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Knigge T. Antidepressants - The new endocrine disruptors? The case of crustaceans. Mol Cell Endocrinol 2024; 583:112155. [PMID: 38185462 DOI: 10.1016/j.mce.2024.112155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/31/2023] [Accepted: 01/05/2024] [Indexed: 01/09/2024]
Abstract
Antidepressants are high-volume pharmaceuticals that accumulate to concentrations in the μg·L-1 range in surface waters. The release of peptide hormones via neurosecretory cells appears as a natural target for antidepressants. Here I review research that suggests that antidepressants indeed disrupt endocrine signalling in crustaceans, by acting on the synthesis and release of neurohormones, such as crustacean hyperglycaemic hormone, moult inhibiting hormone and pigment dispersing hormone in decapods, as well as methyl farnesoate in Daphnids. Hence, antidepressants can affect hormonal regulation of physiological functions: increase in energy metabolism and activity, lowered ecdysteroid levels, potentially disrupting moult and somatic growth, reducing colour change capacity and compromising camouflage, as well as induction of male sex determination. Several studies further suggest effects of antidepressants on crustacean reproduction, but the hormonal regulation of these effects remains elusive. All things considered, a body of evidence strongly suggests that antidepressants are endocrine disrupting compounds in crustaceans.
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Affiliation(s)
- Thomas Knigge
- Normandie Univ, Unilehavre, FR CNRS 3730 Sciences Appliquées à L'Environnement, UMR-I02, Environmental Stress and Biomonitoring of Aquatic Environments, University of Le Havre Normandy, France.
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Cen M, Jiang G, Zhao Y, Yu Z, Li M. Prevalence of inappropriateness of elemene injection for hospitalized cancer patients: a multicenter retrospective study. Front Pharmacol 2024; 15:1334701. [PMID: 38464712 PMCID: PMC10920215 DOI: 10.3389/fphar.2024.1334701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/15/2024] [Indexed: 03/12/2024] Open
Abstract
Background: Elemene injection could provide clinical benefit for the treatment of various cancers, but the clinical evidence is weak. Thus, its wide use in China has raised concerns about the appropriateness of its use. Methods: This was a multicenter retrospective study to evaluate the prevalence of inappropriateness of elemene injection for hospitalized cancer patients. Patients who met the inclusion criteria were retrospectively included, and demographic characteristics were extracted from the hospital information systems. The inappropriateness of elemene injection use was assessed using the preset criteria, and the prevalence was calculated. Multivariate logistic analysis was applied to identify any factors associated with inappropriate use. Results: A total of 275 patients were included in the analysis. The median age was 62 years, and 30.9% were females. The most common cancer was lung cancer (24.0%), and 68.2% of the patients were receiving chemotherapy. The overall prevalence of inappropriateness was 61.8%. The most common reason for inappropriateness was inappropriate indications, and the second was inappropriate doses. Age and oncological department were significant risk factors associated with inappropriate use, while lung cancer, liver cancer and admission to cardiothoracic surgery were associated with a low risk of inappropriate use. Conclusion: The prevalence of inappropriateness among hospitalized elemene injection users was high. More efforts, especially those to improve the appropriateness of indications, should be made to improve the rational use of elemene, as well as other complementary medicines. Physicians should take caution to avoid inappropriate use when prescribing drugs with limited clinical evidence.
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Affiliation(s)
- Mingzheng Cen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Guojun Jiang
- Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Yuhua Zhao
- Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Zhenwei Yu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Minxian Li
- Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
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Wu J, Zhang HL, Guo S, Li X, Dong T, Zhu Y, Tsim KWK. Acori Tatarinowii Rhizoma prevents the fluoxetine-induced multiple-drug resistance of Escherichia coli against antibiotics. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 123:155232. [PMID: 38006809 DOI: 10.1016/j.phymed.2023.155232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/12/2023] [Accepted: 11/18/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND In treating depression, the residual anti-depressant in gut interacts with the microbiome, leading to the appearance of multiple drug resistant (MDR) mutants, which poses a challenge for the treatment of infectious complications. Strategy is needed to combat this issue. Acori Tatarinowii Rhizoma (ATR, rhizome of Acorus tatarinowii Schott, Araceae), a traditional Chinese medicine, has been widely used for treatment of neurological disorders and gastrointestinal digestive disease in China. Here, ATR was demonstrated an excellent MDR-preventing effect in fluoxetine-induced Escherichia coli (E. coli). AIM OF THE STUDY This study aimed to reveal the effective role of ATR and its signaling cascades involved in preventing fluoxetine-induced MDR. MATERIALS AND METHODS The water extract of ATR was co-applied with sub-minimum inhibitory concentration (100 mg/l) of fluoxetine in E. coli to evaluate its anti-MDR potential. Formation of reactive oxygen species (ROS) and expression of MDR-related genes in bacteria were measured by dichloro-dihydro-fluorescein diacetate assay and real-time PCR, respectively. Two fluorescent dyes, 1-N-phenylnapthylamine and 3,3'-dipropylthiadicarbocyanine were used to analyze the outer membrane permeability and inner membrane depolarization of E. coli. The accumulation of fluoxetine in the treated E. coli was determined via HPLC. The active fraction of ATR was identified. RESULTS The water extract of ATR significantly decreased the number of MDR mutants induced by fluoxetine and had half effective concentrations (EC50) of 55.5 μg/ml and 16.8 μg/ml for chloramphenicol and tetracycline, respectively. ATR robustly reversed the fluoxetine-induced superoxide response and membrane damage in E. coli. In addition, the inclusion of ATR significantly reduced the accumulation of fluoxetine in E. coli. After further fractionation, the polysaccharide of ATR was demonstrated as the fraction with the most significant anti-MDR activity. CONCLUSIONS This is the first report to investigate the MDR-preventing effect of ATR. The results of this study proposed ATR as an excellent herbal product to prevent MDR issues, as induced by fluoxetine, with the potential to reduce the side effects during the drug therapy of depression.
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Affiliation(s)
- Jiahui Wu
- Division of Life Science, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Hoi Lam Zhang
- Division of Life Science, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Suisui Guo
- Division of Life Science, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Xin Li
- Jiangsu Key Laboratory for High Technology Research of TCM Formulae and Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Nanjing University of Chinese Medicine, Nan Jing, Jiangsu Province, China
| | - Tingxia Dong
- Division of Life Science, The Hong Kong University of Science and Technology, Hong Kong, China; Shenzhen Key Laboratory of Edible and Medicinal Bioresources, HKUST Shenzhen Research Institute, Shenzhen, China
| | - Yue Zhu
- Jiangsu Key Laboratory for High Technology Research of TCM Formulae and Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Nanjing University of Chinese Medicine, Nan Jing, Jiangsu Province, China
| | - Karl Wah Keung Tsim
- Division of Life Science, The Hong Kong University of Science and Technology, Hong Kong, China; Shenzhen Key Laboratory of Edible and Medicinal Bioresources, HKUST Shenzhen Research Institute, Shenzhen, China.
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Yin J, Song X, Wang C, Lin X, Miao M. Escitalopram versus other antidepressive agents for major depressive disorder: a systematic review and meta-analysis. BMC Psychiatry 2023; 23:876. [PMID: 38001423 PMCID: PMC10675869 DOI: 10.1186/s12888-023-05382-8] [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: 07/08/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Escitalopram is selective serotonin reuptake inhibitors (SSRIs) and one of the most commonly prescribed newer antidepressants (ADs) worldwide. We aimed to explore the efficacy, acceptability and tolerability of escitalopram in comparison with other ADs in the acute-phase treatment of major depressive disorder (MDD). METHODS Medline/PubMed, EMBASE, the Cochrane Library, CINAHL, and Clinical Trials.gov were searched from inception to July 10, 2023. Trial databases of drug-approving agencies were hand-searched for published, unpublished and ongoing controlled trials. All randomized controlled trials comparing escitalopram against any other antidepressant for patients with MDD. Responders and remitters to treatment were calculated on an intention-to-treat basis. For dichotomous data, risk ratios (RRs) were calculated with 95% confidence intervals (CI). Continuous data were analyzed using standardized mean differences (with 95% CI) using the random effects model. RESULTS A total of 30 studies were included in this meta‑analysis, among which sixteen trials compared escitalopram with another SSRI and 14 compared escitalopram with a newer AD. Escitalopram was shown to be significantly more effective than citalopram in achieving acute response (RR 0.67, 95% CI 0.50-0.87). Escitalopram was also more effective than citalopram in terms of remission (RR 0.53, 95% CI 0.30-0.93). CONCLUSIONS Escitalopram was superior to other ADs for the acute phase treatment of MDD in terms of efficacy, acceptability and tolerability. However, no significant difference was found between escitalopram and other ADs in early response or follow-up response to treatment of MDD.
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Affiliation(s)
- Juntao Yin
- Department of Pharmacy, Huaihe Hospital, Henan University, Kaifeng, China
- National International Cooperation Base of Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, 450046, China
| | - Xiaoyong Song
- Department of Pharmacy, Huaihe Hospital, Henan University, Kaifeng, China
| | - Chaoyang Wang
- Department of General Surgery, Huaihe Hospital, Henan University, Kaifeng, China
| | - Xuhong Lin
- Department of Clinical Laboratory, Huaihe Hospital, Henan University, Henan, China.
| | - Mingsan Miao
- National International Cooperation Base of Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, 450046, China.
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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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Yao D, He W, Hu Y, Yuan Y, Xu H, Wang J, Dai H. Prevalence and influencing factors of probiotic usage among colorectal cancer patients in China: A national database study. PLoS One 2023; 18:e0291864. [PMID: 37733795 PMCID: PMC10513277 DOI: 10.1371/journal.pone.0291864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 09/07/2023] [Indexed: 09/23/2023] Open
Abstract
Probiotics have become increasingly popular among cancer patients. However, there is limited data from a real-world setting. This study aims to conduct a retrospective analysis to understand the trend of probiotic prescriptions in Chinese colorectal cancer patients. The Mann-Kendall and Cochran-Armitage trend test was applied to estimate the trend significance. Gephi software identified the combination of probiotic strains. The binary logistic regression investigated influence factors, and Spearman's rank correlation coefficient calculated correlations between probiotics and antitumor drug usage. The probiotic prescription percentage increased from 3.3% in 2015 to 4.2% in 2021 (Z = 12.77, p < 0.001). Although 48.3% of probiotic prescriptions had no indication-related diagnosis, diarrhea (OR 10.91, 95% CI 10.57-11.26) and dyspepsia (3.97, 3.82-4.12) included prescriptions most likely to contain probiotics. Prescriptions from the tertiary hospital (1.43,1.36-1.50), clinics (1.30, 1.28-1.33), and senior patients (1.018 per year, 1.017-1.019) were more likely to contain probiotics. Most probiotic prescriptions (95.0%) contained one probiotic product but multiple strains (69.3%). Enterococcus faecalis (49.7%), Lactobacillus acidophilus (39.4%), and Clostridium butyricum (27.9%) were the most prescribed strains. The probiotics co-prescribed with antitumor agents increased rapidly from 6.6% to 13.8% in seven years (Z = 15.31, p < 0.001). Oral fluorouracil agents (2.35, 2.14-2.59), regorafenib (1.70,1.27-2.26), and irinotecan (1.27,1.15-1.41) had a higher probability to co-prescribed with probiotics. There was no correlation between probiotic strain selection and specific antitumor drug use. The increasing prescription of probiotics in colorectal cancer patients in China may be related to treating the gastrointestinal toxicity of anti-cancer drugs. With unapproved indications and a lack of strain selectivity, evidence-based guidelines are urgently needed to improve probiotic use in this population.
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Affiliation(s)
- Difei Yao
- Department of Pharmacy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Research Center for Clinical Pharmacy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei He
- Department of Pharmacy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Research Center for Clinical Pharmacy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yangmin Hu
- Department of Pharmacy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Research Center for Clinical Pharmacy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ying Yuan
- Department of Medical Oncology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Cancer Prevention and Intervention, Cancer Institute, Ministry of Education, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Huimin Xu
- Department of Pharmacy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Research Center for Clinical Pharmacy, Zhejiang University, Hangzhou, Zhejiang, China
| | - Juan Wang
- Department of Medical Oncology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Haibin Dai
- Department of Pharmacy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Research Center for Clinical Pharmacy, Zhejiang University, Hangzhou, Zhejiang, China
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Tiguman GMB, Hoefler R, Silva MT, Lima VG, Ribeiro-Vaz I, Galvão TF. Prevalence of antidepressant use in Brazil: a systematic review with meta-analysis. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 46:e20233095. [PMID: 37718462 PMCID: PMC11189131 DOI: 10.47626/1516-4446-2023-3095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/27/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To estimate the prevalence of antidepressant use in Brazil. METHODS We conducted a systematic review with searches in MEDLINE, Embase, Scopus, LILACS, and SciELO up to May 2023. Two researchers independently selected studies, extracted data, and assessed the methodological quality. We pooled the prevalence of antidepressant use using meta-analyses of proportions (Freeman-Tukey transformation) and estimated heterogeneity by the I2 statistic. OR meta-analyses of antidepressant use by sex were calculated (men as reference) and between-study variation was explored by meta-regressions. RESULTS Out of 3,299 records retrieved, 23 studies published in 28 reports were included, with a total of 75,061 participants. The overall prevalence of antidepressant use was 4.0% (95%CI 2.7-5.6%; /² = 98.5%). Use of antidepressants in the previous 3 days was higher in women (12.0%; 95%CI 9.5-15.1%; /² = 0%) than men (4.6%; 95%CI 3.1-6.8%; /² = 0%) (p < 0.001; OR = 2.82; 95%CI 1.72-4.62). Gender differences were particularly higher for antidepressant use in the previous year (women: 2.3%; 95%CI 1.6-3.1; /² = 37.6% vs. men: 0.5%; 95%CI 0.2-1.0%; /² = 0%, p < 0.001; OR = 4.18; 95%CI 2.10-8.30). Between-study variation in the overall prevalence of antidepressant use significantly increased with mean participant age (p = 0.035; residual /² = 0%; regression coefficient = 0.003). CONCLUSION Four out of every 100 Brazilians used antidepressants in this 3-decade assessment. Use increased with age and was more prevalent in women compared to men. REGISTRATION NUMBER PROSPERO CRD42022345332.
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Affiliation(s)
| | - Rogério Hoefler
- Departamento de Medicina da Comunidade, Informação e Decisão em Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Marcus Tolentino Silva
- Departamento de Saúde Coletiva, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, Brazil
| | - Vanessa Gomes Lima
- Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Inês Ribeiro-Vaz
- Unidade de Farmacovigilância do Porto, Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Taís Freire Galvão
- Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Lincoln TM, Sommer D, Quazzola M, Witzgall T, Schlier B. Predictors of successful discontinuation of antipsychotics and antidepressants. Psychol Med 2023; 53:3085-3095. [PMID: 34937582 PMCID: PMC10235642 DOI: 10.1017/s0033291721005146] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/15/2021] [Accepted: 11/24/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND To offer support for patients who decide to discontinue antipsychotic and antidepressant medication, identifying which potentially modifiable factors correlate with discontinuation success is crucial. Here, we analyzed the predictive value of the professional support received, circumstances prior to discontinuation, a strategy of discontinuation, and use of functional and non-functional coping strategies during discontinuation on self-reported discontinuation success and on objective discontinuation. METHODS Patients who had attempted discontinuing antipsychotics (AP) and/or antidepressants (AD) during the past 5 years (n = 316) completed an online survey including questions on subjective and objective discontinuation success, sociodemographic, clinical and medication-related factors, and scales to assess the putative predictors. RESULTS A regression model with all significant predictors explained 20-30% of the variance in discontinuation success for AD and 30-40% for AP. After controlling for baseline sociodemographic, clinical and medication-related factors, the most consistent predictor of subjective discontinuation success was self-care behavior, in particular mindfulness, relaxation and making use of supportive relationships. Other predictors depended on the type of medication: For AD, good alliance with the prescribing physician predicted higher subjective success whereas gradual tapering per se was associated with lower subjective success and a lower chance of full discontinuation. In those tapering off AP, leaving time to adjust between dose reductions was associated with higher subjective success and fewer negative effects. CONCLUSIONS The findings can inform evidence-based clinical guidelines and interventions aiming to support patients during discontinuation. Further studies powered to take interactions between variables into account are needed to improve the prediction of successful discontinuation.
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Li G, Wang Q. Analysis of the clinical characteristics of adult patients with hangman's fractures: A retrospective study based on multicenter clinical data. Front Surg 2023; 10:949987. [PMID: 37082367 PMCID: PMC10110880 DOI: 10.3389/fsurg.2023.949987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 03/24/2023] [Indexed: 04/09/2023] Open
Abstract
BackgroundThere are few reports on the clinical characteristics of adult patients with hangman's fractures.MethodsThe clinical data of adult patients were collected from the hangman's fracture database of 7 medical centers. Data on patients who met the inclusion and exclusion criteria were retrospectively analyzed. Data, including gender, age, mechanism of injury, fracture classification, and treatment, were statistically analyzed.ResultsA total of 216 eligible patients (160 males and 56 females, with a mean age of 49.7 years) were selected. There was no statistically significant difference in gender distribution of different age groups. The male-to-female ratio was similar in the young group (18–44 years) and the middle-aged group (45–64 years) (both about 3:1) but decreased in the elderly group (65 years and above) (about 2:1). Overall, high-energy injury was the main mechanism of injury. There was a statistically significant difference in the percentage of patients with high-energy injury in various age groups (the highest in the young group, and the lowest in the elderly group). Overall, unstable fracture was the main fracture type, with a higher proportion in the young and elderly groups than that in the middle-aged group, but there was no statistically significant difference. From the perspective of treatment options, the percentage of patients receiving surgery was higher in the young and elderly groups than that in the middle-aged group.ConclusionHangman's fracture is predominant in males of all age groups, with high-energy injury as the main mechanism of injury. Unstable fracture is common fracture type. The percentage of patients receiving surgery in the young and elderly groups is higher than that in the middle-aged group, which may be correlated with the high incidence of unstable fracture and the life characteristics of the patients in the young and elderly age groups.
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Cavanah LR, Goldhirsh JL, Huey LY, Piper BJ. Specialty-type and state-level variation in paroxetine use among older adult patients. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.15.23285973. [PMID: 36824839 PMCID: PMC9949222 DOI: 10.1101/2023.02.15.23285973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Introduction Paroxetine is an older "selective" serotonin reuptake inhibitor (SSRI) that is notable for its lack of selectivity, resulting in a cholinergic adverse-effect profile, especially among older adults (65+). Methods Paroxetine prescription rates and costs per state were ascertained from the Medicare Specialty Utilization and Payment Data. States' annual prescription rate, corrected per thousand Part D enrollees, outside 95% confidence interval were considered significantly different from the average. Results There was a steady decrease in paroxetine prescriptions (-34.52%) and spending (-16.69%) from 2015-2020 but a consistent, five-fold state-level difference. From 2015-2020, Kentucky (194.9, 195.3, 182.7, 165.1, 143.3, 132.5) showed significantly higher prescriptions rates relative to the national average, and Hawaii (42.1, 37.9, 34.3, 31.7, 27.7, 26.6) showed significantly lower prescription rates. North Dakota was often a frequent elevated prescriber of paroxetine (2016: 170.7, 2018: 143.3), relative to the average. Neuropsychiatry and geriatric medicine frequently prescribed the largest amount of paroxetine prescriptions, relative to the number of providers in that specialty, from 2015-2020. Discussion Despite the American Geriatrics Society prohibition against paroxetine use in the older adults and many effective treatment alternatives, paroxetine was still commonly used in this population, especially in Kentucky and North Dakota and by neuropsychiatry and geriatric medicine. These findings provide information on the specialty types and states where education and policy reform would likely have the greatest impact on improving adherence to the paroxetine prescription recommendations.
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Affiliation(s)
| | - Jessica L. Goldhirsh
- Geisinger Commonwealth School of Medicine, Scranton, PA
- Behavioral Health Initiative, Scranton, PA
| | - Leighton Y. Huey
- Geisinger Commonwealth School of Medicine, Scranton, PA
- Behavioral Health Initiative, Scranton, PA
| | - Brian J. Piper
- Geisinger Commonwealth School of Medicine, Scranton, PA
- Center for Pharmacy Innovation and Outcomes, Forty Fort, PA
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Hoefler R, Tiguman GMB, Galvão TF, Ribeiro-Vaz I, Silva MT. Trends in sales of antidepressants in Brazil from 2014 to 2020: A time trend analysis with joinpoint regression. J Affect Disord 2023; 323:213-218. [PMID: 36436765 DOI: 10.1016/j.jad.2022.11.069] [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: 05/25/2022] [Revised: 11/03/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aimed to investigate the trends in antidepressants sales in Brazil. METHODS We performed a joinpoint analysis of antidepressants sales in Brazil from 2014 to 2020, recorded in the Brazilian National Controlled Products Management System. The primary outcomes were the defined daily dose per 1000 inhabitants per day (DID) and the market shares for each antidepressant per year. We used joinpoint regression to assess the changes in antidepressant consumption in DID to obtain the average annual percent change (AAPC) and 95 % confidence intervals (95 % CI). Changes in market shares were tested by chi-square trend test (p < 0.05 as significant). RESULTS From 2014 to 2020, 42,252,989 antidepressant sales were recorded in the system. Antidepressant sales increased from 13.7 to 33.6 DID in the period (AAPC: 15.7; 95 % CI: 13.0-18.4; p < 0.001); the largest increases were observed for serotonin reuptake inhibitors and 'other' antidepressants (including serotonin-norepinephrine reuptake inhibitors), whereas tricyclics remained steady. Escitalopram and sertraline were the most sold drugs. Market share of serotonin reuptake inhibitors decreased, particularly for paroxetine (13.1 % to 6.5 %; p = 0.016), while 'other' antidepressants' market share expanded from 21.9 % to 33.3 % (p = 0.027), especially for desvenlafaxine (2.9 % to 14.3 %; p < 0.001). LIMITATIONS The dataset does not include antidepressants dispensed in hospitals, public services, and compounding pharmacies, neither their therapeutic indications. CONCLUSION Sales of antidepressants significantly increased in Brazil from 2014 to 2020, which were mainly driven by higher prescriptions of serotonin reuptake inhibitors and 'other' antidepressants classes. Market share changes seem to be driven by novelty of products.
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Affiliation(s)
- Rogério Hoefler
- Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Taís Freire Galvão
- Faculty of Pharmaceutical Sciences, State University of Campinas, Campinas, Sao Paulo, Brazil
| | - Inês Ribeiro-Vaz
- Porto Pharmacovigilance Centre, Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marcus Tolentino Silva
- Post-Graduate Program of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Sao Paulo, Brazil
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12
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Cosgrove L, D'Ambrozio G, Herrawi F, Freeman M, Shaughnessy A. Why psychiatry needs an honest dose of gentle medicine. Front Psychiatry 2023; 14:1167910. [PMID: 37151963 PMCID: PMC10160434 DOI: 10.3389/fpsyt.2023.1167910] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
The pharmaceutical industry's influence on psychiatric research and practice has been profound and has resulted in exaggerated claims of the effectiveness of psychotropic medications and an under-reporting of harms. After the regulatory approval of fluoxetine, the pharmaceutical industry began promoting (and continues to promote) a chemical imbalance theory of emotional distress. In the last decade, there has been an increased awareness about the limits of this theory and the risks of psychotropic medications. Nonetheless, the medicalization of distress, the sedimented belief in "magic bullets," and the push to "scale up" mental health treatment have contributed to the meteoric rise in the prescription of psychiatric drugs and of polypharmacy. A major premise of this paper is that the conceptual framework of medical nihilism can help researchers and clinicians understand and address the harms incurred by inflated claims of the efficacy of psychotropic medications. We propose that psychiatry, and the mental health field more generally, adopt a model of 'gentle medicine' with regard to both the diagnosis of and treatment for mental health conditions and focus greater attention on the upstream causes of distress.
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Affiliation(s)
- Lisa Cosgrove
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, United States
- *Correspondence: Lisa Cosgrove,
| | - Gianna D'Ambrozio
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, United States
| | - Farahdeba Herrawi
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, United States
| | - Moira Freeman
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, United States
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13
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Wu T, Dong S, Yang L, Qiu H, Qiu H, Mellor D, Chen J, Xu Y. Investigation of the pharmacological treatment patterns of Chinese patients with major depressive disorder under real-world settings using multi-channel sequence analysis. Front Psychiatry 2023; 14:1089504. [PMID: 37091706 PMCID: PMC10115953 DOI: 10.3389/fpsyt.2023.1089504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Background Despite many treatment guidelines available now, the treatment patterns of major depressive disorder (MDD) in China haven't been well-understood due to complexity and diversity. Aim To describe pharmacological treatment patterns of MDD patients in real-world settings using electronic health records from a major psychiatric hospital in China. Methods MDD patients (18-65 years, ICD-10: F32.x, F33.x) newly initiated single antidepressant (AD) in 2015 were enrolled, the date of first AD prescription during the study period was defined as index date, and eligible patients were followed up to 1 year. Treatment patterns were revealed and analyzed using multi-channel sequence analysis (MCSA), considering patients' chronological sequences (in days) of AD prescription, cumulative treatment step(s), and polypharmacy usage during the follow-up. Results This study (n = 5,003) identified four types of MDD treatment patterns. The first type (1-time treatment) represents the largest proportion of patients (73.6%, n = 3,686), followed by the second type (6-month consistent treatment) and third type (long-term, consistent treatment) collectively accounted for 20.6% (n = 1,031) of patients, by contrast the last type (long-term, inconsistent treatment) made up the rest 5.7% (n = 286) of patients while exhibiting the most complicated treatments patterns. The choice of AD was dominated by selective serotonin reuptake inhibitors (SSRIs), while treatment duration spent in polypharmacy spanned at 2.8%, 16.4%, 2.0%, and 36.5% over the four types, respectively. Conclusion Treatment patterns reflecting real-world pharmacological treatment practices of MDD in China were revealed using MCSA. The observed discrepancies between real-world practice and treatment guidelines provided additional insights in improving the clinical management of MDD.
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Affiliation(s)
- Tao Wu
- Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Beijing, China
| | - Sijia Dong
- Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Shanghai, China
| | - Lu Yang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Qiu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Qiu
- Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Titusville, NJ, United States
| | - David Mellor
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Jun Chen
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- *Correspondence: Jun Chen
| | - Yifeng Xu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Yifeng Xu
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14
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de Oliveira Costa J, Gillies MB, Schaffer AL, Peiris D, Zoega H, Pearson SA. Changes in antidepressant use in Australia: A nationwide analysis (2015-2021). Aust N Z J Psychiatry 2023; 57:49-57. [PMID: 35176912 DOI: 10.1177/00048674221079740] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Depression and anxiety affect 4-14% of Australians every year; symptoms may have been exacerbated during the COVID-19 pandemic. We examined recent patterns of antidepressant use in Australia in the period 2015-2021, which includes the first year of the pandemic. METHODS We used national dispensing claims for people aged ⩾10 years to investigate annual trends in prevalent and new antidepressant use (no antidepressants dispensed in the year prior). We conducted stratified analyses by sex, age group and antidepressant class. We report outcomes from 2015 to 2019 and used time series analysis to quantify changes during the first year of the COVID-19 pandemic (March 2020-February 2021). RESULTS In 2019, the annual prevalence of antidepressant use was 170.4 per 1000 women and 101.8 per 1000 men, an increase of 7.0% and 9.2% from 2015, respectively. New antidepressant use also increased for both sexes (3.0% for women and 4.9% for men) and across most age groups, particularly among adolescents (aged 10-17 years; 46-57%). During the first year of the COVID-19 pandemic, we observed higher than expected prevalent use (+2.2%, 95% CI = [0.3%, 4.2%]) among females, corresponding to a predicted excess of 45,217 (95% CI = [5,819, 84,614]) females dispensed antidepressants. The largest increases during the first year of the pandemic occurred among female adolescents for both prevalent (+11.7%, 95% CI = [4.1%, 20.5%]) and new antidepressant use (+15.6%, 95% CI = [8.5%, 23.7%]). CONCLUSION Antidepressant use continues to increase in Australia overall and especially among young people. We found a differential impact of the COVID-19 pandemic in treated depression and anxiety, greater among females than males, and greater among young females than other age groups, suggesting an increased mental health burden in populations already on a trajectory of increased use of antidepressants prior to the pandemic. Reasons for these differences require further investigation.
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Affiliation(s)
- Juliana de Oliveira Costa
- Medicines Policy Research Unit, Centre for Big Data Research in Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Malcolm B Gillies
- Medicines Policy Research Unit, Centre for Big Data Research in Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Andrea L Schaffer
- Medicines Policy Research Unit, Centre for Big Data Research in Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Helga Zoega
- Medicines Policy Research Unit, Centre for Big Data Research in Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.,Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Sallie-Anne Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
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Yang W, Wang Y, Huang S, Su X, Jiang W, Ren Y. Analysis of the use of antidepressants in patients from non-psychiatric departments in general hospital. Psychiatry Res 2022; 317:114823. [PMID: 36084542 DOI: 10.1016/j.psychres.2022.114823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/14/2022] [Accepted: 09/01/2022] [Indexed: 01/04/2023]
Abstract
This study aimed to analyze the use of antidepressants in non-psychiatric departments. The data of patients treated with antidepressants in non-psychiatric departments of the First Affiliated Hospital of Xi 'an Jiaotong University, were collected from 2014 to 2018. The average annual growth rate of antidepressants use was 22.83%. According to the number of patients at discharge, the classification descending order was: SSRIs, Flupenthixol-TCA, SNRIs, TCAs, SARIs, and NaSSA. Sertraline and flupenthixol-melitracen were the main drugs used in SSRIs and Flupenthixol-TCA, respectively. Neurology, Cardiology, and Geriatrics were the main departments prescribing SSRIs, Flupenthixol-TCA and SNRIs. The antidepressants used by all patients were mainly SSRIs according to drug classification, but the specific drug use in unclear diagnosis group was dominated by flupenthixol-melitracen, while it was sertraline in clear diagnosis group. The proportion of Flupenthixol-TCA in anxiety state group was higher than that in depression state group, While the situation in SSRIs is the opposite. More guidelines should be formulated to improve the recognition of comorbidities between specialized diseases and psychiatric disorders. Also, multi-level training should be implemented to perform the standard diagnosis and medication of mental disorders in clinical practice.
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Affiliation(s)
- Wei Yang
- Department of Geriatrics, The First Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an 710061, China
| | - Ying Wang
- Department of International Medical Center, The First Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an 710061, China
| | - Shi Huang
- Chaoyangmen Community Health Service Center, Dongcheng District, Beijing 100010, China
| | - Xianming Su
- Department of Geriatrics, The First Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an 710061, China
| | - Wenhui Jiang
- Medical College of Xi 'an Jiaotong University, Xi 'an 710061, China
| | - Yanping Ren
- Department of Geriatrics, The First Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an 710061, China.
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Hoefler R, Galvão TF, Ribeiro-Vaz I, Silva MT. Trends in Brazilian market of antidepressants: A five-year dataset analysis. Front Pharmacol 2022; 13:893891. [PMID: 36267285 PMCID: PMC9577407 DOI: 10.3389/fphar.2022.893891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Depression is an emotional disorder associated with morbidities and disabilities worldwide. The growing use of antidepressants is a concern for health managers because there are still unanswered questions on the effectiveness and safety of these medicines. Drug sales have increased in Brazil in recent years, but investigations on antidepressants sales are not available. We aimed to describe the trends in the antidepressant commerce in Brazil in a five-year period. Materials and Methods: We performed an ecological study on antidepressant sales in Brazil, from November 2014 to October 2019, using data from IQVIA™, a data provider of pharmaceutical sales. Antidepressants were coded by the Anatomical Therapeutic Chemical classification system, and sales were presented in defined daily doses (DDDs) and DDDs per 1,000 inhabitants per day (DIDs). The results were expressed in absolute quantities and growth rates. Results: The analyzed dataset contained 23 active substances in 780 products. The total sales of antidepressants increased from 23.3 DIDs in November 2014 to 38.3 DIDs in October 2019 (p = 0.002). Selective serotonin reuptake inhibitors were the most sold category of drugs (+5.7 million DDDs) in the period. ‘Other’ antidepressants presented the largest growth rate (104.7%). Individually, the most sold active substance was escitalopram (+1.8 million DDDs), and vortioxetine had the largest growth rate (336.2%). Tricyclic sales remained unchanged, and monoamine oxidase inhibitors had low and even decreasing sales (−9.5%). Discussion: The total sales of antidepressants increased in Brazil from November 2014 to October 2019. The higher sale volumes of selective serotonin reuptake inhibitors and higher growth rate of ‘other’ antidepressants, with low sale volume of tricyclics and a decrease of monoamine oxidase inhibitors, suggest the replacement of older drugs by newer ones following a global trend. Therapeutic advances and commercial promotion efforts on new products might explain these findings.
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Affiliation(s)
- Rogério Hoefler
- Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
- Federal Council of Pharmacy, Brasília, Brazil
- *Correspondence: Rogério Hoefler,
| | - Taís Freire Galvão
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
| | - Inês Ribeiro-Vaz
- Porto Pharmacovigilance Centre, Faculty of Medicine, University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
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Zhang X, Hu X, Zhao Y, Lu CY, Nie X, Shi L. Trends in the utilization of psychotropic medications in China from 2018 to 2021. Front Pharmacol 2022; 13:967826. [PMID: 36160455 PMCID: PMC9490132 DOI: 10.3389/fphar.2022.967826] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Monitoring psychotropic medicine consumption trends can provide information on the extent of pharmacological interventions for mental disorders and availability of psychotropic medicines. Objectives: This study aimed to illustrate the trends in psychotropic drug utilization in China’s hospitals. Methods: We retrospectively analyzed the aggregated monthly psychotropic procurement records of 1009 hospitals from 31 provinces in China from January 2018 to September 2021. Total psychotropic medicine consumption included the sales of antipsychotics, antidepressants, anxiolytics, mood stabilizers, and sedatives or hypnotics. Information, including generic name, procurement amount, dosage form, strength, purchase time, and geographical data, was collected. Population-weighted psychotropic utilization was expressed in defined daily dose per 1000 inhabitants per day (DDD/1000/day). Results: Psychotropic medicine sales increased from 4.5 DDD/1000/day in Q1 2018 to 6.4 DDD/1000/day in Q3 2021; total utilization in China’s hospitals increased by 42.2%. The use of each class of psychotropics showed a gradually increasing trend. Antidepressants were the most consumed psychotropics, accounting for 48.4% of the total psychotropic utilization (3.1/6.4 DDD/1000/day), followed by sedatives or hypnotics (31.3%; 2.0/6.4 DDD/1000/day) and antipsychotics (15.6%; 1.0/6.7 DDD/1000/day). Among all sub-classes of psychotropics, a most significant growth in DDD per 1000 inhabitants per day was seen for selective serotonin reuptake inhibitors (1.2–1.9 DDD/1000/day), whereas the consumption of typical antipsychotics (from 0.1 to 0.09 DDD/1000/day) and tricyclic antidepressants (from 0.05 to 0.03 DDD/1000/day) decreased during the study period. Psychotropic utilization substantially increased between Q1 2018 and Q3 2021 in regions with different economic levels. In Q3 2021, total psychotropic utilization in secondary and tertiary hospitals was 9.4 DDD/1000/day and 6.0 DDD/1000/day, respectively. Sedatives or hypnotics in secondary hospitals accounted for the largest proportion of utilized psychotropics (43.6%; 4.1/9.4 DDD/1000/day), whereas antidepressants were the most commonly used psychotropic in tertiary hospitals (50.0%, 3.0/6.0 DDD/1000/day). Conclusion: This study showed that despite increases in psychotropic medication use, the consumption of medicines is still much lower than in other countries and regions internationally. With reference to the estimated prevalence of corresponding mental disorders, our study illustrates that a large treatment gap for mental health problems exists in China. In addition, the wide use of psychotropics with weak clinical evidence raises serious concerns regarding rational use. Greater efforts are needed to increase the availability of psychotropic medicines and to facilitate proper psychotropic use.
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Affiliation(s)
- Xinyan Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xiaowen Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yuxuan Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Christine Y. Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Xiaoyan Nie
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- *Correspondence: Xiaoyan Nie,
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
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18
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Yu Z, Zhao Y, Jin J, Zhu J, Yu L, Han G. Antiviral treatment in outpatients with herps zoster in six major areas of China, 2010–2019. Front Public Health 2022; 10:942377. [PMID: 35968424 PMCID: PMC9372588 DOI: 10.3389/fpubh.2022.942377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022] Open
Abstract
Objective The objective of this study was to assess the status and trends of antiviral treatment in outpatients with herpes zoster in China. Methods Prescription data on antiviral drugs were extracted from the database of the Hospital Prescription Analysis Program of China according to the inclusion criteria. Yearly prescriptions and costs were calculated, and trends were analyzed. The trends were further stratified by age, sex, and specific drug use. The distribution of defined daily costs (DDCs) of valaciclovir and famciclovir were analyzed, and trends in the median DDCs were identified. Results A total of 132,911 prescriptions from 49 hospitals located in six major areas of China were included in the analysis. The yearly prescriptions containing antivirals increased from 8,819 in 2010 to 16,361 in 2019. The percentage of prescriptions for patients aged 65 years and above also increased (27.7% in 2010 to 31.0% in 2019), and the number of prescriptions for females was higher than those for males (P < 0.001). The average cost of antivirals per prescription decreased; thus, the yearly cost showed no increasing trend. The main prescribed antivirals were valaciclovir and famciclovir, which progressively increased in prescriptions. The use of acyclovir decreased during the study period. Prescriptions containing topical formulations, acyclovir and penciclovir, both increased. The DDCs of valaciclovir and famciclovir decreased dramatically. Conclusion The use of antivirals has increased over the decade, while the cost has not. Antiviral treatments adhere well to recent recommendations, except for the use of topical antivirals. The findings of this study may benefit the healthcare source allocation and management of herpes zoster in China.
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Affiliation(s)
- Zhenwei Yu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuhua Zhao
- Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Jiayi Jin
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianping Zhu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingyan Yu
- Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Lingyan Yu
| | - Gang Han
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Gang Han
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Yin X, Li W, Liang T, Lu B, Yue H, Li S, Zhong VW, Zhang W, Li X, Zhou S, Mi Y, Wu H, Xu S. Effect of Electroacupuncture on Insomnia in Patients With Depression: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2220563. [PMID: 35797047 PMCID: PMC9264041 DOI: 10.1001/jamanetworkopen.2022.20563] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPORTANCE Electroacupuncture (EA) is a widely recognized therapy for depression and sleep disorders in clinical practice, but its efficacy in the treatment of comorbid insomnia and depression remains uncertain. OBJECTIVE To assess the efficacy and safety of EA as an alternative therapy in improving sleep quality and mental state for patients with insomnia and depression. DESIGN, SETTING, AND PARTICIPANTS A 32-week patient- and assessor-blinded, randomized, sham-controlled clinical trial (8-week intervention plus 24-week observational follow-up) was conducted from September 1, 2016, to July 30, 2019, at 3 tertiary hospitals in Shanghai, China. Patients were randomized to receive EA treatment and standard care, sham acupuncture (SA) treatment and standard care, or standard care only as control. Patients were 18 to 70 years of age, had insomnia, and met the criteria for depression as classified in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Data were analyzed from May 4 to September 13, 2020. INTERVENTIONS All patients in the 3 groups were provided with standard care guided by psychiatrists. Patients in the EA and SA groups received real or sham acupuncture treatment, 3 sessions per week for 8 weeks, for a total of 24 sessions. MAIN OUTCOMES AND MEASURES The primary outcome was change in Pittsburgh Sleep Quality Index (PSQI) from baseline to week 8. Secondary outcomes included PSQI at 12, 20, and 32 weeks of follow-up; sleep parameters recorded in actigraphy; Insomnia Severity Index; 17-item Hamilton Depression Rating Scale score; and Self-rating Anxiety Scale score. RESULTS Among the 270 patients (194 women [71.9%] and 76 men [28.1%]; mean [SD] age, 50.3 [14.2] years) included in the intention-to-treat analysis, 247 (91.5%) completed all outcome measurements at week 32, and 23 (8.5%) dropped out of the trial. The mean difference in PSQI from baseline to week 8 within the EA group was -6.2 (95% CI, -6.9 to -5.6). At week 8, the difference in PSQI score was -3.6 (95% CI, -4.4 to -2.8; P < .001) between the EA and SA groups and -5.1 (95% CI, -6.0 to -4.2; P < .001) between the EA and control groups. The efficacy of EA in treating insomnia was sustained during the 24-week postintervention follow-up. Significant improvement in the 17-item Hamilton Depression Rating Scale (-10.7 [95% CI, -11.8 to -9.7]), Insomnia Severity Index (-7.6 [95% CI, -8.5 to -6.7]), and Self-rating Anxiety Scale (-2.9 [95% CI, -4.1 to -1.7]) scores and the total sleep time recorded in the actigraphy (29.1 [95% CI, 21.5-36.7] minutes) was observed in the EA group during the 8-week intervention period (P < .001 for all). No between-group differences were found in the frequency of sleep awakenings. No serious adverse events were reported. CONCLUSIONS AND RELEVANCE In this randomized clinical trial of EA treatment for insomnia in patients with depression, quality of sleep improved significantly in the EA group compared with the SA or control group at week 8 and was sustained at week 32. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03122080.
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Affiliation(s)
- Xuan Yin
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei Li
- School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tingting Liang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing Lu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Acupuncture and Moxibustion, Huadong Hospital, Fudan University, Shanghai, China
| | - Hongyu Yue
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shanshan Li
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Victor W. Zhong
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Xia Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuang Zhou
- Department of Traditional Chinese Medicine, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Yiqun Mi
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huangan Wu
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shifen Xu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Baethge C, Braun C, Rink L, Schwarzer G, Henssler J, Bschor T. Dose effects of tricyclic antidepressants in the treatment of acute depression - A systematic review and meta-analysis of randomized trials. J Affect Disord 2022; 307:191-198. [PMID: 35390353 DOI: 10.1016/j.jad.2022.03.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Tricyclic antidepressants (TCA) continue to be an important group of drugs, but it is unclear whether a dose-response relationship is supported by high-level evidence. METHODS Systematic review in the Cochrane Collaboration's Central Register of Controlled Trials (CENTRAL) of studies randomizing patients to at least two doses of one TCA, complemented by searches in Medline, Embase, and PsycInfo. In multilevel regression, we calculated the standardized mean difference (SMD) in antidepressant efficacy per mg TCA dose increase, and we analyzed drop-outs due to adverse events. Finally, we computed random effects meta-analyses of all dose comparisons investigated in a minimum of two studies. RESULTS Out of 5365 studies screened, we included 15 randomized trials on 24 comparisons of 14 different dose contrasts. We found a statistically non-significant positive effect of increasing the dose: 0.34 SMD with 100 mg/d dose increase ([-0.03; 0.70] p = 0.073). While several comparisons showed no clear signal of a dose gradient, 300 mg of imipramine/desipramine is statistically significantly superior to 150 mg (SMD: 0.80 [0.28; 1.33], p = 0.003, I2: 0%). Drop-outs increased with higher doses, albeit not statistically significantly: Odds ratio (OR) of 1.44 with 100 mg dose increase [0.54; 3.86]. Overall, risk of bias was high. LIMITATIONS Limited number of studies with mainly high risk of bias. CONCLUSIONS So far, data on a dose-response relationship in TCAs from direct dose comparisons are inconclusive. Clinically, escalation to high doses may be justified if side effects are bearable.
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Affiliation(s)
- Christopher Baethge
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - Cora Braun
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Lena Rink
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Cologne, Cologne, Germany; Red Cross Children's Hospital Siegen, Siegen, Germany
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Jonathan Henssler
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Cologne, Cologne, Germany; Charité University Medicine, St Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, Berlin, Germany
| | - Tom Bschor
- Department of Psychiatry and Psychotherapy, Technical University of Dresden, Dresden, Germany
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21
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Ang B, Horowitz M, Moncrieff J. Is the chemical imbalance an ‘urban legend’? An exploration of the status of the serotonin theory of depression in the academic literature. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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22
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Funayama Y, Li H, Ishimori E, Kawatake-Kuno A, Inaba H, Yamagata H, Seki T, Nakagawa S, Watanabe Y, Murai T, Oishi N, Uchida S. Antidepressant Response and Stress Resilience Are Promoted by CART Peptides in GABAergic Neurons of the Anterior Cingulate Cortex. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022; 3:87-98. [PMID: 36712563 PMCID: PMC9874166 DOI: 10.1016/j.bpsgos.2021.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/09/2021] [Accepted: 12/27/2021] [Indexed: 02/01/2023] Open
Abstract
Background A key challenge in the understanding and treatment of depression is identifying cell types and molecular mechanisms that mediate behavioral responses to antidepressant drugs. Because treatment responses in clinical depression are heterogeneous, it is crucial to examine treatment responders and nonresponders in preclinical studies. Methods We used the large variance in behavioral responses to long-term treatment with multiple classes of antidepressant drugs in different inbred mouse strains and classified the mice into responders and nonresponders based on their response in the forced swim test. Medial prefrontal cortex tissues were subjected to RNA sequencing to identify molecules that are consistently associated across antidepressant responders. We developed and used virus-mediated gene transfer to induce the gene of interest in specific cell types and performed forced swim, sucrose preference, social interaction, and open field tests to investigate antidepressant-like and anxiety-like behaviors. Results Cartpt expression was consistently upregulated in responders to four types of antidepressants but not in nonresponders in different mice strains. Responder mice given a single dose of ketamine, a fast-acting non-monoamine-based antidepressant, exhibited high CART peptide expression. CART peptide overexpression in the GABAergic (gamma-aminobutyric acidergic) neurons of the anterior cingulate cortex led to antidepressant-like behavior and drove chronic stress resiliency independently of mouse genetic background. Conclusions These data demonstrate that activation of CART peptide signaling in GABAergic neurons of the anterior cingulate cortex is a common molecular mechanism across antidepressant responders and that this pathway also drives stress resilience.
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Affiliation(s)
- Yuki Funayama
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Haiyan Li
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Erina Ishimori
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Kawatake-Kuno
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromichi Inaba
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirotaka Yamagata
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Tomoe Seki
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Shin Nakagawa
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yoshifumi Watanabe
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Toshiya Murai
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoya Oishi
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Naoya Oishi, M.D., Ph.D.
| | - Shusaku Uchida
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Address correspondence to Shusaku Uchida, Ph.D.
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23
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Wang QQ, Cheng L, Wu BY, Xu P, Qiu HY, Wang B, Yan XJ, Chen SL. Short-course antidepressant therapy reduces discontinuation syndrome while maintaining treatment efficacy in patients with refractory functional dyspepsia: A randomized controlled trial. Front Psychiatry 2022; 13:1063722. [PMID: 36569610 PMCID: PMC9772443 DOI: 10.3389/fpsyt.2022.1063722] [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: 10/07/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Long-course (LC) antidepressants for the treatment of disorders of gut-brain interaction, such as refractory functional dyspepsia (rFD), pose patients at risk of antidepressant discontinuation syndrome (ADS). Short-course (SC) therapy of rapid-acting antidepressant may reduce discontinuation syndromes while maintaining efficacy for dyspeptic symptoms. However, the evidence-based research is lacking. This study aims to determine whether SC therapy with antidepressants could decrease the risk of ADS with comparable treatment efficacy to LC therapy in rFD. METHODS This randomized clinical trial with rFD patients was conducted at a tertiary hospital in China. Participants (N = 240) were randomly allocated to receive flupentixol-melitracen (FM) plus omeprazole therapy for 2 (SC group) or 4 (LC group) weeks, respectively. Scores for Leeds Dyspepsia Questionnaire (LDQ), Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 for Depression (PHQ-9) were assessed at baseline and every 2 weeks, ending at 4 weeks after treatment. ADS was assessed after drug cessation. Medication possession ratio (MPR) for FM was calculated. RESULTS The severity and incidence of ADS of patients in SC group were significantly lower than those in LC group (0.60 ± 0.62 vs. 1.71 ± 1.58 and 3.64 vs. 39.45%; both P < 0.0001). The MPR values for FM were significantly higher in patients of SC group than in LC group (P < 0.0001). Scores for LDQ, GAD-7 and PHQ-9 decreased in patients of both groups, and the symptom improvement in SC group was comparable to that in LC group after treatment. CONCLUSIONS Compared to 4-week FM therapy, the 2-week FM therapy reduces the risk of ADS with non-inferior treatment efficacy in patients with rFD. CLINICAL TRIAL REGISTRATION Clinical trials.gov, identifier NCT05099913.
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Affiliation(s)
- Qian-Qian Wang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li Cheng
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bi-Yu Wu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Xu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong-Yi Qiu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Wang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiu-Juan Yan
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sheng-Liang Chen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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24
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The effect of selective serotonin reuptake inhibitors on cognitive impairment in patients with depression: A prospective, multicenter, observational study. J Psychiatr Res 2021; 141:26-33. [PMID: 34171760 DOI: 10.1016/j.jpsychires.2021.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/07/2021] [Accepted: 06/13/2021] [Indexed: 01/10/2023]
Abstract
Whether selective serotonin reuptake inhibitors (SSRIs) can improve cognitive function in depressed patients remains unclear. We aimed to explore the effect of SSRIs on cognitive function and the influencing factors in patients with major depressive disorder (MDD) with impaired cognitive function. We used a neurocognitive test battery to assess five cognitive domains, namely, attention/vigilance, learning, memory, processing speed and executive functioning, and calculated the Global Deficit Score (GDS). A GDS≥0.5 indicated overall cognitive impairment. The changes in the cognitive domains and overall cognitive function were analyzed in MDD patients with a baseline GDS≥0.5 who completed 8 weeks of SSRI treatment. We divided the patients into the cognitive remission and nonremission groups to explore the associated factors. In total, 160 patients (mean age 37.6 ± 10.8 years, 30.6% male) were included in the final analysis. The median (quartiles) of baseline GDS and HRSD17 were 1.4 (0.8, 1.9) and 19.5 (17.0, 23.0), respectively. All five cognitive domains improved after the treatment, while only 41 (25.6%) patients achieved cognitive remission. Recurrence and a higher baseline GDS were risk factors for cognitive nonremission. More aggressive interventions may be needed to promote cognitive remission in clinical practice, especially for patients with severe cognitive impairment and recurrent episodes.
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25
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Yu Z, Wu X, Zhu J, Jin J, Zhao Y, Yu L. Trends in Topical Prescriptional Therapy for Old Patients With Dry Eye Disease in Six Major Areas of China: 2013-2019. Front Pharmacol 2021; 12:690640. [PMID: 34447308 PMCID: PMC8383279 DOI: 10.3389/fphar.2021.690640] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/30/2021] [Indexed: 12/04/2022] Open
Abstract
The prevalence of dry eye disease (DED) in old patients are high, corresponding to a substantial economic burden. In this cross-sectional study, we analyzed the trends in the topical prescriptional treatment of old patients with DED in six major areas of China. Information on topical drug prescriptions for DED patients aged above 60 years was extracted from the Hospital Prescription Analysis Cooperative Program of China database. Trends in yearly prescriptions and cost were analyzed. The data were further stratified by patient age and sex, drug class, and specific drug. A total of 130,734 prescriptions from 52 hospitals located in six major areas of China were analyzed. The number of prescripptions per year for patients with DED increased from 13,308 in 2013 to 22,074 in 2019, with a corresponding increase in cost of all topical drugs from 1,490,014 Chinese Yuan (CNY) to 2,618,206 CNY. Drugs for the treatment of DED accounted for the largest proportion of the total cost in each year. Ocular lubricants were the main pharmacotherapy agent. Sodium hyaluronate use increased over time, and the drug was used by 65.9% of patients by the end of the study. Pranoprofen was the second most frequently used drug. The most frequently used drugs for co-incident disease were antimicrobials. Treatment patterns for DED haven’t changed, and the most frequently used drug combination was sodium hyaluronate and pranoprofen. In summary, prescription for old patients with DED and the cost of treatment are increasing. Ocular lubricants are the main treatment option, while sodium hyaluronate is the most frequently used drug. The observed trends can lead to more efficient allocation of health care resources in China.
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Affiliation(s)
- Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyan Wu
- Department of Pediatrics, Shaoxing Shangyu People's Hospital of Shaoxing, Shaoxing, China
| | - Jianping Zhu
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiayi Jin
- Department of Pediatrics, Shaoxing Shangyu People's Hospital of Shaoxing, Shaoxing, China.,Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuhua Zhao
- Department of Pharmacy, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Lingyan Yu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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26
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Yu Z, Zhu J, Jin J, Yu L, Han G. Trends in Outpatient Prescribing Patterns for Ocular Topical Anti-Infectives in Six Major Areas of China, 2013-2019. Antibiotics (Basel) 2021; 10:916. [PMID: 34438966 PMCID: PMC8388675 DOI: 10.3390/antibiotics10080916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 12/02/2022] Open
Abstract
Topical anti-infectives are important in the management of ocular infections, but little is known about their current status and trends in their use in China. Thus, we carried out a prescription-based, cross-sectional study using the database of Hospital Prescription Analysis Projection of China, and aimed to analyze the trend in the use of ocular topical anti-infectives for outpatients of the ophthalmology department from 2013 to 2019. A total of 2,341,719 prescriptions from 61 hospitals located in six major areas written by ophthalmologists for outpatients were identified, and 1,002,254 of the prescriptions contained at least one anti-infective. The yearly anti-infective prescriptions increased continuously from 126,828 prescriptions in 2013 to 163,434 prescriptions in 2019. The cost also increased from 4,503,711 Chinese Yuan (CNY) in 2013 to CNY 5,860,945 in 2019. However, the use rate of anti-infectives decreased slightly from 46.5% in 2013 to 41.1% in 2019. Patients aged between 19 and 45 years old had the highest anti-infective use rate. Levofloxacin was the most frequently used anti-infective and kept on increasing among all age groups, occupying 67.1% of the total cost at the end of the study. Tobramycin was more frequently used in pediatric patients than in adults, but the use still decreased. Ganciclovir was the preferred anti-viral drug over acyclovir. In conclusion, the prescriptions and cost of ocular topical anti-infectives for outpatients both increased progressively. The increasingly widespread use of levofloxacin raised concerns regarding safety in pediatrics and resistance development. The observed trends can lead to the more efficient management of ocular anti-topical anti-infectives in China.
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Affiliation(s)
- Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; (Z.Y.); (J.Z.)
| | - Jianping Zhu
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; (Z.Y.); (J.Z.)
| | - Jiayi Jin
- Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China;
| | - Lingyan Yu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Gang Han
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; (Z.Y.); (J.Z.)
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Prisco L, Sarwal A, Ganau M, Rubulotta F. Toxicology of Psychoactive Substances. Crit Care Clin 2021; 37:517-541. [PMID: 34053704 DOI: 10.1016/j.ccc.2021.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A trend in the increasing use of prescription psychoactive drugs (PADs), including antidepressants, antipsychotics, and mood stabilizers, has been reported in the United States and globally. In addition, there has been an increase in the production and usage of illicit PADs and emergence of new psychoactive substances (NPSs) all over the world. PADs pose unique challenges for critical care providers who may encounter toxicology issues due to drug interactions, side effects, or drug overdoses. This article provides a summary of the toxicologic features of commonly used and abused PADs: antidepressants, antipsychotics, mood stabilizers, hallucinogens, NPSs, caffeine, nicotine, and cannabis.
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Affiliation(s)
- Lara Prisco
- Neurosciences Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Level 1 West Wing, Headley Way, Oxford OX3 9DU, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Level 6 West Wing, Headley Way, Oxford OX3 9DU, UK.
| | - Aarti Sarwal
- Neurocritical Care Unit, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Mario Ganau
- Neurosciences Department, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Level 2 West Wing, Headley Way, Oxford OX3 9DU, UK
| | - Francesca Rubulotta
- Critical Care Program Department of Anesthesia, McGill University, 845 Sherbrooke St W, Montreal, Quebec H3A 0G4, Canada; Department of Anesthesiology and Intensive Care Medicine, Health Centre, Intensive Care Unit, Imperial College NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
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28
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Kang S, Han M, Park CI, Jung I, Kim EH, Boo YJ, Kang JI, Kim SJ. Use of serotonin reuptake inhibitors and risk of subsequent bone loss in a nationwide population-based cohort study. Sci Rep 2021; 11:13461. [PMID: 34188108 PMCID: PMC8241982 DOI: 10.1038/s41598-021-92821-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Abstract
This study examined whether the use of SRIs is associated with an increased risk of bone loss using a nested case-control design with a nationwide population-based cohort in Korea. Using the Korean National Health Screening Cohort, subjects newly diagnosed with osteoporosis or osteopenia (n = 55,799) were matched with controls (n = 278,995) at a ratio of 1:5. We stratified the participants by their time-dependent use of SRIs and sex and controlled for various confounders, including lifestyle habits, laboratory data, and comorbidities. Conditional logistic regression showed that both recent and former users of SRIs had an increased risk of subsequent bone loss compared with non-users: men [recent users: odds ratio (OR) 1.35, 95% confidential interval (CI) 1.20, 1.53; former-users: OR 1.10, 95% CI 1.01, 1.20]; women (recent users: OR 1.38, 95% CI 1.28-1.48; former-users: OR 1.07, 95% CI 1.02, 1.21). The use of SRIs was associated with an increased risk of bone loss in both men and women. In particular, the association was stronger in recent users. These findings provide population-level evidence for the risk of bone loss associated with SRI exposure and highlight the importance of monitoring the bone health of SRI users.
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Affiliation(s)
- Sunyoung Kang
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minkyung Han
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chun Il Park
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Inkyung Jung
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Hwa Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Jun Boo
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee In Kang
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Psychiatry, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Se Joo Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Psychiatry, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Stupak R, Dobroczyński B. From Mental Health Industry to Humane Care. Suggestions for an Alternative Systemic Approach to Distress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6625. [PMID: 34202995 PMCID: PMC8296326 DOI: 10.3390/ijerph18126625] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 01/17/2023]
Abstract
The article proposes a rough outline of an alternative systemic approach to mental health issues and of a more humane mental health care system. It suggests focusing on understanding mental distress as stemming from problems in living, using medications as agents facilitating psychotherapy, or as a last resort and short-term help, according to the principles of harm reduction. It argues that understanding drugs as psychoactive substances and studying the subjective effects they produce could lead to better utilization of medications and improvements in terms of conceptualizing and assessing treatment effects. Qualitative research could be particularly useful in that regard. It also advocates a radical departure from current diagnostic systems and proposes a synthesis of already existing alternatives to be used for both research and clinical purposes. Accordingly, a general idea for an alternative mental health care system, based on a combination of Open Dialogue Approach, Soteria houses, individual and group psychotherapy, cautious prescribing, services helping with drug discontinuation, peer-led services and social support is presented. The proposition could be seen as a first step towards developing a systemic alternative that could replace the currently dominating approach instead of focusing on implementing partial solutions that can be co-opted by the current one.
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Affiliation(s)
- Radosław Stupak
- Institute of Philosophy, Faculty of Philosophy, Jagiellonian University, 52 Grodzka St., PL 31044 Kraków, Poland
| | - Bartłomiej Dobroczyński
- Institute of Psychology, Faculty of Philosophy, Jagiellonian University, 6 Ingardena St., PL 30060 Kraków, Poland;
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30
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Yu L, Zhu W, Zhu X, Lu Y, Yu Z, Dai H. Anti-seizure Medication Prescription in Adult Outpatients With Epilepsy in China, 2013-2018. Front Neurol 2021; 12:649589. [PMID: 34108928 PMCID: PMC8180859 DOI: 10.3389/fneur.2021.649589] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/16/2021] [Indexed: 01/03/2023] Open
Abstract
This study aimed to assess the national trends in anti-seizure medication (ASM) prescription in Chinese adult outpatients with epilepsy over a 6-year period from 2013 to 2018. Prescriptions for adult outpatients with epilepsy from hospitals in six major cities were extracted from the database of the Hospital Prescription Analysis Cooperative Project. Trends in the annual prescriptions and expenditure of ASM were analyzed. Prescription patterns (monotherapy or combination therapy) were also assessed. A total of 225,767 prescriptions from 60 hospitals were eligible and extracted for analysis. The number of ASM prescriptions increased from 28,360 in 2013 to 44,110 in 2018, and the corresponding cost increased from 9,452,990 Chinese Yuan (CNY) in 2013 to 14,627,865 CNY in 2018. The share of newer ASM use increased continuously, accounting for 56.75% of prescriptions and 85.03% of expenditure in 2018. The most frequently prescribed ASMs were sodium valproate and levetiracetam. The proportion of sodium valproate use decreased, while the proportion of levetiracetam use increased dramatically in terms of both ASM prescriptions and expenditure. Monotherapy was more frequent than combination therapy. The three most common combination therapies were sodium valproate/lamotrigine, levetiracetam/oxcarbazepine, and sodium valproate/levetiracetam. In summary, ASM use increased rapidly in terms of the number of ASM prescriptions and cost during the 6-year period, which raises concern regarding the rational use and pharma-economic profiles of ASMs. In place of valproate, levetiracetam became the most frequently used ASM. The development of ASM prescription is in line with therapy guidelines and reflects the current state of research in China.
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Affiliation(s)
- Lingyan Yu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenjie Zhu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiuping Zhu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Lu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haibin Dai
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Seifert J, Führmann F, Reinhard MA, Engel RR, Bernegger X, Bleich S, Stübner S, Rüther E, Toto S, Grohmann R, Sieberer M, Greil W. Sex differences in pharmacological treatment of major depressive disorder: results from the AMSP pharmacovigilance program from 2001 to 2017. J Neural Transm (Vienna) 2021; 128:827-843. [PMID: 33977402 PMCID: PMC8205885 DOI: 10.1007/s00702-021-02349-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/02/2021] [Indexed: 12/25/2022]
Abstract
Data on drug prescription for outpatients with major depressive disorder (MDD) suggest women are more likely to be treated with psychotropic drugs, while data on sex differences regarding pharmacological treatment of psychiatric inpatients are currently not available. Drug utilization data from the program "Drug Safety in Psychiatry" (German: Arzneimittelsicherheit in der Psychiatrie, AMSP) of 44,418 psychiatric inpatients with MDD were analyzed for sex differences between 2001 and 2017. Sex differences were analyzed using relative risks (RR) and 95% confidence intervals (95% CI). Time trends were analyzed by comparing the first (2001-2003) with the last time period (2015-2017). In general, men and women were equally likely to use psychotropic drugs. Monotherapy was more common in men. Women were more likely to utilize ≥ 4 psychotropic drugs. Antidepressant drugs (ADDs) were the most prescribed drug class. Men had a higher utilization of noradrenergic and specific serotonergic antidepressants (RR 1.15; 95% CI 1.12-1.19), especially mirtazapine (RR 1.16; 95% CI 1.12-1.19), but also of other ADDs such as bupropion (RR 1.50; 95% CI 1.35-1.68). Males had a slightly higher utilization of second-generation antipsychotic drugs (RR 1.06; 95% CI 1.03-1.09) and were less often treated with low-potency first-generation antipsychotic drugs (RR 0.86; 95% CI 0.83-0.90). Tranquilizing (e.g., benzodiazepines; RR 0.89; 95% CI 0.86-0.92) and hypnotic drugs (e.g., Z-drugs; RR 0.85; 95% CI 0.81-0.89) were less utilized in the treatment of male patients. Not all sex differences were stable over time. More sex differences were detectable in 2015-2017 than in 2001-2003. Findings suggest that certain psychotropic drugs are preferred in the treatment of men vs. women, however, sex differences found in this study are not as large as in ambulatory settings. To make evidence-based sex-specific recommendations in the treatment of MDD, differences in drug response and tolerability need to be further researched.
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Affiliation(s)
- Johanna Seifert
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Fabienne Führmann
- Department of Psychiatry and Psychotherapy, KRH Psychiatrie GmbH, Wunstorf, Germany
| | - Matthias A Reinhard
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Rolf R Engel
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Xueqiong Bernegger
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Witten/Herdecke, Witten, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Susanne Stübner
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Department of Forensic Psychiatry, Bezirksklinikum Ansbach, Ansbach, Germany
| | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Prosomno, Clinic for Sleep Medicine, Munich, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Marcel Sieberer
- Department of Psychiatry, Psychotherapy, and Psychosomatics, St. Marien-Hospital Hamm gGmbH, Hamm, Germany.,Department of Psychiatry and Psychotherapy, University Witten/Herdecke, Witten, Germany
| | - Waldemar Greil
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Psychiatric Private Hospital, Sanatorium Kilchberg, Kilchberg, Switzerland
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Wang Z, Wu X, Yu Z, Yu L. Utilization of Drugs for Attention-Deficit Hyperactivity Disorder Among Young Patients in China, 2010-2019. Front Psychiatry 2021; 12:802489. [PMID: 35222107 PMCID: PMC8863856 DOI: 10.3389/fpsyt.2021.802489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The use of attention-deficit hyperactivity disorder (ADHD) medication is increasing worldwide, but its status in China is unknown. This research aimed to assess the trends of ADHD medication use in young Chinese patients between 2010 and 2019. METHODS Dispensing data related to ADHD medication use were extracted from the Hospital Prescription Analysis Cooperative Project of China. The trends in the yearly prescription number of ADHD drugs and corresponding cost were analyzed. We further stratified the data by age, sex, and specific drug. RESULTS From 2010 to 2019, sampled prescriptions for ADHD medication increased from 902 to 4531, and the total expenditure increased rapidly from 276,580 to 2,412,308 Chinese Yuan. Prescriptions for males were almost fourfold more than that for females. Patients aged 6-11 years had the highest number of prescriptions for ADHD medication each year, accounting for more than 50% of the total number of prescriptions. The percentage of methylphenidate prescriptions decreased from 91.9% in 2010 to 76.9% in 2019, and the corresponding cost declined from 77.3% to 66.8%. In contrast, atomoxetine prescriptions increased progressively and accounted for about 24.5% of the total prescriptions at the end of the study. CONCLUSIONS The use of ADHD drugs and the corresponding cost increased rapidly in China, and methylphenidate was the most frequently prescribed medicine. The increase in ADHD prescriptions requires attention to ensure that it reflects appropriate use, especially in patients aged 6-11 years.
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Affiliation(s)
- Zhiliang Wang
- Department of Pediatrics, Shangyu People's Hospital of Shaoxing, Shaoxing, China
| | - Xiaoyan Wu
- Department of Pediatrics, Shangyu People's Hospital of Shaoxing, Shaoxing, China
| | - Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lingyan Yu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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