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Wang L, Zhou L, Zhu Y, Yan J, Bu N, Fei W, Wu F. Trends in prescription therapy for adolescents with depression in nine major areas of China during 2017-2021. Front Psychiatry 2023; 14:1175002. [PMID: 37953934 PMCID: PMC10639118 DOI: 10.3389/fpsyt.2023.1175002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Objective To date, no national-scale drug usage survey for adolescents with depression has been conducted in China, and the purpose of this study was to examine the national trends in prescriptions in Chinese adolescent depression patients from 2017 to 2021. Methods Prescribing data were extracted from the Hospital Prescription Analysis Cooperative Project. The average number of patients per year, the cost of treatment, and the prescription patterns (monotherapy vs. combination therapy) were analyzed, and subgroup analyses were conducted depending on age, sex, and drug class. Results The study included 674,099 patients from 136 hospitals located in nine major areas of China. Of all patients, the proportion of adolescents increased from 1.63% in 2017 to 6.75% in 2021. Visits by adolescent depression patients increased from 1,973 in 2017 to 9,751 in 2021, and the corresponding cost increased from 607,598 Chinese Yuan in 2017 to 2,228,884 Chinese Yuan in 2021. The incidence of adolescent depression among female individuals was far beyond that among male individuals. Combination therapy was more frequent than monotherapy, and the most commonly prescribed drugs were antidepressants, antipsychotics, antiepileptics, and antianxietics. Despite the use of sertraline decreasing from 47.90 to 43.39%, it was the most frequently used drug. Conclusion In summary, the prescriptions and cost of treatment for adolescent depression patients both increased rapidly. The widespread use of those drugs with weak clinical evidence reflects the current state of China, which should arouse our attention. The study can provide references for clinical treatment decisions and a basis for more efficient allocation of healthcare resources by the government.
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Affiliation(s)
- Li Wang
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linpo Zhou
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yao Zhu
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing Yan
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Na Bu
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weidong Fei
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fan Wu
- Department of Pharmacy, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
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Goryunov AV, Golubeva NI, Shushpanova OV. [Experience of clinical use of fluvoxamine for the treatment of comorbid depression in childhood and adolescence]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:14-21. [PMID: 38127696 DOI: 10.17116/jnevro202312311214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To identify the frequency of administration of fluvoxamine, to determine the main targets of the drug and the expediency of its use in depression of various genesis in children and adolescents. MATERIAL AND METHODS To assess the frequency of prescribing fluvoxamine, 195 medical histories of patients who were inpatients in the children's department of the Mental Health Research Center in 2023 were analyzed. To assess the dynamics of depression during treatment with fluvoxamine, a clinical group was formed of 12 patients aged 10 to 15 years (age 13.1±3.6 years) who received fluvoxamine for the treatment of depression with comorbid obsessive-compulsive and anxiety-phobic disorders. Clinical and psychopathological, psychometric (Hamilton Depression Rating Scale - HDRS) and statistical research methods were used. RESULTS In total, in 2023, fluvoxamine was received by 20% (n=37) of all inpatient patients of child age (from 7 to 16 years). All patients received combination therapy. The therapeutic targets were comorbid depressive, obsessive-compulsive and anxiety symptoms developing in the structure of nosologically heterogeneous states, with the dominance of schizophrenic spectrum disorders. Against the background of the use of the drug fluvoxamine for 4 weeks in the clinical group, there was a significant reduction in depressive symptoms on the HDRS. Adverse events during complex therapy were observed in 20% of patients, but were not severe, did not require discontinuation of therapy and were unreliably associated with the use of fluvoxamine. CONCLUSION The use of the fluvoxamine provides reduction of depressive symptoms within the framework of various nosologies, and is characterized by sufficient safety. The variety of therapeutic targets of the fluvoxamine, including antidepressant, anti-anxiety, cognitive effects, is certainly a significant advantage of the studied fluvoxamine for use in childhood.
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Contingent self-worth and depression in early adolescents: The role of psychological inflexibility as a mediator. Acta Psychol (Amst) 2022; 230:103744. [PMID: 36113250 DOI: 10.1016/j.actpsy.2022.103744] [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: 12/07/2021] [Revised: 09/02/2022] [Accepted: 09/11/2022] [Indexed: 11/23/2022] Open
Abstract
This study investigated whether lower psychological flexibility (psychological inflexibility) mediates the relationship between contingent self-worth and depressive symptoms among Japanese adolescents. A total of 210 Japanese junior high school students aged 12 to 15 years (106 boys and 104 girls) were recruited for this study. Participants completed the Japanese adaptations of the Self-Worth Contingency Questionnaire, the Avoidance and Fusion Questionnaire for Youth, and the Depression Self-Rating Scale for Children. Results indicated that psychological inflexibility mediated the association between contingent self-worth and depressive symptoms. Specifically, contingent self-worth affected lower psychological flexibility, which influenced higher depressive symptoms. The results highlight the importance of fostering autonomy and promoting psychological flexibility to reduce the risk of depression among adolescents.
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Lam MK, Lam LT, Butler-Henderson K, King J, Clark T, Slocombe P, Dimarco K, Cockshaw W. Prescribing behavior of antidepressants for depressive disorders: A systematic review. Front Psychiatry 2022; 13:918040. [PMID: 36159914 PMCID: PMC9501861 DOI: 10.3389/fpsyt.2022.918040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/12/2022] [Indexed: 12/01/2022] Open
Abstract
Objective Guidelines for the prescription of antidepressants for Depressive Disorders (DD) have been in place for a long time. However, there is a lack of systematic information on the prescribing behavior of antidepressants in evidence-based clinical practice in psychopharmacotherapy of depressive disorders. This may suggest a lack of implementation of clinical guidelines by clinicians. Existing literature mainly focuses on specific issues or medications. To provide general information on the prescribing behavior of antidepressants for depressive disorders, a systematic review of available studies since 2013 was conducted. Methods and materials To ensure a structured and systematic approach for the literature search and subsequent review process, the PRISMA guidelines for systematic reviews were followed. Major medical and health and psychological databases were used for the literature search. These included Ebsco Host, OVID, PubMed, Science Direct, Scopus, and Web of Science. The online application "Covidence" was employed to manage the titles collected and the full articles retrieved from the initial literature search. Upon finalizing the list of selected studies, data extraction was then conducted using a build-in function of the Covidence platform with the required information pre-set on a template for data extraction. The extracted information was tabulated and summarized in a table. Results Forty-one studies were identified after an extensive search of the literature following the PRISMA guidelines. Of these, 37 quantitative studies providing useful information were systematically reviewed and information extracted. There was a high level of heterogeneity among these studies with different foci or characteristics. Most studies were conducted in or utilized data obtained from hospital and primary healthcare settings. SSRIs were the most commonly prescribed type of antidepressant in the past decade, particularly among younger patients. Among these studies, antidepressants were mainly prescribed by psychiatrists with some by other physicians and general practitioners. This might reflect differences in legislation regarding professional requirements for prescribers or clinical practices. Conclusions A few themes that would be considered important in terms of the effect of prescription behavior on depression, specifically children/adolescents, special target populations, and off-label prescription. The results highlighted the need for more studies on a community-based approach and the role of GPs in the treatment of DD.
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Affiliation(s)
- Mary K. Lam
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Lawrence T. Lam
- Faculty of Medicine, Macau University of Science and Technology, Macau, Macau SAR, China
- Specialty of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Jonathan King
- Lysn (A Danewell Health Company), Sydney, NSW, Australia
| | - Tahnee Clark
- Lysn (A Danewell Health Company), Sydney, NSW, Australia
| | - Peta Slocombe
- Lysn (A Danewell Health Company), Sydney, NSW, Australia
| | - Katherine Dimarco
- Lysn (A Danewell Health Company), Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Wendell Cockshaw
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
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Nagamitsu S, Kanie A, Sakashita K, Sakuta R, Okada A, Matsuura K, Ito M, Katayanagi A, Katayama T, Otani R, Kitajima T, Matsubara N, Inoue T, Tanaka C, Fujii C, Shigeyasu Y, Ishii R, Sakai S, Matsuoka M, Kakuma T, Yamashita Y, Horikoshi M. Adolescent Health Promotion Interventions Using Well-Care Visits and a Smartphone Cognitive Behavioral Therapy App: Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e34154. [PMID: 35604760 PMCID: PMC9171600 DOI: 10.2196/34154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 12/04/2022] Open
Abstract
Background Adolescent health promotion is important in preventing risk behaviors and improving mental health. Health promotion during adolescence has been shown to contribute to the prevention of late onset of the mental health disease. However, scalable interventions have not been established yet. Objective This study was designed to test the efficacy of two adolescent health promotion interventions: a well-care visit (WCV) with a risk assessment interview and counseling and self-monitoring with a smartphone cognitive behavioral therapy (CBT) app. Our hypothesis was that participants who had received both WCV and the CBT app would have better outcomes than those who had received only WCV or those who had not received any intervention. We conducted a prospective multi-institutional randomized controlled trial. Methods Participants were 217 adolescents aged 13-18 years. They were randomly divided into two intervention groups (WCV group and WCV with CBT app group) and a nonintervention group. WCV comprised a standardized physical examination along with a structured interview and counseling for youth risk assessment, which was designed with reference to the Guideline for Health Supervision of Adolescents of Bright Futures. A smartphone-based CBT program was developed based on the CBT approach. The CBT app comprised a 1-week psychoeducation component and a 1-week self-monitoring component. During the CBT program, participants created several self-monitoring sheets based on the CBT model with five window panels: event, thoughts, feelings, body response, and actions. The primary outcome was the change in scores for depressive symptoms. Secondary outcomes included changes in scores for self-esteem, quality of life, self-monitoring, and an adolescent health promotion scale. These outcomes were evaluated at baseline and at 1, 2, and 4 months after baseline. The exploratory outcome was the presence of suicidal ideation during the observation period. Intervention effects were estimated using mixed effect models. Results In total, 94% (204/217) of the participants completed the 4-month evaluation. Both intervention groups showed a significant effect in the form of reduced scores for depressive symptoms at 1 month in high school students; however, these effects were not observed at 2 and 4 months. The intervention effect was significantly more predominant in those scoring above cutoff for depressive symptoms. There was significantly less suicidal ideation in the intervention groups. As for secondary outcomes, there was significant increase in health promotion scale scores at the 4-month follow-up among junior high school students in the WCV group. Moreover, the CBT app was significantly effective in terms of obtaining self-monitoring skills and reducing depressive symptoms. Conclusions Although adolescent health promotion interventions may have short-term benefits, the frequency of WCV and further revision of the CBT app should be considered to evaluate long-term effectiveness. Trial Registration University Hospital Medical Information Network Clinical Trials Registry UMIN 000036343; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041246
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Affiliation(s)
- Shinichiro Nagamitsu
- Department of Pediatrics, Fukuoka University Faculty of Medicine, Fukuoka, Japan
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Ayako Kanie
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Kazumi Sakashita
- Department of Interdisciplinary Medicine, National Center for Child Health and Development, Setagaya, Japan
| | - Ryoichi Sakuta
- Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Ayumi Okada
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kencho Matsuura
- Department of Nursing, Fukuoka Prefectural University, Tagawa, Japan
| | - Masaya Ito
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Akiko Katayanagi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Kodaira, Japan
| | | | - Ryoko Otani
- Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Tasuku Kitajima
- Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Naoki Matsubara
- Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Takeshi Inoue
- Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Chie Tanaka
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Chikako Fujii
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshie Shigeyasu
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryuta Ishii
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Sayaka Sakai
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Michiko Matsuoka
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan
| | | | - Yushiro Yamashita
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Kodaira, Japan
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