La evolución de la prescripción y los costes de los antidepresivos en un área de Atención Primaria (1996-2001)

[Medicalization of life at the GP level: Where are we headed to?]

El poder de la medicina ha hecho atractiva la idea de «medicalizar» aspectos de la vida que se pueden percibir como problemas médicos aun sin serlo. La medicina, como reflejo de la cultura del bienestar, genera en ocasiones falsas necesidades, y aspectos de la vida cotidiana son medicalizados con el pretexto de tratar falsas enfermedades como astenia primaveral y timidez, o procesos biológicos naturales como la menopausia.

A pesar del mayor bienestar material, cada día atendemos a más personas que se quejan de malestares que quizá tengan más que ver con «estar mal» que con auténticas «enfermedades». La lista puede ser interminable: tristeza, niños hiperactivos, vigorexias o adolescentes problemáticos, entre otros. En este artículo se revisan algunas intervenciones que desde la consulta contribuyen a fomentar dichas situaciones. La adversidad cotidiana adquiere hoy rango de enfermedad, de ahí el notable aumento de las consultas en los diferentes dispositivos sanitarios.

Follow up of patients who start treatment with antidepressants: treatment satisfaction, treatment compliance, efficacy and safety

BACKGROUND

Measuring satisfaction with treatment has proved useful to ascertain the treatment features that are most important to the patients, and to explain increased treatment compliance. However, there are few studies that relate satisfaction to other clinical or self-perceived health status indicators. Recent studies have shown the close relationship between satisfaction with treatment, treatment compliance, and effectiveness. This study attempts to design and validate a scale to evaluate satisfaction with antidepressant drug therapy, assess treatment compliance (self-reported, validated questionnaire, drug accountability and electronic monitorization system), assess efficacy in reducing depressive symptoms and safety in patients who initiate antidepressant drug therapy, as well as to establish predictors of satisfaction, compliance and effectiveness with these drugs.

METHODS/DESIGN

This is an observational longitudinal study with a cohort of adults initiating treatment with antidepressant drugs. A multi-centre study will be performed in which 20 Primary Care practices from Castilla-La Mancha are expected to participate. An initial interview and follow-up visits at 15 days, 1, 3, 6, 9 and 12 months will be conducted with all study participants. 706 subjects will be studied (95% confidence interval, precision ± 3%, expected rate of non-compliance 50%, expected non-responders and lost to follow up rate 15%). The following measurements will be performed: development and validation of a scale of satisfaction with antidepressant therapy, participant and antidepressant characteristics, treatment compliance evaluation (Haynes-Sackett Test, Morisky-Green Test, drug accountability and Medication Event Monitoring System), depression symptom reduction (Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale), observation of adverse effects, and beliefs about treatment (The Beliefs about Medicines Questionnaire).

DISCUSSION

Antidepressant drugs are an extraordinarily important therapeutic group in the pharmacy composition; economic repercussions and social impact associated to their use is clear. Despite their well-established efficacy in clinical trials, treatment non-compliance is a major obstacle to their effectiveness in clinical practice. The proposed study brings about useful conclusions to improve the results of these drugs. Additionally, devising a scale specifically designed to evaluate satisfaction with antidepressant treatment could be of interest in healthcare outcomes research.