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Munkholm K, Ussing A, Brink M, Edemann-Callesen H, Canbolat SS, Christensen R, Dahl KS, Ebdrup BH, Jensen MEJ, Kierulf-Lassen C, Madsen GK, Nielsen SM, Paulsen CP, Rohde JF, Tarp S, Baandrup L. Minor tranquillizers for short-term treatment of newly onset symptoms of anxiety and distress: a systematic review with network meta-analysis of randomized trials. Eur Arch Psychiatry Clin Neurosci 2024; 274:475-486. [PMID: 37624378 PMCID: PMC10995039 DOI: 10.1007/s00406-023-01680-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023]
Abstract
Unspecific symptoms of anxiety and distress are frequently encountered in patients in both general practice and acute psychiatric services. Minor tranquillizers may be a treatment option when non-pharmacological interventions are insufficient or unavailable. We conducted a systematic review with network meta-analysis of the evidence for short-term (1-4 weeks) pharmacological treatment of newly onset symptoms of anxiety and distress. We searched the PsycInfo, MEDLINE, EMBASE and Cochrane Library databases and extracted data following a predefined hierarchy of outcomes. We assessed risk of bias using the Cochrane Risk of Bias tool and the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation framework (GRADE). We included 34 randomized trials comprising a total of 7044 patients with adjustment disorders or anxiety spectrum disorders. The network meta-analysis showed that regarding the critical outcome symptoms of anxiety within 1-4 weeks benzodiazepines (SMD - 0.58, 95% CI - 0.77 to - 0.40), quetiapine (SMD - 0.51, 95% CI - 0.90 to - 0.13) and pregabalin (SMD - 0.58, 95% CI - 0.87 to - 0.28) all performed better than placebo with no statistically significant difference between the drugs. Data on other important outcomes were inconsistently reported. Adverse effects varied, but overall, it was uncertain whether adverse effects differed between interventions. The evidence regarding the risk of dependence was uncertain, but dependence may be a concern in susceptible individuals even with short-term treatment. Overall, the certainty of the evidence according to GRADE was rated as low to very low across outcomes. Despite the limitations in the evidence, the results of this review can inform treatment guidelines, supporting clinicians in the choice of minor tranquillizer in this prevalent and help-seeking, clinically heterogeneous population.
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Affiliation(s)
- Klaus Munkholm
- Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark.
- Mental Health Centre Copenhagen, Hovedvejen 17, 1st Floor, 2000, Frederiksberg, Denmark.
| | - Anja Ussing
- Danish Health Authority, Copenhagen, Denmark
| | - Maria Brink
- Department of Psychiatry Odense, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | | | | | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Kristine Søgaard Dahl
- Mental Health Services in the Capital Region of Denmark, Mental Health Centre Sct. Hans, Roskilde, Denmark
| | - Bjørn H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Sabrina Mai Nielsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | | | - Jeanett Friis Rohde
- Danish Health Authority, Copenhagen, Denmark
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Simon Tarp
- Danish Health Authority, Copenhagen, Denmark
| | - Lone Baandrup
- Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
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Højlund M, Støvring H, Andersen K, Correll CU, Hallas J. Impact of low-dose quetiapine-use on glycosylated hemoglobin, triglyceride and cholesterol levels. Acta Psychiatr Scand 2023; 147:105-116. [PMID: 36281759 PMCID: PMC10099591 DOI: 10.1111/acps.13515] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/20/2022] [Accepted: 10/20/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Quetiapine use at standard doses has been associated with hyperglycemia and dyslipidemia. However, whether even frequently prescribed low-dose quetiapine results in significant metabolic disturbances remains unclear. Thus, this study aimed to investigate the association between off-label, low-dose quetiapine and changes in glycosylated hemoglobin (HbA1c) levels/lipid parameters. METHODS We identified new users of low-dose quetiapine (≤50 mg tablets) in Denmark 2008-2018 with measurements of HbA1c, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), or fasting triglycerides (fTG) within 365 days before and after quetiapine initiation. Mixed-effects linear regression models were used to estimate coefficients (β) with 95% confidence intervals (95%CIs) for change in cardiometabolic parameters after quetiapine initiation. Inverse probability weighting was used to mitigate selection bias. Higher doses of quetiapine (>50 mg) were included in sensitivity analyses. RESULTS Among 106,711 eligible new low-dose quetiapine users (median age = 45 years, females = 55%), low-dose quetiapine initiation was associated with increased fTG (β = 1.049[95%CI:1.027-1.072]) and decreased HDL-C (β = 0.982[0.978-0.986]). Although HbA1c did not change significantly and TC and LDL-C even decreased considering all subjects, all three metabolic parameters increased significantly among individuals with normal pre-quetiapine initiation levels. The adverse metabolic effect of quetiapine on HbA1c, TC, LDL-C, and HDL-C was dose-dependent, which was not the case for fTG. CONCLUSIONS Low-dose quetiapine was associated with a significant increase in fTG and decreases in HDL-C in all subjects, as well as with significant increases in HbA1c, TC, and LDL-C among those with normal baseline values. The risk of metabolic worsening with quetiapine was dose-dependent, except for fTG.
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Affiliation(s)
- Mikkel Højlund
- Department of Public Health, Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark.,Mental Health Services Region of Southern Denmark, Department of Psychiatry Aabenraa, Aabenraa, Denmark
| | - Henrik Støvring
- Department of Public Health, Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kjeld Andersen
- Department of Clinical Medicine, Psychiatry, University of Southern Denmark, Odense, Denmark.,Mental Health Services Region of Southern Denmark, Department of Psychiatry Odense, Odense, Denmark
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Glen Oaks, New York, USA.,Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York, USA.,Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Jesper Hallas
- Department of Public Health, Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark.,Department of Pharmacology, Odense University Hospital, Odense, Denmark
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Pirhonen E, Haapea M, Rautio N, Nordström T, Turpeinen M, Laatikainen O, Koponen H, Silvan J, Miettunen J, Jääskeläinen E. Characteristics and predictors of off-label use of antipsychotics in general population sample. Acta Psychiatr Scand 2022; 146:227-239. [PMID: 35781871 PMCID: PMC9543108 DOI: 10.1111/acps.13472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Increasing number of people have been prescribed antipsychotics (APs) off-label in recent decades. This study aimed to identify the characteristics and predictors of receiving prescription of antipsychotics off-label. METHODS The study sample was part of the Northern Finland Birth Cohort 1966 (n = 7071). Data included questionnaires and national register data. Information on prescribed medications was extracted from the national register. The sample was divided into three groups: Persons who had been prescribed APs off-label (n = 137), individuals with non-psychotic mental disorders without APs off label (n = 1478) and individuals who had been diagnosed with psychosis or bipolar disorder and who had been prescribed APs (n = 151). We compared sociodemographic, lifestyle and clinical characteristics between the off-label and the comparison groups using logistic regression. RESULTS The most common diagnoses in the off-label group were depression (n = 96, 70.1%) and anxiety (n = 55, 40.1%). Compared with individuals with non-psychotic mental disorders who were not prescribed APs off-label, individuals with prescribed off-label APs had a lower level of education, lower socioeconomic status, were less often married, had a higher level of somatic and psychiatric morbidity, were more often smokers and more often had a substance abuse disorder and heavy alcohol consumption. When comparing the off-label group to individuals with psychosis or bipolar disorder who used APs, there were less differences, though individuals with psychosis or bipolar disorder had more markers of morbidity and a lower level of education. CONCLUSION Individuals who had been prescribed APs off label had a higher level of mental and somatic morbidity and poorer socioeconomic status than individuals with non-psychotic mental disorders who did not use APs.
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Affiliation(s)
- Eero Pirhonen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
| | - Marianne Haapea
- Center for Life Course Health ResearchUniversity of OuluOuluFinland,Research Unit of Biomedicine, Medical Research Center Oulu and Oulu University HospitalUniversity of OuluOuluFinland,Department of PsychiatryOulu University HospitalOuluFinland
| | - Nina Rautio
- Center for Life Course Health ResearchUniversity of OuluOuluFinland,Research Unit of Biomedicine, Medical Research Center Oulu and Oulu University HospitalUniversity of OuluOuluFinland
| | - Tanja Nordström
- Center for Life Course Health ResearchUniversity of OuluOuluFinland,Research Unit of Biomedicine, Medical Research Center Oulu and Oulu University HospitalUniversity of OuluOuluFinland,Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population StudiesUniversity of OuluOuluFinland
| | - Miia Turpeinen
- Research Unit of Biomedicine, Medical Research Center Oulu and Oulu University HospitalUniversity of OuluOuluFinland
| | - Outi Laatikainen
- Research Unit of Biomedicine, Medical Research Center Oulu and Oulu University HospitalUniversity of OuluOuluFinland
| | - Hannu Koponen
- Helsinki University Hospital, PsychiatryUniversity of HelsinkiHelsinkiFinland
| | - Jenni Silvan
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
| | - Jouko Miettunen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland,Research Unit of Biomedicine, Medical Research Center Oulu and Oulu University HospitalUniversity of OuluOuluFinland
| | - Erika Jääskeläinen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland,Research Unit of Biomedicine, Medical Research Center Oulu and Oulu University HospitalUniversity of OuluOuluFinland,Department of PsychiatryOulu University HospitalOuluFinland
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