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Antidepressant Use (antidepressant + use)

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Medical Sciences	100%

Selected Abstracts

Provider Characteristics Related to Antidepressant Use in Older People

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2006
Gerda G. Fillenbaum PhD
OBJECTIVES: To determine whether the characteristics of the usual medical care providers of older antidepressant users changed between 1986 and 1997 with the introduction of selective serotonin reuptake inhibitors. DESIGN: Longitudinal study. SETTING: Five-county Piedmont area of North Carolina. PARTICIPANTS: Stratified random sample of African-American (n=2,261) and white (n=1,875) community residents aged 65 to 105. MEASUREMENTS: Sample members provided information on prescription medications, demographic and health status, and usual medical care provider (matched to North Carolina Health Professions Data Systems files to ascertain provider characteristics) in 1986/87, 1989/90, 1992/93, and 1996/97. Most (77.5%) named a provider (name unmatchable for 4.1%). Sample member characteristics were aggregated into probability (propensity) scores summarizing predisposing (demographic), enabling (medical care access), and need (health status) categories. Along with wave of study and whether a provider was named, these were entered as control variables in generalized estimating equation models that examined the association between provider race (white vs nonwhite), sex, age, location of practice, and primary versus specialist care and antidepressant use. RESULTS: The characteristics of the usual medical care providers remained stable over the decade, although prevalence of antidepressant use increased. Two provider characteristics,race and area of practice (but not the interaction between them),were significantly associated with patients' use of antidepressants. Patients of white physicians and of physicians with urban practices were more likely to use antidepressants. CONCLUSION: Although use of antidepressants has increased over time, there has been little change in the characteristics of users' usual medical care providers. [source]

Antidepressant use in a nationally representative sample of community-dwelling US Latinos with and without depressive and anxiety disorders,

DEPRESSION AND ANXIETY, Issue 7 2009
Hector M. González Ph.D.
Abstract Background: Antidepressant drugs are among the most widely prescribed drugs in the United States; however, little is known about their use among major ethnic minority groups. Method: Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of Latino and non-Latino White adults antidepressant use. Setting: The 48 coterminous United States was the setting. Participants: Household residents aged 18 years and older (N=9,250). Main outcome: Past year antidepressant use. Results: Compared to non-Latino Whites, few Latinos, primarily Mexican Americans, with 12-month depressive and/or anxiety disorders reported past year antidepressant use. Mexican Americans (OR=0.48; 95%CI=0.30,0.77) had significantly lower odds of use compared to non-Latino Whites, which were largely unaffected by factors associated with access to care. Over half of antidepressant use was by respondents not meeting 12-month criteria for depressive or anxiety disorders. Lifetime depressive and anxiety disorders explained another 21% of past year antidepressant use, leaving another 31% of drug use unexplained. Discussion: We found a disparity in antidepressant use for Mexican Americans compared to non-Latino Whites that was not accounted for by differences in need and factors associated with access to care. About one third of antidepressant use was by respondents not meeting criteria for depressive or anxiety disorders. Our findings underscore the importance of disaggregating Latino ethnic groups. Additional work is needed to understand the medical and economic value of antidepressant use beyond their primary clinical targets. Depression and Anxiety, 2009. Published 2009 Wiley-Liss, Inc. [source]

Factors associated with antidepressant use in depressed and non-depressed community-dwelling elderly: the three-city study

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2008
Agnès Soudry
Abstract Objectives The aim of this study was to identify factors associated with antidepressant use in non-depressed and depressed elderly persons, assuming that they varied according to clinical status. Methods We studied 7,868 French community-dwelling subjects aged 65 years and over. The Center for Epidemiological Studies-Depression scale and the Mini International Neuropsychiatric Interview were used to define three groups: non-depressed, high depressive symptoms and current major depressive disorder. Separate analyses were performed to identify the factors which were associated with antidepressant use in each group. Results Antidepressant use (55% selective serotonin re-uptake inhibitors, 25% tricyclic antidepressants, 20% other types) increased from 4.9% in non-depressed subjects to 17.3% in subjects with high depressive symptoms (HDS) and 33.6% of in those with current major depressive disorder (MDD). The factors associated with antidepressant use varied according to depression status. In particular, men with current MDD were more often treated with antidepressants than women whereas, in both the HDS and the non-depressed groups, antidepressant use was, as has been observed elsewhere, more frequent in women. Gender also had a strong modifying effect on the relationship between antidepressant use and history of major depression. Finally, the direction of the association between antidepressant use and cognitive performance varied according to depression status. Conclusions This study showed that the direction and strength of the association between antidepressant use and demographic and health-related factors varied according to the severity of depression symptoms. Further studies are needed to clarify the relationship between gender and cognition and antidepressant use. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Antidepressant use in a nationally representative sample of community-dwelling US Latinos with and without depressive and anxiety disorders,

Metabolic syndrome abnormalities are associated with severity of anxiety and depression and with tricyclic antidepressant use

ACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2010
A. K. B. Van Reedt Dortland
van Reedt Dortland AKB, Giltay EJ, van Veen T, Zitman FG, Penninx BWJH. Metabolic syndrome abnormalities are associated with severity of anxiety and depression and with tricyclic antidepressant use. Objective:, The metabolic syndrome (MetSyn) predisposes to cardiovascular disease and diabetes mellitus. There might also be an association between the MetSyn and anxiety and depression, but its nature is unclear. We aimed to investigate whether diagnosis, symptom severity and antidepressant use are associated with the MetSyn. Method:, We addressed the odds for the MetSyn and its components among 1217 depressed and/or anxious subjects and 629 controls, and their associations with symptom severity and antidepressant use. Results:, Symptom severity was positively associated with prevalence of the MetSyn, [adjusted odds ratio (OR) 2.21 for very severe depression: 95% confidence interval (CI): 1.06,4.64, P = 0.04], which could be attributed to abdominal obesity and dyslipidemia. Tricyclic antidepressant (TCA) use also increased odds for the MetSyn (OR 2.30, 95% CI: 1.21,4.36, P = 0.01), independent of depression severity. Conclusion:, The most severely depressed people and TCA users more often have the MetSyn, which is driven by abdominal adiposity and dyslipidemia. [source]

SSRIs and cognitive performance in a working sample

HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 8 2005
Emma J. K. Wadsworth
Abstract Background Studies of the impact of antidepressant use on cognitive performance have frequently been carried out among the elderly or on healthy volunteers. Comparatively little research has considered their impact on a relatively young, working population, particularly within the context of everyday life. Aims To examine any association between SSRI use and cognitive performance, mood and human error at work. Methods SSRI users and controls completed a battery of laboratory based computer tasks measuring mood and cognitive function pre- and post-work at the start and end of a working week. They also completed daily diaries reporting their work performance. Results SSRI use was associated with memory impairment: specifically poorer episodic, though not working or semantic memory. Effects of SSRI use on recognition memory seemed to vary according to the underlying psychopathology, while effects on delayed recall were most pronounced among those whose symptoms had not (yet) resolved. There were no detrimental effects on psychomotor speed, attention, mood or perceived human error at work. Conclusions The findings lend support to the SSRIs comparative safety, even among workers, particularly as the symptoms of the underlying psychopathology are successfully addressed. Possible memory impairments may, however, be found in those taking SSRIs. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Benzodiazepine use in the elderly: an indicator for inappropriately treated geriatric depression?

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2009
Eva Assem-Hilger
Abstract Objective To measure the prevalence of benzodiazepine (BZD) use and to explore associated demographic and clinical variables of BZD use within a cohort of 75-year- old inhabitants of an urban district of Vienna. Methods This is a prospective, interdisciplinary cohort study on aging. Our investigation is based on the first consecutive 500 subjects that completed the study protocol. Demographic and clinical characteristics, benzodiazepine and antidepressant use were documented using a standardized questionnaire. Affective status was assessed using the Hamilton Depression Rating Scale (HAMD), the Geriatric Depression Scale (GDS), and the Spielberger State-and Trait Anxiety Inventory subscales (STAI). Results Prevalence of BZD use was 13.8%. Compared to non-users, BZD users had significantly higher mean scores at the HAMD (p,=,0.001), the GDS (p,=,0.026), and the Spielberger State-and Trait Anxiety Inventory subscales (p,=,0.003; p,=,0.001). Depression was found in 12.0% (HAMD) and 17.8% when using a self-rating instrument (GDS). Less than one-third of depressed subjects were receiving antidepressants. Statistically equal numbers were using benzodiazepines. Conclusions Inappropriate prescription of BZD is frequent in old age, probably indicating untreated depression in many cases. The implications of maltreated geriatric depression and the risks associated with benzodiazepine use highlight the medical and socioeconomic consequences of inappropriate BZD prescription. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Factors associated with antidepressant use in depressed and non-depressed community-dwelling elderly: the three-city study

Prevalence of psychotropic drug use in nursing homes for the aged in Quebec and in the French-speaking area of Switzerland

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2005
Micheline Gobert
Abstract Background The use of psychotropic drugs is high in institutionalised elderly, which raises the question of its appropriateness. This study aimed to: (1) estimate the use of psychotropics, for each family, in terms of the prevalence and dosage among the elderly in nursing homes in French-speaking Switzerland and Quebec; and (2) assess, for each family of psychotropic drugs and for each care facility, the prevalence of use and departure from average prescription (ratio of observed-to-expected prevalence). Method An administrative database was used for this cross-sectional analysis. The sample included 8183 Quebec and 7592 Swiss long-term care residents. Three classes of psychotropics (antipsychotics, antidepressants, hypnotics-anxiolytics) were defined as dichotomous variables. Logistic regressions were conducted to identify residents characteristics associated with the use of each psychotropic type and to compute expected prevalence. Results Swiss residents were slightly older and less dependent than Quebec residents. Use of psychotropic drugs was higher in Swiss than in Quebec residents, on the whole as well as for each family of drug. A total of 78.1% of Swiss residents used at least one drug as compared to 66.9% in Quebec. Ninety percent of residents were given less than 7 defined daily doses per week, irrespective of the drug family. According to Beer's criteria, only 4.9% of prescriptions were inadequate. In Quebec and in Switzerland, the prevalence of antidepressant use was associated with the prevalence of hypnotic-anxiolytic use. No ratios of observed-to-expected reached statistical significance. Interpretation There was a considerable use of psychotropics in Quebec and Switzerland with, seemingly, no dramatic departure from the average practice. Our data cannot tell if there is a global overuse of psychotropics, but indicated that dosage and medication selection seem adequate. Physicians should critically reassess the necessity of prescribed medications for their patients. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Provider Characteristics Related to Antidepressant Use in Older People

Comparison of desipramine and citalopram treatments for depression in Parkinson's disease: A double-blind, randomized, placebo-controlled study

MOVEMENT DISORDERS, Issue 6 2008
David Devos MD
Abstract Depression is one of the most common psychiatric disturbances in Parkinson's disease (PD). Recent reviews have highlighted the lack of controlled trials and the ensuing difficulty in formulating recommendations for antidepressant use in PD. We sought to establish whether antidepressants provide real benefits and whether tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants differ in their short-term efficacy, because the time to onset of therapeutic benefit remains an important criterion in depression. The short-term efficacy (after 14 and 30 days) of two antidepressants (desipramine, a predominantly noradrenergic reuptake inhibitor tricyclic and citalopram, a SSRI) was assessed in a double-blind, randomized, placebo- controlled study of 48 nondemented PD patients suffering from major depression. After 14 days, desipramine prompted an improvement in the Montgomery Asberg Depression Rating Scale (MADRS) score, compared with citalopram and placebo. Both antidepressants produced significant improvements in the MADRS score after 30 days. Mild adverse events were twice as frequent in the desipramine group as in the other groups. A predominantly noradrenergic tricyclic antidepressant induced a more intense short-term effect on parkinsonian depression than did an SSRI. However, desipramine's lower tolerability may outweigh its slight short-term clinical advantage. © 2008 Movement Disorder Society [source]

Hemorrhagic stroke associated with antidepressant use in patients with depression: does degree of serotonin reuptake inhibition matter?

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 3 2009
Yan Chen MD
Abstract Objective This study aimed to determine whether the degree of serotonin (5-HT) reuptake inhibition affects risk of hemorrhagic stroke associated with antidepressant use in patients with depression. Method A population-based, nested case-control study was performed using a managed care medical claims database. Ninety two depressed patients with a diagnosis of hemorrhagic stroke were identified and matched with 552 controls by age, sex, and year of index date of depression (IDD). Diagnoses of depression, hemorrhagic stroke, and other medical comorbidities were identified using ICD-9 codes. Antidepressants were classified as high, medium, or low reuptake inhibition based on their affinities for the 5-HT reuptake transporter, determined using their respective equilibrium dissociation constants (KD; high: KD,<,1,nM; medium: 1,,,KD,<,10,nM; low: KD,,,10,nM). Conditional logistic regression analysis was performed to estimate the crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of the risk of hemorrhagic stroke. Results Compared to non-users of antidepressants, risk of hemorrhagic stroke did not significantly differ between patients who had ever used antidepressants with high (OR,=,0.82; 95% CI,=,0.44,1.55), medium (OR,=,0.93; 95% CI,=,0.37,2.31), or low (OR,=,0.38; 95% CI,=,0.11,1.41) 5-HTT inhibition. Conclusion Risk of hemorrhagic stroke associated with antidepressant use may not be related to an antidepressant's degree of 5-HT reuptake inhibition. Given the limitations of this study, additional studies are needed to confirm these findings. Copyright © 2009 John Wiley & Sons, Ltd. [source]

The association between antidepressant use and hypoglycaemia in diabetic patients: a nested case,control study,

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008
Hieronymus J. Derijks PharmD
Abstract Purpose Hypoglycaemia is a limiting factor for glycaemic management of diabetes with intensive insulin and/or oral antidiabetic drug (OAD) regimen. Case reports suggest that antidepressants may interfere with blood glucose metabolism in patients with diabetes mellitus potentially increasing the risk of clinically relevant hypoglycaemia. Comorbid depression treated with antidepressants could therefore further complicate glycaemic control. We have carried out a nested case,control study among diabetic patients to assess the risk of hypoglycaemia requiring hospitalisation associated with the use of antidepressants. Methods Diabetic patients treated with insulin and/or OADs were selected from the Dutch Pharmo system. Exposure to antidepressants was the primary determinant investigated. Use of antidepressants was further subclassified based on the receptor binding profile to investigate whether specific pharmacological properties could explain a potential influence on glucose homeostasis. Conditional logistic regression was used to estimate odds ratios and to adjust for confounding factors. Results From the base cohort (40 600 patients), 549 (1.35%) cases were identified and 1897 controls were selected. Current use of any antidepressant was not associated with a significantly higher risk of hypoglycaemia requiring hospitalisation (OR: 1.36 (95%CI: 0.84,2.20)). A trend for a higher risk on hypoglycaemia was identified for antidepressants with high affinity for the serotonin reuptake transporter. The risk on severe hypoglycaemia was increased after 3 years of use (OR: 2.75 (95%CI: 1.31,5.77)). Conclusions It is important for diabetic patients using antidepressants for more than 3 years to pay attention for symptoms of hypoglycaemia and strict blood glucose self-monitoring. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Depression: current approaches to management in primary care

PRESCRIBER, Issue 4 2009
Ian Reid PhD, MRCPsych
Our Drug review describes current prescribing guidelines and the properties of the antidepressant drugs available and discusses recent controversies surrounding antidepressant use. This is followed by further sources of information in Resources and an analysis of prescription data. Copyright © 2009 Wiley Interface Ltd [source]

Adjunctive antidepressant use and its clinical correlates in patients with schizophrenia: an East Asia multicenter comparative prescribing audit

ASIA-PACIFIC PSYCHIATRY, Issue 1 2010
FAMS, Kang Sim MBBS, MMed (Psychiatry)
Abstract Aims: Previous pharmacoepidemiological studies have highlighted considerable rates of adjunctive psychotropic medication prescriptions in patients with schizophrenia, including the use of adjunctive antidepressants, but this has not previously been studied in East Asia. This study examined the frequency of adjunctive antidepressant prescriptions in patients with schizophrenia and their clinical correlates in six East Asian countries and territories. Methods: Co-prescription of antidepressants for a sample of 2,136 patients with schizophrenia from six countries and territories (China, Hong Kong, Korea, Japan, Taiwan, Singapore) were evaluated in 2004 using a standardized protocol. Results: Adjunctive antidepressant prescriptions were found in 6.5% (n=139) of the patients with some intercountry differences. Co-prescription of antidepressants was significantly associated with younger age, shorter duration of index admission, electroconvulsive therapy in the past month, less likelihood of manifesting disorganized speech, and prescription of first generation antipsychotic drugs. Concomitant antidepressant prescription was associated with greater weight and increased number of adverse events including constipation, sedation and sexual dysfunction. On multivariate analysis, it was found that country, younger age and history of electroconvulsive therapy for the past month were significantly associated with adjunctive antidepressant use. Discussion: Adjunctive antidepressant use for schizophrenia in East Asia was associated with a number of demographic, clinical, and treatment variables. The association with greater weight and more adverse events reinforces the notion that prescription of adjunctive psychotropic medication is not without its costs. The challenge for the clinician is to constantly reevaluate the risk benefit ratio in the process of understanding the patient in a holistic context and to optimize the treatment regimes for patients with schizophrenia. [source]

Initiation of stimulant and antidepressant medication and clinical presentation in juvenile bipolar I disorder

BIPOLAR DISORDERS, Issue 2 2008
Maria 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]

Introduction to special issue on antidepressant use in bipolar disorder

BIPOLAR DISORDERS, Issue 6 2003
S Nassir Ghaemi
No abstract is available for this article. [source]