by agmatine may contribute, at least in part, to the antidepressant-like response of this compound in this mouse model of stress induced by chronic exposure to corticosterone.
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Affiliation(s)
- Gislaine Olescowicz
- Department of Biochemistry, Center of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, SC, Brazil
| | - Vivian B Neis
- Department of Biochemistry, Center of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, SC, Brazil
| | - Daiane B Fraga
- Department of Biochemistry, Center of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, SC, Brazil
| | - Priscila B Rosa
- Department of Biochemistry, Center of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, SC, Brazil
| | - Dayane P Azevedo
- Department of Biochemistry, Center of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, SC, Brazil
| | - Fernando Falkenburger Melleu
- Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, SC, Brazil
| | - Patricia S Brocardo
- Department of Morphological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, SC, Brazil
| | - Joana Gil-Mohapel
- Division of Medical Sciences, UBC Island Medical Program, University of Victoria, Victoria, British Columbia, Canada
| | - Ana Lúcia S Rodrigues
- Department of Biochemistry, Center of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, SC, Brazil.
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Ballinger BR, Irvine EA. Refusal of prescribed drugs in a psychiatric hospital. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.23.6.346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodsA survey of recorded refusal of drug administration to patients in a psychiatric hospital over a six-month period in 1996 was made using drug administration records. For comparison 150 patients were randomly selected from the 1975 drug sheets and instances of drug refusal noted.ResultsEighteen per cent of patients refused drugs on at least one occasion, and of those over 65 years of age 26.2% refused drugs. All the main diagnostic categories and groups of drugs were involved. of the 150 patients studied from 1975 only four refused drugs.Clinical implicationsDoctors should be alert to the possibility of refusal of drug treatment in a wide range of psychiatric conditions. When refusal occurs interventions are likely to be necessary, including a review of drug treatment.
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Bangratz M, Ait Abdellah S, Berlin A, Blondeau C, Guilbot A, Dubourdeaux M, Lemoine P. A preliminary assessment of a combination of rhodiola and saffron in the management of mild-moderate depression. Neuropsychiatr Dis Treat 2018; 14:1821-1829. [PMID: 30034237 PMCID: PMC6049049 DOI: 10.2147/ndt.s169575] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The medicinal plants Rhodiola rosea L. (rhodiola, golden root) and Crocus sativus L. (saffron) have been shown separately to induce significant effects in depression. The objective of this study was to assess a fixed combination of rhodiola and saffron in mild-moderate depression. METHODS In this observational study conducted with general practitioners (GPs), 45 adults (aged 18-85 years) suffering from mild or moderate depression (International Statistical Classification of Diseases and Related Health Problems 10th Revision definition) and reaching a score on the Hamilton Rating Scale for Depression of 8-18 were supplemented with a combination of rhodiola and saffron extracts (one tablet, 154 mg of rhodiola and 15 mg of saffron; recommended dose two tablets per day for 6 weeks). RESULTS After 6 weeks (D42) of supplementation, Hamilton Rating Scale for Depression scores (primary outcome) decreased significantly by 58%±28.5% (from 13.6±2.3 at D0 to 5.6±3.8 at D42, P<0.0001; n=41). Score improvement was reported in 85.4% of patients. A significant drop in both Hospital Anxiety and Depression Scale anxiety and depression scores was also observed at D42, the decrease being significant from 2 weeks of supplementation. At the end of the study, both GPs and patients deemed there was a significant improvement in depression (Clinical Global Impression - improvement and Patient Global Impression of Change). Safety was excellent, and no serious adverse effects were recorded. CONCLUSION Results of this observational study performed in primary care suggest that the combination of rhodiola and saffron tested could be useful for the management of mild-moderate depression and improve depressive and anxiety symptoms. A double-blind placebo-controlled study is needed to confirm these results.
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Jelodar G, Javid Z, Sahraian A, Jelodar S. Saffron improved depression and reduced homocysteine level in patients with major depression: A Randomized, double-blind study. AVICENNA JOURNAL OF PHYTOMEDICINE 2018; 8:43-50. [PMID: 29387573 PMCID: PMC5787996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives: A correlation between hyperhomocysteinemia, and depression has been reported. Saffron (Crocus sativus) is recommended for treatment of depression; hence, in this study the effect of co-administration of saffron and fluoxetine on plasma homocysteine and depression was evaluated. Material and methods: This was a 4-week randomized and double-blind clinical trial which was conducted from March 2013 to February 2014. In this trial, 40 male and females (20-55 years old) diagnosed with severe depression were selected and following filing the Beck form, were randomly divided into two groups. Experimental group was treated with fluoxetine 20 mg/day and saffron 30 mg /day and the control group received placebo and fluoxetine 20 mg/day for four weeks. Before treatment and at the end of the study, fasting blood samples were collected. For females, blood samples were collected on the third day of their menstrual cycle. Results: A significant reduction of homocysteine levels was observed in both sex in the experimental group compared to before treatment (p<0.04), while no such significant change was observed in the control group. A Beck questionnaire value showed lower level in both groups on the last day of treatment as compared to before treatment. There was no significant difference between the two groups in Beck value neither before nor after treatment. Conclusion: Saffron has beneficial effects on depression and homocysteine level in patients with major depression.
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Affiliation(s)
| | - Zahra Javid
- Department of Physiology, Shiraz University, Shiraz,Iran
| | - Ali Sahraian
- Research Center for psychiatry and Behavior Science, Department of Psychiatry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sina Jelodar
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Aly M, García-Cárdenas V, Williams K, Benrimoj SI. WITHDRAWN: A Review Of International Pharmacy- Based Minor Ailment Services And Proposed Service Design Model. Res Social Adm Pharm 2017:S1551-7411(17)30469-2. [PMID: 29275152 DOI: 10.1016/j.sapharm.2017.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Mariyam Aly
- Graduate School of Health, University of Technology Sydney, PO Box 123 Broadway NSW 2007, Sydney, New South Wales, Australia.
| | - Victoria García-Cárdenas
- Graduate School of Health, University of Technology Sydney, PO Box 123 Broadway NSW 2007, Sydney, New South Wales, Australia.
| | - Kylie Williams
- Graduate School of Health, University of Technology Sydney, PO Box 123 Broadway NSW 2007, Sydney, New South Wales, Australia.
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, PO Box 123 Broadway NSW 2007, Sydney, New South Wales, Australia.
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Brijnath B, Antoniades J. Playing With Antidepressants: Perspectives From Indian Australians and Anglo-Australians Living With Depression. QUALITATIVE HEALTH RESEARCH 2017; 27:1970-1981. [PMID: 27288015 DOI: 10.1177/1049732316651404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Patient perspectives were explored on the meaning and experience of antidepressant use by applying Johan Huizinga's theory of play to interviews from Indian Australians and Anglo-Australians diagnosed with depression. Through the analysis, the centrality of Huizinga's "magic circle" emerged, that is, defining the boundaries within which one could safely play. Consumption of antidepressants involved learning, breaking, and modulating rules of the game of adherence, then forging a new "magic circle." In these games, there were playful elements including experimentation, improvisation, absorption, and experiential learning. This application of Huizinga's theory in relation to antidepressant use is a novel approach in the literature on medication non/adherence. This application not only opens a new theoretical line of inquiry but also shows that antidepressant non/adherence is not a static practice but dynamic and changing, revealing critical insights around participant's agency, capabilities, desires, and notions of selfhood with regard to managing their depression and conceptualizing their recovery.
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Mazidi M, Shemshian M, Mousavi SH, Norouzy A, Kermani T, Moghiman T, Sadeghi A, Mokhber N, Ghayour-Mobarhan M, Ferns GAA. A double-blind, randomized and placebo-controlled trial of Saffron (Crocus sativus L.) in the treatment of anxiety and depression. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2016; 13:195-199. [PMID: 27101556 DOI: 10.1515/jcim-2015-0043] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 03/11/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Depression and anxiety are prevalent serious psychiatric disorders. Several drugs are used to treat these conditions but these are often associated with serious side effects. For this reason alternative therapies, including herbal medication such as saffron, have been proposed. We aimed to assess the effects of saffron extract for the treatment of anxiety and depression using a 12-week double-blind, placebo-controlled trial design. METHODS Sixty adult patients with anxiety and depression were randomized to receive a 50 mg saffron capsule (Crocus sativus L. stigma) or a placebo capsule twice daily for 12 weeks. Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) questionnaires were used at baseline, 6 and 12 weeks after initiating medication. 54 subjects completed the trial. RESULTS Saffron supplements had a significant effect on the BDI and BAI scores of subjects in comparison to placebo at the 12 week time-point (p<0.001). CONCLUSIONS Saffron appears to have a significant impact in the treatment of anxiety and depression disorder. Side effects were rare.
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Vannachavee U, Seeherunwong A, Yuttatri P, Chulakadabba S. The Effect of a Drug Adherence Enhancement Program on the Drug Adherence Behaviors of Patients With Major Depressive Disorder in Thailand: A Randomized Clinical Trial. Arch Psychiatr Nurs 2016; 30:322-8. [PMID: 27256936 DOI: 10.1016/j.apnu.2015.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 12/07/2015] [Accepted: 12/13/2015] [Indexed: 11/28/2022]
Abstract
This study aimed to compare drug adherence behaviors during the sixth week between patients with first diagnosed major depressive disorder who received the Drug Adherence Enhancement Program and those who received only the usual care. A randomized clinical trial, post-test only design was conducted in the outpatient-unit of a medical school hospital in Bangkok, Thailand. The experimental and control groups consisted of 30 and 26 participants respectively. Participants in the experimental group exhibited significantly higher drug adherence behaviors than the control group. This is important for nurses in promoting adherence to antidepressant drugs for patients with first diagnosed major depressive disorder.
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Affiliation(s)
- Usa Vannachavee
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | | | - Prapa Yuttatri
- Faculty of Nursing, Mahidol University, Bangkok, Thailand.
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Factors Associated With Drug Non-Adherence After Discharge Among Patients With Mood Disorders Hospitalized in Shahid Beheshti Hospital in Kerman: A Prospective Study. ACTA ACUST UNITED AC 2015. [DOI: 10.5812/zjrms.17(4)2015.968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ghaffari-Nejad A, Mashayekhi A, Mazhari S, Ghayoumi A. Factors Associated With Drug Non-Adherence After Discharge Among Patients With Mood Disorders Hospitalized in Shahid Beheshti Hospital in Kerman: A Prospective Study. ACTA ACUST UNITED AC 2015. [DOI: 10.17795/zjrms968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Slabbert FN, Harvey BH, Brink CB, Lubbe MS. The impact of HIV/AIDS on compliance with antidepressant treatment in major depressive disorder: A prospective study in a South African private healthcare cohort. AIDS Res Ther 2015; 12:9. [PMID: 26261459 PMCID: PMC4397684 DOI: 10.1186/s12981-015-0050-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 03/02/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND MDD and HIV/AIDS have a high prevalence worldwide with severe consequences for patients. In both conditions, compliance with treatment is key to successfully treat these disorders. In the current study, we examine the effect of MDD on the compliance with ADs in patients diagnosed with co-morbid HIV/AIDS and how different classes of ADs influence compliance in this group of patients. METHODS A prospective, cohort study design was used to analyse nationally representative medicine claims data submitted to a privately-owned South African Pharmaceutical Benefit Management (PBM) company. Two groups were distinguished in the database, namely patients with only MDD and patients with both MDD and HIV/AIDS, over a six-year study period. The study population was determined by the following inclusion criteria: patients older than 18 years, MDD should be diagnosed by a psychiatrist supported by an appropriate ICD-10 code, and all patients have to be on combination antiretroviral treatment (cARV) treatment. The medicine possession ratio (MPR) was used as proxy to determine patient compliance with AD medication. RESULTS 127 patients (i.e. 0.24%) met the criteria of co-morbid MDD and HIV/AIDS. Females have a significantly higher prevalence of MDD and HIV/AIDS when compared to males. Patients diagnosed with both HIV/AIDS and MDD (74.43. ± 32.03, 95% Cl: 71.51-77.34) have a statistical significantly (p < 0.0001) lower compliance with AD treatment vs. MDD patients (80.94% ± 29.44, 95% Cl: 80.56-81.33), but the practical significance thereof, is low (Cohen's d = 0.2255). In this group only 26.83% of TCA had acceptable compliance compared to the 58.57% of SNRIs. Noteworthy observations were that 75% (p < 0.0217; Cramer's V = 0.0388) of venlafaxine and 28.6% (p < 0.0197; Cramer's V = -0.0705) of the paroxetine items were compliant in patients diagnosed with both HIV/AIDS and MDD. CONCLUSIONS AD compliance is statistical significantly lower in depressed HIV/AIDS vs. depressed non-HIV/AIDS patients. However, these differences is of low practical or clinical significance, meaning that depressed HIV/AIDS patients would have missed approximately two AD doses (6.5% of a 30-day treatment period) more than the non-HIV/AIDS depressed patient over the same treatment period.
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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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Bordson SJ, Atayee RS, Ma JD, Best BM. Tricyclic Antidepressants: Is Your Patient Taking Them? Observations on Adherence and Unreported Use Using Prescriber-Reported Medication Lists and Urine Drug Testing. PAIN MEDICINE 2014; 15:355-63. [DOI: 10.1111/pme.12300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vahdati Hassani F, Naseri V, Razavi BM, Mehri S, Abnous K, Hosseinzadeh H. Antidepressant effects of crocin and its effects on transcript and protein levels of CREB, BDNF, and VGF in rat hippocampus. ACTA ACUST UNITED AC 2014; 22:16. [PMID: 24401376 PMCID: PMC3927874 DOI: 10.1186/2008-2231-22-16] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 11/10/2013] [Indexed: 12/29/2022]
Abstract
Background Antidepressants have been shown to affect levels of brain-derived neurotrophic factor (BDNF) and VGF (non-acronymic) whose transcriptions are dependent on cAMP response element binding protein (CREB) in long term treatment. The aim of this study was to verify the subacute antidepressant effects of crocin, an active constituent of saffron (Crocus sativus L.), and its effects on CREB, BDNF, and VGF proteins, transcript levels and amount of active, phosphorylated CREB (P-CREB) protein in rat hippocampus. Methods Crocin (12.5, 25, and 50 mg/kg), imipramine (10 mg/kg; positive control) and saline (1 mL/kg; neutral control) were administered intraperitoneally (IP) to male Wistar rats for 21 days. The antidepressant effects were studied using the forced swimming test (FST) on day 21 after injection. Protein expression and transcript levels of genes in the rat hippocampus were evaluated using western blot and quantitative reverse transcription-polymerase chain reaction (qRT-PCR), respectively. Results Crocin significantly reduced the immobility time in the FST. Western blot analysis showed that 25 and 50 mg/kg of crocin increased the levels of CREB and BDNF significantly and dose dependently. All doses of crocin increased the VGF levels in a dose-dependent manner. Levels of p-CREB increased significantly by 50 mg/kg dose of crocin. Only 12.5 mg/kg crocin could significantly increase the transcript levels of BDNF. No changes in CREB and VGF transcript levels were observed in all groups. Conclusions These results suggest that crocin has antidepressant-like action by increasing CREB, BDNF and VGF levels in hippocampus.
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Affiliation(s)
| | | | | | | | | | - Hossein Hosseinzadeh
- Pharmaceutical Research Center, Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Health care providers' perspectives of medication adherence in the treatment of depression: a qualitative study. Soc Psychiatry Psychiatr Epidemiol 2013. [PMID: 23179094 DOI: 10.1007/s00127-012-0625-3] [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] [Indexed: 10/27/2022]
Abstract
PURPOSE Non-adherence to antidepressant medications is a significant barrier to the successful treatment of depression. The purpose of this study was to explore the perspectives of health care providers on antidepressant medication non-adherence in clinical practice. METHODS Individual semi-structured interviews were conducted with a purposive sample of 31 health care providers from a range of disciplines and settings in the state of New South Wales, Australia. Interviews focused on medication adherence issues in depression and participants' strategies in addressing them. Interviews were audio recorded, transcribed verbatim and thematically content analyzed using a constant comparison approach. RESULTS Participants acknowledged medication non-adherence to be a complex problem in depression, and attributed this problem to patient, medication and environmental-specific issues. Five approaches in addressing non-adherence were reported: patient education, building partnerships with patients, pharmacological management, developing behavioural skills and building supportive networks. Challenges to the management of non-adherence were lack of time and skills, assessment of medication adherence, transition period immediately post-discharge and conflicts in views between providers. CONCLUSION Participants were able to identify issues and strategies in addressing antidepressant non-adherence; however, barriers were also identified that could impact on providers' ability to address this issue effectively. More research is needed to develop effective multidisciplinary strategies that take into account providers' perspectives in improving adherence to antidepressant medications.
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Rivero-Santana A, Perestelo-Perez L, Pérez-Ramos J, Serrano-Aguilar P, De las Cuevas C. Sociodemographic and clinical predictors of compliance with antidepressants for depressive disorders: systematic review of observational studies. Patient Prefer Adherence 2013; 7:151-69. [PMID: 23487319 PMCID: PMC3592507 DOI: 10.2147/ppa.s39382] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The literature shows that compliance with antidepressant treatment is unsatisfactory. Several personal and disease-related variables have been shown to be related to compliance behavior. The objective of this study was to review the literature about sociodemographic and clinical predictors of compliance in patients with depressive disorders. METHODS The Medline, Embase, Cochrane Central, PsycInfo, and Cinahl databases were searched until May 2012. Studies that analyzed sociodemographic and clinical predictors or correlates of compliance in patients with depressive disorder were included. A quantitative synthesis was not performed because of the heterogeneity and availability of the data reported. For similar reasons, the results were not classified according to the different phases of treatment. The search was limited to studies published in English and Spanish. RESULTS Thirty-two studies fulfilled the inclusion criteria. The most consistent associations with compliance were found for age (older patients showed more compliance) and race (white patients were more likely to adhere to treatment than minority ethnic groups). Few studies assessed clinical factors, and the most plausible predictors of compliance were certain comorbidities and substance abuse. Severity of depression did not play an important role in predicting compliance. CONCLUSION The impact of the variables studied on compliance behavior appeared to be inconsistent. Identifying potential predictors of compliance with antidepressant treatment is important, both for the routine practice of the mental health professional and for refining interventions to enhance adherence and target them to specific populations at risk of noncompliance.
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Affiliation(s)
- Amado Rivero-Santana
- Canary Islands Foundation of Health and Research
- Correspondence: Amado Rivero-Santana Canary Islands Foundation of Health and Research, Evaluation Unit of the Canary Islands Health Service, C/Perez de Rozas 5, 4ª Planta, Santa Cruz de Tenerife 38004, Spain Tel +34 922 475 755 Fax +34 922 475 768 Email
| | - Lilisbeth Perestelo-Perez
- Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC), Santa Cruz de Tenerife
- Evaluation Unit, Canary Islands Health Service, Santa Cruz de Tenerife
| | | | - Pedro Serrano-Aguilar
- Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC), Santa Cruz de Tenerife
- Evaluation Unit, Canary Islands Health Service, Santa Cruz de Tenerife
| | - Carlos De las Cuevas
- Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC), Santa Cruz de Tenerife
- Department of Psychiatry, University of La Laguna, Canary Islands, Spain
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Jeon-Slaughter H. Economic factors in of patients' nonadherence to antidepressant treatment. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1985-98. [PMID: 22415606 DOI: 10.1007/s00127-012-0497-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 03/03/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Patients' nonadherence to antidepressant treatment hampers cost and efficacy of depression-specific treatment. However, previous studies have failed to find consistent findings in economic effect on nonadherence and also failed to reach consensus in how to measure nonadherence to treatment. The study attempts to investigate income effect on nonadherence to selective serotonin reuptake inhibitors (SSRIs) treatment with clear definitions of nonadherence: self discontinuation of SSRIs (nonpersistence) and under-dose of SSRIs (noncompliance). METHODS The study extracted data from the National Comorbidity Survey-Replication (NCS-R). The study sample (n = 280) includes adults between the ages of 18 and 64 who were diagnosed with Diagnostic Statistics Manual IV Major Depressive Episode (MDE) at some point during their lifetime and medicated with SSRIs in the past 12 months. RESULTS Just above poverty level of family income and no health insurance increased the risk of medication nonpersistence in SSRIs treatment. The study findings confirmed that African Americans were at higher risk of medication noncompliance than Whites (odds ratio, 4.53) and MDE comorbidity was positively associated with medication noncompliance (odds ratio, 4.25). CONCLUSIONS Low income level, combined with health insurance status, and race/ethnicity, predict nonadherence to antidepressant treatment. The study findings would help physicians and hospitals developing interventional strategies and programs to increase patients' adherence rates in antidepressant treatment.
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Affiliation(s)
- Haekyung Jeon-Slaughter
- Department of Psychiatry and Behavioral Sciences, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Jindal A, Mahesh R, Gautam B, Bhatt S, Pandey D. Antidepressant-like effect of etazolate, a cyclic nucleotide phosphodiesterase 4 inhibitor—an approach using rodent behavioral antidepressant tests battery. Eur J Pharmacol 2012; 689:125-31. [DOI: 10.1016/j.ejphar.2012.05.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/03/2012] [Accepted: 05/16/2012] [Indexed: 02/07/2023]
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Gabriela GC, Javier AAF, Elisa VA, Gonzalo VP, Herlinda BJ. Antidepressant-Like Effect of Tagetes lucida Cav. Extract in Rats: Involvement of the Serotonergic System. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2012; 40:753-68. [DOI: 10.1142/s0192415x12500565] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It has been demonstrated that the decoction of the aerial parts of Tagetes lucida Cav. produces an antidepressant effect during the forced swimming test (FST) in rats. The aim of this study was to evaluate the effect of different organic extracts and one aqueous extract of the aerial parts of T. lucida on the FST. In addition, the possible involvement of the serotonergic system in the antidepressant-like effect of T. lucida in the FST was evaluated, as was its potential toxicological effect. The different extracts of T. lucida (methanol, hexane, dichloromethane and aqueous, 10 and 50 mg/kg), as well as fluoxetine (FLX, 5 mg/kg), were administered per os (p.o.) to rats for 14 days. All animals were subjected to the FST. Only the aqueous extract of T. lucida at a dose of 50 mg/kg significantly reduced immobility behavior and increased swimming in the FST, similar to FLX. Later, the aqueous extract of T. lucida (50mg/kg) was administered for 1, 7 and 14 days. An antidepressant effect was observed after 7 days of treatment. To evaluate the participation of the serotoninergic system, the animals were pretreated with PCPA, an inhibitor of serotonin synthesis (100 mg/kg/day for 4 consecutive days). The animals were treated with the aqueous extract of T. lucida (50 mg/kg) and FLX (5 mg/kg) 24 h after the final injection and were then subjected to the FST. Pretreatment with PCPA inhibited the antidepressant effect of both T. lucida and FLX. Finally, T. lucida was administered p.o. and intraperitoneal route to evaluate its acute toxicological effect. The aqueous extract of T. lucida, administered p.o., did not produce lethality or any significant changes in behavior. In conclusion, the aqueous extract of T. lucida manifested an antidepressant-like effect in the FST mediated by the serotonergic system, with no adverse effects when administered p.o.
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Affiliation(s)
- Guadarrama-Cruz Gabriela
- Experimental Biology Posgrade, Department of Biology of Reproduction, D.C.B.S., Universidad Autónoma Metropolitana Iztapalapa, México, D.F., C.P. 09340, México
| | - Alarcón-Aguilar Francisco Javier
- Laboratory of Pharmacology, Department of Biology of Reproduction, D.C.B.S., Universidad Autónoma Metropolitana Iztapalapa, México, D.F., C.P. 09340, México
| | - Vega-Avila Elisa
- Laboratory of Experimental Hematology, Department of Health Sciences, Department of Biology of Reproduction, D.C.B.S., Universidad Autónoma Metropolitana Iztapalapa, México, D.F., C.P. 09340, México
| | - Vázquez-Palacios Gonzalo
- Academy of Biology, College of Science and Technology, Universidad Autónoma de la Ciudad de México-San Lorenzo Tezonco, México D.F., C.P. 09790, México
| | - Bonilla-Jaime Herlinda
- Behavioral Pharmacology Laboratory, Department of Biology of Reproduction, D.C.B.S., Universidad Autónoma Metropolitana Iztapalapa, México, D.F., C.P. 09340, México
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Vrijens B, De Geest S, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, Dobbels F, Fargher E, Morrison V, Lewek P, Matyjaszczyk M, Mshelia C, Clyne W, Aronson JK, Urquhart J. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol 2012; 73:691-705. [PMID: 22486599 PMCID: PMC3403197 DOI: 10.1111/j.1365-2125.2012.04167.x] [Citation(s) in RCA: 1159] [Impact Index Per Article: 96.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Interest in patient adherence has increased in recent years, with a growing literature that shows the pervasiveness of poor adherence to appropriately prescribed medications. However, four decades of adherence research has not resulted in uniformity in the terminology used to describe deviations from prescribed therapies. The aim of this review was to propose a new taxonomy, in which adherence to medications is conceptualized, based on behavioural and pharmacological science, and which will support quantifiable parameters. A systematic literature review was performed using MEDLINE, EMBASE, CINAHL, the Cochrane Library and PsycINFO from database inception to 1 April 2009. The objective was to identify the different conceptual approaches to adherence research. Definitions were analyzed according to time and methodological perspectives. A taxonomic approach was subsequently derived, evaluated and discussed with international experts. More than 10 different terms describing medication-taking behaviour were identified through the literature review, often with differing meanings. The conceptual foundation for a new, transparent taxonomy relies on three elements, which make a clear distinction between processes that describe actions through established routines ('Adherence to medications', 'Management of adherence') and the discipline that studies those processes ('Adherence-related sciences'). 'Adherence to medications' is the process by which patients take their medication as prescribed, further divided into three quantifiable phases: 'Initiation', 'Implementation' and 'Discontinuation'. In response to the proliferation of ambiguous or unquantifiable terms in the literature on medication adherence, this research has resulted in a new conceptual foundation for a transparent taxonomy. The terms and definitions are focused on promoting consistency and quantification in terminology and methods to aid in the conduct, analysis and interpretation of scientific studies of medication adherence.
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Vrijens B, De Geest S, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, Dobbels F, Fargher E, Morrison V, Lewek P, Matyjaszczyk M, Mshelia C, Clyne W, Aronson JK, Urquhart J. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol 2012. [PMID: 22486599 DOI: 10.1111/j.1365‐2125.2012.04167.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Interest in patient adherence has increased in recent years, with a growing literature that shows the pervasiveness of poor adherence to appropriately prescribed medications. However, four decades of adherence research has not resulted in uniformity in the terminology used to describe deviations from prescribed therapies. The aim of this review was to propose a new taxonomy, in which adherence to medications is conceptualized, based on behavioural and pharmacological science, and which will support quantifiable parameters. A systematic literature review was performed using MEDLINE, EMBASE, CINAHL, the Cochrane Library and PsycINFO from database inception to 1 April 2009. The objective was to identify the different conceptual approaches to adherence research. Definitions were analyzed according to time and methodological perspectives. A taxonomic approach was subsequently derived, evaluated and discussed with international experts. More than 10 different terms describing medication-taking behaviour were identified through the literature review, often with differing meanings. The conceptual foundation for a new, transparent taxonomy relies on three elements, which make a clear distinction between processes that describe actions through established routines ('Adherence to medications', 'Management of adherence') and the discipline that studies those processes ('Adherence-related sciences'). 'Adherence to medications' is the process by which patients take their medication as prescribed, further divided into three quantifiable phases: 'Initiation', 'Implementation' and 'Discontinuation'. In response to the proliferation of ambiguous or unquantifiable terms in the literature on medication adherence, this research has resulted in a new conceptual foundation for a transparent taxonomy. The terms and definitions are focused on promoting consistency and quantification in terminology and methods to aid in the conduct, analysis and interpretation of scientific studies of medication adherence.
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Patients' views of antidepressants: from first experiences to becoming expert. Br J Gen Pract 2011; 61:142-8. [PMID: 21439171 DOI: 10.3399/bjgp11x567045] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The majority of patients discontinue antidepressant treatment earlier than prescribed. The factors behind this and the influences on patients' choices about whether to take medication remain poorly understood. AIM To explore factors that influence patients' decisions about taking antidepressant medication. DESIGN OF STUDY Qualitative interview study. SETTING Interviews were conducted across three sites: London, East Lancashire, and North East England. METHOD Semi-structured interviews were conducted with a purposive sample of 65 primary care patients who were prescribed antidepressants in the past year for depression or mixed anxiety/depression. RESULTS Participants described their first course of antidepressants as typically occurring when they had 'hit rock bottom', having exhausted all other possibilities; therefore, there was little sense of a positive choice at this stage. There would typically follow a period of experimentation where it was usual to stop and restart medication, often several times. Ultimately, these recurring cycles lead to participants becoming more expert about their condition and better able to make an informed decision about medication. For younger participants, recovery typically remained a goal, although for older people there was often an acceptance that their condition, and medication use, would be long term. CONCLUSION Participants' accounts demonstrated how they could become expert at managing their condition through a process of trial and error.
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Barraco A, Rossi A, Nicolò G. Description of study population and analysis of factors influencing adherence in the observational Italian study "Evaluation of Pharmacotherapy Adherence in Bipolar Disorder" (EPHAR). CNS Neurosci Ther 2010; 18:110-8. [PMID: 21199448 DOI: 10.1111/j.1755-5949.2010.00225.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In patients with bipolar disorder, medication is effective in preventing relapses. Unfortunately, adherence to treatment in bipolar disorder, as in other chronic or recurrent conditions, is not optimal. Estimates of nonadherence to prescribed treatment range from 30% to 60% in epidemiological studies, and are at around 30% in clinical trials. Adherence to treatment is a potent predictor of effectiveness, both in clinical trials and cohort studies, therefore is a very relevant area of investigation. This study will try to show a picture of the real life care where adherence is influenced by a wide range of variables. METHODS Prospective, observational, multicenter study in 650 adult patients with bipolar disorder, who had to initiate or change their treatment regimen, observed for 1 year. Adherence was measured by the Simplified Medication Adherence Questionnaire (SMAQ). Additional variables: Symptom severity, Montgomery-Åsberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Clinical Global Impression-Bipolar Disorder (CGI-BD), the Drug Attitude Inventory score (DAI-30), and quality of life (EuroQoL 5 Dimensions). The variables were recorded every 3 months for the next year. RESULTS Most subjects were out-patients (77.1%), female (58.8%), aged 31-50 years (50.1%) and overweight (41.8%) or obese (28.7%); 67.4% had type I bipolar disorder and 66.8% had depressive or mixed symptoms. Adherence was 39.9% at baseline (and increased up to 67.0% at completion. The main predictors of nonadherence were alcohol consumption, severe bipolar symptoms, young age at time of first treatment, negative attitude towards treatment. CONCLUSIONS The patient population of this observational trial was representative of the patients changing their therapy for bipolar disorder seen in clinical practice in Italy. Lack of adherence to pharmacotherapy for bipolar disorder is a serious issue, which is more likely to arise in alcohol users and patients with severe symptoms, negative attitude towards medication and/or initiation of treatment early in life. The findings could lead to a more adequate approach of adherence in patients with bipolar disorders.
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Affiliation(s)
- Alessandra Barraco
- Medical Department, Eli Lilly Italia S.p.A., Sesto Fiorentino, Florence, Rome, Italy
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Sajatovic M, Velligan D, Weiden PJ, Valenstein M, Ogedegbe G. Measurement of psychiatric treatment adherence. J Psychosom Res 2010; 69:591-9. [PMID: 21109048 PMCID: PMC3930068 DOI: 10.1016/j.jpsychores.2009.05.007] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 04/29/2009] [Accepted: 05/14/2009] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Nonadherence to medications for mental disorders substantially limits treatment effectiveness and results in higher rates of relapse, hospitalization, and disability. Accurate measurement of medication adherence is important not only in adherence research but also in clinical trials in which medications are being evaluated and in clinical practice where failure to detect nonadherence results in premature medication changes, unnecessary polypharmacy, and greater likelihoods of functional deteriorations and hospitalizations. This is a review of psychiatric treatment adherence methods and measures arising from a meeting on "Methodological Challenges in Psychiatric Treatment Adherence Research" held on September 27-28, 2007, in Bethesda, MD, and organized by the National Institute of Mental Health (NIMH). METHODS This paper reviews the range of modalities currently available for assessing adherence behavior including pill counts, pharmacy records, technology-assisted monitoring, biological assays, and a range of self-report and interviewer-rated scales. Measures of adherence attitudes are also reviewed. RESULTS Each of the adherence measures described are imperfect estimates of actual medication ingestion, but each provides informative estimates of adherence or the attitudinal factors associated with adherence. Measure selection depends on a range of factors including the patient sample, the context in which the measure is being used, and the clinical outcomes expected from various levels of nonadherence. The use of multiple measures of adherence is encouraged to balance the limitations of individual measures. CONCLUSION While adherence assessment has become increasingly sophisticated in recent years, there remains a need for refinement and expansion on currently available methods and measures.
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Affiliation(s)
- Martha Sajatovic
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Dawn Velligan
- University of Texas Health Science Center San Antonio
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Hospital patients' perceptions during treatment and early discontinuation of serotonin selective reuptake inhibitor antidepressants. J Clin Psychopharmacol 2010; 30:716-9. [PMID: 21105288 DOI: 10.1097/jcp.0b013e3181fc343b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Studies have suggested that discontinuation of treatment in depressed patients is associated with their perceptions about their treatment. We surveyed 403 adults treated for major depressive disorder with a selective serotonin reuptake inhibitor (SSRI) 3 months after onset of treatment to assess their interactions with clinicians, reasons they stopped SSRI treatment, and SSRI side effects (SEs). Bothersome SEs, poorer instruction by physicians about SSRI SEs, and self-reported change in depression, sex, marital status, and employment were significantly (P < 0.05) associated with discontinuation. Logistic regression examined the associations between patients' perceptions during treatment planning and SSRI discontinuation. Seventeen percent of patients felt uninvolved in treatment decisions, 9% disagreed with the diagnosis, and 24% subsequently stopped treatment. Elevated risk of discontinuation was found among patients who felt uninvolved in treatment decisions (unadjusted risk ratio [RR], 2.3; 95% confidence interval [CI], 1.2-4.3) and those who disagreed with the diagnosis (RR, 2.0; CI, 0.9-4.4). Patients who both felt uninvolved and disagreed with the diagnosis were 7-fold as likely to discontinue their SSRI (RR, 7.3; CI, 1.5-36.3) compared with those who felt neither uninvolved nor disagreed. Selective serotonin reuptake inhibitor SEs, specific interactions with clinicians, self-assessed outcomes, and sociodemographics did not explain these associations. To improve adherence to medications, clinicians should consider patients' perceptions about their involvement in treatment decisions and agreement with their diagnosis.
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Abstract
Recognition of the value of acceptance of the self, others, and the flux of human experience, has philosophical and religious roots that date back thousands of years. The past two decades have witnessed a swell of interest in acceptance, as evidenced by an increase in acceptance-based therapeutic interventions, and a growing appreciation of the paradoxical nature of acceptance and personal change and the role of experiential avoidance in psychopathology. In this article we review historical and contemporary descriptions and definitions of acceptance, measures of acceptance, the relation between acceptance and change, and the role of acceptance in psychopathology and psychotherapy. Our central objective is to delineate a rich conceptual scheme that encompasses the diverse ways in which acceptance has been explicated in classical and contemporary writings, and to highlight the need for further validation of this useful and popular construct.
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Velligan D, Sajatovic M, Valenstein M, Riley WT, Safren S, Lewis-Fernandez R, Weiden P, Ogedegbe G, Jamison J. Methodological challenges in psychiatric treatment adherence research. ACTA ACUST UNITED AC 2010; 4:74-91. [PMID: 20643631 DOI: 10.3371/csrp.4.1.6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Reflecting an increasing awareness of the importance of treatment adherence on outcomes in psychiatric populations, the National Institute of Mental Health (NIMH) convened a panel of treatment adherence researchers on September 27-28, 2007 to discuss and articulate potential solutions for dealing with methodological adherence research challenges. Panel discussions and presentations were augmented with targeted review of the literature on specific topics, with a focus on adherence to medication treatments in adults with serious mental illness. The group discussed three primary methodological areas: participants, measures, and interventions. When selecting patients for adherence-enhancing interventions (AEIs), a three-tier model was proposed that draws from the universal (targeting all patients receiving medication treatment for a specific condition, regardless of current adherence), selective (targeting patients at risk for nonadherence), and indicated (targeting patients who are currently nonadherent) prevention model and emphasizes careful patient characterization in relevant domains and appropriate matching of interventions to the selected population. Proposals were also made to reduce problematic selection biases in patient recruitment and retention. The panel addressed the pros and cons of various methods that can be used to measure adherence, and concluded that it is appropriate to use multiple measures whenever possible. Finally, the panel identified a broad range of intervention approaches, and conditions under which these interventions are likely to be most effective at reducing barriers to adherence and reinforcing adherence behavior.
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Affiliation(s)
- Dawn Velligan
- Department of Psychiatry, Mail Stop 7797, The University of Texas Health Science Center, 7704 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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Freitas AE, Budni J, Lobato KR, Binfaré RW, Machado DG, Jacinto J, Veronezi PO, Pizzolatti MG, Rodrigues ALS. Antidepressant-like action of the ethanolic extract from Tabebuia avellanedae in mice: evidence for the involvement of the monoaminergic system. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:335-43. [PMID: 20026371 DOI: 10.1016/j.pnpbp.2009.12.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 11/28/2009] [Accepted: 12/12/2009] [Indexed: 02/06/2023]
Abstract
The antidepressant-like effect of the ethanolic extract obtained from barks of Tabebuia avellanedae, a plant widely employed in folk medicine, was investigated in two predictive models of depression: forced swimming test (FST) and tail suspension test (TST) in mice. Additionally, the mechanisms involved in this antidepressant-like action and the effects of the association of the extract with the antidepressants fluoxetine, desipramine and bupropion in the TST were investigated. The extract from T. avellanedae produced an antidepressant-like effect, in the FST (100 mg/kg, p.o.) and in the TST (10-300 mg/kg, p.o.), without accompanying changes in ambulation when assessed in the open-field test. The anti-immobility effect of the extract (30 mg/kg, p.o.) in the TST was prevented by pre-treatment of mice with ketanserin (5 mg/kg, i.p., a preferential 5-HT(2A) receptor antagonist), prazosin (1 mg/kg, i.p., an alpha(1)-adrenoceptor antagonist), yohimbine (1 mg/kg, i.p., an alpha(2)-adrenoceptor antagonist), propranolol (2 mg/kg, i.p., a beta-adrenoceptor antagonist), sulpiride (50 mg/kg, i.p., a dopamine D(2) receptor antagonist) and SCH23390 (0.05 mg/kg, s.c., a dopamine D(1) receptor antagonist). The combined administration of a subeffective dose of WAY100635 (0.1 mg/kg, s.c., a selective 5-HT(1A) receptor antagonist) and a subeffective dose of the extract (1 mg/kg, p.o.) produced a significant reduction in the immobility time in the TST. In addition, the combination of fluoxetine (1 mg/kg, p.o.), desipramine (0.1 mg/kg, p.o.), or bupropion (1 mg/kg, p.o.) with a subeffective dose of the extract (1 mg/kg, p.o.) produced a synergistic antidepressant-like effect in the TST, without causing hyperlocomotion in the open-field test. It may be concluded that the extract from T. avellanedae produces an antidepressant-like effect in the FST and in the TST that is dependent on the monoaminergic system. Taken together, our results suggest that T. avellanedae deserves further investigation as a putative alternative therapeutic tool that could help the conventional pharmacotherapy of depression.
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Affiliation(s)
- Andiara E Freitas
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Campus Universitário-Trindade-88040-900, Florianópolis-SC, Brazil
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41
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Non-adherence with psychotropic medications in the general population. Soc Psychiatry Psychiatr Epidemiol 2010; 45:47-56. [PMID: 19347238 DOI: 10.1007/s00127-009-0041-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Accepted: 03/13/2009] [Indexed: 01/05/2023]
Abstract
BACKGROUND Non-adherence with medications is a general medical issue that has received much attention. However, the majority of studies have been on various clinical populations and the relevance of their results to the general population is unknown. In this study, we sought to determine the degree of non-adherence with antidepressants, antipsychotics, anxiolytics, mood stabilizers and sedative hypnotics, and to determine the reasons for non-adherence, in the general population of Canada. METHODS We used data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), conducted in 2002 (n = 36,984 adults), to produce population-based estimates of the degree of reported non-adherence with psychotropic medications and the reasons for non-adherence. RESULTS The number of individuals taking psychotropic medications was 6,201. The prevalence of antipsychotic use over the last 12 months was estimated at 0.4% (95% CI 0.3-0.4). The corresponding estimates for sedative-hypnotics, anxiolytics, mood stabilizers and antidepressants were 10.2% (95% CI 9.8-10.7), 5.5% (95% CI 5.2-5.8), 1.1% (1.0-1.3) and 5.8% (95% CI 5.5-6.2), respectively. Non-adherence was estimated to be 34.6% (95% CI 25.5-44.9) for antipsychotics, 34.7% (95% CI 32.2-37.4) for sedative-hypnotics, 38.1% (95% CI 35.0-41.4) for anxiolytics, 44.9% (95% CI 38.1-51.9) for mood stabilizers and 45.9% (95% CI 43.1-48.7) for antidepressants. The degree of non-adherence decreased with age for antidepressants and anxiolytics. Forgetting was the main reported reason for non-adherence, but its degree varied with medication class. The proportion of respondents that reported forgetting as a reason was 36.3% (95% CI 32.0-40.8) for sedative-hypnotics, 46.7% (95% CI 41.3-52.2) for anxiolytics, 72.7% (95% CI 55.5-85.0) for antipsychotics, 74.2% (95% CI 64.0-82.3) for mood stabilizers and 74.5% (95% CI 70.7-77.9) for antidepressants. The degree of non-adherence and the frequency of forgetting were not associated with the level of interference by the associated condition with usual activities. The majority of these estimates were also not impacted by educational status, employment status, rural/urban residence, income or the presence of a comorbid physical condition. CONCLUSION A high frequency of non-adherence was found with all five classes of psychotropic medication. Both the frequency of reported non-adherence and the reasons reported for it differ according to the medication. However, the degree of non-adherence was not affected by the level of interference of the associated condition.
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Cunha MDF, Gandini RDC. Adesão e não-adesão ao tratamento farmacológico para depressão. PSICOLOGIA: TEORIA E PESQUISA 2009. [DOI: 10.1590/s0102-37722009000300015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O presente estudo objetivou compreender aspectos relacionados à adesão e a não-adesão ao tratamento farmacológico para depressão, envolvendo usuários e ex-usuários de um serviço público de saúde mental. Foram entrevistados, individualmente, 24 pacientes (12 aderentes e 12 não aderentes ao tratamento medicamentoso para depressão). Por meio da análise de conteúdo das entrevistas, identificou-se que o fenômeno da adesão/não-adesão estaria inter-relacionado a aspectos intrapessoais, interpessoais e ao contexto do tratamento do paciente. Os resultados fomentaram reflexões acerca do papel de equipes de saúde mental no incremento da adesão ao tratamento, bem como da necessidade de uma maior consideração do indivíduo, da família e do atendimento prestado pela instituição.
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GARFIELD SARA, SMITH FELICITY, FRANCIS SALLYANNE. The paradoxical role of antidepressant medication - returning to normal functioning while losing the sense of being normal. J Ment Health 2009. [DOI: 10.1080/09638230310001603582] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chakraborty K, Avasthi A, Kumar S, Grover S. Attitudes and beliefs of patients of first episode depression towards antidepressants and their adherence to treatment. Soc Psychiatry Psychiatr Epidemiol 2009; 44:482-8. [PMID: 19011717 DOI: 10.1007/s00127-008-0468-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 10/28/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Treatment adherence is influenced by factors like illness and patient characteristics, side effects, time taken to improve and the doctor-patient relationship. One of the important patient characteristic which has been reported to influence treatment adherence is their attitudes and beliefs towards medication. METHODOLOGY 50 subjects of first episode unipolar depression (except for severe depression with psychotic symptoms), aged 18-50 years, duration of depression of more than 1 month, with no comorbid psychiatric disorders and comorbid medical illnesses were assessed twice. At first intake, antidepressant compliance questionnaire (ADCQ) was administered. Second intake was done after 3 months for assessment of treatment adherence by using the questionnaire for assessment of treatment adherence. RESULTS On component-1 of ADCQ (doctor-patient relationship), 92% agreed that doctor gave sufficient time to listen to their problem, explained the causes of depression sufficiently, felt confident that antidepressants are suitable treatment of their depression. On component-2 (preserved autonomy), most (88%) subjects believed that antidepressants are difficult to stop when taken over a long period of time and can alter patient's personality. On component-3 (positive beliefs on anti-depressants), 72% of the subjects felt, fewer tablets could be taken on days one feels better. On component-4 (partner agreement), 96% of subjects reported their partner's positive attitude towards diagnosis and treatment. At the time of second assessment, majority of the subjects (88%) missed the antidepressant medication on less than 25% days in the last 3 months whereas only 4% of the subjects missed antidepressants for more than 75% of the days. Thirty eight percent of the subjects dropped out of the follow up at 3 months of first assessment. CONCLUSION Most of the patients value the doctor-patient relationship & their partners are also supportive regarding diagnosis and treatment of depression. However, most patients have erroneous beliefs regarding antidepressants per se which in turn influence the drug compliance.
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Affiliation(s)
- Kaustav Chakraborty
- Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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45
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Guadarrama-Cruz G, Alarcon-Aguilar FJ, Lezama-Velasco R, Vazquez-Palacios G, Bonilla-Jaime H. Antidepressant-like effects of Tagetes lucida Cav. in the forced swimming test. JOURNAL OF ETHNOPHARMACOLOGY 2008; 120:277-281. [PMID: 18782612 DOI: 10.1016/j.jep.2008.08.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 08/04/2008] [Accepted: 08/09/2008] [Indexed: 05/26/2023]
Abstract
AIM OF THE STUDY Tagetes lucida (Asteraceae), has been referred in Mexican traditional medicine for the treatment of different central nervous system (CNS) diseases, mainly depression. Nevertheless, the available scientific information about this species is scarce and there are no reports related to its possible effect on the CNS. In this work, the antidepressant-like effect of extract of Tagetes lucida was evaluated in rats, as well as its potential adverse effects on male sexual behavior (MSB). MATERIALS AND METHODS Antidepressant activity was studied using forced swimming test (FST), motor activity in the open-field test and on MSB in sexually experienced male. The aqueous extract of Tagetes lucida in doses of 5, 10, 50, 100 and 200mg/(kgday)(-1) were administered orally for 14 consecutive days and evaluated on day 14, 2h after the last dose treatment. Fluoxetine (10mg/(kgday)(-1), p.o.) was used as the control positive. RESULTS The aqueous extract (10, 50, 100mg/(kgday)(-1)) significantly reduced immobility and increased swimming without affecting climbing behavior in the FST. These same doses were not able to modify neither the motor activity nor the MSB. CONCLUSION These data indicate that the extract of Tagetes lucida possesses antidepressant-like properties in rats.
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Affiliation(s)
- G Guadarrama-Cruz
- Universidad Autonoma Metropolitana Iztapalapa, Mexico, D.F. CP 09340, Mexico
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Åkerblad AC, Bengtsson F, Holgersson M, von Knorring L, Ekselius L. Identification of primary care patients at risk of nonadherence to antidepressant treatment. Patient Prefer Adherence 2008; 2:379-86. [PMID: 19920985 PMCID: PMC2770387 DOI: 10.2147/ppa.s3511] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Poor adherence to antidepressant treatment is common, and results in increased disability and costs. Several factors are thought to influence patients' ability and willingness to adhere. So far, however, consensus is lacking regarding patient characteristics that predict nonadherence. The purpose of this study was to identify predictors of nonadherence to antidepressant treatment that can be ascertained at treatment start. METHOD The present study used data from a randomized controlled trial with the main objective of studying the effect of two different compliance-enhancing programs on treatment adherence and treatment response in 1031 primary care patients with major depression. In this study, logistic regression analyses were performed to examine patient- and illness-related characteristics potentially associated with nonadherence. RESULTS Nonadherence to antidepressant treatment was predicted by age under 35 or over 64 years, presence of personality disorder, sensation-seeking personality traits, substance abuse, and absence of concomitant medications. CONCLUSION Certain patient- and illness-related characteristics may imply an increased risk of nonadherence to antidepressant treatment. Giving special attention to subjects with such characteristics may improve adherence.
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Affiliation(s)
- Ann-Charlotte Åkerblad
- Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
- Correspondence: Ann-Charlotte Åkerblad, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala University, SE-751 85 Uppsala, Sweden, Email
| | - Finn Bengtsson
- Division of Clinical Pharmacology, Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | | | - Lars von Knorring
- Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Lisa Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
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Bosworth HB, Voils CI, Potter GG, Steffens DC. The effects of antidepressant medication adherence as well as psychosocial and clinical factors on depression outcome among older adults. Int J Geriatr Psychiatry 2008; 23:129-34. [PMID: 17563920 DOI: 10.1002/gps.1852] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the contribution of medication adherence to 12-month depression scores in the context of other psychosocial and clinical predictors of depression in a sample of older adults treated for depression. METHODS Secondary analysis of a prospective cohort study involving 241 older patients undergoing depression treatment using a standardized algorithm. Depression was measured at baseline and 12-months post-baseline. Baseline predictor variables included antidepressant adherence, barriers to antidepressant adherence, four domains of social support, basic and instrumental activities of daily living (BADLs and IADLs), and clinical factors including past history of depression and medical comorbidities. RESULTS Nearly 28% of patients reported being nonadherent with their antidepressant medication. In bivariate analyses, greater antidepressant medication nonadherence, more medication barriers, poorer subjective social support, less non-family interaction, greater BADL and IADL limitations, poor self-rated health, higher baseline depression scores, and not having diabetes were related to higher 12-month depression scores. In multivariable analyses, greater medication nonadherence, not having diabetes, poorer subjective social support, greater BADL limitations, and higher baseline depression scores were related to higher 12-month depression scores. CONCLUSION Interventions should be directed toward improving antidepressant adherence and modifiable psychosocial variables.
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Affiliation(s)
- Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham VAMC, NC 27705, USA.
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Bockting CLH, ten Doesschate MC, Spijker J, Spinhoven P, Koeter MWJ, Schene AH. Continuation and maintenance use of antidepressants in recurrent depression. PSYCHOTHERAPY AND PSYCHOSOMATICS 2008; 77:17-26. [PMID: 18087204 DOI: 10.1159/000110056] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Maintenance antidepressant (AD) medication is the most commonly used preventive strategy in a highly recurrent disease, i.e. depression. Little is known about the discontinuation of maintenance AD use and the association with recurrence in daily clinical practice. The purpose was to examine the discontinuation rate of maintenance AD in daily clinical practice in recurrently depressed patients and the associated risk of recurrence. METHODS Prospectively AD maintenance medication and recurrence were examined in 172 euthymic patients with recurrent depression. AD user profiles before recurrence (nonusers, intermittent users, continuous users) were examined and related to recurrence over a 2-year follow-up period. RESULTS Less than half of the patients (42%) used AD continuously. Taking into account the minimal required adequate used dosage (> or = 20 mg fluoxetine equivalent), only 26% of the patients used AD as recommended by international guidelines. Despite continuous use of AD, 60.4% relapsed in 2 years. This relapse rate was comparable to the rate of the intermittent users (63.6%). In patients who stopped taking AD after remission and who received additional preventive CT, the recurrence rates were significantly lower than in non-AD-using patients treated with usual care (8 vs. 46%). CONCLUSIONS The majority of recurrently depressed patients treated with AD discontinue maintenance AD therapy in daily primary and secondary clinical practice. AD seems to offer poor protection against relapse in this patient group. Patients who stopped using AD experienced less relapse, especially if they were treated with preventive CT. Alternative maintenance treatments (including preventive cognitive therapy after discontinuation of AD) should be studied in recurrently depressed patients with intermittent good remission, not only in secondary but also in primary care.
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Affiliation(s)
- Claudi L H Bockting
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Six-month compliance with antidepressant medication in the treatment of major depressive disorder. Int Clin Psychopharmacol 2008; 23:36-42. [PMID: 18090506 DOI: 10.1097/yic.0b013e3282f1c1d8] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The investigation of compliance in patients with major depressive disorder (in drop-outs versus completers and in first episode versus recurrent episode patients). A total of 85 outpatients with major depressive disorder were followed for 6 months. Different dimensions of compliance were investigated: drop-outs versus completers and their medication adherence (with electronic monitoring). General linear mixed models were applied to examine the time courses of adherence. Drop-out rates were higher in younger patients and in patients with a lower initial depression severity. The adherence during 6 months of treatment with selective serotonin reuptake inhibitors was above 80 in 70% of the patients. The adherence decreased by 2.5% per month and decreased more than three times more rapidly in drop-outs (from baseline to time of drop-out). A medical visit resulted in a temporary increase in pill intake. General linear mixed model analysis showed that the predicted outcome was worse in drop-outs than in completers and worse in recurrent episode patients than in first episode patients (the former showing a higher adherence). Adherence decreases with time during 6 months of treatment with antidepressants and is influenced by demographic and clinical variables. Completers show a higher adherence than drop-outs. The outcome was worse in recurrent episode patients than first episode patients although they had a higher adherence.
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LEHNER RENANAHK, DOPKE CYNTHIAA, COHEN KENNETH, EDSTROM KATHERINE, MASLAR MICHAEL, SLAGG NANCYB, YOHANNA DANIEL. Outpatient Treatment Adherence and Serious Mental Illness: A Review of Interventions. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2007. [DOI: 10.1080/15487760601166324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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