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Rasmussen L, Jensen PB, Reutfors J, Furu K, Skurtveit S, Selmer R, Damkier P, Bliddal M, Wesselhoeft R. Treatment patterns of antidepressants in children and adolescents in Scandinavia. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02433-7. [PMID: 38683400 DOI: 10.1007/s00787-024-02433-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/01/2024] [Indexed: 05/01/2024]
Abstract
The aim of this study was to examine variations in use of antidepressants among children and adolescents in the three Scandinavian countries (Sweden, Norway, and Denmark). We identified new users of antidepressants (5-17 years) during 2007-2018 and described the annual incidence rate, treatment duration, concomitant psychotropic drug use, and the clinical setting of the prescribing physician (in Sweden and Denmark). Incident use of antidepressants increased by a factor 1.9 in Sweden, 1.3 in Norway and decreased by a factor 0.6 in Denmark during the study period. In Sweden, 58% of antidepressant users were covered by a prescription 12 months after initiation compared to 40% in Norway and 49% in Denmark. Also, 34% of Swedish antidepressant users were in continuous treatment after 12 months compared to 26% in Norway and 31% in Denmark. Concomitant use of other psychotropics was more common in Sweden (57%) than in Norway (37%) and Denmark (27%). During 2007-2018, clinicians from psychiatry settings initiated 75% of antidepressant treatments in Sweden, while this was the case for 50% of prescriptions in Denmark, although the proportion increased over time. The number of new antidepressant users is high and still rising in Sweden compared to Norway and Denmark. Swedish antidepressant users are more likely to use other psychotropics and to be covered by an antidepressant prescription after one year. Most antidepressants in Sweden are prescribed by physicians within psychiatric settings suggesting that they are based on specialized psychiatric evaluation.
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Affiliation(s)
- Lotte Rasmussen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, JB Winsløws Vej 19, 5000, Odense, Denmark.
| | - Peter Bjødstrup Jensen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, JB Winsløws Vej 19, 5000, Odense, Denmark
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kari Furu
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Svetlana Skurtveit
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Randi Selmer
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Per Damkier
- Department of Clinical Pharmacology, Odense University Hospital, 5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark
| | - Mette Bliddal
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, JB Winsløws Vej 19, 5000, Odense, Denmark
- OPEN Research Unit, Department of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark
| | - Rikke Wesselhoeft
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, JB Winsløws Vej 19, 5000, Odense, Denmark
- Research Unit of Child and Adolescent Mental Health, Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
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Zhao Y, Zhang Y, Yang L, Zhang K, Li S. Safety Profile of Selective Serotonin Reuptake Inhibitors in Real-World Settings: A Pharmacovigilance Study Based on FDA Adverse Event Reporting System. Ann Pharmacother 2024:10600280241231116. [PMID: 38407147 DOI: 10.1177/10600280241231116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed agents to treat depression. Considering the growth in antidepressant prescription rates, SSRI-induced adverse events (AEs) need to be comprehensively clarified. OBJECTIVE This study was to investigate safety profiles and potential AEs associated with SSRIs using the Food and Drug Administration Adverse Event Reporting System (FAERS). METHODS A retrospective pharmacovigilance analysis was conducted using the FAERS database, with Open Vigil 2.1 used for data extraction. The study included cases from the marketing date of each SSRI (ie, citalopram, escitalopram, fluoxetine, paroxetine, fluvoxamine, and sertraline) to April 30, 2023. We employed the reporting odds ratio and Bayesian confidence propagation neural network as analytical tools to assess the association between SSRIs and AEs. The Medical Dictionary for Regulatory Activities was used to standardize the definition of AEs. AE classification was achieved using system organ classes (SOCs). RESULTS Overall, 427 655 AE reports were identified for the 6 SSRIs, primarily associated with 25 SOCs, including psychiatric, nervous system, congenital, familial, genetic, cardiac, and reproductive disorders. Notably, sertraline (n = 967) and fluvoxamine (n = 169) exhibited the highest and lowest signal frequencies, respectively. All SSRIs had relatively strong signals related to congenital, psychiatric, and nervous disorders. CONCLUSIONS AND RELEVANCE Most of our findings are consistent with those reported previously, but some AEs were not previously identified. However, AEs attributed to SSRIs remain ambiguous, warranting further validation. Applying data-mining methods to the FAERS database can provide additional insights that can assist in appropriately utilizing SSRIs.
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Affiliation(s)
- Yi Zhao
- Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuzhou Zhang
- School of Information Engineering, Engineering University of People's Armed Police, Xi'an, China
| | - Lin Yang
- Department of Pharmacy, Xi'an Central Hospital, Xi'an, China
| | - Kanghuai Zhang
- Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Sha Li
- Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Jeon SM, Lim H, Cheon HB, Ryu J, Kwon JW. Assessing the Labeling Information on Drugs Associated With Suicide Risk: Systematic Review. JMIR Public Health Surveill 2024; 10:e49755. [PMID: 38289650 PMCID: PMC10865198 DOI: 10.2196/49755] [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] [Received: 06/08/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Drug-induced suicide (DIS) is a severe adverse drug reaction (ADR). Although clinical trials have provided evidence on DIS, limited investigations have been performed on rare ADRs, such as suicide. OBJECTIVE We aimed to systematically review case reports on DIS to provide evidence-based drug information. METHODS We searched PubMed to obtain case reports regarding DIS published until July 2021. Cases resulting from drugs that are no longer used or are nonapproved, substance use, and suicidal intentions were excluded. The quality of each case report was assessed using the CASE (Case Reports) checklist. We extracted data regarding demographics, medication history, suicide symptoms, and symptom improvement and evaluated the causality of DIS using the Naranjo score. Furthermore, to identify the potential suicidal risk of the unknown drugs, we compared the results of the causality assessment with those of the approved drug labels. RESULTS In 83 articles, we identified 152 cases involving 61 drugs. Antidepressants were reported as the most frequent causative drugs of DIS followed by immunostimulants. The causality assessment revealed 61 cases having possible, 89 cases having probable, and 2 cases having definite relationships with DIS. For approximately 85% of suspected drugs, the risk of suicidal ADRs was indicated on the approved label; however, the approved labels for 9 drugs, including lumacaftor/ivacaftor, doxycycline, clozapine, dextromethorphan, adalimumab, infliximab, piroxicam, paclitaxel, and formoterol, did not provide information about these risks. CONCLUSIONS We found several case reports involving drugs without suicide risk information on the drug label. Our findings might provide valuable insights into drugs that may cause suicidal ADRs.
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Affiliation(s)
- Soo Min Jeon
- Jeju Research Institute of Pharmaceutical Sciences, College of Pharmacy, Jeju National University, Jeju, Republic of Korea
| | - HyunJoo Lim
- College of Pharmacy, Kyungpook National University, Daegu, Republic of Korea
| | - Hyo-Bin Cheon
- College of Pharmacy, Kyungpook National University, Daegu, Republic of Korea
| | - Juhee Ryu
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Kyungpook National University, Daegu, Republic of Korea
| | - Jin-Won Kwon
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Daegu, Republic of Korea
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Wang Y, Lin Y, Lin Q, Liang H, Cai W, Jiang D. Exploring the association between selective serotonin reuptake inhibitors and rhabdomyolysis risk based on the FDA pharmacovigilance database. Sci Rep 2023; 13:12257. [PMID: 37507539 PMCID: PMC10382477 DOI: 10.1038/s41598-023-39482-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/26/2023] [Indexed: 07/30/2023] Open
Abstract
Rhabdomyolysis is a syndrome potentially fatal and has been associated with selective serotonin reuptake inhibitors (SSRIs) treatment in a few case reports. Herein, we purpose to establish the correlation between SSRIs use and rhabdomyolysis using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. We conducted an analysis on reports that were submitted to the FAERS database during the period between January 1, 2004, and December 31, 2022. Four algorithms, including reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN), and empirical Bayes geometric mean (EBGM), were employed to quantify the signals of rhabdomyolysis associated with SSRIs. In total, 16,011,277 non-duplicated reports were obtained and analyzed. Among 33,574 reports related to rhabdomyolysis, SSRIs were classified as primary suspected drug in 889 cases. Disproportionality analysis identified a positive signal between rhabdomyolysis and SSRIs (ROR: 2.86, 95% CI 2.67-3.05; PRR: 2.84, χ2: 1037.16; IC0.25 = 1.39; EBGM0.5 = 2.64). Among six SSRIs, fluvoxamine had the strongest signal (ROR: 11.64, 95% CI 8.00-16.93; PRR: 11.38, χ2: 265.51; IC0.25 = 2.41; EBGM0.5 = 8.31), whereas no significant signal of rhabdomyolysis was detected for paroxetine (ROR: 1.83, 95% CI 1.55-2.15; PRR: 1.82, χ2: 53.82; IC0.25 = 0.73; EBGM0.5 = 1.59). After excluding cases co-administered with statins, the signal of rhabdomyolysis associated with SSRIs remains significant. Our analysis reveals that there are differences in safety signals among six SSRIs in respect to the risk of rhabdomyolysis, with fluvoxamine displaying the highest risk signal, while paroxetine did not show a significant signal. Given the potentially lethal nature of rhabdomyolysis, healthcare professionals should inform patients of the potential risk of rhabdomyolysis associated with SSRIs prior to initiating treatment.
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Affiliation(s)
- Yan Wang
- Department of Pharmacy, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Yajing Lin
- Department of Pharmacy, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Qing Lin
- Department of Pharmacy, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Haiming Liang
- Department of Pharmacy, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Weiming Cai
- Department of Pharmacy, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China.
| | - Dongbo Jiang
- Department of Pharmacy, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China.
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