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Antidepressant Medication (antidepressant + medication)
Selected AbstractsSites for depression on the web: a comparison of consumer, professional and commercial sitesAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2000HELEN CHRISTENSEN Objective: To provide information on the range of treatments for depression provided by commercial, professional and consumer web sites. Methods: An audit of the 21 most popular depression sites on the world wide web undertaken from March 1999 to July 1999, in Canberra, ACT. Treatment types and categories of treatment were compared among commercial, professional and consumer web sites. Results: A total of 53 treatments or treatment types were mentioned. The number of treatments mentioned per site ranged from 2 to 38. Antidepressant medication and psychotherapy were noted by almost all sites. Consumer sites mentioned psychological therapies less frequently but did not mention dietary supplements or complementary treatments more frequently. Conclusions and Implications: Consumer web sites provide a point of comparison to those from commercial or professional sources. They provide a voice to inform psychiatrists and GPs about preferred treatments and side effects and to alert researchers to areas that need formal investigation. [source] Structured reminiscence: an intervention to decrease depression and increase self-transcendence in older womenJOURNAL OF CLINICAL NURSING, Issue 2 2006Cynthia Kellam Stinson MSN Aims/objectives., The purpose of this study was to assess the effect of group reminiscing on depression and self-transcendence of older women residing in an assisted living facility in southeast Texas. There were two major objectives for this study. One objective was to determine if depression decreased in older women after structured reminiscence group sessions held twice weekly for a six-week period. A second objective was to determine if self-transcendence increased after structured reminiscence group sessions held twice weekly for a six-week period. Background., Reminiscence has been studied to determine its impact on a variety of conditions including but not limited to depression, self-esteem, fatigue, isolation, socialization, well-being, language acquisition and cognitive functioning. This review of research specifically focused on reminiscence, depression, self-transcendence and older people. Design/methods., Two groups were assessed at baseline, three and six weeks to answer the research questions. A sample of 24 women between the ages of 72 and 96 years were randomly assigned to either a reminiscence (experimental) group or the activity (control) group of the facility. Pearson's r was used to determine the magnitude of the relationship between subjects' responses on the Geriatric Depression Scale and the Self-Transcendence Scale. A mixed design analysis of variance (anova) was used to determine if there was a difference between the experimental and control groups on scores of the Geriatric Depression Scale and the Self-Transcendence Scale at baseline, three and six weeks. Conclusions., Data revealed a non-significant decrease in depression and increase in self-transcendence in the reminiscence group at the completion of six weeks, indicating a trend toward a positive result with reminiscence group sessions. The study also revealed an inverse relationship between depression and self-transcendence. These findings underscore the importance of screening older people for depression. Relevance to clinical practice., One of the primary modalities used for the treatment of depression in elderly women is medication. Antidepressant medications lead to harmful side effects without alleviating the underlying depression. For these reasons, there is a need to research alternative therapies for treatment of depression in the older female. Reminiscence offers a possible intervention for treatment of depression in older women. [source] Moderate and high affinity serotonin reuptake inhibitors increase the risk of upper gastrointestinal toxicity,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008James D. Lewis MD, MSCE Abstract Objective Serotonin release from platelets is important for regulating hemostasis. Some prior studies suggest an association between use of selective serotonin reuptake inhibitors and gastrointestinal bleeding and a possible synergistic effect of these medications with non-steroidal anti-inflammatory drugs (NSAIDs). This study examined the effect of medications that inhibit serotonin uptake on upper gastrointestinal toxicity. Methods 359 case subjects hospitalized for upper gastrointestinal bleeding, perforation, or benign gastric outlet obstruction were recruited from 28 hospitals. 1889 control subjects were recruited by random digit dialing from the same region. Data were collected during structured telephone interviews. Antidepressant medications were characterized according to their affinity for serotonin receptors. Exposure to medications required use on at least 1,day during the week prior to the index date. Results Any moderate or high affinity serotonin reuptake inhibitor (MHA-SRI) use was reported by 61 cases (17.1%) and 197 controls (10.4%). After adjusting for potential confounders, MHA-SRI use was associated with a significantly increased odds of hospitalization for upper gastrointestinal toxicity (adjusted OR,=,2.0, 95%CI 1.4,3.0). A dose,response relationship in terms of affinity for serotonin uptake receptors was not observed (p,=,0.17). No statistical interaction was observed for use of high dose NSAIDs or aspirin concomitantly with MHA-SRIs (p,=,0.5). When MHA-SRIs were used concomitantly with high dose NSAIDs, the adjusted odds ratio for the association with upper gastrointestinal toxicity was 3.5 (95%CI 1.9,6.6). Conclusions Use of MHA-SRIs is associated with an increased risk of hospitalization for upper gastrointestinal toxicity. Copyright © 2008 John Wiley & Sons, Ltd. [source] Homicidal ideation with intent during a manic episode triggered by antidepressant medication in a man with brain injuryBIPOLAR DISORDERS, Issue 1 2008Marie-José Dealberto Background:, Mood disorders are more frequent after brain injury and both depressive and manic episodes are associated in these patients with an increased risk of aggression. Antidepressant medications are associated with a risk of manic induction. Case report:, We describe a case of homicidal ideation with intent during the onset of a manic episode in a patient with prior brain injury on antidepressant medication at low dosage. The manic episode could have been secondary to brain injury and/or triggered by antidepressant medications. This case raises the possibility of the sensitizing role of brain injury for antidepressant-induced mania. Conclusions:, Further studies are needed to assess the role of brain injury as a risk factor for antidepressant-induced mania. Physicians should be cautious when prescribing antidepressants to patients with prior brain injury and inform them and their relatives of the possibility of a switch into mania. [source] Residual cognitive impairments in remitted depressed patients,DEPRESSION AND ANXIETY, Issue 6 2008Wendelien Merens M.A. Abstract Depressive disorders are associated with various cognitive impairments. Studies on whether or not these impairments persist into the euthymic phase have shown conflicting results, due to differences in test versions and in study samples. In this paper, we aimed to compare the cognitive performance of remitted depressed patients with that of age- and gender-matched healthy volunteers across a wide range of cognitive domains. In two studies, we found few differences on neutral as well as emotional information processing tests. The findings indicate that remitted depressed patients who use antidepressant medication still show an increased recognition of facial expression of fear compared to healthy controls. Patients also performed worse on a test of recognition of abstract visual information from long-term memory. No other residual cognitive impairments were found. These results indicate that most of the cognitive impairments associated with depression resolve with recovery through medication, even when recovery is incomplete. Considering the finding that remitted depressed patients have higher levels of cognitive reactivity, future studies may investigate the possibility that these cognitive impairments have not resolved but have become latent, and may therefore easily be triggered by small changes in mood state. Depression and Anxiety 0:1,10, 2007. © 2007 Wiley-Liss, Inc. [source] Non-remission of depression in the general population as assessed by the HAMD-7 scaleDEPRESSION AND ANXIETY, Issue 5 2008Andrew G. Bulloch Ph.D. Abstract Remission from the symptoms of depression is the optimal outcome for depression treatment. Many studies have assessed the frequency of treatment, but there are none that have estimated the frequency of treated remission in the general population. We addressed this issue in the population of Alberta using a brief Hamilton Depression Rating Scale (HAMD)-7 scale (recently validated against the HAMD-17 scale in a clinical setting) that has been proposed as a suitable indicator for remission in primary care. We used data from a survey conducted within the Alberta Depression Initiative in 2005 (n=3,345 adults), to produce a population-based estimate of the number of respondents taking antidepressant medication for depression. From this group we selected a subpopulation that did not screen positive when the MINI module for major depression was administered (i.e., who did not have an active episode). Non-remission in this subpopulation was assessed with a version of the HAMD-7 scale adapted for telephone administration by a nonclinician. Of the survey respondents, 189 reported taking antidepressant medication for depression. Of these, 115 were found not to have an active episode. However, 49.0% of this subpopulation was not in remission as evaluated by the HAMD-7. We estimate that 1.3% (95% confidence interval, 0.9,2.0%) of the population is in treated non-remission for depression. Our study indicates a substantial degree of non-remission from depression in individuals taking antidepressants in the general population. This suggests that, in addition to increasing the frequency of treatment, increasing the effectiveness of treatment can have an impact on population health. Depression and Anxiety 0:1,5, 2007. © 2007 Wiley-Liss, Inc. [source] Quantified superiority of cognitive behaviour therapy to antidepressant drugs: a challenge to an earlier meta-analysisACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2008G. B. Parker Objective:, The study aimed to review the conclusion of a previously published meta-analysis which quantified distinct superiority of cognitive therapy to antidepressant drug-therapy (P < 0.0001). Method:, We sought to include all studies used in the original meta-analysis. Adopting both that study's inclusion criteria and additional criteria resulted in a reduced set of studies. We analysed both ,completer' and ,intention to treat' data, using effect size and odds ratio quantification. Results:, There was an overall trend for cognitive therapy to be superior to antidepressant drug-therapy, but this was significant for only one of the four meta-analyses (an intention to treat analysis). We demonstrated considerable heterogeneity between studies, and a significantly higher drop-out rate in the antidepressant groups. Conclusion:, The previous interpretation , cognitive therapy being distinctly superior to antidepressant medication , cannot be sustained from the currently analysed data set. [source] Depressive pseudodementia in a child with autismDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 7 2004Andrew J Pollard MBBS BSc PhD DIC ILTM MRCP(UK) FRCPCH Depression is rare in early childhood and unusual in autism in this age group. We describe a female child aged 6 years with autism who presented with regression of developmental skills previously gained. Her sleep and appetite were poor, her affect was sad, and she had morbid speech content. She responded to treatment with antidepressant medication. When this clinical picture occurs in adults it is called depressive pseudodementia; paediatric neurologists and neuropsychiatrists need to be aware of it in children. [source] The effectiveness of psychological treatments for treatment-resistant depression: a systematic reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2005S. McPherson Objective:, A systematic review of all studies (controlled and uncontrolled) to evaluate psychological interventions with treatment-resistant depression. Method:, A systematic search to identify studies evaluating a psychological intervention with adults with a diagnosis of major depressive disorder who had not responded to at least one course of antidepressant medication. Results:, Twelve studies met inclusion criteria, of which four were controlled and eight uncontrolled. Treatment effect sizes were computable for four studies and ranged from 1.23 to 3.10 with a number of better quality studies demonstrating some improvements in patients following a psychological intervention. Conclusion:, Psychological treatments for depression are commonly delivered and often recommended following the failure of medication. The paucity of evidence for their effectiveness in these situations is a significant problem. There is a need for studies with a strong controlled design investigating the effectiveness of psychological treatments for patients with treatment-resistant depression. [source] Does increasing dose improve efficacyin patients with poor antidepressantresponse: a reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2000E. Corruble Objective: Therapeutic strategies in depressed patients with no or partial response to adequate first-line antidepressant medication remain a matter of concern. This paper focuses on the strategy of dose increase. Method: This review was based on a systematic Medline search of papers dealing with antidepressant dose issues in major depression since the 1960s. Results: The strategy of dose increase is poorly studied in clinical trials. Conclusion: Until this strategy is better studied, caution is advised in its use. However, antidepressants for which this strategy seems to be the most relevant are tricyclic drugs and serotonin and noradrenaline reuptake inhibitors. These results are discussed both in terms of therapeutic strategies for the clinician and in terms of clinical research. [source] HEPATITIS C AND ADDICTION: Retention rate and side effects in a prospective trial on hepatitis C treatment with pegylated interferon alpha-2a and ribavirin in opioid-dependent patientsADDICTION BIOLOGY, Issue 2 2009Nina Ebner ABSTRACT Hepatitis C viral (HCV) infection is present in 30 to 98% of intravenous drug users. Intravenous substance abuse represents the main route of HCV transmission in industrialized countries. A multi-centre, randomized, controlled, prospective study assessed sustained virological response (SVR), adverse events such as depressive episodes and retention rate of HCV treatment in opioid-dependent patients. Stabilized, opioid-dependent patients with chronic HCV infection (genotype 2 or 3) received pegylated interferon alpha-2a in combination with ribavirin 800 mg/day (Group A) or 400 mg/day (Group B). Participants were randomized, blocked and stratified by genotype and viral load. A standardized psychiatric assessment, Beck Depression Inventory (BDI) and Van Zerssen's list of complaints were administered at each study visit. In 31 months, 300 opioid-dependent patients were screened; 190 (63.3%) were hepatitis C antibody positive. According to study protocol, out of 75 ,potential-to-treat' patients with genotype 2 or 3, 17 stable patients (22.6%) were included in the study. All participants completed the study. Significant haemoglobin decreases occurred in both Groups A (P = 0.001) and B (P = 0.011). All the patients had an end-of-treatment (week 24) HCV RNA negativity. Fifteen (88.2%) achieved SVR at week 48. Overall, 52.9% developed depressive symptoms during treatment. Because of the prompt initiation of antidepressant medication at first appearance of depressive symptoms, no severe depressive episodes occurred. Our data show a high retention rate and reliability, and good viral response for both treatments. Hepatitis C treatment in stable opioid-dependent patients was efficacious, suggesting that addiction clinics can offer antiviral therapy in combination with agonistic treatment as part of multi-disciplinary treatment. [source] The effects of antidepressant medication adherence as well as psychosocial and clinical factors on depression outcome among older adultsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2008Hayden B. Bosworth Abstract Objective To examine the contribution of medication adherence to 12-month depression scores in the context of other psychosocial and clinical predictors of depression in a sample of older adults treated for depression. Methods Secondary analysis of a prospective cohort study involving 241 older patients undergoing depression treatment using a standardized algorithm. Depression was measured at baseline and 12-months post-baseline. Baseline predictor variables included antidepressant adherence, barriers to antidepressant adherence, four domains of social support, basic and instrumental activities of daily living (BADLs and IADLs), and clinical factors including past history of depression and medical comorbidities. Results Nearly 28% of patients reported being nonadherent with their antidepressant medication. In bivariate analyses, greater antidepressant medication nonadherence, more medication barriers, poorer subjective social support, less non-family interaction, greater BADL and IADL limitations, poor self-rated health, higher baseline depression scores, and not having diabetes were related to higher 12-month depression scores. In multivariable analyses, greater medication nonadherence, not having diabetes, poorer subjective social support, greater BADL limitations, and higher baseline depression scores were related to higher 12-month depression scores. Conclusion Interventions should be directed toward improving antidepressant adherence and modifiable psychosocial variables. Copyright © 2007 John Wiley & Sons, Ltd. [source] Expanding the usefulness of Interpersonal Psychotherapy (IPT) for depressed elders with co-morbid cognitive impairmentINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2007Mark D. Miller Abstract Background The utility of Interpersonal Psychotherapy (IPT) has been documented as a maintenance treatment for late life depression as mono-therapy or in combination with antidepressant medication. Late life depression, however, is frequently co-morbid with declining memory or other cognitive abilities such that the usefulness of one-to-one psychotherapies is called into question for this subgroup. Additionally, concerned caregivers often accompany these patients to request help and their role in the presenting symptoms and in their potential resolution must also be addressed by any successful psychotherapy in this population. Objectives To explore ways in which IPT could be modified to better serve the particular presentation and needs of depressed elders with cognitive decline along with their caregivers. Methods Various modifications of traditional IPT techniques were experimented with and refined in our collaborative late life research center using regular group supervision and feedback from patients and their caregivers. Results A key component of these modifications involves the integration of the caregiver into the treatment process in flexible ways that recognize their own role transition that is taking place simultaneously with that of the patient's role transition from a greater to a lesser functional state. Other techniques for resolving role conflicts, particularly those directly involving care issues for the patient, are also delineated. These modifications are collectively referred to as IPT-CI for cognitive impairment. A brief case vignette is presented. Conclusion The modifications outlined in this communication reflect an evolving work-in-progress and serve as a framework for the future development of a manual of guidelines to assist healthcare personnel to optimally treat this population and their caregivers. Copyright © 2006 John Wiley & Sons, Ltd. [source] Treating late-life depression with interpersonal psychotherapy in the primary care sectorINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2007Herbert C. Schulberg Abstract Background Interpersonal psychotherapy (IPT) is an empirically-validated intervention for treating late-life depression. Objective To determine the manner in which IPT is utilized by primary care physicians in relation to antidepressant medications. Methods The authors reviewed treatment logs prepared by care managers during the first 12 months of a patient's participation in the PROSPECT clinical trial to determine initial and longitudinal treatment patterns utilized by physicians, and clinical outcomes associated with initial treatment assignment. Results Primary care physicians in practices randomized to PROSPECT's intervention arm initially prescribed an antidepressant medication for 58% of eligible patients and referred only 11% of them to IPT. Over time, however, 27% of patients participated in IPT as monotherapy or augmentation therapy. Initial treatment assignment was not associated with depressive status at 4 and 12 months nor with suicidal ideation at 4, 8, and 12 months. Conclusion IPT is an effective treatment for late-life depression whose greater use by primary care physicians should be encouraged. Copyright © 2006 John Wiley & Sons, Ltd. [source] The feasibility of a GP led screening intervention for depression among nursing home residentsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2006Sandra Davidson Abstract Aim To examine the feasibility of a brief intervention training general practitioners (GPs) in the administration of a depression screening instrument for use among nursing home residents. Intervention GPs attended a single education session on late-life depression and were trained in the use of the Cornell Scale for Depression in Dementia. Following the intervention GPs reviewed their patients for depression. Outcome measures Diagnosis of depression pre and post intervention; changes in antidepressant medications post intervention. Results Ten GPs and 38 patients completed all components of the study. GPs identified that 24% of their patients had Cornell Scores indicative of probable major depression that was either unrecognised or inadequately treated. 88% of these patients had been previously diagnosed with depression. A further 32% of patients exhibited depression symptoms, half (50%) of whom had a previous diagnosis of depression. Reviewing patients had an effect on antidepressant prescribing for patients with probable major depression, with GPs making changes to the antidepressant medication of 29% of patients. Conclusions The high rate of residents presenting with probable major depression despite being prescribed antidepressants indicate that depression symptoms are inadequately recognised and treated in nursing homes. This study demonstrated that a single education session on late-life depression was feasible and was associated with an improvement in GPs' recognition of depression among nursing home patients. Copyright © 2006 John Wiley & Sons, Ltd. [source] Psychopathology and autobiographical memory in stroke and non-stroke hospitalized patientsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2003Mark John Sampson Abstract Background Psychopathology and autobiographical memory were investigated in a cohort of stroke and non-stroke hospitalized patients. Both these cohorts have been identified as having high levels of psychopathology (Katon and Sullivan 1990; Burvill et al., 1995). Difficulties recalling specific autobiographical memories (overgeneral memory) have been identified as important psychological variables in depression and predictors of outcome (Williams and Scott 1988; Brittlebank et al., 1993). Intrusive autobiographical memories have also been found to be associated with depression and overgeneral memory in depressed women (Kuyken and Brewin, 1995) and depressed cancer patients (Brewin et al., 1998a). This study looked at levels of psychopathology and autobiographical memories in stroke and non-stroke hospital patients. Method 417 patients were screened, of the 176 eligible 103 agreed to participate (54 stroke and 49 non-stroke). Participants were assessed for overgenerality using the Autobiographical Memory Test and intrusiveness of memories using the Impact of Events Scale. Also assessed were PTSD-like symptoms (PCL-S), mood (HADS, GHQ-28) and cognitive ability (MMSE, verbal fluency, digit span and estimated pre-morbid IQ). Results No significant differences were found between stroke and non-stroke patients on severity of depression, anxiety, severity of PTSD-like symptoms or autobiographical memories. Backward multivariate regression analyses for combined data (stroke and non-stroke) indicated that overgeneral memory recall, intrusive memories of past events and intrusive memories of illness were significant independent predictors of depression (HADS). Avoidance of intrusive memories and reported childhood distress were not predictors of overgeneral memory recall. Significant predictors of overgeneral memory recall were; Gender, antidepressant medication, and estimated IQ. Conclusion Significant levels of psychopathology were identified in this cohort. However, there were no significant differences in the levels of depression, anxiety, PTSD symptoms and autobiographical memory between stroke and non-stroke hospitalized patients. Of particular interest was the finding that PTSD-like symptoms did not appear to be influenced by the nature of the person's illness. In combined data (stroke and non-stroke) autobiographical memories (intrusive images of their illness, intrusive memories of other events and overgeneral memory recall variables) were significant predictors of depression in this cohort. This suggests that psychological intervention of memory processes may be a worthwhile target in psychological intervention for depression in these cohorts. Gender, cognitive impairment, antidepressant medication, and estimated IQ were significant predictors of overgeneral memory recall and further investigation into the validity of these findings are warranted. Suggestions for further research and limitations of the study are also discussed. Copyright © 2002 John Wiley & Sons, Ltd. [source] Impact of PTSD comorbidity on one-year outcomes in a depression trialJOURNAL OF CLINICAL PSYCHOLOGY, Issue 7 2006Bonnie L. Green Low-income African American, Latino, and White women were screened and recruited for a depression treatment trial in social service and family planning settings. Those meeting full criteria for major depression (MDD; N = 267) were randomized to cognitive,behavior therapy (CBT), antidepressant medication, or community mental health referral. All randomly assigned participants were evaluated by baseline telephone and clinical interview, and followed by telephone for one year. Posttraumatic stress disorder (PTSD) comorbidity was assessed at baseline and one-year follow-up in a clinical interview. At baseline, 33% of the depressed women had current comorbid PTSD. These participants had more exposure to assaultive violence, had higher levels of depression and anxiety, and were more functionally impaired than women with depression alone. Depression in both groups improved over the course of one year, but the PTSD subgroup remained more impaired throughout the one-year follow-up period. Thus, evidence-based treatments (antidepressant medication or structured psychotherapy) decrease depression regardless of PTSD comorbidity, but women with PTSD were more distressed and impaired throughout. Including direct treatment of PTSD associated with interpersonal violence may be more effective in alleviating depression in those with both diagnoses. © 2006 Wiley Periodicals, Inc. J Clin Psychol 62: 815,835, 2006. [source] The effectiveness of antidepressant medication in the management of behaviour problems in adults with intellectual disabilities: a systematic reviewJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 10 2007S. K. Sohanpal Abstract Background A comprehensive systematic review was performed to establish the current evidence base regarding the effectiveness of antidepressant medication for the management of behaviour problems in adults with intellectual disabilities. Method An electronic search of PsycInfo, Embase, Medline and Cinahl databases was conducted spanning the time period 1990 to October 2005 for primary trials. This was supplemented by hand searching and cross-referencing of relevant reviews. Strict scientific methodology requirements were formulated that the studies had to meet in order to merit inclusion in this review. Results One crossover randomized controlled trial in a small cohort, seven prospective uncontrolled trials and two retrospective studies were yielded in the search. Of these, one explored the effectiveness of the tricyclic antidepressant , clomipramine, and nine considered various selective serotonin reuptake inhibitors (SSRIs). Conclusion Evidence based primarily on a small number of either prospective or retrospective case studies that included a small number of participants and often used non-validated outcome measures for a short period of follow-up, suggests that antidepressants, particularly SSRIs, show improvement of aggression and self-injurious behaviour on average in less than 50% of cases and the rest show either no improvement or deterioration. The effect is most pronounced in the presence of an underlying anxiety or an associated diagnosis of obsessive-compulsive disorder. Most studies have highlighted the concern regarding adverse effects. [source] Psychopharmacological and electroconvulsive treatment of anxiety and depression in the elderlyJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2000W. A. Heffern MN The pharmacotherapeutics of antianxiety and antidepressant medication in the elderly is reviewed, and the benefits and risks of electroconvulsive therapy (ECT) are discussed. Physiological changes in normal ageing are described, and the pharmacodynamic and pharmacokinetic implications are addressed. Finally, the role of the advanced practice nurse (mental health/psychiatry) is discussed in terms of accountability, collaboration, and the development of empirical knowledge to enhance quality patient care. [source] A Primary Care Intervention for DepressionTHE JOURNAL OF RURAL HEALTH, Issue 4 2000Jeffrey I. Smith B.S. The study enrolled 479 depressed patients, with 432 (90.2 percent) completing telephone follow-up at six months. Multilevel analytic models revealed that rural enhanced care patients had 2.70 times the odds (P=0.02) of rural usual care patients of taking a three-month course of antidepressant medication at recommended dosages in the six months following baseline; urban enhanced care patients had 2.43 times the odds compared with their urban usual care counterparts (P=0.007). Rural enhanced care patients had 3.00 times the odds of rural usual care patients of making eight or more visits to a mental health specialist for counseling in the six months following baseline (P=0.03). Comparisons of patients in enhanced care practices showed that rural enhanced care patients had 2.00 times the odds (P=0.12) of urban enhanced care patients of making at least one visit to a mental health specialist for counseling in the six months following baseline and had comparable odds to urban enhanced care patients (odds ratio [OR] = 1.06, P=0.77) of making eight or more visits to such specialists during that interval. The study's intervention improved the care received by both rural and urban depressed primary care patients. Moreover, the interventions effect appears to have been greater in rural settings, particularly in terms of increasing depressed rural patients' use of mental health specialists for counseling. [source] Initiation of stimulant and antidepressant medication and clinical presentation in juvenile bipolar I disorderBIPOLAR DISORDERS, Issue 2 2008Maria E Pagano Objectives:, The primary purpose of this study was to examine the extent to which the initiation of stimulant and antidepressant medication was associated with the subsequent onset of juvenile bipolar I disorder (BP I). Another aim was to investigate differences in clinical presentation between youths prescribed stimulant or antidepressant medication before and after the onset of juvenile BP I disorder. Methods:, Youths between the ages of 5 and 17 years meeting full, unmodified DSM-IV diagnostic symptom criteria for BP were included in this study. Data regarding the age of onset of BP I, psychiatric comorbidities, and current symptoms of mania and depression were obtained. Medication history was recorded as part of the assessment interview with parents and youths. Results:, Of the 245 youths with BP I, 65% (n = 160) were treated with stimulant medication; 32% (56/173) were treated after the onset of BP I, and 19% (32/173) were treated before the onset of BP I. Forty-six percent (113/245) were treated with antidepressant medication; 33% (67/206) were treated after the onset of BP I, and 3% (7/206) were treated before the onset of BP I. Patients who were treated with stimulants after the onset of BP I were significantly more likely to be younger (p < 0.0001). Patients who were treated with antidepressants before the onset of BP I were significantly more likely to be older and to have lower levels of mania on the Young Mania Rating Scale at assessment (p < 0.01). Conclusions:, Data from this retrospective case series do not support the association between initial stimulant or antidepressant use and the onset of BP I or presenting symptoms of depression or manic symptoms. [source] Homicidal ideation with intent during a manic episode triggered by antidepressant medication in a man with brain injuryBIPOLAR DISORDERS, Issue 1 2008Marie-José Dealberto Background:, Mood disorders are more frequent after brain injury and both depressive and manic episodes are associated in these patients with an increased risk of aggression. Antidepressant medications are associated with a risk of manic induction. Case report:, We describe a case of homicidal ideation with intent during the onset of a manic episode in a patient with prior brain injury on antidepressant medication at low dosage. The manic episode could have been secondary to brain injury and/or triggered by antidepressant medications. This case raises the possibility of the sensitizing role of brain injury for antidepressant-induced mania. Conclusions:, Further studies are needed to assess the role of brain injury as a risk factor for antidepressant-induced mania. Physicians should be cautious when prescribing antidepressants to patients with prior brain injury and inform them and their relatives of the possibility of a switch into mania. [source] Prevalence and associated factors of restless legs in a 57-year-old urban population in northern FinlandACTA NEUROLOGICA SCANDINAVICA, Issue 1 2010A. K. Juuti Juuti AK, Läärä E, Rajala U, Laakso M, Härkönen P, Keinänen-Kiukaanniemi S, Hiltunen L. Prevalence and associated factors of restless legs in a 57-year-old urban population in northern Finland. Acta Neurol Scand: 2010: 122: 63,69. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objective,,, We examined the prevalence and associated factors of restless legs syndrome (RLS) in a 57-year-old unselected urban population in northern Finland. Methods,,, A health survey was conducted in 2002 that targeted persons born in 1945 and residing in the city of Oulu on 31 December, 2001. Their history of RLS, coronary heart disease (CHD), daytime sleepiness, depressive symptoms and snoring was assessed by means of questionnaires. Results,,, Altogether 995 of 1332 eligible subjects (74%) participated (556 women, 439 men). The overall prevalence of RLS , 1 per week was 20% in women and 15% in men. In the fitted multiple logistic regression model, RLS was found to be associated with female gender (OR 1.64, 95% CI 0.98,2.72), CHD (OR 2.92, 95% CI 1.18,7.23), daytime sleepiness (OR 2.12, 95% CI 1.32,3.41), moderately elevated (31,45) or high (46,65) Zung sum scores (OR 1.95, 95% CI 1.09,3.48 and OR 3.67, 95% CI 1.71,7.90, respectively), antidepressant medication (OR 2.10, 95% CI 1.06,4.19) and arthropathy (OR 1.69, 95% CI 1.04,2.72). Insufficient evidence was found of an association between RLS and type 2 diabetes or impaired glucose regulation. Conclusions,,, Restless legs syndrome is fairly common in subjects aged 57 years. A particularly strong positive association was observed between RLS and depressive symptoms and CHD. [source] Late-Life Depression: Detection, Risk Reduction, and Somatic Intervention: Commentary on Delano-Wood and AbelesCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 3 2005Morgan T. SammonsArticle first published online: 11 MAY 200 Somatic interventions such as antidepressant medication and electroconvulsive therapy (ECT) have the potential to produce dramatic, potentially life-saving, responses in elderly patients suffering from depression. At the same time, the body of systematically collected evidence supporting the use of such interventions in geriatric populations is not robust and may not be sufficient to adequately guide clinicians regarding their use. In light of the greater risks associated with somatic treatments in the elderly vis-à-vis younger populations, clinicians suggesting the application of somatic interventions for late-life depression should be aware of the limitations to the data and should recommend these interventions with caution. To maximize effectiveness, somatic interventions should be incorporated into a comprehensive psychosocial treatment plan. [source] Emotional issues after kidney transplantation: a prospective psychotherapeutic studyCLINICAL TRANSPLANTATION, Issue 6 2002Lyndsay S Baines Abstract:,Background:, Negative emotional states are the single most influential factor in determining quality of life after a successful kidney transplant. We designed a prospective study using psychotherapeutic principles to understand and intervene in emotional issues in adult recipients of first cadaver kidney transplants. Methods:, Forty-nine recipients of first cadaver kidney transplants were subjected to 12 sessions (at weekly intervals) of psychotherapy within 3 months of receiving their transplant. The Beck Depression Inventory (BDI) was utilized as a measure of change in emotional state, pretherapy, at 3, 6, 9 and 12 months. A higher score on BDI was suggestive of psychological dysfunction. In the first instance, data was analysed within a quantitative framework, by virtue of the BDI. In the second instance, data was considered in terms of recurring themes described by patients during psychotherapy and was analysed qualitatively. In the third instance, both qualitative and quantitative data was considered in terms of individual patient's ability to achieve some feeling of having implemented some social, relational and vocational equilibrium into their everyday life. Recipients of live kidneys, paediatric transplants and patients who received more than one transplant were excluded, as emotional issues are different in this cohort of patients. All patients have completed 1 yr of follow up. None of the patients were on antidepressant medication before or after therapy. Results:, This is an ongoing study in which we are comparing individual vs. group therapy vs. controls (who receive no therapy). The total number of patients recruited will be 120 and the final report will be available in 2003,04. The results reported in this paper form the 49 patients in the individual arm of the study. All the patients in our study happened to be white people. There was significant improvement in the BDI scores following therapy. The mean score was 26.3 ± 7.9 before and 20.5 ± 8.8 after therapy (p = 0.001); the lowering of the scores remained sustained at 12 months. Multivariate analysis of age, gender, employment status, duration of dialysis (if in dialysis for more than 3 yrs) and psychotherapy given before transplantation did not affect the results of our study. For the qualitative aspect of the study, we grouped the emotional problems as expressed by the patients into three recurring themes (i) fear of rejection, (ii) feelings of paradoxical loss post-transplant despite having received a successful transplant and (iii) the psychological integration of the newly acquired kidney. Conclusions:, Psychotherapeutic intervention was an effective means of addressing emotional problems in recipients of kidney transplants. The recurring themes as identified above provided a baseline for psychotherapeutic exploration and resolution of these issues. Successful resolution of these issues was associated with lower BDI scores and the redefinition of normality in daily living post-transplant. [source] Mixture and single-substance toxicity of selective serotonin reuptake inhibitors toward algae and crustaceansENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 1 2007Anne Munch Christensen Abstract Selective serotonin reuptake inhibitors (SSRIs) are used as antidepressant medications, primarily in the treatment of clinical depression. They are among the pharmaceuticals most often prescribed in the industrialized countries. Selective serotonin reuptake inhibitors are compounds with an identical mechanism of action in mammals (inhibit reuptake of serotonin), and they have been found in different aqueous as well as biological samples collected in the environment. In the present study, we tested the toxicities of five SSRIs (citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline) as single substances and of citalopram, fluoxetine, and sertraline in binary mixtures in two standardized bioassays. Test organisms were the freshwater algae Pseudokirchneriella subcapitata and the freshwater crustacean Daphnia magna. In algae, test median effect concentrations (EC50s) ranged from 0.027 to 1.6 mg/L, and in daphnids, test EC50s ranged from 0.92 to 20 mg/L, with sertraline being one of the most toxic compounds. The test design and statistical analysis of results from mixture tests were based on isobole analysis. It was demonstrated that the mixture toxicity of the SSRIs in the two bioassays is predictable by the model of concentration addition. Therefore, in risk assessment based on chemical analysis of environmental samples, it is important to include the effect of all SSRIs that are present at low concentrations, and the model of concentration addition may be used to predict the combined effect of the mixture of SSRIs. [source] Treating Chronic Tension-type Headache Not Responding to Amitriptyline Hydrochloride With Paroxetine Hydrochloride: A Pilot EvaluationHEADACHE, Issue 9 2003Kenneth A. Holroyd PhD Context.,In some individuals, chronic tension-type headache fails to respond to tricyclic antidepressant medications that often serve as first-line therapy. Objective.,To evaluate the clinical efficacy of paroxetine hydrochloride for chronic tension-type headache not responding to amitriptyline hydrochloride. Design and Setting.,Open-label trial of paroxetine conducted at 2 outpatient sites in Ohio. Participants and Intervention.,Thirty-one adults (mean age, 37 years; 20 women) with chronic tension-type headache (mean, 25 headache days per month) who had failed to respond (less than 30% improvement) to treatment with either amitriptyline (n = 13) or matched placebo (n = 18). All participants were treated with paroxetine (up to 40 mg per day) in a 9-month protocol. Outcome Measures.,Monthly headache index calculated as the mean of pain ratings (0 to 10 scale) recorded by participants in a diary 4 times per day, number of days per month with at least moderate pain (pain rating of 5 or greater), and analgesic medication use. Results.,In patients who had not responded to amitriptyline, paroxetine failed to reduce chronic tension-type headaches or analgesic medication use. In patients who had not responded to placebo, paroxetine produced modest reductions in chronic tension-type headaches and analgesic use. Conclusions.,We found no evidence that chronic tension-type headaches that failed to respond to tricyclic antidepressant therapy with amitriptyline improved when subsequently treated with paroxetine. More support was found for the efficacy of paroxetine in patients with chronic tension-type headaches who had failed to respond to placebo. [source] Treating late-life depression with interpersonal psychotherapy in the primary care sectorINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2007Herbert C. Schulberg Abstract Background Interpersonal psychotherapy (IPT) is an empirically-validated intervention for treating late-life depression. Objective To determine the manner in which IPT is utilized by primary care physicians in relation to antidepressant medications. Methods The authors reviewed treatment logs prepared by care managers during the first 12 months of a patient's participation in the PROSPECT clinical trial to determine initial and longitudinal treatment patterns utilized by physicians, and clinical outcomes associated with initial treatment assignment. Results Primary care physicians in practices randomized to PROSPECT's intervention arm initially prescribed an antidepressant medication for 58% of eligible patients and referred only 11% of them to IPT. Over time, however, 27% of patients participated in IPT as monotherapy or augmentation therapy. Initial treatment assignment was not associated with depressive status at 4 and 12 months nor with suicidal ideation at 4, 8, and 12 months. Conclusion IPT is an effective treatment for late-life depression whose greater use by primary care physicians should be encouraged. Copyright © 2006 John Wiley & Sons, Ltd. [source] The feasibility of a GP led screening intervention for depression among nursing home residentsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2006Sandra Davidson Abstract Aim To examine the feasibility of a brief intervention training general practitioners (GPs) in the administration of a depression screening instrument for use among nursing home residents. Intervention GPs attended a single education session on late-life depression and were trained in the use of the Cornell Scale for Depression in Dementia. Following the intervention GPs reviewed their patients for depression. Outcome measures Diagnosis of depression pre and post intervention; changes in antidepressant medications post intervention. Results Ten GPs and 38 patients completed all components of the study. GPs identified that 24% of their patients had Cornell Scores indicative of probable major depression that was either unrecognised or inadequately treated. 88% of these patients had been previously diagnosed with depression. A further 32% of patients exhibited depression symptoms, half (50%) of whom had a previous diagnosis of depression. Reviewing patients had an effect on antidepressant prescribing for patients with probable major depression, with GPs making changes to the antidepressant medication of 29% of patients. Conclusions The high rate of residents presenting with probable major depression despite being prescribed antidepressants indicate that depression symptoms are inadequately recognised and treated in nursing homes. This study demonstrated that a single education session on late-life depression was feasible and was associated with an improvement in GPs' recognition of depression among nursing home patients. Copyright © 2006 John Wiley & Sons, Ltd. [source] Personal characteristics and depression-related attitudes of older adults and participation in stages of implementation of a multi-site effectiveness trial (PRISM-E)INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2005Marsha N. Wittink Abstract Background No study has assessed attitudes about depression and its treatment and participation at each step of recruitment and implementation of an effectiveness trial. Our purpose was to determine the association between personal characteristics and attitudes of older adults about depression with participation at each step of the Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) treatment effectiveness trial. Methods Information on personal characteristics and attitudes regarding depression and its treatment were obtained from all potential participants in PRISM-E. Results Persons who reported better social support were more likely to complete a baseline interview, but were less likely to meet with the mental health professional carrying out the intervention. Attitudes about taking medicines were significantly associated with uptake of the intervention, but not with earlier phases of recruitment. Persons were much more likely to have a visit with the mental health professional for treatment of depression if they were willing to take medicine for depression but did not endorse waiting for the depression to get better [odds ratio (OR),=,3.16, 95% confidence interval (CI),=,1.48,6.75], working it out on one's own (OR,=,5.18, 95% CI,=,1.69,15.85), or talking to a minister, priest, or rabbi (OR,=,2.01, 95% CI,=,1.02,3.96). Conclusion Social support and other personal characteristics may be the most appropriate for tailoring recruitment strategies, but later steps in the recruitment and implementation may require more attention to specific attitudes towards antidepressant medications. Copyright © 2005 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||||||||||||||