1
|
Schuster JP, Strippoli MPF, Hoertel N, Marques-Vidal P, Vandeleur CL, Limosin F, Preisig M, von Gunten A. Healthcare use for major depressive disorders among middle-aged and older adults in the community. Soc Psychiatry Psychiatr Epidemiol 2022; 57:953-961. [PMID: 34842964 DOI: 10.1007/s00127-021-02193-8] [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: 05/19/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE There is a substantial gap between people having a mental disorder and those treated for this disorder. Studies that assessed the influence of age on healthcare use for major depressive disorder (MDD) have provided inconsistent results. We aimed to assess healthcare use in terms of treatment-seeking and psychotropic medication use in four age groups of 45- to 85-year-old community dwellers meeting criteria for MDD. METHODS Data stemmed from CoLaus|PsyCoLaus, a population-based prospective cohort study. Diagnostic information on mental disorders, utilization of professional healthcare and psychotropic drugs was elicited using a semi-structured interview. Associations between age groups and healthcare use were established using logistic regression models with serial adjustments for socio-demographic and depression characteristics as well as comorbid mental disorders and cardio-metabolic features. RESULTS Compared to participants of the youngest age group (ages 45 to 54 years), (1) those older than 75 years were less likely to use healthcare from psychiatrists or psychologists (OR: 0.4 [95% CI 0.17-0.96]), although the frequency of using any professional health care did not vary across age groups; (2) those older than 55 years used any psychotropic medication more frequently; and (3) those aged 55-64 years used antidepressants more frequently (OR: 1.61 [95% CI 1.07-2.44]), whereas those aged 65-74 years used anxiolytics more frequently (OR: 2.30 [95% CI 1.15-4.58]). CONCLUSION Age is a complex biological and social factor that influences healthcare use.
Collapse
Affiliation(s)
- Jean-Pierre Schuster
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Prilly, Switzerland.
| | - Marie-Pierre F Strippoli
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Centre Psychiatrie Et Neurosciences, Inserm Umr 894, Paris, France
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Caroline L Vandeleur
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Centre Psychiatrie Et Neurosciences, Inserm Umr 894, Paris, France
| | - Martin Preisig
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Prilly, Switzerland
| |
Collapse
|
2
|
Rezaei Kelishadi M, Alavi Naeini A, Askari G, Khorvash F, Heidari Z. The efficacy of alpha-lipoic acid in improving oxidative, inflammatory, and mood status in women with episodic migraine in a randomised, double-blind, placebo-controlled clinical trial. Int J Clin Pract 2021; 75:e14455. [PMID: 34105866 DOI: 10.1111/ijcp.14455] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/19/2021] [Indexed: 11/28/2022] Open
Abstract
AIM Migraine is a common neurovascular disorder, which is associated with severe to moderate disabling headaches. Oxidative stress and inflammation might play a role in migraine pathogenesis and the mood disorders. Considering the antioxidant and anti-inflammatory properties of alpha-lipoic acid (ALA), this study was designed to investigate its effect on oxidative, inflammatory, and mood conditions in women with episodic migraine. METHODS In total, 92 women with episodic migraine participated in the study. The patients were randomly divided into two groups, receiving a 300-mg capsule of ALA or placebo twice daily for 3 months. To assess the oxidative and inflammatory status, the serum levels of total antioxidant capacity (TAC), total oxidant status (TOS), glutathione (GSH), malondialdehyde (MDA), oxidative stress index (OSI), and C-reactive protein (CRP) were determined at the beginning and at the end of the intervention. A depression, anxiety, stress scale (DASS-21-items) questionnaire was used to evaluate mood status. RESULTS Finally, 79 patients reached the final analysis stage. At the end of the intervention, a significant decrease in the serum levels of MDA (means difference [MD]: -0.83, 95% confidence intervals (CI): -1.04, -0.62 nmol/mL vs MD: -0.32, CI: -0.48, -0.15 nmol/mL; P < .001) and CRP (MD: -0.78, CI: -1.17, -0.39 mg/L vs MD: -0.63, CI: -1.80, 0.52 mg/L; P < .001) was observed in the ALA as compared with the placebo group, but changes in serum GSH (P = .086), TAC (P = .068), TOS (P = .225), and OSI (P = .404) were not statistically significant. In addition, depression, anxiety, and stress (with P < .001, in all cases) had significantly decreased in the intervention as compared with the control group. CONCLUSION The results of this study suggest that ALA supplementation for 3 months has beneficial effects on improving the oxidative, inflammatory, and mood conditions of patients suffering from episodic migraine.
Collapse
Affiliation(s)
- Mahnaz Rezaei Kelishadi
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirmansour Alavi Naeini
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
3
|
Chavarria J, Wells S, Elton-Marshall T, Rehm J. Associations of antidepressant use with alcohol use and problem drinking: Ontario population data from 1999 to 2017. Canadian Journal of Public Health 2021; 112:919-926. [PMID: 34076877 DOI: 10.17269/s41997-021-00526-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/31/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study investigated the rates of and change in past-year antidepressant use from 1999 to 2017 among a representative sample of Ontario adults and past-year alcohol users and problem drinkers. It examined whether alcohol use and problem drinking are associated with antidepressant use over time, whether gender moderated the effect of problem drinking on antidepressant use, and the potential correlates of past-year antidepressant use. METHOD This study utilized data from the Centre for Addiction and Mental Health Monitor study, a repeat cross-sectional telephone survey of the Ontario general adult population. Data are from 15 annual cycles of the survey 1999-2017 (where relevant variables were included), resulting in a sample size of N = 35,210. Variables of interest included demographic variables, past-year antidepressant use, past-year alcohol use, and past-year problem drinking (e.g., 8+ on the Alcohol Use Disorders Identification Test). RESULTS Past-year antidepressant use increased from 1999 to 2017 similarly among the full sample, past-year alcohol users, and past-year problem drinkers. Approximately 9% of Ontarians reported past-year antidepressant use in 2017. Overall, past-year problem drinkers were 1.5 times more likely to use antidepressants than non-problem drinkers. Past-year alcohol use was not associated with antidepressant use. Gender moderated the association between past-year problem drinking and antidepressant use. CONCLUSION This study determined that past-year antidepressant use increased from 1999 to 2017, that past-year problem drinkers are more likely to use antidepressants than non-problem drinkers, and that past-year problem drinking is associated with past-year antidepressant use among women but not among men.
Collapse
Affiliation(s)
- Jesus Chavarria
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 100 Collip Circle, Suite 200, ON, N6G 4X8, London, Canada.
| | - Samantha Wells
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 100 Collip Circle, Suite 200, ON, N6G 4X8, London, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.,School of Psychology, Deakin University, Geelong, Australia
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 100 Collip Circle, Suite 200, ON, N6G 4X8, London, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 100 Collip Circle, Suite 200, ON, N6G 4X8, London, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie & Psychotherapie, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| |
Collapse
|
4
|
Habib B, Tamblyn R, Girard N, Eguale T, Huang A. Detection of adverse drug events in e-prescribing and administrative health data: a validation study. BMC Health Serv Res 2021; 21:376. [PMID: 33892716 PMCID: PMC8063436 DOI: 10.1186/s12913-021-06346-y] [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] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/03/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Administrative health data are increasingly used to detect adverse drug events (ADEs). However, the few studies evaluating diagnostic codes for ADE detection demonstrated low sensitivity, likely due to narrow code sets, physician under-recognition of ADEs, and underreporting in administrative data. The objective of this study was to determine if combining an expanded ICD code set in administrative data with e-prescribing data improves ADE detection. METHODS We conducted a prospective cohort study among patients newly prescribed antidepressant or antihypertensive medication in primary care and followed for 2 months. Gold standard ADEs were defined as patient-reported symptoms adjudicated as medication-related by a clinical expert. Potential ADEs in administrative data were defined as physician, ED, or hospital visits during follow-up for known adverse effects of the study medication, as identified by ICD codes. Potential ADEs in e-prescribing data were defined as study drug discontinuations or dose changes made during follow-up for safety or effectiveness reasons. RESULTS Of 688 study participants, 445 (64.7%) were female and mean age was 64.2 (SD 13.9). The study drug for 386 (56.1%) patients was an antihypertensive, and for 302 (43.9%) an antidepressant. Using the gold standard definition, 114 (16.6%) patients experienced an ADE, with 40 (10.4%) among antihypertensive users and 74 (24.5%) among antidepressant users. The sensitivity of the expanded ICD code set was 7.0%, of e-prescribing data 9.7%, and of the two combined 14.0%. Specificities were high (86.0-95.0%). The sensitivity of the combined approach increased to 25.8% when analysis was restricted to the 27% of patients who indicated having reported symptoms to a physician. CONCLUSION Combining an expanded diagnostic code set with e-prescribing data improves ADE detection. As few patients report symptoms to their physician, higher detection rates may be achieved by collecting patient-reported outcomes via emerging digital technologies such as patient portals and mHealth applications.
Collapse
Affiliation(s)
- Bettina Habib
- Clinical and Health Informatics Research Group, McGill University, 1140 Pine Avenue West, Montreal, QC, H3A 1A3, Canada.
| | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, McGill University, 1140 Pine Avenue West, Montreal, QC, H3A 1A3, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.,Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Nadyne Girard
- Clinical and Health Informatics Research Group, McGill University, 1140 Pine Avenue West, Montreal, QC, H3A 1A3, Canada
| | - Tewodros Eguale
- Department of Medicine, McGill University Health Centre, Montreal, Canada.,School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | - Allen Huang
- Division of Geriatric Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
5
|
Use of Antidepressants among Patients Diagnosed with Depression: A Scoping Review. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6699028. [PMID: 33791379 PMCID: PMC7984896 DOI: 10.1155/2021/6699028] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/02/2021] [Accepted: 03/08/2021] [Indexed: 01/11/2023]
Abstract
Introduction Depression is a major global health problem with a relatively high lifetime prevalence and significant disability. Antidepressants are the most effective medications used for the treatment of depression. Hence, this study is aimed at summarizing the studies on antidepressant use among patients diagnosed with depression. Method PubMed, Embase, Web of Science, Scopus, and Google Scholar were searched for literature (2000-2019) using keywords such as depression, drug utilization, antidepressants, prescription, serotonin reuptake inhibitor, serotonin and norepinephrine reuptake inhibitor, tricyclic antidepressants, and atypical antidepressants. Results Antidepressant users were mostly females, married people, housewives, lower-income people, employees, and highly educated people, as they were found to be more prone to develop depression than their counterparts. Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, were most commonly prescribed among depressive patients. Conclusion Our study suggested that out of five major antidepressant drugs available for the treatment of depression, selective serotonin reuptake inhibitors are preferred over others because of their better side effects and tolerability profile.
Collapse
|
6
|
Serafini G, Vazquez G, Monacelli F, Pardini M, Pompili M, Amore M. The use of antidepressant medications for Bipolar I and II disorders. Psychiatry Res 2021; 296:113273. [PMID: 32653094 DOI: 10.1016/j.psychres.2020.113273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/19/2022]
Abstract
Given that the patterns and clinical correlates related to antidepressant drugs (ADs) prescription for Bipolar Disorder (BD) remain generally unclear, this study aimed to compare socio-demographic and clinical features of BD patients treated vs. not treated with ADs. The sample consists of 287 currently euthymic bipolar patients. Among participants (mean age=51.9±15.02), 157 54.7% were receiving ADs. Based on the main findings, subjects given ADs were older and more frequently retired than those without receiving ADs. Moreover, patients given ADs were more likely to have had a first major depressive episode. Lifetime substance abuse/dependence history was less frequently reported among patients given ADs. Furthermore, ADs given patients had a higher number of affective episodes, and longer duration of their illness. Additionally, subjects treated with ADs reported higher hopelessness levels, and lower positive reinterpretations than those who were not treated with ADs. Factors associated with ADs-use by multivariate modeling were reduced personal autonomy (OR=.070), and hopelessness levels (OR=1.391). These results may help clinicians to better understand the clinical correlates of BD subtypes and improve their differential management. Additional studies are needed to replicate these findings, and facilitate the differential trajectories of BD patients based on socio-demographic/clinical profiles.
Collapse
Affiliation(s)
- Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - Gustavo Vazquez
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Fiammetta Monacelli
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties, DIMI, Section of Geriatrics, University of Genoa, viale Benedetto XV n6, 16132, Genoa, Italy
| | - Matteo Pardini
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Suicide Prevention Center, Sant'Andrea Hospital, University of Rome, Rome, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| |
Collapse
|
7
|
Tamblyn R, Bates DW, Buckeridge DL, Dixon WG, Girard N, Haas JS, Habib B, Iqbal U, Li J, Sheppard T. Multinational Investigation of Fracture Risk with Antidepressant Use by Class, Drug, and Indication. J Am Geriatr Soc 2020; 68:1494-1503. [PMID: 32181493 PMCID: PMC7383967 DOI: 10.1111/jgs.16404] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/04/2020] [Accepted: 02/11/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Antidepressants increase the risk of falls and fracture in older adults. However, risk estimates vary considerably even in comparable populations, limiting the usefulness of current evidence for clinical decision making. Our aim was to apply a common protocol to cohorts of older antidepressant users in multiple jurisdictions to estimate fracture risk associated with different antidepressant classes, drugs, doses, and potential treatment indications. DESIGN Retrospective (2009–2014) cohort study. SETTING Five jurisdictions in the United States, Canada, United Kingdom, and Taiwan. PARTICIPANTS Older antidepressant users—subjects were followed from first antidepressant prescription or dispensation to first fracture or until the end of follow‐up. MEASUREMENTS The risk of fractures with antidepressants was estimated by multivariable Cox proportional hazards models using time‐varying measures of antidepressant dose and use vs nonuse, adjusting for patient characteristics. RESULTS Between 42.9% and 55.6% of study cohorts were 75 years and older, and 29.3% to 45.4% were men. Selective serotonin reuptake inhibitors (SSRIs) (48.4%‐60.0%) were the predominant class used in North America compared with tricyclic antidepressants (TCAs) in the United Kingdom and Taiwan (49.6%‐53.6%). Fracture rates varied from 37.67 to 107.18 per 1,000. The SSRIs citalopram (hazard ratio [HR] = 1.23; 95% confidence interval [CI] = 1.11‐1.36 to HR = 1.43; 95% CI = 1.11‐1.84) and sertraline (HR = 1.36; 95% CI = 1.10‐1.68), the SNRI duloxetine (HR = 1.41; 95% CI = 1.06‐1.88), TCAs doxepin (HR = 1.36; 95% CI = 1.00‐1.86) and imipramine (HR = 1.16; 95% CI = 1.05‐1.28), and atypicals (HR = 1.34; 95% CI = 1.14‐1.58) increased fracture risk in some but not all jurisdictions. In the United States and the United Kingdom, fracture risk with all classes was higher when prescribed for depression than chronic pain, a trend that is likely explained by drug choice. CONCLUSION The fracture risk for patients may be reduced by selecting paroxetine, an SSRI with lower risk than citalopram, the SNRI venlafaxine over duloxetine, and the TCA amitriptyline over imipramine or doxepin. There is uncertainty about the risk associated with the atypical antidepressants. J Am Geriatr Soc 68:1494‐1503, 2020.
Collapse
Affiliation(s)
- Robyn Tamblyn
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | | | - David L Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - William G Dixon
- Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Nadyne Girard
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | | | - Bettina Habib
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - Usman Iqbal
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Master's Program in Global Health and Development, PhD Program in Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Jack Li
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan.,Department of Dermatology, Taipei Wanfang Hospital, Taipei, Taiwan
| | - Therese Sheppard
- Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| |
Collapse
|
8
|
Chyurlia L, Tasca GA, Bissada H. An Integrative Approach to Clinical Decision-Making for Treating Patients With Binge-Eating Disorder. Front Psychol 2019; 10:2573. [PMID: 31824375 PMCID: PMC6881374 DOI: 10.3389/fpsyg.2019.02573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/30/2019] [Indexed: 11/25/2022] Open
Abstract
Transtheoretical integrative decision-making models help clinicians to use patient factors that are known to predict outcomes in order to inform individualized treatment. Patient factors with a strong evidence base include: functional impairment, social support and interpersonal functioning, complexity and comorbidity, coping style, level of resistance, and level of subjective distress. Among those with binge-eating disorder (BED), patient factors have not been extensively characterized relative to norms or other clinical samples. We used an integrative decision-making model of these six patient factor domains related to patient outcomes to characterize a sample of 424 adults seeking treatment for BED. Data were from medical charts, a demographics questionnaire, and validated psychometric scales. We then compared these data to published data from normative and other eating disorder (ED) samples. Results showed that the average patient with BED: (1) was significantly more functionally impaired compared to non-clinical norms but somewhat less impaired than other patients with ED, (2) demonstrated clinically significant problems in social support and interpersonal functioning, (3) presented with complex comorbid pathology and high levels of chronicity, (4) used a more internalizing coping style compared to the norm and other ED samples, (5) had low levels of resistance to interventions, and (6) experienced a moderately high level of subjective distress indicating good motivation for treatment. Corresponding recommendations to these findings are that the average patient with BED should be provided higher intensity treatment that is longer in duration, interpersonally focused, directive in nature, and emphasizing self-reflection and insight. Despite the nomothetic nature of the findings, clinicians are encouraged to assess these patient domains when developing an ideographic case conceptualization and to tailor precision treatment to the individual patient with BED.
Collapse
Affiliation(s)
- Livia Chyurlia
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Giorgio A Tasca
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Hany Bissada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
9
|
Shoval G, Balicer RD, Feldman B, Hoshen M, Eger G, Weizman A, Zalsman G, Stubbs B, Golubchik P, Gordon B, Krivoy A. Adherence to antidepressant medications is associated with reduced premature mortality in patients with cancer: A nationwide cohort study. Depress Anxiety 2019; 36:921-929. [PMID: 31332883 DOI: 10.1002/da.22938] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/24/2019] [Accepted: 05/25/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Depression and anxiety are common in cancer and antidepressants (AD) are efficacious treatment. The relationship between AD adherence and mortality in cancer is unclear. This study aimed to evaluate the association between adherence to AD and all-cause mortality in a population-based cohort of patients with cancer. MATERIALS AND METHODS We conducted a 4-year historical prospective cohort study including 42,075 patients with cancer who purchased AD at least once during the study period. Adherence to AD was modeled as nonadherence (<20%), poor (20-50%), moderate (50-80%), and good (>80%) adherence. We conducted multivariable survival analyses adjusted for demographic and clinical variables that may affect mortality. RESULTS During 1,051,489 person-years at risk follow-up, the adjusted hazard ratios (HR) for mortality were 0.89 (95% confidence interval [CI]: 0.83-0.95), 0.77 (95% CI: 0.66-0.72), and 0.80 (95% CI: 0.76-0.85) for the poor, moderate, and good adherence groups, respectively, compared to the nonadherent group. Analysis of the entire sample and a subgroup with depression, for cancer subtypes, revealed similar patterns for breast, colon, lung, and prostate cancers, but not for melanoma patients. Multivariate predictors of premature mortality included male gender (HR 1.48 [95% CI: 1.42-1.55]), current/past smoking status (HR 1.1, [95% CI: 1.04-1.15]; P < .0001), low socioeconomic status (HR 1.1, [95% CI: 1.03-1.17]; P < .0001) and more physical comorbidities. CONCLUSIONS The present study is the first to demonstrate that higher adherence to AD is associated with a decrease of all-cause mortality in a large nationwide cohort of cancer patients. Our data add to the pressing need to encourage adherence to AD among cancer patients.
Collapse
Affiliation(s)
- Gal Shoval
- Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel.,Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran D Balicer
- Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel.,Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Becca Feldman
- Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Moshe Hoshen
- Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Gilad Eger
- Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, New York
| | - Gil Zalsman
- Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, New York.,Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pavel Golubchik
- Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Gordon
- Medical Corps, Israel Defense Forces, Tel Aviv, Israel.,Department of Family Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Amir Krivoy
- Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel.,Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
10
|
Tamblyn R, Bates DW, Buckeridge DL, Dixon W, Forster AJ, Girard N, Haas J, Habib B, Kurteva S, Li J, Sheppard T. Multinational comparison of new antidepressant use in older adults: a cohort study. BMJ Open 2019; 9:e027663. [PMID: 31092665 PMCID: PMC6530307 DOI: 10.1136/bmjopen-2018-027663] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES We used an international pharmacosurveillance network to estimate the rate and characteristics of antidepressant use in older adults in countries with more conservative (UK) and liberal depression guidelines (Canada, USA). SETTING Electronic health records and population-based administrative data from six jurisdictions in four countries (UK, Taiwan, USA and Canada). PARTICIPANTS A historical cohort of older adults (≥65 years) who had a new episode of antidepressant use between 2009 and 2014. OUTCOME MEASURES The age and sex-standardised cumulative incidence of new episodes of antidepressant use in older adults was measured. Descriptive statistics were used to compare the proportion of new users by the antidepressant prescribed, therapeutic class, potential treatment indication and country, as well as the characteristics of the first treatment episode (standardised daily doses, duration and changes). RESULTS The incidence of antidepressant use between 2009 and 2014 varied from 4.7% (Montreal and Quebec City) to 18.6% (Taiwan). Tricyclic antidepressants (TCAs) were the most commonly used class in the UK (48.8%) and Taiwan (52.4%) compared with selective serotonin reuptake inhibitors (SSRIs) in North American jurisdictions (42.3%-53.3%). Chronic pain was the most common potential treatment indication (41.2%-68.2%). Among users with chronic pain, TCAs were used most frequently in the UK and Taiwan (55.2%-60.4%), whereas SSRIs were used most frequently in North America (33.5%-46.4%). Treatment was longer (252-525 vs 169-437 days), standardised doses were higher (0.7-1.3 vs 0.5-1.0) and treatment was more likely to be changed (31%-46% vs 21%-34%) among patients with depression (9.1%-43%) than those with chronic pain. CONCLUSION Antidepressant use in older adults varied 24-fold by country, with the UK, which has the most conservative treatment guidelines, being among the lowest. Chronic pain was the most common potential treatment indication. Evaluation of real-world risks of TCAs is a priority for future research, given high rates of use and the potential for increased toxicity in older adults because of potent anticholinergic effects.
Collapse
Affiliation(s)
- Robyn Tamblyn
- Department of Medicine and Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | | | - David L Buckeridge
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Direction de santé publique, Agence de la Santé et des services Sociaux de Montréal, Montreal, Quebec, Canada
| | - Will Dixon
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Alan J Forster
- Internal Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nadyne Girard
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - Jennifer Haas
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Bettina Habib
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - Siyana Kurteva
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jack Li
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
| | - Therese Sheppard
- Department of Medicine, University of Manchester, Manchester, UK
| |
Collapse
|
11
|
Jayalakshmi S, Vooturi S. Migraine and Mood Disorders: Prevalence, Clinical Correlations, and Disability. J Neurosci Rural Pract 2019; 10:1-2. [PMID: 30765959 PMCID: PMC6338002 DOI: 10.4103/jnrp.jnrp_323_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Sudhindra Vooturi
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| |
Collapse
|
12
|
Vicente ART, Castro-Costa É, Diniz BS, Firmo JOA, Lima-Costa MF, Loyola Filho AID. Antidepressant use and associated factors among the elderly: the Bambuí Project. CIENCIA & SAUDE COLETIVA 2017; 20:3797-804. [PMID: 26691804 DOI: 10.1590/1413-812320152012.09662015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/07/2015] [Indexed: 11/22/2022] Open
Abstract
This study examined the factors associated with antidepressant use among community-dwelling elderly individuals. Data collected from the Bambuí Project, a population-based study on aging and health with a cohort of 1,606 elderly individuals, were used. Gender, age, education, marital status, household income and cohabitation status were the sociodemographic characteristics investigated. Health conditions included self-reported health, number of chronic diseases, depressive symptoms, cognitive impairment and functional disability. Poisson regression with robust variance was used to test associations and to estimate prevalence ratios with 95% confidence intervals. The prevalence of antidepressant use was 8.4%. After multivariate analysis, antidepressant use was associated with the female gender (PR = 2.96; 95%CI 1.82-4.81), being single or divorced (PR = 0.48; 95%CI 0.25-0.91), cognitive impairment (PR = 0.44; 95%CI 0.24-0.84) and worse self-reported health (poor/very poor) (PR=1.86; 95%CI 1.11-3.10). The results are similar to those observed in several other studies conducted in higher-income countries and suggest that self-reported health in the elderly population of Bambuí is a key factor in the decision to use antidepressants.
Collapse
Affiliation(s)
- Adriano Roberto Tarifa Vicente
- Laboratório de Epidemiologia e Antropologia Médica, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brasil,
| | - Érico Castro-Costa
- Laboratório de Epidemiologia e Antropologia Médica, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brasil,
| | | | - Josélia Oliveira Araújo Firmo
- Laboratório de Epidemiologia e Antropologia Médica, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brasil,
| | - Maria Fernanda Lima-Costa
- Laboratório de Epidemiologia e Antropologia Médica, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brasil,
| | - Antônio Ignácio de Loyola Filho
- Laboratório de Epidemiologia e Antropologia Médica, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brasil,
| |
Collapse
|
13
|
Aarts N, Noordam R, Hofman A, Tiemeier H, Stricker BH, Visser LE. Self-reported indications for antidepressant use in a population-based cohort of middle-aged and elderly. Int J Clin Pharm 2016; 38:1311-7. [PMID: 27586370 PMCID: PMC5031724 DOI: 10.1007/s11096-016-0371-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/10/2016] [Indexed: 11/20/2022]
Abstract
Background Population-based studies investigating indications for antidepressant prescribing mostly rely on diagnoses from general practitioners. However, diagnostic codes might be incomplete and drugs may be prescribed ‘off-label’ for indications not investigated in clinical trials. Objective We aimed to study indications for antidepressant use based on self-report. Also, we studied the presence of depressive symptoms associated with the self-reported indications. Setting Our study population of antidepressant users was selected based on interview data between 1997 and 2013 from the prospective population-based Rotterdam Study cohort (age >45 years). Method Antidepressant use, self-reported indication for use, and presence of depressive symptoms (Center for Epidemiological Studies Depression Scale) were based on interview. Self-reported indications were categorized by the researchers into officially approved, clinically-accepted and commonly mentioned off-label indications. Main outcome measures A score of 16 and higher on the Center for Epidemiological Studies Depression Scale was considered as indicator for clinically-relevant depressive symptoms. Results The majority of 914 antidepressant users reported ‘depression’ (52.4 %) as indication for treatment. Furthermore, anxiety, stress and sleep disorders were reported in selective serotonin reuptake inhibitor and other antidepressant users (ranging from 5.9 to 13.3 %). The indication ‘pain’ was commonly mentioned by tricyclic antidepressant users (19.0 %). Indications were statistically significantly associated with higher depressive symptom scores when compared to non-users (n = 10,979). Conclusions Depression was the main indication for antidepressant treatment. However, our findings suggest that antidepressants are also used for off-label indications, subthreshold disorders and complex situations, which were all associated with clinically-relevant depressive symptoms in the middle-aged and elderly population.
Collapse
Affiliation(s)
- Nikkie Aarts
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Raymond Noordam
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Inspectorate of Health Care, Utrecht, The Netherlands.
| | - Loes E Visser
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Apotheek Haagse Ziekenhuizen - HAGA, The Hague, The Netherlands
| |
Collapse
|
14
|
Kouvonen A, Vahtera J, Pentti J, Korhonen MJ, Oksanen T, Salo P, Virtanen M, Kivimäki M. Antidepressant use and work-related injuries. Psychol Med 2016; 46:1391-1399. [PMID: 26804130 DOI: 10.1017/s0033291715002925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adverse effects of antidepressants are most common at the beginning of the treatment, but possible also later. We examined the association between antidepressant use and work-related injuries taking into account the duration of antidepressant use. METHOD Antidepressant use and work-related injuries between 2000 and 2011 were measured among 66 238 employees (mean age 43.8 years, 80% female) using linkage to national records (the Finnish Public Sector study). We analysed data using time-dependent modelling with individuals as their own controls (self-controlled case-series design). RESULTS In 2238 individuals who had used antidepressants and had a work-related injury during a mean follow-up of 7.8 years, no increase in the risk of injury was observed in the beginning of antidepressant treatment. However, an increased injury risk was seen after 3 months of treatment (rate ratio, compared with no recent antidepressant use, 1.27, 95% confidence interval 1.10-1.48). This was also the case among those who had used only selective serotonin reuptake inhibitors (n = 714; rate ratio 1.41, 95% confidence interval 1.08-1.83). CONCLUSIONS Antidepressant use was not associated with an increased risk of work-related injury at the beginning of treatment. Post-hoc analyses of antidepressant trials are needed to determine whether long-term use of antidepressants increases the risk of work-related injury.
Collapse
Affiliation(s)
- A Kouvonen
- Department of Social Research,University of Helsinki,Helsinki,Finland
| | - J Vahtera
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| | - J Pentti
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| | - M J Korhonen
- Department of Pharmacology, Drug Development and Therapeutics,University of Turku,Turku,Finland
| | - T Oksanen
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| | - P Salo
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| | - M Virtanen
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| | - M Kivimäki
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| |
Collapse
|
15
|
Raissi A, Bulloch AGM, Fiest KM, McDonald K, Jetté N, Patten SB. Exploration of Undertreatment and Patterns of Treatment of Depression in Multiple Sclerosis. Int J MS Care 2015; 17:292-300. [PMID: 26664335 DOI: 10.7224/1537-2073.2014-084] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Depression is a common comorbid condition with multiple sclerosis (MS). Historically, however, it has been undertreated. Little is known about the characteristics of those who receive, or do not receive, treatment for depression in the MS population. This study evaluated depression treatment in patients with MS, associated patient characteristics, and probable determinants of antidepressant drug use in those with and without depression. METHODS A total of 152 patients with MS completed questionnaires and the Structured Clinical Interview for DSM-IV-TR (SCID) to determine depression status. Tabular analyses and a binary regression model were used to identify patient characteristics associated with antidepressant drug use. RESULTS Of participants with major depression according to the SCID, 65% were taking antidepressant medications. With adjustment for successful treatment (antidepressant drug use by those not currently depressed and currently depressed), the prevalence of treated depression increased to 85.7%. Of those receiving treatment for depression, 19% were receiving nonpharmacologic treatment alone, 38% were taking antidepressant drugs only, and 44% were receiving both pharmacologic and nonpharmacologic treatments. Demographic and clinical variables were not statistically significantly associated with antidepressant drug use in those with depression. CONCLUSIONS A large proportion of participants with depression in MS are now receiving treatment, a change from previous reports. The adequacy of treatment has become a bigger question because many of the treated patients continued to have depressive symptoms. Further research is needed to identify ways to achieve better outcomes for depression.
Collapse
Affiliation(s)
- Aida Raissi
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute (AR, AGMB, KMF, KM, SBP), Department of Community Health Sciences (AGMB, KMF, KM, NJ, SBP), Department of Psychiatry (AGMB, SBP), and Department of Clinical Neurosciences, Hotchkiss Brain Institute, and Institute for Public Health (NJ), University of Calgary, AB, Canada
| | - Andrew G M Bulloch
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute (AR, AGMB, KMF, KM, SBP), Department of Community Health Sciences (AGMB, KMF, KM, NJ, SBP), Department of Psychiatry (AGMB, SBP), and Department of Clinical Neurosciences, Hotchkiss Brain Institute, and Institute for Public Health (NJ), University of Calgary, AB, Canada
| | - Kirsten M Fiest
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute (AR, AGMB, KMF, KM, SBP), Department of Community Health Sciences (AGMB, KMF, KM, NJ, SBP), Department of Psychiatry (AGMB, SBP), and Department of Clinical Neurosciences, Hotchkiss Brain Institute, and Institute for Public Health (NJ), University of Calgary, AB, Canada
| | - Keltie McDonald
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute (AR, AGMB, KMF, KM, SBP), Department of Community Health Sciences (AGMB, KMF, KM, NJ, SBP), Department of Psychiatry (AGMB, SBP), and Department of Clinical Neurosciences, Hotchkiss Brain Institute, and Institute for Public Health (NJ), University of Calgary, AB, Canada
| | - Nathalie Jetté
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute (AR, AGMB, KMF, KM, SBP), Department of Community Health Sciences (AGMB, KMF, KM, NJ, SBP), Department of Psychiatry (AGMB, SBP), and Department of Clinical Neurosciences, Hotchkiss Brain Institute, and Institute for Public Health (NJ), University of Calgary, AB, Canada
| | - Scott B Patten
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute (AR, AGMB, KMF, KM, SBP), Department of Community Health Sciences (AGMB, KMF, KM, NJ, SBP), Department of Psychiatry (AGMB, SBP), and Department of Clinical Neurosciences, Hotchkiss Brain Institute, and Institute for Public Health (NJ), University of Calgary, AB, Canada
| |
Collapse
|
16
|
Morkem R, Barber D, Williamson T, Patten SB. A Canadian Primary Care Sentinel Surveillance Network Study Evaluating Antidepressant Prescribing in Canada From 2006 to 2012. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:564-70. [PMID: 26720825 PMCID: PMC4679165 DOI: 10.1177/070674371506001207] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 04/01/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the prescribing patterns of antidepressants (ADs) by primary care providers to youth, adults, and seniors, from 2006 to 2012, using data from electronic medical records (EMRs). METHOD This was a retrospective cross-sectional database study that used primary care data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Data on more than 600 000 Canadian primary care patients were used to determine the prevalence and incidence of AD prescribing to patients 15 years and older who had an encounter in the years of study (from 2006 to 2012). Each study year was evaluated independently. RESULTS The study population consisted of 86 927 patients in 2006 (mean age 48.1 years [SD 18.7], 38% male) and grew to 273 529 (mean age 49.6 years [SD 19.3], 40% male) in 2012. The prevalence of AD prescribing increased from 9.20% in 2006 to 12.80% in 2012 (P < 0.001). While the incidence rate of AD prescribing dropped from 3.54% in 2006 to 2.72% in 2008 (P < 0.001) the rate started to significantly rise again, reaching an incidence of 3.07% by 2012 (P < 0.001). CONCLUSIONS The prevalence of AD prescribing by primary care providers in Canada continued to rise from 2006 to 2012. Conversely, incidence has remained stable or declined during the 6-year study period. While many complex factors likely contribute to the observed prevalence and incidence rates, our findings suggest that the guidelines indicating the efficacy of long-term AD therapy for patients with highly recurrent or severe depression are being followed.
Collapse
Affiliation(s)
| | - David Barber
- Network Director and Assistant Professor, Queen's University, Kingston, Ontario
| | | | - Scott B Patten
- Editor-in-Chief, The Canadian Journal of Psychiatry, Ottawa, Ontario; Professor, Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta; Member, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
| |
Collapse
|
17
|
Krivoy A, Balicer RD, Feldman B, Hoshen M, Zalsman G, Weizman A, Shoval G. The impact of age and gender on adherence to antidepressants: a 4-year population-based cohort study. Psychopharmacology (Berl) 2015; 232:3385-90. [PMID: 26093655 DOI: 10.1007/s00213-015-3988-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 06/06/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Impaired adherence is common among patients using antidepressant drugs (ADs). However, few studies investigated the role of age and gender in adherence to AD and finding conflict. OBJECTIVE This study aimed to determine how gender and age impact adherence to AD in a large-scale cohort. METHODS We conducted a historical cohort study (N = 310,994 individuals) that claimed AD prescriptions during a 4-year period. Adherence was defined as the ratio between the duration of claimed AD prescriptions and the duration of continuously prescribed AD. RESULTS Substantial differences in the mean adherence to AD were noted throughout the lifespan, ranging from 0.38 (first decade) to 0.63 (tenth decade). Average adherence was significantly higher for males aged 20-40 years than for females of that age, but this relationship reversed later in life (50-70 years). A regression analysis model of adherence as the dependent variable showed a significant interaction between age and gender variables (beta = 0.001, p < 0.0001). CONCLUSIONS This study demonstrates the effect of age and gender, and their interaction, on adherence to AD across the entire life span. The marked age- and modest, yet significant, gender-related effects should be taken into consideration when targeting impaired adherence to these commonly prescribed medications.
Collapse
Affiliation(s)
- Amir Krivoy
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel
| | | | | | | | | | | | | |
Collapse
|
18
|
Quintana MI, Andreoli SB, Peluffo MP, Ribeiro WS, Feijo MM, Bressan RA, Coutinho ESF, Mari JDJ. Psychotropic Drug Use in São Paulo, Brazil--An Epidemiological Survey. PLoS One 2015; 10:e0135059. [PMID: 26252517 PMCID: PMC4529275 DOI: 10.1371/journal.pone.0135059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 07/17/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of one month psychotropic drug use in São Paulo, Brazil, and to assess the gap treatment between the presence of mental disorders and psychotropic drug users. METHOD A probabilistic sample of non-institutionalized individuals from the general population of São Paulo (n = 2336; turnout: 84.5%) who were 15 years or older were interviewed by a trained research staff, applying the Composite International Diagnostic Interview 2.1 (CIDI WHO) (depression, anxiety-phobia, OCD\PTSD, alcoholism sections), and an inventory investigating psychotropic drug use during the 12-month and one-month periods immediately preceding the interview. Logistic models were fitted to investigate associations between psychotropic drug use as well as socio-demographic and clinical variables. RESULTS The one month prevalence of psychotropic drug use in São Paulo was 5.89%, the most commonly used drugs were antidepressants (3.15%) and tranquilizers (2.67%). A higher consumption of psychotropic drugs (overall, antidepressants and tranquilizers) was observed among women (OR:2.42), older individuals (OR:1.04), individuals with higher levels of formal education (1.06), and individuals with a family (OR:2.29) or personal history of mental illness (OR:3.27). The main psychotropic drug prescribers were psychiatrists (41%), followed by general practitioners (30%); 60% of psychotropic drugs were obtained through a government-run dispensing program. Most individuals who obtained a positive diagnosis on the CIDI 2.1 during the previous month were not using psychotropic medication (85%). Among individuals with a diagnosis of moderate to severe depression, 67.5% were not on any pharmacological treatment. CONCLUSION There is a change in the type of psychotropic more often used in São Paulo, from benzodiazepines to antidepressants, this event is observed in different cultures. The prevalence of use is similar to other developing countries. Most of the patients presenting a psychiatric illness in the month prior to testing were not receiving any sort of psychiatric medication. This may be explained by a failure to identify cases in primary care, which could be improved (and access to treatment could be facilitated) if professionals received more specialized training in managing cases with mental health problems.
Collapse
Affiliation(s)
- Maria Ines Quintana
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
- * E-mail:
| | - Sergio Baxter Andreoli
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
- Universidade Catolica de Santos, Santos, Brazil
| | | | - Wagner Silva Ribeiro
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
| | - Marcelo M. Feijo
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
| | - Rodrigo Affonseca Bressan
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
| | | | - Jair de Jesus Mari
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
| |
Collapse
|
19
|
Renoux C, Lix LM, Patenaude V, Bresee LC, Paterson JM, Lafrance JP, Tamim H, Mahmud SM, Alsabbagh MW, Hemmelgarn B, Dormuth CR, Ernst P. Serotonin-Norepinephrine Reuptake Inhibitors and the Risk of AKI: A Cohort Study of Eight Administrative Databases and Meta-Analysis. Clin J Am Soc Nephrol 2015; 10:1716-22. [PMID: 26231193 DOI: 10.2215/cjn.11271114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 06/30/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVES A safety signal regarding cases of AKI after exposure to serotonin-norepinephrine reuptake inhibitors (SNRIs) was identified by Health Canada. Therefore, this study assessed whether the use of SNRIs increases the risk of AKI compared with selective serotonin reuptake inhibitors (SSRIs) and examined the risk associated with each individual SNRI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Multiple retrospective population-based cohort studies were conducted within eight administrative databases from Canada, the United States, and the United Kingdom between January 1997 and March 2010. Within each cohort, a nested case-control analysis was performed to estimate incidence rate ratios (RRs) of AKI associated with SNRIs compared with SSRIs using conditional logistic regression, with adjustment for high-dimensional propensity scores. The overall effect across sites was estimated using meta-analytic methods. RESULTS There were 38,974 cases of AKI matched to 384,034 controls. Current use of SNRIs was not associated with a higher risk of AKI compared with SSRIs (fixed-effect RR, 0.97; 95% confidence interval [95% CI], 0.94 to 1.01). Current use of venlafaxine and desvenlafaxine considered together was not associated with a higher risk of AKI (RR, 0.96; 95% CI, 0.92 to 1.00). For current use of duloxetine, there was significant heterogeneity among site-specific estimates such that a random-effects meta-analysis was performed showing a 16% higher risk, although this risk was not statistically significant (RR, 1.16; 95% CI, 0.96 to 1.40). This result is compatible with residual confounding, because there was a substantial imbalance in the prevalence of diabetes between users of duloxetine and users of others SNRIs or SSRIs. After further adjustment by including diabetes as a covariate in the model along with propensity scores, the fixed-effect RR was 1.02 (95% CI, 0.95 to 1.10). CONCLUSIONS There is no evidence that use of SNRIs is associated with a higher risk of hospitalization for AKI compared with SSRIs.
Collapse
Affiliation(s)
- Christel Renoux
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Lisa M Lix
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Valérie Patenaude
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Lauren C Bresee
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - J Michael Paterson
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Jean-Philippe Lafrance
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Hala Tamim
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Salaheddin M Mahmud
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Mhd Wasem Alsabbagh
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Brenda Hemmelgarn
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Colin R Dormuth
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Pierre Ernst
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
| | | |
Collapse
|
20
|
Wemakor A, Casson K, Dolk H. Prevalence and sociodemographic patterns of antidepressant use among women of reproductive age: a prescription database study. J Affect Disord 2015; 167:299-305. [PMID: 25005798 DOI: 10.1016/j.jad.2014.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND There has been a steady increase in the prescription of antidepressants in developed countries in recent decades. Antidepressant treatment prevalence and sociodemographic pattern data can inform the review of clinical guidelines for depression treatment. We determined the one-year prevalence and sociodemographic pattern of antidepressant dispensing among women of childbearing age (15-45 years) in Northern Ireland (NI). METHODS A cross-sectional study using individual electronic prescribing data for 2009. Our study population was 268,917 women of childbearing age (15-45 years), with/without prescriptions, registered with the 246 out of 363GP practices in NI with high electronic prescribing data coverage. Socioeconomic deprivation (in quintiles) was measured by an area indicator attached to residential postcode. RESULTS The one-year prevalence of redeemed antidepressant prescriptions was 16.3% (95% CI 16.1-16.4). More than two-thirds of antidepressant prescriptions were for SSRIs. Thirty-five per cent of the women who redeemed prescriptions for antidepressants also redeemed prescriptions for psycholeptics within 2 months of the antidepressant prescriptions. Redeemed antidepressant prescription prevalence increased from 4.8% (15-19 years) to 24.6% (40-45 years), from 13.5% (quintile 1, least deprived) to 20.7% (quintile 5, most deprived), and with urbanity of GP practice location. LIMITATION Only GP practices with high capture of electronic prescribing data were included, which may not be entirely representative of NI. We could not assess the appropriateness of prescribing according to national guidelines. CONCLUSIONS Antidepressant use is high among women of childbearing age in NI and increases with age and socioeconomic deprivation. This reinforces the need to address the determinants of depression, and assess the appropriateness of treatment policies and practices.
Collapse
Affiliation(s)
- Anthony Wemakor
- School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana; Centre for Maternal, Foetal and Infant Research, Institute of Nursing and Health Research, University of Ulster, Jordanstown, United Kingdom
| | - Karen Casson
- Centre for Maternal, Foetal and Infant Research, Institute of Nursing and Health Research, University of Ulster, Jordanstown, United Kingdom
| | - Helen Dolk
- Centre for Maternal, Foetal and Infant Research, Institute of Nursing and Health Research, University of Ulster, Jordanstown, United Kingdom.
| |
Collapse
|
21
|
Patten SB, Williams JVA, Lavorato DH, Wang JL, McDonald K, Bulloch AGM. Descriptive epidemiology of major depressive disorder in Canada in 2012. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:23-30. [PMID: 25886546 PMCID: PMC4314053 DOI: 10.1177/070674371506000106] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/01/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The epidemiology of major depressive disorder (MDD) was first described in the Canadian national population in 2002. Updated information is now available from a 2012 survey: the Canadian Community Health Study-Mental Health (CCHS-MH). METHOD The CCHS-MH employed an adaptation of the World Health Organization World Mental Health Composite International Diagnostic Interview and had a sample of n=25 113. Demographic variables, treatment, comorbidities, suicidal ideation, and perceived stigma were assessed. The analysis estimated adjusted and unadjusted frequencies and prevalence ratios. All estimates incorporated analysis methods to account for complex survey design effects. RESULTS The past-year prevalence of MDD was 3.9% (95% CI 3.5% to 4.2%). Prevalence was higher in women and in younger age groups. Among respondents with past-year MDD, 63.1% had sought treatment and 33.1% were taking an antidepressant (AD); 4.8% had past-year alcohol abuse and 4.5% had alcohol dependence. Among respondents with past-year MDD, the prevalence of cannabis abuse was 2.5% and that of dependence was 2.9%. For drugs other than cannabis, the prevalence of abuse was 2.3% and dependence was 2.9%. Generalized anxiety disorder was present in 24.9%. Suicide attempts were reported by 6.6% of respondents with past-year MDD. Among respondents accessing treatment, 37.5% perceived that others held negative opinions about them or treated them unfairly because of their disorder. CONCLUSIONS MDD is a common, burdensome, and stigmatized condition in Canada. Seeking help from professionals was reported at a higher frequency than in prior Canadian studies, but there has been no increase in AD use among Canadians with MDD.
Collapse
Affiliation(s)
- Scott B Patten
- Professor, Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta; Member, Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
| | - Jeanne V A Williams
- Research Associate, Department of Community Health Sciences, University of Calgary, Calgary, Alberta
| | - Dina H Lavorato
- Research Associate, Department of Community Health Sciences, University of Calgary, Calgary, Alberta
| | - Jian Li Wang
- Associate Professor, Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta; Member, Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
| | - Keltie McDonald
- MSc Student, Department of Community Health Sciences, University of Calgary, Calgary, Alberta; Member, Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
| | - Andrew G M Bulloch
- Professor, Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta; Member, Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
| |
Collapse
|
22
|
Giabbanelli PJ, Crutzen R. Creating groups with similar expected behavioural response in randomized controlled trials: a fuzzy cognitive map approach. BMC Med Res Methodol 2014; 14:130. [PMID: 25495712 PMCID: PMC4292828 DOI: 10.1186/1471-2288-14-130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Controlling bias is key to successful randomized controlled trials for behaviour change. Bias can be generated at multiple points during a study, for example, when participants are allocated to different groups. Several methods of allocations exist to randomly distribute participants over the groups such that their prognostic factors (e.g., socio-demographic variables) are similar, in an effort to keep participants' outcomes comparable at baseline. Since it is challenging to create such groups when all prognostic factors are taken together, these factors are often balanced in isolation or only the ones deemed most relevant are balanced. However, the complex interactions among prognostic factors may lead to a poor estimate of behaviour, causing unbalanced groups at baseline, which may introduce accidental bias. METHODS We present a novel computational approach for allocating participants to different groups. Our approach automatically uses participants' experiences to model (the interactions among) their prognostic factors and infer how their behaviour is expected to change under a given intervention. Participants are then allocated based on their inferred behaviour rather than on selected prognostic factors. RESULTS In order to assess the potential of our approach, we collected two datasets regarding the behaviour of participants (n = 430 and n = 187). The potential of the approach on larger sample sizes was examined using synthetic data. All three datasets highlighted that our approach could lead to groups with similar expected behavioural changes. CONCLUSIONS The computational approach proposed here can complement existing statistical approaches when behaviours involve numerous complex relationships, and quantitative data is not readily available to model these relationships. The software implementing our approach and commonly used alternatives is provided at no charge to assist practitioners in the design of their own studies and to compare participants' allocations.
Collapse
Affiliation(s)
- Philippe J Giabbanelli
- />Interdisciplinary Research in the Mathematical and Computational Sciences (IRMACS) Centre, Simon Fraser University, Burnaby, Canada
- />UKCRC Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Rik Crutzen
- />Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands
| |
Collapse
|
23
|
De Long NE, Hyslop JR, Raha S, Hardy DB, Holloway AC. Fluoxetine-induced pancreatic beta cell dysfunction: New insight into the benefits of folic acid in the treatment of depression. J Affect Disord 2014; 166:6-13. [PMID: 25012404 DOI: 10.1016/j.jad.2014.04.063] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 04/25/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Major depressive disorder is a common psychiatric illness with reported prevalence rates of 12-16% in persons aged 12 and over. Depression is also associated with a high risk of new onset of type 2 diabetes (T2D). This relationship between depression and diabetes may be related to depression itself and/or drugs prescribed. Importantly, the use of selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed class of antidepressants, increases the risk of developing T2D. However, the mechanism(s) underlying this association remains elusive. METHODS Here we examine the effects of the SSRI fluoxetine (Prozac®) on beta cell function utilizing INS-1E cells, a rat beta cell line, to elucidate the underlying molecular mechanisms. RESULTS Fluoxetine treatment significantly reduced glucose stimulated insulin secretion (GSIS). This decreased beta cell function was concomitant with an increased production of reactive oxygen species and oxidative damage which may contribute to decreased mitochondrial electron transport chain enzyme (ETC) activity. Importantly the fluoxetine-induced deficits in beta cell function were prevented by the addition of the antioxidant folic acid. LIMITATIONS These studies were conducted in vitro; the in vivo relevance remains to be determined. CONCLUSIONS These findings suggest that use of SSRI antidepressants may increase the risk of new-onset T2D by causing oxidative stress in pancreatic beta cells. However, folic acid supplementation in patients taking SSRIs may reduce the risk of new onset diabetes via protection of normal beta cell function.
Collapse
Affiliation(s)
- Nicole E De Long
- Department of Obstetrics and Gynecology, McMaster University, RM HSC-3N52 1280 Main Street West, Hamilton, ON, Canada L8S 4K1
| | - Jillian R Hyslop
- Department of Obstetrics and Gynecology, McMaster University, RM HSC-3N52 1280 Main Street West, Hamilton, ON, Canada L8S 4K1
| | - Sandeep Raha
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada L8S 4K1
| | - Daniel B Hardy
- Departments of Obstetrics and Gynecology and Physiology and Pharmacology, Western University, London, ON, Canada N6A5C1
| | - Alison C Holloway
- Department of Obstetrics and Gynecology, McMaster University, RM HSC-3N52 1280 Main Street West, Hamilton, ON, Canada L8S 4K1.
| |
Collapse
|
24
|
Hsu SW, Chiang PH, Chang YC, Lin JD, Tung HJ, Chen CY. Trends in the use of psychotropic drugs in people with intellectual disability in Taiwan: a nationwide outpatient service study, 1997-2007. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:364-372. [PMID: 24333807 DOI: 10.1016/j.ridd.2013.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/14/2013] [Accepted: 11/14/2013] [Indexed: 06/03/2023]
Abstract
This study aims to examine trends in outpatient psychotropic drug use among people with intellectual disabilities in Taiwan. The NHI outpatient medication records between January 1, 1997 and December 31, 2007 for people with intellectual disabilities were analyzed to observe the percent change, prevalence and prescription trends in psychotropic drugs. The overall prevalence of psychotropic medication increased from 17.82% to 23.22% during the study period. Results from stepwise logistic analysis demonstrated that females, the elderly, and individuals suffering from catastrophic disease were more prone to receive psychotropic drugs and that those with mild intellectual disability were less likely to receive psychotropic drugs. The percentage change in prescription rates of antipsychotics, hypnotics/sedatives, and antidepressants were 85.30%, 127.25%, and 167.50%, respectively, and the trends were statistically significant (p<0.05). Taiwan's NHI program and off-label use of psychotropic drugs might have attributed to this trend.
Collapse
Affiliation(s)
- Shang-Wei Hsu
- Department of Healthcare Administration, Asia University, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan.
| | - Po-Huang Chiang
- Department of Healthcare Administration, Asia University, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan
| | - Yu-Chia Chang
- Department of Healthcare Administration, Asia University, Taichung, Taiwan; Research Center of Health Policy and Management, Asia University, Taichung, Taiwan
| | - Jin-Ding Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ho-Jui Tung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan; Research Center of Health Policy and Management, Asia University, Taichung, Taiwan
| | - Chao-Yun Chen
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| |
Collapse
|
25
|
Kronström K, Karlsson H, Nabi H, Oksanen T, Salo P, Sjösten N, Virtanen M, Pentti J, Kivimäki M, Vahtera J. Optimism and pessimism as predictors of initiating and ending an antidepressant medication treatment. Nord J Psychiatry 2014; 68:1-7. [PMID: 23286692 DOI: 10.3109/08039488.2012.752523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The personality variables optimism and pessimism are potential risk factors for disorders commonly treated with antidepressants. AIMS To evaluate optimism and pessimism as predictors of initiating and ending an antidepressant treatment. METHODS Data consisted of 29,930 public sector employees with no record of diagnosed depression. Optimism and pessimism were measured using the Revised Life Orientation Test (LOT-R) at baseline. The data of purchases of antidepressants were from the national Drug Prescription Register. RESULTS During the mean follow-up of 4.4 years, 1681 participants initiated and of them 1288 ended an antidepressant treatment lasting at least 100 days. In the adjusted model, high optimism was associated with a lower likelihood of starting antidepressant medication treatment (hazard ratios, HR, 0.67, 95% CI 0.62-0.73) and a higher likelihood of stopping the treatment (HR = 1.18, 95% CI 1.08-1.30). High pessimism was associated with a higher likelihood of starting antidepressant medication treatment (HR = 1.27, 95% CI 1.16-1.38) and a lower likelihood of stopping it (HR = 0.89, 95% CI 0.80-0.98). These associations remained after optimism score was adjusted for pessimism and vice versa or those with symptoms of mental health problems at baseline were removed from the analyses. CONCLUSIONS Low optimism and high pessimism are independently associated with an increased likelihood of initiating antidepressant medication treatment, but with a decreased likelihood of ending it during the follow-up.
Collapse
Affiliation(s)
- Kim Kronström
- Researcher, Department of Psychiatry, University of Turku , Turku , Finland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
The Impact of Psychotropic Drug Costs on the Brazilian Family Budget: An Analysis of the Family Budget Surveys of 2003 and 2009. Value Health Reg Issues 2013; 2:361-367. [DOI: 10.1016/j.vhri.2013.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
27
|
Metsä-Simola N, Martikainen P. Divorce and changes in the prevalence of psychotropic medication use: a register-based longitudinal study among middle-aged Finns. Soc Sci Med 2013; 94:71-80. [PMID: 23931947 DOI: 10.1016/j.socscimed.2013.06.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 04/30/2013] [Accepted: 06/24/2013] [Indexed: 11/16/2022]
Abstract
The annual prevalence of psychotropic medication use exceeds 10 percent in Europe and the United States, the prevalence being higher among the divorced than the married. We analysed changes in the three-month prevalence of psychotropic medication use (psycholeptics and psychoanaleptics excluding medication for dementia) by proximity to divorce, sex, medication type and socio-demographic characteristics, using register-data on 304,111 Finns between 25 and 64 years of age, of whom 23,956 divorced between 1995 and 2003 and 142,093 were continuously married from 1995 to 2004. Five years before divorce, men and women already displayed about one percentage point higher prevalence of psychotropic medication use than those who continued their marriage. The excess prevalence increased with approaching divorce and peaked six to nine months before divorce, reaching 7.3 percent (95% CI 6.8-8.0) among divorcing men and 8.1 percent (95% CI 7.5-8.8) among divorcing women. The peak was followed by an 18-month decline, after which the excess compared to the continuously married settled at nearly three percentage points. The excess was not due to being socio-economically disadvantaged, and socio-demographic factors also seemed to have few modifying effects. The changes in prevalence were largest for antidepressants and almost non-existent for antipsychotics. Our results suggest that the high prevalence of psychotropic medication use among the divorced results both from selective factors already present five years before divorce and the acute and long-term causal effects of becoming and being divorced. Counselling is needed for individuals in the process of divorce, rather than economic support for divorced individuals.
Collapse
Affiliation(s)
- Niina Metsä-Simola
- University of Helsinki, Department of Social Research, P.O. Box 59, 00014 Helsinki, Finland.
| | | |
Collapse
|
28
|
Quintana MI, Andreoli SB, Moreira FG, Ribeiro WS, Feijo MM, Bressan RA, Coutinho ESF, Mari JJ. Epidemiology of psychotropic drug use in Rio de Janeiro, Brazil: gaps in mental illness treatments. PLoS One 2013; 8:e62270. [PMID: 23690934 PMCID: PMC3653914 DOI: 10.1371/journal.pone.0062270] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 03/19/2013] [Indexed: 12/05/2022] Open
Abstract
Objective Estimate the prevalence of psychotropic drugs use in the city of Rio de Janeiro, Brazil, and establish its relationship with the presence of mental disorders. Methods A probabilistic sample of non-institutionalized individuals, from the general population of Rio de Janeiro (n = 1208;turn out:81%), 15 years or older, who were interviewed using the Composite International Diagnostic Interview 2.1 (depression, anxiety-phobia, OCD\PTSD, alcoholism sections), and asked about their psychotropic use during a 12 and one-month period before the interview. Data were collected between June/2007-February/2008.The prevalence was estimated with a confidence interval of 95%. The associations between psychotropics use and mental disorders were analyzed through a logistic regression model (Odds Ration – OR). Results The one-month prevalence of psychotropic drug use was 6.55%, 3.19% for men and 9.13% for women. Antidepressants were the most frequently used drug (2.78%), followed by anorectics (1.65%), tranquilizers (1.61%) and mood stabilizers (1.23%). General practitioners issued the highest number of prescriptions (46.3%), followed by psychiatrists (29.3%); 86.6% of the psychotropic drugs used were paid for by the patient himself. Individuals with increased likelihood of using psychotropic drugs were those that had received a psychiatric diagnosis during a one-month period before the study (OR:3.93), females (OR:1.82), separated/divorced (OR:2.23), of increased age (OR:1.03), with higher income (OR:2.96), and family history of mental disorder (OR:2.59); only 16% of the individuals with a current DSM IV diagnosis were using a psychotropic drug; 17% among individuals with a depression-related diagnosis and 8% with Phobic Anxiety Disorders-related diagnosis used psychotropics. Conclusion Approximately 84% of individuals displaying some mental disorder did not use psychotropic drugs, which indicates an important gap between demand and access to treatment. A significant failure is evident in the health system for patients with mental disorders; this could be due to health workers' inability to recognize mental disorders among individuals.
Collapse
Affiliation(s)
- Maria Ines Quintana
- Federal University of São Paulo - Paulista Medical School, São Paulo, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Deyell RJ, Lorenzi M, Ma S, Rassekh SR, Collet JP, Spinelli JJ, McBride ML. Antidepressant use among survivors of childhood, adolescent and young adult cancer: a report of the Childhood, Adolescent and Young Adult Cancer Survivor (CAYACS) Research Program. Pediatr Blood Cancer 2013; 60:816-22. [PMID: 23281214 DOI: 10.1002/pbc.24446] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 11/26/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although survivors of childhood, adolescent, and young adult (AYA) cancer are at risk for late psychological sequelae, it is unclear if they are more likely to be prescription antidepressant users than their peers. PROCEDURE All 5-year survivors of childhood or AYA cancer diagnosed before age 25 years in British Columbia from 1970 to 1995 were identified. Those with complete follow-up in the provincial health insurance registry from 2001 to 2004 were included (n = 2,389). A birth-cohort and gender-matched set of population controls 10 times the size of the survivor group was randomly selected (n = 23,890). All prescriptions filled between 2001 and 2004 were identified through linkage to the provincial prescription drug administrative database. Logistic regression analyses determined the impact of cancer survivorship on the likelihood of ever filling an antidepressant prescription. RESULTS After adjusting for sociodemographic factors, survivors of childhood and AYA cancer were more likely to have filled an antidepressant prescription compared to controls (OR 1.21, 95% CI 1.09-1.35). Cancer survivors had an increased likelihood of using all categories of antidepressants, and of using drugs from two or more antidepressant categories, compared to peers (OR 1.31, 95% CI 1.11-1.55 [≥2 antidepressant categories]). Treatment was not a significant predictor of antidepressant use. Female survivors, those in young adulthood and those more than 20 years post-treatment had increased antidepressant use. CONCLUSIONS Survivors of childhood and AYA cancer are more likely to fill antidepressant prescriptions compared to peer controls. This may indirectly reflect an increased underlying prevalence of mental health conditions among survivors.
Collapse
Affiliation(s)
- Rebecca J Deyell
- Division of Oncology, Hematology and Bone Marrow Transplant, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | |
Collapse
|
30
|
Assayag J, Forget A, Kettani FZ, Beauchesne MF, Moisan J, Blais L. The impact of the type of insurance plan on adherence and persistence with antidepressants: a matched cohort study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:233-9. [PMID: 23547647 DOI: 10.1177/070674371305800409] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare adherence to, and persistence with, antidepressants (AD) in Quebec patients who are covered by private and public drug insurance. METHOD A matched cohort study was conducted using prescription claims databases: reMed, a medication data registry for Quebec residents covered by private drug insurance, and Régie de l'assurance maladie du Québec database for Quebec residents with public drug insurance. Patients were aged 18 to 64 years and filled at least 1 prescription for an AD in monotherapy between December 2007 and September 2009 (194 privately and 2055 publicly insured patients). Adherence over 1 year was estimated using the proportion of prescribed days covered (PPDC). The difference in mean PPDC between patients with private and public drug insurance was estimated with linear regression. Persistence was compared between the groups with a Cox regression model. RESULTS The PPDC was 86.4% (95% CI 83.3% to 89.5%) in privately insured and 82.2% (95% CI 78.5% to 85.9%) in publicly insured patients and the adjusted mean difference was 5.1% (95% CI 1.6% to 8.6%). Persistence was 51.0% in the private group and 19.7% in the public group at 1 year (P < 0.001); the adjusted hazard ratio was 0.49 (95% CI 0.30 to 0.79). CONCLUSION Better adherence and persistence were observed in privately insured patients. Adherence difference may be due to lower copayment among privately insured patients.
Collapse
|
31
|
Vasiliadis HM, Latimer E, Dionne PA, Préville M. The costs associated with antidepressant use in depression and anxiety in community-living older adults. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:201-9. [PMID: 23547643 DOI: 10.1177/070674371305800405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the costs associated with antidepressant (AD) use by depression and anxiety status in a public-managed health care system. METHODS Data were obtained from a population-based health survey of 1869 older adults. Depression and anxiety were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and measured at 2 time points 1 year apart. AD and health service use and costs were identified from provincial administrative databases and included hospitalizations, physician fees, outpatient medications, and ambulatory visits. Patient costs considered were related to drug copayments, transportation, and time spent seeking medical care. Annual costs associated with AD use were studied as a function of mental health status at baseline and follow-up interviews (persistence, incidence, remission, or no illness). Generalized linear models with a gamma distribution were used to control for individual factors. RESULTS The costs incurred by participants using ADs as a whole (17.8%) reached $6678 (95% CI $5449 to $8182), significantly more than in participants not using ADs ($4698; 95% CI $3710 to $5949). AD use was associated with greater total adjusted costs among respondents with no depression (adjusted difference = $1769; 95% CI $236 to $3702) and no anxiety (adjusted difference = $1845; 95% CI $203 to $3486). CONCLUSION The results showed that AD use was not associated with cost savings in any group, and indeed with greater costs among participants who were neither depressed nor anxious at any time point. Future cost studies may consider the analyses of different AD classes regarding the different clinical mental health profiles in older adults.
Collapse
|
32
|
Patterns of depressive symptoms and antidepressant use among women survivors of intimate partner violence. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1527-37. [PMID: 22134337 DOI: 10.1007/s00127-011-0459-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 11/19/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE One of the primary mental health responses of women experiencing intimate partner violence (IPV) is depression, yet little is known about the mental health and antidepressant use of women in the period after leaving an abusive partner. We investigate patterns of antidepressant use and depressive symptoms by various social indicators (parenting status, socioeconomic status, severity of abuse and disclosure of abuse). Second, we examine whether variation in antidepressant use is explained by higher rates of depression diagnoses and/or depressive symptoms, taking these social indicators into consideration. METHODS We examine data from the Women's Health Effects Study, a community sample of 309 Canadian women who have recently left an abusive partner. RESULTS Bivariate results reveal that over 80% of women with elevated depressive symptoms are without diagnosis and antidepressant medication. Multivariate analyses show that antidepressant use is predicted by an indicator of economic disadvantage, with women who receive social assistance or disability benefits being more likely to report elevated antidepressant use, controlling for both depressive symptoms and depression diagnoses. CONCLUSIONS Documenting and explaining depressive symptoms and antidepressant use among IPV survivors provides insight into one of many possible treatment options available to women with depression, and sheds light on potential health disparities among this subgroup of the population.
Collapse
|
33
|
Sanyal C, Asbridge M, Kisely S, Sketris I, Andreou P. The utilization of antidepressants and benzodiazepines among people with major depression in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:667-76. [PMID: 22114921 DOI: 10.1177/070674371105601105] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although clinical guidelines recommend monotherapy with antidepressants (ADs) for major depression, polypharmacy with benzodiazepines (BDZs) remains an issue. Risks associated with such treatments include tolerance and dependence, among others. We assessed the prevalence and determinants of AD and BDZ utilization among Canadians who experienced a major depressive episode (MDE) in the previous 12 months, and determined the association of seeing a psychiatrist on the utilization of ADs and BDZs. METHOD Data were drawn from the 2002 Canadian Community Health Survey: Health and Well-Being, a nationally representative sample of Canadians aged 15 years and older. Descriptive statistics quantified utilization, while logistic regression identified factors associated with utilization, such as sociodemographic characteristics or type of physician seen. Sampling weights and bootstrap variance estimations were used for all analysis. RESULTS The overall prevalence of AD and BDZ utilization was 49.3% of respondents who experienced an MDE in the past 12 months and reported AD use. Key determinants of utilization were younger age and unemployment in the past week (OR 2.6; P < 0.001). Being seen by a psychiatrist increased utilization (OR 2.5; P < 0.001), possibly because psychiatrists were seeing patients with severe depression. CONCLUSION A large proportion of people with past-year MDEs utilized ADs and BDZs. It is unclear how much of this is appropriate given that evidence-based clinical guidelines recommend monotherapy with ADs in the treatment of major depression.
Collapse
|
34
|
Kuo CC, Chien IC, Lin CH, Lee WG, Chou YJ, Lee CH, Chou P. Prevalence, correlates, and disease patterns of antidepressant use in Taiwan. Compr Psychiatry 2011; 52:662-9. [PMID: 21353216 DOI: 10.1016/j.comppsych.2011.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Revised: 12/31/2010] [Accepted: 01/01/2011] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We used the population-based National Health Insurance database to investigate the prevalence, correlates, and disease patterns of antidepressant use in Taiwan. METHODS The National Health Research Institutes provided a database of 200,000 random subjects for study. We obtained a random sample of 145,304 subjects 18 years or older in 2004. Study subjects who had been given at least 1 antidepressant drug prescription during this year were identified. We detected factors associated with any antidepressant use. We also examined the proportion of antidepressant use for psychiatric and medical disorders. RESULTS The 1-year prevalence of antidepressant use was 4.3%. Higher antidepressant use was found in the aged group, in female subjects, in individuals with a fixed premium and with an insurance amount lower than US $640, in individuals with disability, and among subjects in the central area. Among subjects with antidepressant use, the higher proportions of psychiatric disorders were for neurotic depression (21.1%), anxiety state (17.6%), major depressive disorder (14.6%), special symptoms or syndromes not elsewhere classified (8.5%), and depressive disorder not elsewhere classified (5.4%). With respect to medical disorders, the higher proportions of antidepressant use were for diseases of the genitourinary system; musculoskeletal system and connective tissue; symptoms, signs, and ill-defined conditions; circulatory system; endocrine, nutritional, and metabolic diseases and immunity disorders; and nervous system and sense organs. CONCLUSION Higher proportion of psychiatric disorders among subjects with antidepressant use were for depressive disorder and anxiety disorder. However, 39% of the subjects were using antidepressants for nonpsychiatric disorders in Taiwan.
Collapse
Affiliation(s)
- Chien-Cheng Kuo
- Jianan Mental Hospital, Department of Health, Tainan, Taiwan
| | | | | | | | | | | | | |
Collapse
|
35
|
Psychological Distress, Service Utilization, and Prescribed Medications among Youth with and without Histories of Involvement with Child Protective Services. Int J Ment Health Addict 2011. [DOI: 10.1007/s11469-011-9327-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
36
|
Most antidepressant use in primary care is justified; results of the Netherlands Study of Depression and Anxiety. PLoS One 2011; 6:e14784. [PMID: 21479264 PMCID: PMC3066192 DOI: 10.1371/journal.pone.0014784] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 02/18/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Depression is a common illness, often treated in primary care. Many studies have reported undertreatment with antidepressants in primary care. Recently, some studies also reported overtreatment with antidepressants. The present study was designed to assess whether treatment with antidepressants in primary care is in accordance with current guidelines, with a special focus on overtreatment. METHODOLOGY We used baseline data of primary care respondents from the Netherlands Study of Depression and Anxiety (NESDA) (n = 1610). Seventy-nine patients with treatment in secondary care were excluded. We assessed justification for treatment with antidepressant according to the Dutch primary care guidelines for depression and for anxiety disorders. Use of antidepressants was based on drug-container inspection or, if unavailable, on self-report. Results were recalculated to the original population of primary care patients from which the participants in NESDA were selected (n = 10,677). PRINCIPAL FINDINGS Of 1531 included primary care patients, 199 (13%) used an antidepressant, of whom 188 (94.5%) (possibly) justified. After recalculating these numbers to the original population (n = 10,677), we found 908 (95% CI 823 to 994) antidepressant users. Forty-nine (95% CI 20 to 78) of them (5.4%) had no current justification for an antidepressant, but 27 of them (54.5%) had a justified reason for an antidepressant at some earlier point in their life. CONCLUSIONS We found that overtreatment with antidepressants in primary care is not a frequent problem. Too long continuation of treatment seems to explain the largest proportion of overtreatment as opposed to inappropriate initiation of treatment.
Collapse
|
37
|
Harris MG, Burgess PM, Pirkis J, Siskind D, Slade T, Whiteford HA. Correlates of antidepressant and anxiolytic, hypnotic or sedative medication use in an Australian community sample. Aust N Z J Psychiatry 2011; 45:249-60. [PMID: 21438749 DOI: 10.3109/00048674.2010.531459] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To explore the rates and correlates of antidepressant (AD) and anxiolytic, hypnotic or sedative (AHS) medication use in Australia, and describe possible reasons for their use. METHOD Analysis of data from the 2007 National Survey of Mental Health and Wellbeing, a nationally representative household survey of 8841 Australians aged 16 to 85 years. Two primary outcome variables: (i) use of any AD medication; and (ii) use of any AHS medication, in the past 2 weeks. RESULTS Rates of AD and AHS medication use were 6.8% and 4.7% respectively. AD and AHS medication use were each associated with 12-month affective or anxiety disorder, age, chronic physical illness, sleep difficulties, and impaired role functioning. Psychological distress and lifetime affective or anxiety disorder or 12-month symptoms were associated with AD use; being previously married was associated with AHS use. Potential reasons for use are complex. Almost one third (30.6%) of AD users and half (49.2%) of AHS users did not report symptoms consistent with a 12-month or lifetime affective or anxiety disorder. Chronic physical illness was reported by 68.8% of AD users and 73.5% of AHS users, around half of whom had a 12-month mental disorder. People with mental-physical comorbidity had especially high rates of AD and AHS use. People with musculoskeletal and other conditions that may involve chronic pain had elevated rates of AD and AHS use, even in the absence of a mental disorder. CONCLUSIONS Low rates of medication use in younger adults and high rates of AHS use in older people warrant further investigation. Many AD and AHS users were not assessed as having an affective or anxiety disorder, suggesting that these medications are frequently used for other indications. Findings call for further research to explore the relationship between mental disorders, physical conditions and medication use.
Collapse
Affiliation(s)
- Meredith G Harris
- School of Population Health, The University of Queensland, Queensland Centre for Mental Health Research, Australia.
| | | | | | | | | | | |
Collapse
|
38
|
Sundell KA, Gissler M, Petzold M, Waern M. Antidepressant utilization patterns and mortality in Swedish men and women aged 20-34 years. Eur J Clin Pharmacol 2010; 67:169-78. [PMID: 21063694 DOI: 10.1007/s00228-010-0933-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 10/17/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare antidepressant utilization patterns and mortality in relation to antidepressant use in men and women aged 20-34 years. METHODS We used data from the Swedish Prescribed Drug Register to identify adults aged 20-34 years who purchased at least one antidepressant in 2006. Information on death and migration was obtained from the Total Population Register by record linkage. One-year prevalence and proportion of new users, amount of purchased antidepressants, concurrent use of other antidepressants, mood stabilizers and antipsychotics and mortality were assessed. RESULTS The one-year prevalence of antidepressant use was 5.6% among all Swedes aged 20-34 years (n = 94,239) and was higher among women than men (7.2 vs. 4.0%, p < 0.001). Selective serotonin reuptake inhibitors were the most dominant class of antidepressants at baseline and were more common among women than men (78.7 vs. 71.7%, p < 0.001). Of the new users, 22.3% filled only one prescription during the study period, men more often than women (24.1 vs. 21.4%, p < 0.001). The mortality rate was higher in men than in women (24 vs. 14 per 10,000, p = 0.009). Concurrent use of mood stabilizers (48 vs. 16 per 10,000, p < 0.001) and antipsychotics (50 vs. 14 per 10,000, p < 0.001) was associated with increased mortality in men and women. CONCLUSIONS Almost twice as many Swedish women than men aged 20-34 years purchased antidepressants in 2006. Differences in utilization patterns between sexes were rather small. Discontinuation rates were high, indicating that health care providers need to acquire an increased awareness on attitudes to treatment. In both sexes, mortality rates were elevated among those concurrently using mood stabilizers and antipsychotics, which needs further investigation.
Collapse
|
39
|
Ivanova A, Nitka D, Schmitz N. Epidemiology of antidepressant medication use in the Canadian diabetes population. Soc Psychiatry Psychiatr Epidemiol 2010; 45:911-9. [PMID: 19730761 DOI: 10.1007/s00127-009-0129-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 08/14/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depression has been shown to be a common co-morbidity in diabetes. From a public health point of view, there is a lack of population-based studies regarding the use of antidepressant medication in non-clinical samples of people with diabetes. The objective of the present study was to provide demographic and clinical information about the use of antidepressant medication in a representative community sample of people with diabetes. METHOD The Canadian Community Health Survey 1.2 (CCHS 1.2) is a cross-sectional survey that collects information related to health status, health-care utilization and health determinants of the Canadian general population. Diabetes presence was ascertained by self-report of physician diagnosis. Depression and anxiety were assessed using a modified version of the World Mental Health Composite International Diagnostic Interview. Antidepressant use was determined through self-report. RESULTS The population prevalence of self-reported antidepressant use in the past 12 months was 8.4% (SE = 0.95) among people with diabetes (n = 1,662). People who took antidepressants had higher average body mass index (M = 32.6, SD = 6.5) than those not taking antidepressants (M = 29.2, SD = 5.7). The use of antidepressants was associated with poorer health status and higher number of co-morbid chronic conditions. Half of diabetes subjects who used antidepressant medication in the last year did not have a lifetime history of major depression. CONCLUSIONS In a community sample of people with diabetes, the prevalence of antidepressant use exceeded the prevalence of major depression. Anxiety disorders and other somatic chronic conditions were associated with the prescription of antidepressant medication in people with diabetes, but without a history of major depression.
Collapse
Affiliation(s)
- Anna Ivanova
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montreal, QC H4H 1R3, Canada
| | | | | |
Collapse
|
40
|
Patten SB, Wang JL, Williams JVA, Lavorato DH, Beck CA, Bulloch AGM. Frequency of antidepressant use in relation to recent and past major depressive episodes. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:532-5. [PMID: 20723281 DOI: 10.1177/070674371005500808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There has been a trend toward increasing antidepressant (AD) use in recent decades. We used data from the National Population Health Survey (NPHS) to determine whether this trend is continuing and to provide updated estimates of the frequency of use. METHODS The NPHS is a longitudinal general health survey that began collecting data in 1994. The NPHS evaluates past-year major depressive episodes (MDEs) using a brief diagnostic instrument. At each biannual interview (from 1994 to 2006) current medication use is recorded. We estimated the frequency with which ADs were taken by respondents (aged 12 years and older) with and without past-year MDEs. These frequencies were cross-tabulated by sex, year of interview, and the reported duration of symptoms. RESULTS ADs are taken by about 5.4% of the household population at any point in time. Most respondents taking ADs did not report past-year MDEs but 63.9% of respondents taking ADs in the absence of past-year episodes reported previous episodes or being diagnosed by a health professional with depression. This pattern is consistent with long-term treatment for relapse prevention. The overall frequency of use of ADs is increasing only in respondents without past-year episodes. CONCLUSIONS AD use among community residents with past-year MDEs is no longer increasing. The continued increase in the overall frequency of use may point toward broadening indications for AD treatment and may indicate that people are taking these medications for longer periods of time.
Collapse
Affiliation(s)
- Scott B Patten
- Departments of Community Health Sciences and Psychiatry, University of Calgary, Alberta.
| | | | | | | | | | | |
Collapse
|
41
|
Milea D, Verpillat P, Guelfucci F, Toumi M, Lamure M. Prescription patterns of antidepressants: findings from a US claims database. Curr Med Res Opin 2010; 26:1343-53. [PMID: 20373875 DOI: 10.1185/03007991003772096] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Introduction of serotonin reuptake inhibitors in the 1990s has increased the use of antidepressants and modified their prescription patterns. OBJECTIVE To identify reasons for prescriptions of antidepressants and factors associated with absence of a labelled indication on the prescription patterns of antidepressants and healthcare costs in a claims database. METHODS Antidepressant users with a new treatment episode with bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline or venlafaxine in 2003 and 2004 were identified in the PharMetrics database. Any ICD-9 code for an approved or clinically-accepted diagnosis for antidepressant treatments ('diagnosis of interest') occurring within the month before or after the index claim was considered as a reason for prescription. Socio-demographic and medical characteristics were described between users with and without a diagnosis of interest and analysed using logistic regression. RESULTS A total of 392 409 antidepressant users were identified. Diagnoses of interest were recorded for 46.7% of users, the most frequent diagnosis being depressive disorders (29% of the patients), anxiety disorders (17%) and abuse and dependence (5%). There were no major differences in patterns of diagnoses of interest between the antidepressants except for fluvoxamine and bupropion. Users without a diagnosis of interest had similar somatic comorbidities and overall baseline costs to users with a diagnosis of interest. However, they used specialised care less often (4.3 vs. 17.8%, OR = 0.50 [0.48; 0.51]), received psychotherapies less frequently (2.7 vs. 26.6%, OR = 0.12 [0.12; 0.12]), and had a shorter duration of use of antidepressants more often (36.9 vs. 28.5%, OR = 1.18 [1.17; 1.20]). CONCLUSIONS The reason for prescribing antidepressants was often not reported in claims databases, and although antidepressant users with or without a diagnosis of interest can have similar somatic medical profiles and overall costs, they do not follow the same trajectory in the mental healthcare system. Depending on the research question to be answered, it is therefore important to specify which users are being targeted.
Collapse
|
42
|
Uhlenhake E, Yentzer BA, Feldman SR. Acne vulgaris and depression: a retrospective examination. J Cosmet Dermatol 2010; 9:59-63. [DOI: 10.1111/j.1473-2165.2010.00478.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
43
|
Ereshefsky L, Saragoussi D, Despiégel N, Hansen K, François C, Maman K. The 6-month persistence on SSRIs and associated economic burden. J Med Econ 2010; 13:527-36. [PMID: 20701432 DOI: 10.3111/13696998.2010.511050] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To assess persistence on SSRIs (most prescribed antidepressants) and associated healthcare costs in a naturalistic setting. METHODS For this retrospective cohort study based on a US reimbursement claims database, all adults with a claim for a SSRI (citalopram, escitalopram, fluoxetine, paroxetine or sertraline) related to a diagnosis of depression were included. Patients should have had no previous reimbursement for any antidepressant within the previous 6 months. Non-persistence was defined as failing to renew prescription within 30 days in the 6-month period after the index date. RESULTS In the 45,481 patients included, persistence decreased from 95.5% at 1 month, to 52.6% at 2 months, 37.6% at 3 months and 18.9% at 6 months. Among factors associated with higher 6-month persistence were age 18-34 years, physician's specialty, treatment with escitalopram, absence of abuse history and psychotropic prescription history. During the 6-month after index date, healthcare costs tended to be higher in non-persistent than in persistent patients although not significantly (RR=1.05, adjusted p=0.055). CONCLUSION Despite some limitations associated with the use of computerized administrative claims data (residual unmeasured confounding), these results highlight a generally low persistence rate at 6 months. Special attention should be given to persistence on treatment, with consideration of potential antidepressant impact.
Collapse
|
44
|
Ziegelstein RC, Thombs BD, Coyne JC, de Jonge P. Routine screening for depression in patients with coronary heart disease never mind. J Am Coll Cardiol 2009; 54:886-90. [PMID: 19712796 DOI: 10.1016/j.jacc.2009.01.082] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 01/20/2009] [Accepted: 01/25/2009] [Indexed: 01/01/2023]
Abstract
A recent Science Advisory from the American Heart Association (AHA) recommended routine screening of all patients with coronary heart disease (CHD) for depression. The authors of the advisory noted that the high prevalence of depression in patients with CHD supports this strategy. A systematic review of the evidence on depression screening and treatment in CHD patients published soon after the AHA advisory found that screening tools for major depression are reasonably accurate among patients with CHD, but that the majority of patients who screen positive will not have major depression; that depression treatment in CHD patients only accounts for a small amount of variance in depression symptom change scores; and that there is no evidence that screening for depression improves CHD outcomes. We call for the AHA to reassess their recommendations in light of this systematic review and considering the potential impact of their document on clinical practice.
Collapse
Affiliation(s)
- Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | | | | | |
Collapse
|
45
|
|
46
|
Zivin K, Ganoczy D, Pfeiffer PN, Miller EM, Valenstein M. Antidepressant adherence after psychiatric hospitalization among VA patients with depression. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2009; 36:406-15. [PMID: 19609666 DOI: 10.1007/s10488-009-0230-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 06/30/2009] [Indexed: 02/03/2023]
Abstract
Depressed patients discharged from psychiatric hospitalizations face increased risks for adverse outcomes including suicide, yet antidepressant adherence rates during this high-risk period are unknown. Using Veterans Affairs (VA) data, we assessed antidepressant adherence and predictors of poor adherence among depressed veterans following psychiatric hospitalization. We identified VA patients nationwide with depressive disorders who had a psychiatric hospitalization between April 1, 1999 and September 30, 2003, received antidepressant medication, and had an outpatient appointment following discharge. We calculated medication possession ratios (MPRs), a measure of medication adherence, within 3 and 6 months following discharge. We assessed patient factors associated with having lower levels of adherence (MPRs < 0.8) after discharge. The criteria for 3- and 6-month MPRs were met by 20,931 and 23,182 patients respectively. The mean 3 month MPR was 0.79 (SD = 0.37). The mean 6 month MPR was 0.66 (SD = 0.40). Patients with poorer adherence were male, younger, non-white, and had a substance abuse disorder, but were less likely to have PTSD or other anxiety disorders. Poor antidepressant adherence is common among depressed patients after psychiatric hospitalization. Efforts to improve adherence at this time may be critical in improving the outcomes of these high-risk patients.
Collapse
Affiliation(s)
- Kara Zivin
- Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA.
| | | | | | | | | |
Collapse
|
47
|
Abstract
Despite the remarkably widespread use of the new generation of antidepressants, almost everything we know about their effects comes from animal studies and clinical trials in which the sole parameter of interest is depressive symptomatology. Almost nothing is known about the effects that antidepressants have on cognition, affect, or motivation when used over a period of months or years. Nor do we understand what effects, if any, antidepressants have on what we think of as the self. In this article, we argue that neither psychiatry nor philosophy, in their current state, are well equipped to think about these issues. In order to explore this idea, we consider the neurobiology of romantic love and its relation to antidepressant neurochemistry. This case study, we suggest, supports the view that antidepressants are very likely to have significant effects on personhood as well as the suggestion that we are in need of new ways of thinking about the self and its pathologies.
Collapse
Affiliation(s)
- Ian Gold
- Department of Philosophy, McGill University, Montreal, QC H3A 2T7.
| | | |
Collapse
|
48
|
Patten SB, Bilsker D, Goldner E. The evolving understanding of major depression epidemiology: implications for practice and policy. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:689-95. [PMID: 18940037 DOI: 10.1177/070674370805301008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Epidemiologic studies have confirmed that major depression (MD) is an extremely common condition, but also one that is associated with an unexpectedly broad spectrum of morbidity. It is no longer a tenable position to regard MD as being a simple indicator of treatment need, nor is a one-size-fits-all approach to treatment likely to be an effective guide to health care delivery. The objective of this commentary is to explore the implications of these new epidemiologic findings for policy and practice in Canada. METHOD This paper is a selective review and commentary. RESULTS Whereas the acute and long-term treatment needs of a subset of individuals with MD have received much attention in the literature, the needs of other groups have not. A sizable proportion of individuals with episodes meeting the Diagnostic and Statistical Manual of Mental Disorders-fourth edition definition in community populations may not need the intensive treatment emphasized by current Canadian practice guidelines. The strategy of watchful waiting may have a role in primary care. On the policy front, guided and perhaps self-guided management strategies deserve greater emphasis than they have received. Stepped-care strategies are an appealing option, but how best to effectively implement these in the Canadian context is unclear. CONCLUSIONS The spectrum of morbidity among individuals with MD in community populations is much wider than has been previously appreciated. The health system should respond with an appropriate spectrum of services, but many questions remain about how to facilitate this.
Collapse
Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences and Hotchkiss Brain Institute, University of Calgary, Alberta.
| | | | | |
Collapse
|
49
|
Sihvo S, Isometsä E, Kiviruusu O, Hämäläinen J, Suvisaari J, Perälä J, Pirkola S, Saarni S, Lönnqvist J. Antidepressant utilisation patterns and determinants of short-term and non-psychiatric use in the Finnish general adult population. J Affect Disord 2008; 110:94-105. [PMID: 18276016 DOI: 10.1016/j.jad.2008.01.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 01/11/2008] [Accepted: 01/11/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim was to study utilisation patterns and determinants of antidepressant use in the general population >30 years, especially short-term use or use not related to known psychiatric morbidity. METHODS Participants from a cross-sectional population-based Finnish Health 2000 Study (2000--2001) were linked with the National Prescription Register and National Care Register for Health Care. Within a representative sample (N=7112) of the adult population (>30 years), 12-month DSM-IV depressive, anxiety, and alcohol use disorders were assessed with the M-CIDI. Utilisation patterns of antidepressants were categorised to short-term, intermittent and continuous use. Factors predicting short-term use or use not related to known psychiatric morbidity were investigated. RESULTS Of Finnish adults 7.1% had used antidepressants in 2000, of which two-thirds reported a physician-diagnosed mental disorder; a third (35%) had major depressive or anxiety disorder during the previous 12 months. In terms of utilisation pattern, 43% were long-term users, 32% intermittent users and 26% short-term users. Short-term use was related to care by a general practitioner and having no known mental disorder. A quarter of all users had no known psychiatric morbidity. This type of user was most common among the older age groups, and inversely related to being single, on disability pension and using mental health services. LIMITATIONS Not all psychiatric indications for antidepressant use could be explored. CONCLUSIONS Depression remains the main indication for antidepressant use. About a quarter of users had no known psychiatric indication and the indication remained unclear. Short-term and non-psychiatric use are more commonly prescribed for the elderly.
Collapse
Affiliation(s)
- Sinikka Sihvo
- STAKES National Research and Development Centre for Welfare and Health, Helsinki, Finland.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Sewitch MJ, Cole M, McCusker J, Ciampi A, Dyachenko A. Medication use and nonadherence to psychoactive medication for mental health problems by community-living Canadian seniors with depression. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:609-20. [PMID: 18801224 DOI: 10.1177/070674370805300908] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the relation between level of depression and psychoactive medication use and nonadherence in Canadian seniors, given that late-life depression is a common, serious mental health problem in Canada. METHODS Canadian Community Health Survey-Mental Health and Well-Being respondents aged 65 years and older (n = 7,736) comprised the study sample. Using the Composite International Diagnostic Interview to assess depressive symptoms, we created 4 depression levels to capture a spectrum of depressive disorders and (or) symptoms: major depression, comorbid major depression, depressive symptoms, and no depressive symptoms. Psychoactive medications assessed included sleep aids, anxiolytics, and mood stabilizers and (or) antidepressants (AD). Nonadherence was defined as either not taking medication as recommended or taking medication at a lower dosage than prescribed. RESULTS In total, 22.5% of respondents took psychoactive medication for a mental health problem in the previous 12 months. Psychoactive medication use was 46.8% for major depression, 43.1% for comorbid major depression, 34.0% for depressive symptoms, and 17.6% for no depressive symptoms. Rates of psychoactive medication use ranged from 46.5% of those with major depression, to 17.6% of those with no depressive symptoms. Overall, the rate of nonadherence to psychoactive medication was 31%; rates were highest among those with depressive symptoms (37.4%) and lowest among those with no depressive symptoms (27.4%). All 3 depressive categories were associated with greater odds of use and nonadherence. CONCLUSION All 3 depression categories were associated with increased use of and nonadherence to psychoactive medication; however, rates of AD and (or) mood stabilizer use for clinically significant depression were low.
Collapse
Affiliation(s)
- Maida J Sewitch
- Department of Medicine, McGill University, Montreal, Quebec.
| | | | | | | | | |
Collapse
|