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Sinclair LI, Ball HA, Bolea-Alamanac BM. Does depression in mid-life predispose to greater cognitive decline in later life in the Whitehall II cohort? J Affect Disord 2023; 335:111-119. [PMID: 37172658 DOI: 10.1016/j.jad.2023.05.014] [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: 10/19/2022] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Later-life depression appears to have different symptomatology and possibly underlying pathology to younger adults. Depression is linked to dementia but whether it is a risk factor or an early sign of dementia remains unclear. Neuroinflammation is increasingly recognised in both conditions. AIMS To investigate the link between depression, inflammation and dementia. We hypothesised that recurrent depression increases the rate of cognitive decline in older adults and that this effect is modified by anti-inflammatory medication. METHODS We used data from Whitehall II including cognitive test results and reliable measures to assess depression. Depression was defined as a self-reported diagnosis or a score of ≥20 on the CESD. The presence/absence of inflammatory illness was assessed using a standardised list of inflammatory conditions. Individuals with dementia, chronic neurological and psychotic conditions were excluded. Logistic and linear regression was used to examine the effect of depression on cognitive test performance and the effect of chronic inflammation. LIMITATIONS Lack of clinical diagnoses of depression. RESULTS There were 1063 individuals with and 2572 without depression. Depression did not affect deterioration in episodic memory, verbal fluency or the AH4 test at 15-year follow up. We found no evidence of an effect of anti-inflammatory medication. Depressed individuals had worse cross-sectional performance on the Mill Hill test and tests of abstract reasoning and verbal fluency at both baseline and 15-year follow-up. CONCLUSIONS Using a UK based study with a long follow-up interval we have shown that depression in individuals aged >50 is not associated with increased cognitive decline.
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Affiliation(s)
- Lindsey Isla Sinclair
- Department of Clinical Neuroscience, Bristol Medical School, University of Bristol, Learning & Research Building, Southmead Hospital, BS10 5NB, United Kingdom of Great Britain and Northern Ireland.
| | - Harriet Ann Ball
- Department of Clinical Neuroscience, Bristol Medical School, University of Bristol, Learning & Research Building, Southmead Hospital, BS10 5NB, United Kingdom of Great Britain and Northern Ireland
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2
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Sinclair LI, Ball HA, Bauermeister S, Gallacher JEJ, Bolea-Alamanac BM. Recurrent depression has persistent effects on cognition but this does not appear to be mediated by neuroinflammation. J Affect Disord 2022; 306:232-239. [PMID: 35337923 DOI: 10.1016/j.jad.2022.03.043] [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: 01/05/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Later-life depression appears to be different to depression in younger adults. The underlying pathology may also differ. Depression is linked to dementia but whether it is a risk factor or an early sign of a developing dementia remains unclear. Neuroinflammation is increasingly recognised in both depression and Alzheimer's Disease. AIMS To investigate the link between depression, inflammation and dementia. We hypothesised that recurrent depression has adverse effects on performance in cognitive tests in middle to older age and that this effect is modified by anti-inflammatory medication. METHODS We identified UK based cohort studies which included individuals aged >50, had medical information, results from detailed cognitive testing and had used reliable measures to assess depression. Individuals with recurrent depression had ≥ 2 episodes of depression. Controls had no history of depression. The presence/absence of inflammatory illness was assessed using a standardised list of inflammatory conditions. Individuals with dementia, chronic neurological and psychotic conditions were excluded. Logistic and linear regression were used to examine the effect of depression on cognitive test performance and the mediating effect of chronic inflammation. RESULTS Unexpectedly in both studies there was evidence that those with recurrent depression performed better in some cognitive tasks (e.g Mill Hill vocabulary) but worse in others (e.g. reaction time). In UK Biobank there was no evidence that anti-inflammatories moderated this effect. LIMITATIONS Cross-sectional assessment of cognition. CONCLUSIONS Although previous recurrent depression has small effects on cognitive test performance this does not appear to be mediated by chronic inflammatory disease.
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Affiliation(s)
- Lindsey I Sinclair
- Department of Clinical Neuroscience, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Harriet A Ball
- Department of Clinical Neuroscience, Bristol Medical School, University of Bristol, Bristol, UK
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3
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Noori T, Sureda A, Sobarzo-Sánchez E, Shirooie S. The Role of Natural Products in Treatment of Depressive Disorder. Curr Neuropharmacol 2022; 20:929-949. [PMID: 34979889 PMCID: PMC9881107 DOI: 10.2174/1570159x20666220103140834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/09/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022] Open
Abstract
Depressive disorder is one of the most common psychiatric syndromes that, if left untreated, can cause many disturbances in a person's life. Numerous factors are involved in depression, including inflammation, brain-derived neurotrophic factor (BDNF), GABAergic system, hypothalamic- pituitary-adrenal (HPA) Axis, monoamine neurotransmitters (serotonin (5-HT), noradrenaline, and dopamine). Common treatments for depression are selective serotonin reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase inhibitors, but these drugs have several side effects such as anxiety, diarrhea, constipation, weight loss, and sexual dysfunctions. These agents only reduce the symptoms and temporarily reduce the rate of cognitive impairment associated with depression. As a result, extensive research has recently been conducted on the potential use of antidepressant and sedative herbs. According to the available data, herbs used in traditional medicine can be significantly effective in reducing depression, depressive symptoms and improving patients' performance. The present study provides a summary of biomarkers and therapeutic goals of depression and shows that natural products such as saffron or genipin have antidepressant effects. Some of the useful natural products and their mechanisms were evaluated. Data on various herbs and natural isolated compounds reported to prevent and reduce depressive symptoms is also discussed.
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Affiliation(s)
- Tayebeh Noori
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Antoni Sureda
- Research Group on Community Nutrition and Oxidative Stress (NUCOX) and Health Research Institute of Balearic Islands (IdISBa), University of Balearic Islands-IUNICS, Palma de Mallorca E-07122, Balearic Islands, Spain;,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029, Madrid, Spain
| | - Eduardo Sobarzo-Sánchez
- Instituto de Investigación y Postgrado, Facultad de Ciencias de la Salud, Universidad Central de Chile; Chile;,Department of Organic Chemistry, Faculty of Pharmacy, University of Santiago de Compostela, Santiago, Spain
| | - Samira Shirooie
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran;,Address correspondence to this author at the Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; E-mail:
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4
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Torres NPB, Alvares-Teodoro J, Júnior AAG, Horizonte PDB, Acurcio FDA. Social and economic factors associated with antidepressant use: results of a national survey in primary care. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2021.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Baxter GL, Tooth LR, Mishra GD. Psychological distress in young Australian women by area of residence: findings from the Australian Longitudinal Study on Women's Health. J Affect Disord 2021; 295:390-396. [PMID: 34492432 DOI: 10.1016/j.jad.2021.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 07/08/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The association between psychological distress and area of residence has been extensively discussed and debated. However, the focus has been largely on men and area of residence is often dichotomised to urban and rural. The aim of this study is to examine the association between psychological distress and area of residence in young Australian women using a broader geographical measure. METHODS Data were from 8961 women aged 19-26 in the 1989-95 cohort of the Australian Longitudinal Study on Women's Health in 2015. The association between area of residence (measured by the Modified Monash Model) and psychological distress (measured by the K10), adjusted for demographic factors, indicators of socioeconomic position and health behaviour characteristics, was analysed using logistic regression. RESULTS Women in regional centres had lower odds of high to very high psychological distress compared with women in metropolitan areas (adjusted odds ratio 0.73 (95% confidence interval 0.60-0.89)). Women living in large rural towns, medium rural towns and small rural towns/remote/very remote communities had similar levels of psychological distress as women living in metropolitan areas. LIMITATIONS ALSWH uses self-report questionnaires which may introduce potential self-report bias. The small sample size in areas outside of metropolitan areas resulted in the need to collapse small rural towns, remote communities and very remote communities into one category. CONCLUSIONS The subtle regional differences in levels of psychological distress in young women in Australia highlights the importance of the link between health and where people live and suggests further work is required to understand the regional differences and encourage location specific mental health services.
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Affiliation(s)
- Grace L Baxter
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD, Australia.
| | - Leigh R Tooth
- Principal Research Fellow, Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD, Australia.
| | - Gita D Mishra
- NHMRC Principal Research Fellow, Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD, Australia.
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6
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Scoppetta O, Cassiani-Miranda CA, Arocha-Díaz KN, Cabanzo-Arenas DF, Campo-Arias A. Validity of the patient health questionnaire-2 (PHQ-2) for the detection of depression in primary care in Colombia. J Affect Disord 2021; 278:576-582. [PMID: 33032028 DOI: 10.1016/j.jad.2020.09.096] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 08/01/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The PHQ-2 is a screening test for major depressive disorder (MDD) derived from PHQ-9, which has shown to be useful in the detection of cases of clinical significance in previous studies. The psychometric properties of PHQ-2 in the Colombian population are unknown. METHODS PHQ-2 were assessed in 243 patients in general medical consultations using the Mini-International Neuropsychiatric Interview (MINI) as the gold standard. Internal consistency, convergent validity and criterion validity were calculated by analyzing the Receptor Operating Characteristics (ROC) and the area under the curve (AUC). RESULTS Cronbach's alpha and McDonald's omega coefficients were 0.71. Spearman's rho coefficients for correlations with PHQ-9 and HADS-D scores were 0.63 and 0.59 (p<0.01). AUC was 0.89. The optimal cut point was ≥2 with the following indicators: sensitivity 0.87 specificity 0.74; Youden index 0.60; PPV 0.47; NPV 0.95; (LR+) 3.24; (LR-) 0.18 (95% CI 0.09-0.37). Kappa coefficient between PHQ-2 and MINI for depression was .458 and 0.46 for HADS-D. LIMITATIONS Since this study was done with people attending hospital, which could has implications for the prevalence of depression, affecting the validity indicators of the instrument. CONCLUSIONS PHQ-2 show an acceptable test performance in the context of the study. However, the test could yield a considerable amount of false positives that would require specialized evaluation to establish a reliable diagnosis.
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Affiliation(s)
- Orlando Scoppetta
- Universidad Católica de Colombia, Faculty of Psychology, GAEM Group (Research methods applied to behavioral sciences), Bogotá, Colombia
| | - Carlos Arturo Cassiani-Miranda
- Universidad de Santander, Faculty of Health Sciences, medicine program, Neurosciences Research Group, Bucaramanga, Colombia.
| | - Karen Nicolle Arocha-Díaz
- Universidad de Santander, Faculty of Health Sciences, medicine program, Neurosciences Research Group, Bucaramanga, Colombia
| | - Diego Fernando Cabanzo-Arenas
- Universidad de Santander, Faculty of Health Sciences, medicine program, Neurosciences Research Group, Bucaramanga, Colombia
| | - Adalberto Campo-Arias
- Universidad del Magdalena, Faculty of Health Sciences, Health Psychology and Psychiatry Research Group, Santa Marta, Colombia
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Alang S, McAlpine D. Treatment Modalities and Perceived Effectiveness of Treatment Among Adults With Depression. Health Serv Insights 2020; 13:1178632920918288. [PMID: 32425544 PMCID: PMC7218458 DOI: 10.1177/1178632920918288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/20/2020] [Indexed: 12/15/2022] Open
Abstract
Patient-reported outcomes of mental health treatment, such as perceived effectiveness, are important. They indicate whether treatment is perceived to reduce symptoms and minimize psychiatric disability. Outpatient treatment for depression typically includes medication or counseling, either alone or in combination. This study examines the relationship between treatment modality and perceived effectiveness of treatment. Using a sample of adults who received outpatient treatment for depression from the 2015-2016 National Survey on Drug Use and Health (N = 4169), logistic regressions estimated the odds of rating treatment as effective among persons who received medication only, counseling only, and a combination of medication and counseling. There were no differences in perceived effectiveness between counseling only and medication only. However, receiving both was associated with greater odds of rating treatment as effective. Poor self-rated health and severe mental illness were associated with lower perceived effectiveness of medication. Those with substance use problems had lower odds of rating counseling and both counseling and medication as effective. A combined treatment for depression may be perceived as better than single-modality treatment. Therefore, there might be benefits to increasing access to both forms of treatment for persons less likely to rate either single modality as effective.
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Affiliation(s)
- Sirry Alang
- Department of Sociology and Anthropology, and Program in Health, Medicine, and Society, Lehigh University, Bethlehem, PA, USA
| | - Donna McAlpine
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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The effect of causal attributions for depression on help-seeking and treatment preferences. J Affect Disord 2019; 257:477-485. [PMID: 31319339 DOI: 10.1016/j.jad.2019.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/28/2019] [Accepted: 07/04/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Depression is a leading cause of ill-health and disability globally and encouraging help-seeking and treatment engagement is a key priority of health authorities worldwide. Causal attributions for mental illness have numerous attitudinal and behavioural consequences; however, limited research has explored their implications for attitudes to treatment. This study experimentally investigates the impact of causal attributions for depression on attitudes to specific help-seeking and treatment options. METHODS In an online study, 196 participants read a vignette that emphasised either biological, social or biopsychosocial causes of a character's depression. Participants rated several help-seeking and treatment options on how helpful or harmful they would be for the individual described in the vignette and for themselves personally. RESULTS The causal attribution manipulation significantly affected treatment attitudes. Relative to social attributions, emphasising biological causes of depression significantly decreased the perceived helpfulness of lifestyle-based treatments, but did not affect attitudes to psychotherapeutic or medical treatment options. Participants rated most help-seeking and treatment options as less helpful for themselves compared to the vignette character. Participants with personal experience of depression had lower confidence in informal sources of help-seeking and greater confidence in medical treatment. LIMITATIONS Limitations include reliance on self-report measures and low reliability of certain sub-scales. CONCLUSIONS These findings suggest emphasising the biological underpinnings of depression could deter people from engaging with lifestyle-based treatment options. Promoting biopsychosocial theories of depression could increase awareness about the multifactorial causes of depression without negatively impacting the perceived efficacy of any help-seeking or intervention options.
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Blackburn TP. Depressive disorders: Treatment failures and poor prognosis over the last 50 years. Pharmacol Res Perspect 2019; 7:e00472. [PMID: 31065377 PMCID: PMC6498411 DOI: 10.1002/prp2.472] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/11/2019] [Accepted: 03/18/2019] [Indexed: 12/12/2022] Open
Abstract
Depression like many diseases is pleiotropic but unlike cancer and Alzheimer's disease for example, is still largely stigmatized and falls into the dark shadows of human illness. The failure of depression to be in the spotlight for successful treatment options is inherent in the complexity of the disease(s), flawed clinical diagnosis, overgeneralization of the illness, inadequate and biased clinical trial design, restrictive and biased inclusion/exclusion criteria, lack of approved/robust biomarkers, expensive imaging technology along with few advances in neurobiological hypotheses in decades. Clinical trial studies summitted to the regulatory agencies (FDA/EMA) for approval, have continually failed to show significant differences between active and placebo. For decades, we have acknowledged this failure, despite vigorous debated by all stakeholders to provide adequate answers to this escalating problem, with only a few new antidepressants approved in the last 20 years with equivocal efficacy, little improvement in side effects or onset of efficacy. It is also clear that funding and initiatives for mental illness lags far behind other life-treating diseases. Thus, it is no surprise we have not achieved much success in the last 50 years in treating depression, but we are accountable for the many failures and suboptimal treatment. This review will therefore critically address where we have failed and how future advances in medical science offers a glimmer of light for the patient and aid our future understanding of the neurobiology and pathophysiology of the disease, enabling transformative therapies for the treatment of depressive disorders.
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10
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Gul A, Pastuszak A, Kabasakal L, Bates J, Altinay S, Celik DS, Semercioz A, Serefoglu EC. Tadalafil Preserves Penile Nitric Oxide Synthase from Detrimental Effect of Paroxetine in Rats. Eurasian J Med 2019; 51:60-63. [PMID: 30911259 DOI: 10.5152/eurasianjmed.2018.18160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Paroxetine is a commonly prescribed SSRI that can impair erectile function in animal models via inhibition of nitric oxide synthase (NOS). Tadalafil potentiates nitric oxide (NO)-mediated responses in isolated trabecular smooth muscle and penile erection. The purpose of this study was to evaluate the impact of co-administering tadalafil with paroxetine on penile NOS levels in rats. Materials and Methods A total of 30 male Sprague-Dawley rats were divided into 3 groups as control (Group-C), paroxetine (Group-P) and paroxetine plus tadalafil (Group-P+T). After 28 days of treatment, rats were sacrificed and their penile tissues were harvested for analysis. NOS isoform protein levels and immunoreactivity scores of NOS were assessed. Statistical significance level was set at p<0.05. Results Neuronal NOS (nNOS) levels were significantly decreased in group-P, compared with group-C (p<0.001). In comparison, rats in group-P+T had significantly higher nNOS levels compared to group-P (p<0.001). Endothelial NOS (eNOS) and inducible NOS (iNOS) levels were significantly higher in group-P compared with group-C (p<0.01). The levels of eNOS and iNOS in group-P+T were similar to group-C. Conclusion Daily treatment with tadalafil prevented chronic paroxetine-induced changes in all three NOS isoform levels. Tadalafil treatment may therefore be a useful therapy in men with paroxetine-associated erectile dysfunction.
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Affiliation(s)
- Abdullah Gul
- Department of Urology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | | | - Levent Kabasakal
- Department of Pharmacology, Marmara University School of Pharmacy, Istanbul, Turkey
| | - Jenna Bates
- Baylor College of Medicine, Houston, TX, USA
| | - Serdar Altinay
- Department of Patology, University of Health Sciences, Bakirkoy Training and Research Hospital, Istanbul, Turkey
| | - Duygu Sultan Celik
- Department of Comparative Medicine, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Atilla Semercioz
- Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Ege Can Serefoglu
- Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Abstract
PURPOSE Chronic fatigue syndrome (CFS) is a debilitating disease characterized by fatigue, postexertional malaise, cognitive dysfunction, sleep disturbances, and widespread pain. A pilot, online survey was used to determine the common presentations of CFS patients in the emergency department (ED) and attitudes about their encounters. METHODS The anonymous survey was created to score the severity of core CFS symptoms, reasons for going to the ED, and Likert scales to grade attitudes and impressions of care. Open text fields were qualitatively categorized to determine common themes about encounters. RESULTS Fifty-nine percent of respondents with physician-diagnosed CFS (total n=282) had gone to an ED. One-third of ED presentations were consistent with orthostatic intolerance; 42% of participants were dismissed as having psychosomatic complaints. ED staff were not knowledgeable about CFS. Encounters were unfavorable (3.6 on 10-point scale). The remaining 41% of subjects did not go to ED, stating nothing could be done or they would not be taken seriously. CFS subjects can be identified by a CFS questionnaire and the prolonged presence (>6 months) of unremitting fatigue, cognitive, sleep, and postexertional malaise problems. CONCLUSION This is the first investigation of the presentation of CFS in the ED and indicates the importance of orthostatic intolerance as the most frequent acute cause for a visit. The self-report CFS questionnaire may be useful as a screening instrument in the ED. Education of ED staff about modern concepts of CFS is necessary to improve patient and staff satisfaction. Guidance is provided for the diagnosis and treatment of CFS in these challenging encounters.
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Affiliation(s)
- Christian R Timbol
- Division of Rheumatology, Immunology and Allergy, Georgetown University, Washington, DC, USA,
| | - James N Baraniuk
- Division of Rheumatology, Immunology and Allergy, Georgetown University, Washington, DC, USA,
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Hawkins M, Lee A, Leung S, Hawa R, Wnuk S, Yanofsky R, Sockalingam S. Prevalence and Factors Associated With Psychiatric Medication Use in Bariatric Surgery Candidates. PSYCHOSOMATICS 2018; 60:449-457. [PMID: 30558795 DOI: 10.1016/j.psym.2018.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We aimed to describe the rates of psychiatric medication use in bariatric surgery candidates and factors associated with psychiatric medication use. METHODS Patients from the Toronto Western Hospital Bariatric Surgery Program were recruited from 2011 to 2014. Data extracted included demographics, clinical factors (e.g., mood disorder, anxiety disorder, eating disorder, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7), and psychiatric medication use. Logistic regression analyses were used to examine the relationship between demographic variables, clinical factors, and psychiatric medication use. Multiple logistic regression was conducted to determine the predictors of clinical factors from demographic variables with psychiatric medication use. RESULTS A total of 262 (35.1%) patients were taking at least 1 psychiatric medication and 105 patients (14.1%) were taking more than 1 psychiatric medication. Antidepressants were the most common psychiatric medication reported. The majority of patients taking a psychiatric medication had a psychiatric illness, with 16.0% not having a lifetime diagnosis of a mental illness. Being male and being employed significantly predicted lower odds of being on a psychiatric medication. Older age significantly predicted higher odds of being on a psychiatric medication. Psychiatric disorders were significantly associated with psychiatric medication use independent of demographic variables. CONCLUSION Our study provides insights into clinical and demographic factors related to psychiatric medication use in bariatric surgery patients. The findings support careful screening and clarification of psychiatric medications, especially in patients without a formal psychiatric diagnosis.
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Affiliation(s)
- Michael Hawkins
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Lee
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Samantha Leung
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada; Toronto Western Hospital, Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada
| | - Raed Hawa
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Mental Health, University Health Network, Toronto, Ontario, Canada; Toronto Western Hospital, Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada
| | - Susan Wnuk
- Toronto Western Hospital, Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada
| | - Richard Yanofsky
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Mental Health, University Health Network, Toronto, Ontario, Canada; Toronto Western Hospital, Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Mental Health, University Health Network, Toronto, Ontario, Canada; Toronto Western Hospital, Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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Read J, Cartwright C, Gibson K. How many of 1829 antidepressant users report withdrawal effects or addiction? Int J Ment Health Nurs 2018; 27:1805-1815. [PMID: 29873165 DOI: 10.1111/inm.12488] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2018] [Indexed: 12/30/2022]
Abstract
More than 10% of adults are prescribed antidepressants annually in some countries. Recent increases in prescribing can be explained more by repeat prescriptions than new patients. This raises the question of whether antidepressants are addictive. A total of 1829 New Zealanders who had been prescribed antidepressants completed an online survey; 44% had been taking antidepressants for more than 3 years and were still taking them. Withdrawal effects when stopping medication were reported by 55%, and addiction by 27%. Paroxetine had particularly high rates of withdrawal symptoms. Only 1% of participants recalled being told about withdrawal effects when prescribed the drugs. Such high rates of withdrawal symptoms suggest that all concerned, including mental health nurses, need to help people considering antidepressants to understand that it can be difficult to withdraw from them. It will also be beneficial to closely monitor people already taking antidepressants and who are at risk of long-term usage.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London, UK
| | | | - Kerry Gibson
- School of Psychology, University of Auckland, Auckland, New Zealand
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14
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Finkelstein Y, Macdonald EM, Li P, Mamdani MM, Gomes T, Juurlink DN. Second-generation anti-depressants and risk of new-onset seizures in the elderly. Clin Toxicol (Phila) 2018; 56:1179-1184. [PMID: 29989445 DOI: 10.1080/15563650.2018.1483025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Anti-depressants are among the most widely-prescribed medications. It is unknown whether the risk of seizure during therapeutic use differs by drug. We ranked the seizure risk of popular anti-depressants. METHODS We conducted a population-based case-control study between April 2002 and March 2015 in Ontario, Canada. Cases were Ontario residents aged ≥65 years hospitalized for a first-ever seizure within 60 d of filling a prescription for one of nine second-generation anti-depressants, each dispensed more than 1 million times (range: 1,196,810 [fluvoxamine] to 19,849,930 [citalopram]) during the study period. For each case, we identified up to four seizure-free controls receiving a similar anti-depressant, and matched on age, sex, date and a pre-defined seizure-specific disease risk index. RESULTS We identified 5701 patients hospitalized with a first-ever seizure and matched them with 21,872 controls. Relative to bupropion, the risk of new-onset seizure during therapeutic use was highest for escitalopram (adjusted odds ratio [OR] 1.79; 95% confidence interval [CI] 1.42-2.25) and citalopram (OR 1.67; 95% CI 1.35-2.07), while no incremental risk was found for fluoxetine (OR 1.02; 95%CI 0.78-1.33) and duloxetine (OR 0.94; 95%CI 0.75-1.22). Other anti-depressants were associated with modest increase in seizure risk. CONCLUSIONS The risk of seizure during therapeutic use among elderly patients varies among second-generation anti-depressants. Escitalopram and citalopram are associated with the highest risk. Prescribers should consider the seizure risk of individual anti-depressants and use discretion when selecting an anti-depressant, especially for patients with other risk factors for seizure. Frontline clinicians should be cognizant of this differential risk.
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Affiliation(s)
- Yaron Finkelstein
- a Faculty of Medicine, Divisions of Emergency Medicine, Hospital for Sick Children , University of Toronto , Toronto , Ontario , Canada.,b Faculty of Medicine, Department of Clinical Pharmacology and Toxicology, Hospital for Sick Children , University of Toronto , Toronto , Ontario , Canada.,c Child Health Evaluative Sciences , Research Institute, The Hospital for Sick Children , Toronto , Ontario , Canada.,d The Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada
| | - Erin M Macdonald
- d The Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada
| | - Ping Li
- d The Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada
| | - Muhammad M Mamdani
- d The Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.,e St. Michael's Hospital , Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada.,f Dalla Lana School of Public Health , University of Toronto , Ontario , Canada.,g Department of Medicine , University of Toronto , Toronto , Ontario , Canada
| | - Tara Gomes
- d The Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada
| | - David N Juurlink
- d The Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.,h Sunnybrook Hospital , Sunnybrook Research Institute , Toronto , Ontario , Canada.,i Departments of Medicine, Pediatrics and Health Policy, Management and Evaluation , University of Toronto , Ontario , Canada
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15
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Westermair AL, Schaich A, Willenborg B, Willenborg C, Nitsche S, Schunkert H, Erdmann J, Schweiger U. Utilization of Mental Health Care, Treatment Patterns, and Course of Psychosocial Functioning in Northern German Coronary Artery Disease Patients with Depressive and/or Anxiety Disorders. Front Psychiatry 2018; 9:75. [PMID: 29593584 PMCID: PMC5858067 DOI: 10.3389/fpsyt.2018.00075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/23/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Comorbid mental disorders in patients with coronary artery disease (CAD) are common and associated with adverse somatic outcomes. However, data on utilization rates of mental health care and treatment efficiency are scarce and inconsistent, which we tried to remedy with the present preliminary study on Northern German CAD patients. METHOD A total of 514 German CAD patients, as diagnosed by cardiac catheterization, were assessed using the Mini International Neuropsychiatric Interview and the Global Assessment of Functioning (GAF) scale. RESULTS Global utilization of mental health care since onset of CAD was 21.0%. Depressive disorders, younger age, and lower GAF at onset of CAD were associated with higher utilization rates, while anxiety disorders and gender were not. Lower GAF at onset of CAD, female gender, and psychotherapy was positively associated with higher gains in GAF, while younger age and anxiety disorders were negatively associated. CONCLUSION The majority of CAD patients with comorbid depression reported to have received mental health treatment and seemed to have benefited from it. However, we found preliminary evidence of insufficiencies in the diagnosis and treatment of anxiety disorders in CAD patients. Further studies, preferably prospective and with representative samples, are needed to corroborate or falsify these findings and explore possible further mediators of health-care utilization by CAD patients such as race, ethnicity, and socioeconomic status.
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Affiliation(s)
- Anna Lisa Westermair
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Anja Schaich
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Bastian Willenborg
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Christina Willenborg
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany.,Partner Site Hamburg and Lübeck and Kiel, German Research Centre for Cardiovascular Research (DZHK), Lübeck, Germany.,University Heart Center Lübeck, Lübeck, Germany
| | - Stefan Nitsche
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany.,Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany.,Partner Site Hamburg and Lübeck and Kiel, German Research Centre for Cardiovascular Research (DZHK), Lübeck, Germany.,University Heart Center Lübeck, Lübeck, Germany
| | - Heribert Schunkert
- German Heart Center Munich, Technical University Munich, Munich, Germany.,Partner Site Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Jeanette Erdmann
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany.,Partner Site Hamburg and Lübeck and Kiel, German Research Centre for Cardiovascular Research (DZHK), Lübeck, Germany.,University Heart Center Lübeck, Lübeck, Germany
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
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16
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Torvinen-Kiiskinen S, Tolppanen AM, Koponen M, Tanskanen A, Tiihonen J, Hartikainen S, Taipale H. Antidepressant use and risk of hip fractures among community-dwelling persons with and without Alzheimer's disease. Int J Geriatr Psychiatry 2017; 32:e107-e115. [PMID: 28055139 DOI: 10.1002/gps.4667] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/21/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To study whether antidepressant use is associated with an increased risk of hip fracture among community-dwelling persons with and without Alzheimer's disease (AD), and to compare the risk according to duration of use and between antidepressant groups. METHODS Retrospective cohort study, including 50,491 persons with AD (mean age 80) and 100,982 comparison persons without AD from Finnish register-based MEDALZ cohort. Antidepressant use was compared with nonuse with Cox proportional hazard models. Incident users were identified with a one year washout period from Prescription register data. Main outcome was hospitalization due to hip fracture. RESULTS During antidepressant use, the age-adjusted rate of hip fractures per 100 person-years was 3.01 (95% CI 2.75-3.34) among persons with and 2.28 (1.94-2.61) among persons without AD. Antidepressant use was associated with an increased risk of hip fracture among persons with and without AD (adjusted HR 1.61, 95% CI 1.45-1.80 and 2.71, 2.35-3.14, respectively) compared with nonuse. The risk was most prominent in the beginning of use and was elevated even up to 4 years. The risk was increased with all of the most frequently used antidepressants. CONCLUSION Antidepressant use is associated with an increased risk of hip fracture among older persons. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Sanna Torvinen-Kiiskinen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Heidi Taipale
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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17
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Djokic G, Korcok D, Djordjevic V, Agic A, Rankovic A, Djukic D. The effects of S-adenosyl-L-methionine-vitamin B complex on mild and moderate depressive symptoms. Hippokratia 2017; 21:140-143. [PMID: 30479476 PMCID: PMC6247995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND S-adenosyl-L-methionine (SAMe) acts as a methyl donor, with dopamine, norepinephrine, and serotonin elevating properties, with potential antidepressant effects. In this study, we evaluated the efficacy of SAMe-vitamin B complex supplement for improving mild and moderate depressive symptoms. SUBJECTS AND METHODS The study included 60 patients diagnosed with depression, with mild or moderate depressive symptoms, randomly allocated into two groups. The study group was treated with SAMe-vitamin B complex while the control group was administered a placebo, once daily for three months. The severity of depressive symptoms was measured by the Hamilton Depression rating scale (HAMD17). We measured the symptoms' severity with the Clinical Global Impression-Severity scale (CGI-S), and the improvement or worsening after treatment with the Clinical Global Impression-Improvement scale (CGI-I). RESULTS The mean HAMD17 score at zero point refers to moderate depressive symptoms in both groups. We found a statistically significant difference between the two groups regarding the mean HAMD17 and CGI-S scores at three months (p <0.001) and a significant difference within the study group without an influence by the age or gender. Mean CGI-I score in the study group at three months showed minimally or much improvement while no change or minimal worsening was observed in the control group with significant differences between the groups (p <0.001). CONCLUSION Three months of supplementation with SAMe-vitamin B complex is effective for the treatment of mild to moderate depressive symptoms. HIPPOKRATIA 2017, 21(3): 140-143.
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Affiliation(s)
- G Djokic
- ¹Scientific Research Department, Clinic for Mental Disorders "Dr Laza Lazarevic", Belgrade, Serbia
- ²Abela Pharm, Belgrade, Serbia
| | - D Korcok
- ¹Scientific Research Department, Clinic for Mental Disorders "Dr Laza Lazarevic", Belgrade, Serbia
- ²Abela Pharm, Belgrade, Serbia
| | - V Djordjevic
- ¹Scientific Research Department, Clinic for Mental Disorders "Dr Laza Lazarevic", Belgrade, Serbia
- ²Abela Pharm, Belgrade, Serbia
| | - A Agic
- ¹Scientific Research Department, Clinic for Mental Disorders "Dr Laza Lazarevic", Belgrade, Serbia
- ²Abela Pharm, Belgrade, Serbia
| | - A Rankovic
- ¹Scientific Research Department, Clinic for Mental Disorders "Dr Laza Lazarevic", Belgrade, Serbia
- ²Abela Pharm, Belgrade, Serbia
| | - Dejanovic Djukic
- ¹Scientific Research Department, Clinic for Mental Disorders "Dr Laza Lazarevic", Belgrade, Serbia
- ²Abela Pharm, Belgrade, Serbia
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18
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Depression as a modifiable factor to decrease the risk of dementia. Transl Psychiatry 2017; 7:e1117. [PMID: 28463236 PMCID: PMC5534958 DOI: 10.1038/tp.2017.90] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/13/2017] [Accepted: 03/16/2017] [Indexed: 02/07/2023] Open
Abstract
Depression is an accepted risk factor for dementia, but it is unclear if this relationship is causal. This study investigated whether dementia associated with depression decreases with antidepressant use and is independent of the time between exposure to depression and the onset of dementia. We completed a 14-year longitudinal study of 4922 cognitively healthy men aged 71-89 years, and collected information about history of past depression, current depression and severity of depressive symptoms. Other measures included use of antidepressants, age, education, smoking and history of diabetes, hypertension, coronary heart disease, and stroke. The onset of dementia and death during follow-up was ascertained via the Western Australian Data Linkage System. A total of 682 men had past (n=388) or current (n=294) depression. During 8.9 years follow-up, 903 (18.3%) developed dementia and 1884 (38.3%) died free of dementia. The sub-hazard ratios (SHRs) of dementia for men with past and current depression were 1.3 (95% confidence interval (CI)=1.0, 1.6) and 1.5 (95% CI=1.2, 2.0). The use of antidepressants did not decrease this risk. Compared to men with no symptoms, the SHRs of dementia associated with questionable, mild-to-moderate and severe depressive symptoms were 1.2 (95% CI=1.0, 1.4), 1.7 (95% CI=1.4, 2.2) and 2.1 (95% CI=1.4, 3.2), respectively. The association between depression and dementia was only apparent during the initial 5 years of follow-up. Older men with history of depression are at increased risk of developing dementia, but depression is more likely to be a marker of incipient dementia than a truly modifiable risk factor.
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19
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Maust DT, Gerlach LB, Gibson A, Kales HC, Blow FC, Olfson M. Trends in Central Nervous System-Active Polypharmacy Among Older Adults Seen in Outpatient Care in the United States. JAMA Intern Med 2017; 177:583-585. [PMID: 28192559 PMCID: PMC5378654 DOI: 10.1001/jamainternmed.2016.9225] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses data from the National Ambulatory Medical Care Survey to describe the central nervous system polypharmacy practices among outpatient older adults.
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Affiliation(s)
- Donovan T Maust
- Department of Psychiatry, University of Michigan, Ann Arbor2Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | | | | | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor2Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Frederic C Blow
- Department of Psychiatry, University of Michigan, Ann Arbor2Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York5New York State Psychiatric Institute, New York
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20
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Maust DT, Blow FC, Wiechers IR, Kales HC, Marcus SC. National Trends in Antidepressant, Benzodiazepine, and Other Sedative-Hypnotic Treatment of Older Adults in Psychiatric and Primary Care. J Clin Psychiatry 2017; 78:e363-e371. [PMID: 28448697 PMCID: PMC5408458 DOI: 10.4088/jcp.16m10713] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 08/12/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe how use of antidepressants, benzodiazepines, and other anxiolytic/sedative-hypnotics among older adults (age ≥ 65 years) has changed over time among visits to primary care providers and psychiatrists. METHODS Data were from the National Ambulatory Medical Care Survey (years 2003-2005 and 2010-2012), a nationally representative cross-section of outpatient physician visits. Analysis focused on visits to primary care providers (n = 14,282) and psychiatrists (n = 1,095) at which an antidepressant, benzodiazepine, or other anxiolytic/sedative-hypnotic was prescribed, which were stratified by demographic and clinical characteristic (including ICD-9-CM diagnosis) and compared across study intervals. Odds of medication use were calculated for each stratum, adjusting for demographic and clinical characteristics. RESULTS The visit rate by older adults to primary care providers where any of the medications were prescribed rose from 16.4% to 21.8% (adjusted odds ratio [AOR] = 1.43, P < .001) while remaining steady among psychiatrists (75.4% vs 68.5%; AOR = 0.69, P = .11). Primary care visits rose for antidepressants (9.9% to 12.3%; AOR = 1.28, P = .01) and other anxiolytic/sedative-hypnotics (3.4% to 4.7%; AOR = 1.39, P = .01), but the largest growth was among benzodiazepines (5.6% to 8.7%; AOR = 1.62, P < .001). Among patients in primary care, increases primarily occurred among men, non-Hispanic white patients, and those with pain diagnoses as well as those with no mental health or pain diagnoses. CONCLUSIONS From 2003 to 2012, use of the most common psychotropic medications among older adults seen in primary care increased, with concentration among patients with no mental health or pain diagnosis. As the population of older adults grows and receives mental health treatment in primary care, it is critical to examine the appropriateness of psychotropic use.
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Affiliation(s)
- Donovan T. Maust
- Department of Psychiatry and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Frederic C. Blow
- Department of Psychiatry and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Ilse R. Wiechers
- Northeast Program Evaluation Center, Office of Mental Health Operations, U.S. Department of Veterans Affairs, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Helen C. Kales
- Department of Psychiatry and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Steven C. Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA
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21
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Maust DT, Langa KM, Blow FC, Kales HC. Psychotropic use and associated neuropsychiatric symptoms among patients with dementia in the USA. Int J Geriatr Psychiatry 2017; 32:164-174. [PMID: 26889640 PMCID: PMC4990518 DOI: 10.1002/gps.4452] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/28/2016] [Accepted: 01/28/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the national prevalence of psychotropic use and association with neuropsychiatric symptoms among patients with dementia. METHODS Participants diagnosed with dementia (n = 414) in the Aging, Demographics, and Memory Study, a nationally representative survey of US adults >70 years old. Diagnosis was based on in-person clinical assessment and informant interview. Information collected included demographics, place of residence, 10-item Neuropsychiatric Inventory (NPI), and prescribed medications (antipsychotic, sedative-hypnotic, antidepressant, mood stabilizer). RESULTS Of 414 participants with dementia, 41.4% were prescribed a psychotropic medication, including 84.0% of nursing home residents and 28.6% of community-dwellers. Of participants, 23.5% were prescribed an antidepressant. Compared with the total NPI score of those on no medication (4.5), those on antipsychotics and those on sedative-hypnotics had much higher scores (respectively: 12.6, p < 0.001; 11.8, p = 0.03), although those antidepressants did not (6.9, p = 0.15). A larger proportion of patients on antipsychotics exhibited psychosis and agitation compared with those on no medication, while those on antidepressants exhibited more depressive symptoms. In multivariable logistic regression that included dementia severity and nursing home residence, nursing home residence was the characteristic most strongly associated with psychotropic use (odds ratio ranging from 8.96 [p < 0.001] for antipsychotics to 15.59 [p < 0.001] for sedative-hypnotics). More intense psychotic symptoms and agitation were associated with antipsychotic use; more intense anxiety and agitation were associated with sedative-hypnotic use. More intense depression and apathy were not associated with antidepressant use. CONCLUSIONS In this nationally representative sample, 41.4% of patients were taking psychotropic medication. While associated with neuropsychiatric symptoms, nursing home residence was most strongly tied to use. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Donovan T. Maust
- Department of Psychiatry, University of Michigan, Ann Arbor, MI,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Kenneth M. Langa
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,Department of Internal Medicine, University of Michigan, Ann Arbor, MI,Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, MI,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Helen C. Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, MI,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
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22
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Carrasco-Garrido P, Hernández-Barrera V, Jiménez-Trujillo I, Esteban-Hernández J, Álvaro-Meca A, López-de Andrés A, DelBarrio-Fernández JL, Jiménez-García R. Time Trend in Psychotropic Medication Use in Spain: A Nationwide Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121177. [PMID: 27886138 PMCID: PMC5201318 DOI: 10.3390/ijerph13121177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 11/10/2016] [Accepted: 11/22/2016] [Indexed: 11/24/2022]
Abstract
Background: We performed an epidemiologic study to analyze nationwide time trends in adult psychotropic drug use over a period from 2006 to 2012, and to identify those factors associated with the likelihood of consumption of these drugs during the study period; Methods: Cross-sectional study on psychotropic medication in the Spanish adult population. We used secondary individualized data drawn from the 2006 and 2012 Spanish National Health Surveys (SNHS). The dependent variable was the use of psychotropic drugs in the previous two weeks. Independent variables included socio-demographic characteristics, comorbidity, lifestyles and healthcare resource utilization. Using logistic multivariate regression models, we analyzed the temporal evolution of psychotropic medication consumption between 2006 and 2012 in both sexes; Results: The prevalence of psychotropic drug use was significantly greater in women (18.14% vs. 8.08% in 2012 (p < 0.05). In Spanish women, the variables associated with a greater probability of psychotropic use were, age, unemployment (adjusted odds ratio (AOR), 1.60; 95% CI, 1.24–2.07), negative perception of health or taking non-psychotropic drugs. Among men, psychotropic use is associated with presence of chronic disease, negative perception of health (AOR, 3.27; 95% CI, 2.62–4.07 in 2012) or inactive status; Conclusions: Between 2006 and 2012, the probability of having taken psychotropic drugs increased by 16% among women. Unemployed women aged ≥45 years with a negative perception of their health constitute a clear risk profile in terms of psychotropic drug use. Inactive men who have a negative perception of their health are the group most likely to consume psychotropic drugs.
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Affiliation(s)
- Pilar Carrasco-Garrido
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón 28922, Spain.
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón 28922, Spain.
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón 28922, Spain.
| | - Jesús Esteban-Hernández
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón 28922, Spain.
| | - Alejandro Álvaro-Meca
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón 28922, Spain.
| | - Ana López-de Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón 28922, Spain.
| | - José Luis DelBarrio-Fernández
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón 28922, Spain.
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón 28922, Spain.
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23
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Read J, Gibson KL, Cartwright C. Are older people prescribed antidepressants on the basis of fewer symptoms of depression, and for longer periods of time? A survey of 1825 New Zealanders. Australas J Ageing 2016; 35:193-7. [DOI: 10.1111/ajag.12314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- John Read
- School of Psychology; University of East London; Stratford London UK
| | - Kerry L Gibson
- School of Psychological Science; University of Auckland; Auckland New Zealand
| | - Claire Cartwright
- School of Psychological Science; University of Auckland; Auckland New Zealand
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24
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Mitchell AJ, Yadegarfar M, Gill J, Stubbs B. Case finding and screening clinical utility of the Patient Health Questionnaire (PHQ-9 and PHQ-2) for depression in primary care: a diagnostic meta-analysis of 40 studies. BJPsych Open 2016; 2:127-138. [PMID: 27703765 PMCID: PMC4995584 DOI: 10.1192/bjpo.bp.115.001685] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 12/17/2015] [Accepted: 12/21/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The Patient Health Questionnaire (PHQ) is the most commonly used measure to screen for depression in primary care but there is still lack of clarity about its accuracy and optimal scoring method. AIMS To determine via meta-analysis the diagnostic accuracy of the PHQ-9-linear, PHQ-9-algorithm and PHQ-2 questions to detect major depressive disorder (MDD) among adults. METHOD We systematically searched major electronic databases from inception until June 2015. Articles were included that reported the accuracy of PHQ-9 or PHQ-2 questions for diagnosing MDD in primary care defined according to standard classification systems. We carried out a meta-analysis, meta-regression, moderator and sensitivity analysis. RESULTS Overall, 26 publications reporting on 40 individual studies were included representing 26 902 people (median 502, s.d.=693.7) including 14 760 unique adults of whom 14.3% had MDD. The methodological quality of the included articles was acceptable. The meta-analytic area under the receiver operating characteristic curve of the PHQ-9-linear and the PHQ-2 was significantly higher than the PHQ-9-algorithm, a difference that was maintained in head-to-head meta-analysis of studies. Our best estimates of sensitivity and specificity were 81.3% (95% CI 71.6-89.3) and 85.3% (95% CI 81.0-89.1), 56.8% (95% CI 41.2-71.8) and 93.3% (95% CI 87.5-97.3) and 89.3% (95% CI 81.5-95.1) and 75.9% (95% CI 70.1-81.3) for the PHQ-9-linear, PHQ-9-algorithm and PHQ-2 respectively. For case finding (ruling in a diagnosis), none of the methods were suitable but for screening (ruling out non-cases), all methods were encouraging with good clinical utility, although the cut-off threshold must be carefully chosen. CONCLUSIONS The PHQ can be used as an initial first step assessment in primary care and the PHQ-2 is adequate for this purpose with good acceptability. However, neither the PHQ-2 nor the PHQ-9 can be used to confirm a clinical diagnosis (case finding). DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
- Alex J Mitchell
- , MD, Department of Cancer Studies, University of Leicester, and Department of Psycho-Oncology, Leicestershire Partnership NHS Trust, Leicester, UK
| | | | - John Gill
- , MBChB, Medical School, University of Leicester, Leicester, UK
| | - Brendon Stubbs
- , PhD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Physiotherapy Department, South London and Maudsley NHS Foundation Trust, UK
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25
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Lorenzo-Luaces L. Heterogeneity in the prognosis of major depression: from the common cold to a highly debilitating and recurrent illness. Epidemiol Psychiatr Sci 2015; 24:466-72. [PMID: 26081748 PMCID: PMC8367371 DOI: 10.1017/s2045796015000542] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 05/27/2015] [Indexed: 11/06/2022] Open
Abstract
Two different and seemingly competing views on the diagnosis of major depressive disorder (MDD) exist. The first is that the diagnosis conflates adaptive sadness reactions with pathological states of depressed mood and that MDD is overdiagnosed and overtreated. The second is that MDD is an underdiagnosed and undertreated disorder, and one that is best characterised by a severe, chronic, recurrent or treatment-resistant course. Existing research suggests that both views are valid and merit being integrated. Anywhere from 30 to 50% of individuals will meet criteria for MDD at some point in their life. About half of these episodes are of brief duration and unlikely to recur. However, a remaining half is either chronic or recurrent. Data on the outpatient diagnosis of depression support the view that depression is simultaneously underdiagnosed and undertreated as well as overdiagnosed and overtreated. About one-third of the patients who meet criteria for MDD and receive placebos experience clinically significant and long-lasting improvement. Many other patients, however, are unresponsive to one or multiple active treatments. Thus, the diagnosis of MDD likely applies to individuals who are experiencing either normal periods of sadness or single-episode afflictions that are mild, unlikely to recur, and are placebo responsive, as well as to individuals with more severe clinical profiles. More research is needed that can help ascertain what contextual or biopsychological variables help distinguish between individuals who may be experiencing adaptive states of negative affect and those who experience severe, chronic, recurrent or treatment-resistant depressions.
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Affiliation(s)
- L. Lorenzo-Luaces
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA
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