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dosReis S, Espinal Pena D, Fincannon A, Gorman EF, Amill-Rosario A. Discrete Choice Experiments to Elicit Patient Preferences for the Treatment of Major Depressive Disorder: A Systematic Review. THE PATIENT 2024:10.1007/s40271-024-00706-6. [PMID: 38969878 DOI: 10.1007/s40271-024-00706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Individual preferences for treatment options for major depressive disorder can impact therapeutic decision making, adherence, and ultimately outcomes. OBJECTIVES This systematic review of discrete choice experiments (DCEs) on patient preferences for major depressive disorder treatment assessed the range of DCE applications in major depressive disorder to document patient stakeholder involvement in DCE development and to identify the relative importance of treatment attributes. METHODS We searched MEDLINE via Ovid (1946-present), EMBASE (Elsevier interface), Cochrane Central Register of Controlled Trials (Wiley interface), and PsycINFO (EBSCO interface) databases on 29 May, 2024. Covidence software facilitated the review, which four members completed independently. The review was conducted in two phases: title and abstract and then a full-text review. We used an established quality reporting tool to evaluate selected articles. The Covidence extraction tool was adapted for this study. RESULTS A total of 19 articles were included in this review. Most studies elicited preferences for depression treatment (63.2%) and care delivery (10.5%). Two assessed willingness to pay. Individuals prefer a combination of medicine and counseling over each treatment alone. Treatment efficacy, relapse prevention, and symptom relief were among the most important attributes. Individuals were willing to accept larger risks to achieve symptom improvement. Few studies examined preference heterogeneity with latent subgroups. CONCLUSIONS Discrete choice experiments for major depressive disorder treatment preferences enable an assessment of trade-offs for first-line therapeutic options. Patient stakeholders are infrequently involved as collaborators in the DCE development. Few examined preference heterogeneity among subgroups.
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Affiliation(s)
- Susan dosReis
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, 21201, USA.
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, PAVE Center, Baltimore, MD, USA.
| | - Dafne Espinal Pena
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, 21201, USA
| | - Alexandra Fincannon
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, 21201, USA
| | - Emily F Gorman
- Health Sciences and Human Services Library, University of Maryland Baltimore, Baltimore, MD, USA
| | - Alejandro Amill-Rosario
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, 21201, USA
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, PAVE Center, Baltimore, MD, USA
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Tünneßen M, Hiligsmann M, Stock S, Vennedey V. Patients' preferences for the treatment of anxiety and depressive disorders: a systematic review of discrete choice experiments. J Med Econ 2020; 23:546-556. [PMID: 32011209 DOI: 10.1080/13696998.2020.1725022] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Matching available mental health services to patients' preferences, as well as is possible, may increase patient satisfaction and help increase adherence to certain treatments. This study systematically reviewed discrete-choice experiments (DCEs) on patients' preferences for treatment of depressive and anxiety disorders and assessed the relative importance of outcome, process and cost attributes to improve the current and future treatment situations.Methods: A systematic literature review using PubMed, EMBASE and PsychInfo was conducted to retrieve all relevant DCEs published up to 15 April 2019, eliciting patient preferences for treatment of depressive and anxiety disorders. Data were extracted using an extraction sheet, and attributes were classified into outcome, process and cost attributes. The relative importance of each attribute category was then assessed, and studies were evaluated according to their reporting quality, using validated checklists.Results: A total of 11 studies were identified for qualitative analysis. All studies received an aggregate score of 4 on the five-point PREFS checklist (Purpose, Respondents, Explanation, Findings and Significance). Most attributes were outcome related (52%), followed by process (42%) and cost (6%) attributes. Comparing the attribute categories and summing up the relative importance weights for each category within the studies, process attributes were ranked as most important, followed by cost and outcome attributes.Conclusions: In this systematic review, heterogeneous results were observed regarding the inclusion and framing of different attributes across studies. Overall, patients considered process and cost attributes to be more important than outcome attributes. Outcomes and process are important for patients, and thus clinicians should be particularly aware of this and take patients' preferences into account, although the attribute importance may depend on chosen attributes and related levels.
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Affiliation(s)
- Maike Tünneßen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI - Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Vera Vennedey
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
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Eveleigh R, Speckens A, van Weel C, Oude Voshaar R, Lucassen P. Patients' attitudes to discontinuing not-indicated long-term antidepressant use: barriers and facilitators. Ther Adv Psychopharmacol 2019; 9:2045125319872344. [PMID: 31516691 PMCID: PMC6724488 DOI: 10.1177/2045125319872344] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/02/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Long-term antidepressant use has increased exponentially, though this is not always according to guidelines. Our previous randomized controlled trial (RCT) showed that participants using antidepressants long term without a proper indication were apprehensive to stop: only half were willing to attempt to discontinue their antidepressant use. The objective of this study was to explore participants' barriers and facilitators for stopping long-term antidepressant use without a current proper indication. METHODS Semistructured interviews with participants from the intervention group of our RCT, a cluster-RCT in general practice in the Netherlands. The latter study was a stop trial with patients on long-term antidepressant use without a current indication (no psychiatric diagnosis). Participants of the intervention group of the RCT had been provided with advice to stop antidepressants. Participants of the current interview study were purposively sampled (from the intervention group of the RCT) to ensure diversity in age, sex, and intention to discontinue the antidepressant. Analysis was performed as an iterative process, based on the constant comparative method. Data collection proceeded until saturation was reached. RESULTS A total of 16 participants were interviewed. Fear (of recurrence, relapse, or to disturb the equilibrium) was the most important barrier; prior attempts fueled these anticipations. Also prominent as a barrier was the notion that antidepressants are necessary to counter a deficiency of serotonin. Facilitators were information on duration of usage given at the time of first prescription and confidence in a successful attempt. We found many participants struggling between barriers and facilitators to discontinue and participants not discontinuing while experiencing no barriers (ambivalence). CONCLUSION Fear is an important motive for patients considering discontinuation of antidepressants. Serotonin deficiency as explanation for antidepressant effectiveness promotes life-long use and hinders discontinuation of antidepressant treatment. The prospect of discontinuation at first prescription can facilitate a future discontinuation attempt. General practitioners should be aware of their patients' fears, expectations, and attributions toward antidepressant use/discontinuation, and of new developments in taper methods.
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Affiliation(s)
- Rhona Eveleigh
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anne Speckens
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Chris van Weel
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Richard Oude Voshaar
- University Centre for Psychiatry and Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), University Medical Centre Groningen, The Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
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Rodenburg-Vandenbussche S, Carlier IVE, van Vliet IM, van Hemert AM, Stiggelbout AM, Zitman FG. Clinical and sociodemographic associations with treatment selection in major depression. Gen Hosp Psychiatry 2018; 54:18-24. [PMID: 30048764 DOI: 10.1016/j.genhosppsych.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate treatment selection in a naturalistic sample of MDD outpatients and the factors influencing treatment selection in specialized psychiatric care. METHOD Multinomial Logistic Regression analysis investigated associations between treatment selection and patients' sociodemographic and clinical characteristics, using retrospective chart review data and Routine Outcome Monitoring (ROM) data of MDD outpatients. RESULTS Of the patients included for analyses (N = 263), 34% received psychotherapy, 32% received an antidepressant (AD) and 35% received a combination. Men were more likely than women to receive AD with reference to psychotherapy (ORAD = 5.57, 95% CI 2.38-13.00). Patients with severe depression and patients with AD use upon referral, prescribed by their general practitioner, were more likely to receive AD (ORsevere depression = 5.34, 95% CI 1.70-16.78/ORAD GP = 9.26, 95% CI 2.53-33.90) or combined treatment (ORsevere depression = 6.32, 95% CI 1.86-21.49/ORAD GP = 22.36, 95% CI 5.89-83.59) with respect to psychotherapy. More severe patients with AD upon referral received combined treatment less often compared to psychotherapy (OR = 0.14, 95% CI 0.03-0.68). CONCLUSION AD prescriptions in primary care, severity and gender influenced treatment selection for depressive disorders in secondary psychiatric care. Other factors such as the accessibility of treatment and patient preferences may have played a role in treatment selection in this setting and need further investigation.
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Affiliation(s)
| | - I V E Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - I M van Vliet
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - A M van Hemert
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - A M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - F G Zitman
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
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Hagerty BM, Williams RA, Aikens J, Bathish MA, West BT, Fuller DS, Kazemi J. Assessing Cognitive Representations of Antidepressants: Development and Validation of the Attitudes Toward Medication–Depression Inventory. West J Nurs Res 2018; 40:1220-1235. [DOI: 10.1177/0193945917705136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Antidepressant drugs represent the mainstay of treatment for depression; however, nonadherence is a major problem. Attitudes are predictors of long-term adherence and drive medication use. The Attitudes Toward Medication–Depression (ATM-D) Inventory was developed and tested with 131 patients in primary care settings who reported a diagnosis of depression. Content validity was assessed by experts with a 94.4% agreement on item relevancy. Exploratory factor analysis showed three factors (course of medication treatment, identity, and control) that accounted for 57% of the total variance in the final 17-item scale. The instrument demonstrated good internal consistency reliability (α = .76-.84) and test–retest reliability (α = .74-.83). Results support the construct validity and reliability of the instrument and revealed unique insights into patients’ cognitive representations of their antidepressants. This study supported that patients have cognitive representations related to depression and antidepressants that go beyond simple concerns about the effects of the medication.
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Affiliation(s)
| | | | | | | | | | | | - Joe Kazemi
- University of Michigan, Ann Arbor, MI, USA
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Batelaan NM, Bosman RC, Muntingh A, Scholten WD, Huijbregts KM, van Balkom AJLM. Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials. BMJ 2017; 358:j3927. [PMID: 28903922 PMCID: PMC5596392 DOI: 10.1136/bmj.j3927] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives To examine the risk of relapse and time to relapse after discontinuation of antidepressants in patients with anxiety disorder who responded to antidepressants, and to explore whether relapse risk is related to type of anxiety disorder, type of antidepressant, mode of discontinuation, duration of treatment and follow-up, comorbidity, and allowance of psychotherapy.Design Systematic review and meta-analyses of relapse prevention trials.Data sources PubMed, Cochrane, Embase, and clinical trial registers (from inception to July 2016).Study selection Eligible studies included patients with anxiety disorder who responded to antidepressants, randomised patients double blind to either continuing antidepressants or switching to placebo, and compared relapse rates or time to relapse.Data extraction Two independent raters selected studies and extracted data. Random effect models were used to estimate odds ratios for relapse, hazard ratios for time to relapse, and relapse prevalence per group. The effect of various categorical and continuous variables was explored with subgroup analyses and meta-regression analyses respectively. Bias was assessed using the Cochrane tool.Results The meta-analysis included 28 studies (n=5233) examining relapse with a maximum follow-up of one year. Across studies, risk of bias was considered low. Discontinuation increased the odds of relapse compared with continuing antidepressants (summary odds ratio 3.11, 95% confidence interval 2.48 to 3.89). Subgroup analyses and meta-regression analyses showed no statistical significance. Time to relapse (n=3002) was shorter when antidepressants were discontinued (summary hazard ratio 3.63, 2.58 to 5.10; n=11 studies). Summary relapse prevalences were 36.4% (30.8% to 42.1%; n=28 studies) for the placebo group and 16.4% (12.6% to 20.1%; n=28 studies) for the antidepressant group, but prevalence varied considerably across studies, most likely owing to differences in the length of follow-up. Dropout was higher in the placebo group (summary odds ratio 1.31, 1.06 to 1.63; n=27 studies).Conclusions Up to one year of follow-up, discontinuation of antidepressant treatment results in higher relapse rates among responders compared with treatment continuation. The lack of evidence after a one year period should not be interpreted as explicit advice to discontinue antidepressants after one year. Given the chronicity of anxiety disorders, treatment should be directed by long term considerations, including relapse prevalence, side effects, and patients' preferences.
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Affiliation(s)
- Neeltje M Batelaan
- Department of Psychiatry and Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, Amsterdam, Netherlands
- GGZ inGeest, Academic Outpatient Department for Anxiety Disorders, Amsterdam, Netherlands
| | - Renske C Bosman
- Department of Psychiatry and Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, Amsterdam, Netherlands
| | - Anna Muntingh
- Department of Psychiatry and Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, Amsterdam, Netherlands
- GGZ inGeest, Academic Outpatient Department for Anxiety Disorders, Amsterdam, Netherlands
| | - Willemijn D Scholten
- Department of Psychiatry and Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, Amsterdam, Netherlands
- GGZ inGeest, Academic Outpatient Department for Anxiety Disorders, Amsterdam, Netherlands
| | - Klaas M Huijbregts
- Department of Psychiatry and Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, Amsterdam, Netherlands
- GGZ inGeest, Academic Outpatient Department for Anxiety Disorders, Amsterdam, Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry and Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, Amsterdam, Netherlands
- GGZ inGeest, Academic Outpatient Department for Anxiety Disorders, Amsterdam, Netherlands
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Martinez KA, Fagerlin A, Witteman HO, Holmberg C, Hawley ST. What Matters to Women When Making Decisions About Breast Cancer Chemoprevention? PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 9:149-59. [PMID: 26115846 DOI: 10.1007/s40271-015-0134-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Despite the effectiveness of chemoprevention (tamoxifen and raloxifene) in preventing breast cancer among women at high risk for the disease, uptake is low. The objective of this study was to determine the tradeoff preferences for various attributes associated with chemoprevention among women not currently taking the drugs. METHODS We used rating-based conjoint analysis to evaluate the relative importance of a number of attributes associated with chemoprevention, including risk of side effects, drug effectiveness, time needed to take the drugs, and availability of a blood test to see if the drugs were working in an Internet sample of women. We generated mean importance values and part-worth utilities for all attribute levels associated with taking chemoprevention. We then used multivariable linear regression to examine attribute importance scores controlling for participant age, race, Hispanic ethnicity, educational level, and a family history of breast cancer. RESULTS Overall interest in taking chemoprevention was low among the 1094 women included in the analytic sample, even for the scenario in which participants would receive the greatest benefit and fewest risks associated with taking the drugs. Time needed to take the pill for it to work and 5-year risk of breast cancer were the most important attributes driving tradeoff preferences between the chemoprevention scenarios. CONCLUSIONS Interest in taking chemoprevention among this sample of women at average risk was low. Addressing women's concerns about the time needed to take chemoprevention for it to work may help clinicians improve uptake of the drugs among those likely to benefit.
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Affiliation(s)
- Kathryn A Martinez
- Ann Arbor VA Center for Clinical Management Research, Building 16, 4th Floor, 2800 Plymouth Road, Ann Arbor, MI, 48105, USA.
| | - Angela Fagerlin
- Ann Arbor VA Center for Clinical Management Research, Building 16, 4th Floor, 2800 Plymouth Road, Ann Arbor, MI, 48105, USA.,Division of General Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Holly O Witteman
- Department of Family and Emergency Medicine and Office of Education and Continuing Professional Development, Laval University, Quebec City, QC, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec City, QC, Canada
| | | | - Sarah T Hawley
- Ann Arbor VA Center for Clinical Management Research, Building 16, 4th Floor, 2800 Plymouth Road, Ann Arbor, MI, 48105, USA.,Division of General Medicine, University of Michigan, Ann Arbor, MI, USA
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Abstract
Adverse effects are common, bothersome, and a leading cause of discontinuation of treatment. The methodology for evaluating adverse effects of medications has been greatly neglected, however, especially in comparison to the methodology for assessment of efficacy of medications. Existing methods for assessment and reporting of adverse effects have important limitations leading to lack of much-needed data related to adverse effects. Lastly, there is little systematic research into management of most adverse effects. A series of recommendations are made in this article about how to improve identification, assessment, reporting, and management of adverse effects.
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Burton C, Cochran AJ, Cameron IM. Restarting antidepressant treatment following early discontinuation--a primary care database study. Fam Pract 2015; 32:520-4. [PMID: 26251027 DOI: 10.1093/fampra/cmv063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many patients in primary care stop antidepressant treatment after only one prescription, so do not benefit from treatment. Some patients who stop initial antidepressant treatment go on to restart it, but neither the incidence of restarting nor the probability that patients who restart treatment subsequently complete an adequate course of treatment is known. OBJECTIVE To examine subsequent antidepressant use in patients who discontinued treatment after only one antidepressant prescription. METHODS We used a primary care database (over 1.2 million records) to study patients who commenced treatment with an eligible antidepressant between April 2007 and March 2008 and who stopped treatment for at least 1 month after the first prescription. We examined their subsequent antidepressant prescriptions to estimate the probability of restarting antidepressant treatment, the likelihood of continuing subsequent treatment and the patient characteristics associated with these. RESULTS Out of 24817 patients, 6952 (28%) patients discontinued antidepressant treatment after the first prescription. The cumulative probability of restarting treatment after early discontinuation was 8.6% (95% confidence interval [CI] 8.0-9.3) after 1 month off-treatment, and 24.1% (22.9-25.2) after 9 months off-treatment. The probability of those who restarted treatment continuing for 6 months or more was 29.3% (26.5-32.5). CONCLUSIONS Few patients who stop antidepressant treatment after the first prescription subsequently complete an adequate treatment course within the next year. Initiatives to promote adherence to appropriate antidepressant treatment should begin during the first prescription.
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Lyubov ЕB, Ignatenko SA. [Evidence-based choice and antidepressants treatment in psychiatry]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:36-42. [PMID: 25909805 DOI: 10.17116/jnevro20151151236-42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression is a severe and usually recurrent mental disorder which leads to a prominent impairment of physical and social functioning, a reduced quality of life of the patients, implies as well an increased morbidity and mortality. Reducing the social-economic depression burden is possible in the optimization of decision-making process of antidepressant choice (including SSRIs and SNRIs) based on the evidence-based risk/benefit ratio and resource saving potential treatment involving target psychosocial interventions and monitoring of long-term treatment adherence.
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Affiliation(s)
- Е B Lyubov
- Moscow Research Institute of Psychiatry, Moscow
| | - S A Ignatenko
- Moscow Research Institute of Psychiatry, Moscow, Kamenev Tula Regional Clinical Psychiatric Hospital #1, Tula
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