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A 9-week randomized trial comparing a chronotherapeutic intervention (wake and light therapy) to exercise in major depressive disorder patients treated with duloxetine.

https://arctichealth.org/en/permalink/ahliterature119944
Source
J Clin Psychiatry. 2012 Sep;73(9):1234-42
Publication Type
Article
Date
Sep-2012
Author
Klaus Martiny
Else Refsgaard
Vibeke Lund
Marianne Lunde
Lene Sørensen
Britta Thougaard
Lone Lindberg
Per Bech
Author Affiliation
Psykiatrisk Center København, Rigshospitalet, Afsnit 6202, Blegdamsvej 9, 2100 København ø, Denmark. klaus.martiny@regionh.dk
Source
J Clin Psychiatry. 2012 Sep;73(9):1234-42
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antidepressive Agents - administration & dosage
Combined Modality Therapy
Denmark
Depressive Disorder, Major - drug therapy - therapy
Exercise
Female
Humans
Logistic Models
Male
Middle Aged
Phototherapy
Prospective Studies
Seasons
Single-Blind Method
Sleep Phase Chronotherapy
Thiophenes - administration & dosage
Abstract
The onset of action of antidepressants often takes 4 to 6 weeks. The antidepressant effect of wake therapy (sleep deprivation) comes within hours but carries a risk of relapse. The objective of this study was to investigate whether a new chronotherapeutic intervention combining wake therapy with bright light therapy and sleep time stabilization could induce a rapid and sustained augmentation of response and remission in major depressive disorder.
75 adult patients with DSM-IV major depressive disorder, recruited from psychiatric wards, psychiatric specialist practices, or general medical practices between September 2005 and August 2008, were randomly assigned to a 9-week chronotherapeutic intervention using wake therapy, bright light therapy, and sleep time stabilization (n = 37) or a 9-week intervention using daily exercise (n = 38). Patients were evaluated at a psychiatric research unit. The study period had a 1-week run-in phase in which all patients began treatment with duloxetine. This phase was followed by a 1-week intervention phase in which patients in the wake therapy group did 3 wake therapies in combination with daily morning light therapy and sleep time stabilization and patients in the exercise group began daily exercise. This phase was followed by a 7-week continuation phase with daily light therapy and sleep time stabilization or daily exercise. The 17-item Hamilton Depression Rating Scale was the primary outcome measure, and the assessors were blinded to patients' treatment allocation.
Both groups responded well to treatment. Patients in the wake therapy group did, however, have immediate and clinically significantly better response and remission compared to the exercise group. Thus, immediately after the intervention phase (week 2), response was obtained in 41.4% of wake therapy patients versus 12.8% of exercise patients (odds ratio [OR] = 4.8; 95% CI, 1.7-13.4; P = .003), and remission was obtained in 23.9% of wake therapy patients versus 5.4% of exercise patients (OR = 5.5; 95% CI, 1.7-17.8; P = .004). These superior response and remission rates obtained by the wake therapy patients were sustained for the whole study period. At week 9, response was obtained in 71.4% of wake therapy patients versus 47.3% of exercise patients (OR = 2.8; 95% CI, 1.1-7.3; P = .04), and remission was obtained in 45.6% of wake therapy patients and 23.1% of exercise patients (OR = 2.8; 95% CI, 1.1-7.3, P = .04). All treatment elements were well tolerated.
Patients treated with wake therapy in combination with bright light therapy and sleep time stabilization had an augmented and sustained antidepressant response and remission compared to patients treated with exercise, who also had a clinically relevant antidepressant response.
ClinicalTrials.gov identifier: NCT00149110.
PubMed ID
23059149 View in PubMed
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[Agents, methods and environments against suicide]

https://arctichealth.org/en/permalink/ahliterature68447
Source
Lakartidningen. 1997 Apr 16;94(16):1525-7
Publication Type
Article
Date
Apr-16-1997
Author
J. Thorson
Author Affiliation
Karolinska institutet, Riksförsäkringsverkets sjukhus, Nynäshamn.
Source
Lakartidningen. 1997 Apr 16;94(16):1525-7
Date
Apr-16-1997
Language
Swedish
Publication Type
Article
Keywords
Antidepressive Agents - administration & dosage
Environment
Humans
Psychotherapy - methods
Risk factors
Suicide - prevention & control
Sweden
PubMed ID
9173201 View in PubMed
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Analysing duration of episodes of pharmacological care: an example of antidepressant use in Danish general practice.

https://arctichealth.org/en/permalink/ahliterature83059
Source
Pharmacoepidemiol Drug Saf. 2006 Mar;15(3):167-77
Publication Type
Article
Date
Mar-2006
Author
Gichangi Anthony
Andersen Morten
Kragstrup Jakob
Vach Werner
Author Affiliation
Department of Statistics, University of Southern Denmark, DK-5000 Odense C, Denmark. anthony@stat.sdu.dk
Source
Pharmacoepidemiol Drug Saf. 2006 Mar;15(3):167-77
Date
Mar-2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Antidepressive Agents - administration & dosage - adverse effects
Databases, Factual
Denmark - epidemiology
Drug Utilization - statistics & numerical data - trends
Episode of Care
Family Practice
Female
Humans
Incidence
Male
Middle Aged
Mortality
Patient Compliance - statistics & numerical data
Pharmacoepidemiology - methods
Proportional Hazards Models
Risk assessment
Risk factors
Time Factors
Treatment Outcome
Abstract
Analysing duration of treatment episodes has become a standard task in many pharmacoepidemiological studies. However, such analyses are often carried out in a rather simplistic manner and more subtle issues are often ignored. In this paper, methods of analysing duration treatment episodes beyond simple analyses allowing investigation of the risk for certain events over time are demonstrated. In particular, the use of cumulative incidence functions, cause-specific hazard functions, hazard rate models and expected mortality in analysing duration of episodes is presented. We used these statistical techniques in analysing the early treatment history of patients who started a regular treatment with antidepressant drugs in the primary health care sector in Denmark. We have extracted some important features: The risk of discontinuing and switching treatment was very high around 10 weeks after starting treatment. After discontinuing the first treatment period, many patients soon started a second treatment period depending on the duration of the first treatment period with highest risk around 10 weeks. The mortality rate among the patients in treatment was about three times higher than the expected mortality. The risk of dying immediately after stopping treatment was about twice the expected mortality. The analysis suggests that: (1) there is a critical period for a first discontinuing, switching and restarting treatment around 10 weeks, (2) the GPs prescribing habits have more influence on the patterns than patient or drug characteristics, (3) over time Danish GPs tend to prolong the duration of first treatment period and avoid longer treatment breaks.
PubMed ID
16315340 View in PubMed
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An increased risk of road traffic accidents after prescriptions of lithium or valproate?

https://arctichealth.org/en/permalink/ahliterature151821
Source
Pharmacoepidemiol Drug Saf. 2009 Jun;18(6):492-6
Publication Type
Article
Date
Jun-2009
Author
Jørgen G Bramness
Svetlana Skurtveit
C Ineke Neutel
Jørg Mørland
Anders Engeland
Author Affiliation
Division of Epidemiology, Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway. jorgen.bramness@fhi.no
Source
Pharmacoepidemiol Drug Saf. 2009 Jun;18(6):492-6
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - statistics & numerical data
Adult
Aged
Antidepressive Agents - administration & dosage - adverse effects
Antimanic Agents - administration & dosage - adverse effects
Automobile Driving - statistics & numerical data
Databases, Factual
Drug Prescriptions - statistics & numerical data
Female
Humans
Lithium Compounds - administration & dosage - adverse effects
Male
Middle Aged
Norway - epidemiology
Registries
Risk factors
Sex Distribution
Valproic Acid - administration & dosage - adverse effects
Abstract
Studies have shown that lithium may cause psychomotor and cognitive impairment and impose an increased risk of traffic accidents. The antiepileptic drug valproate is also used as a mood stabilizer, but the impact on traffic safety has not been studied. The objective of the present study was to examine whether the use of lithium or valproate increased the risk of being involved in traffic accidents.
Between April 2004 and September 2006, information on prescriptions, road accidents and emigrations/deaths was obtained from three Norwegian population-based registries. Data on people between the ages 18-70 (3.1 million) were linked. Exposure consisted of receiving prescriptions for either lithium or valproate. Standardized incidence ratios (SIRs) were calculated by comparing the incidence of motor vehicle accidents during time exposed with the incidence over the time not exposed. Lithium was studied separately from valproate.
During the study period, 20,494 road accidents occurred including 36 while exposed to lithium and 31 while exposed to valproate. The overall accident risk was neither increased after having received prescriptions for lithium (SIR 1.3; 95%CI: 0.9-1.8), nor after having received a prescription for valproate (SIR 0.9; 0.6-1.3). The exception was a three-fold increase in risk for younger female drivers exposed to lithium.
We found no increase in the traffic accident risk after being exposed to lithium or valproate, except for young female drivers on lithium. This may be because these drugs carry no increased risk or because patients exposed to these drugs refrain from driving.
PubMed ID
19326366 View in PubMed
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Antidepressant dose patterns in Swedish clinical practice.

https://arctichealth.org/en/permalink/ahliterature46364
Source
Int Clin Psychopharmacol. 1997 Sep;12(5):283-90
Publication Type
Article
Date
Sep-1997
Author
K. Bingefors
D. Isacson
L. von Knorring
Author Affiliation
Department of Psychiatry, University Hospital, Uppsala University, Sweden.
Source
Int Clin Psychopharmacol. 1997 Sep;12(5):283-90
Date
Sep-1997
Language
English
Publication Type
Article
Keywords
Antidepressive Agents - administration & dosage
Comparative Study
Depressive Disorder - drug therapy
Drug Utilization
Humans
Physician's Practice Patterns
Physicians, Family
Psychiatry
Research Support, Non-U.S. Gov't
Sweden
Abstract
The Swedish Diagnosis and Therapy Survey was used to analyse the prescribing of antidepressants from 1991 to 1996. There were considerable differences in doses prescribed depending on diagnosis. Adequate dosage is an important factor in antidepressant treatment, and this study showed that tricyclic antidepressants are often prescribed at lower than recommended doses for the treatment of depression. Significantly higher doses were prescribed in continued treatment, as opposed to in new treatment, indicating dose titration when using tricyclic antidepressants and the most common selective serotonin reuptake inhibitors in depression. The findings from the present study suggest that the optimal dosage for some of the new antidepressants in clinical practice has not yet been determined and that costs of treatment in a natural setting might be considerably higher than costs calculated from dose recommendations.
PubMed ID
9466162 View in PubMed
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Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression.

https://arctichealth.org/en/permalink/ahliterature138809
Source
Arch Gen Psychiatry. 2010 Dec;67(12):1256-64
Publication Type
Article
Date
Dec-2010
Author
Zindel V Segal
Peter Bieling
Trevor Young
Glenda MacQueen
Robert Cooke
Lawrence Martin
Richard Bloch
Robert D Levitan
Author Affiliation
Centre for Addiction and Mental Health, Toronto, ON, Canada. zindel_segal@camh.net
Source
Arch Gen Psychiatry. 2010 Dec;67(12):1256-64
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Antidepressive Agents - administration & dosage - therapeutic use
Attention
Cognitive Therapy - methods
Combined Modality Therapy - methods
Depressive Disorder, Major - drug therapy - prevention & control - psychology
Diagnostic and Statistical Manual of Mental Disorders
Drug Administration Schedule
Female
Follow-Up Studies
Humans
Male
Middle Aged
Ontario
Outpatients - psychology
Psychiatric Status Rating Scales
Psychotherapy, Group - methods
Recurrence - prevention & control
Treatment Outcome
Young Adult
Abstract
Mindfulness-based cognitive therapy (MBCT) is a group-based psychosocial intervention designed to enhance self-management of prodromal symptoms associated with depressive relapse.
To compare rates of relapse in depressed patients in remission receiving MBCT against maintenance antidepressant pharmacotherapy, the current standard of care.
Patients who met remission criteria after 8 months of algorithm-informed antidepressant treatment were randomized to receive maintenance antidepressant medication, MBCT, or placebo and were followed up for 18 months.
Outpatient clinics at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and St Joseph's Healthcare, Hamilton, Ontario.
One hundred sixty patients aged 18 to 65 years meeting DSM-IV criteria for major depressive disorder with a minimum of 2 past episodes. Of these, 84 achieved remission (52.5%) and were assigned to 1 of the 3 study conditions.
Patients in remission discontinued their antidepressants and attended 8 weekly group sessions of MBCT, continued taking their therapeutic dose of antidepressant medication, or discontinued active medication and were switched to placebo.
Relapse was defined as a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression on module A of the Structured Clinical Interview for DSM-IV.
Intention-to-treat analyses showed a significant interaction between the quality of acute-phase remission and subsequent prevention of relapse in randomized patients (P = .03). Among unstable remitters (1 or more Hamilton Rating Scale for Depression score >7 during remission), patients in both MBCT and maintenance treatment showed a 73% decrease in hazard compared with placebo (P = .03), whereas for stable remitters (all Hamilton Rating Scale for Depression scores =7 during remission) there were no group differences in survival.
For depressed patients achieving stable or unstable clinical remission, MBCT offers protection against relapse/recurrence on a par with that of maintenance antidepressant pharmacotherapy. Our data also highlight the importance of maintaining at least 1 long-term active treatment in unstable remitters.
Notes
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PubMed ID
21135325 View in PubMed
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Antidepressants and antipsychotics classified with torsades de pointes arrhythmia risk and mortality in older adults - a Swedish nationwide study.

https://arctichealth.org/en/permalink/ahliterature278475
Source
Br J Clin Pharmacol. 2016 Apr;81(4):773-83
Publication Type
Article
Date
Apr-2016
Author
Bengt Danielsson
Julius Collin
Gudrun Jonasdottir Bergman
Natalia Borg
Peter Salmi
Johan Fastbom
Source
Br J Clin Pharmacol. 2016 Apr;81(4):773-83
Date
Apr-2016
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Antidepressive Agents - administration & dosage - adverse effects - classification - therapeutic use
Antipsychotic Agents - administration & dosage - adverse effects - classification - therapeutic use
Drug Prescriptions - statistics & numerical data
Female
Humans
Logistic Models
Male
Mortality - trends
Multivariate Analysis
Registries
Risk
Sweden - epidemiology
Torsades de Pointes - chemically induced - mortality
Abstract
The aim of the study was to examine mortality risk associated with use of antidepressants and antipsychotics classified with torsades de pointes (TdP) risk in elderly.
A matched case-control register study was conducted in people 65 years and older dying outside hospital from 2008-2013 (n = 286,092) and matched controls (n = 1,430,460). The association between prescription of antidepressants and antipsychotics with various TdP risk according to CredibleMeds (www.crediblemeds.org) and all-cause mortality was studied by multivariate conditional logistic regression adjusted for comorbidity and several other confounders.
Use of antidepressants classified with known or possible TdP risk, was associated with higher adjusted risk for mortality (OR 1.53, 95% CI 1.51, 1.56 and OR 1.63, 95% CI 1.61, 1.67, respectively) compared with antidepressants classified with conditional TdP risk (OR 1.25, 95% CI 1.22, 1.28) or without TdP classification (OR 0.99, 95% CI 0.94, 1.05). Antipsychotics classified with known TdP risk were associated with higher risk (OR 4.57, 95% CI 4.37, 4.78) than antipsychotics with possible risk (OR 2.58, 95% CI 2.52, 2.64) or without TdP classification (OR 2.14, 95% CI 2.03, 2.65). The following risk ranking was observed for commonly used antidepressants: mirtazapine > citalopram > sertraline > amitriptyline and for antipsychotics: haloperidol > risperidone >olanzapine > quetiapine.
The CredibleMeds system predicted drug-associated risk for mortality in the elderly at the risk class level. Among antipsychotics, haloperidol, and among antidepressants, mirtazapine and citalopram, were associated with the highest risks. The results suggest that the TdP risk with antidepressants and antipsychotics should be taken into consideration when prescribing to the elderly.
Notes
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PubMed ID
26574175 View in PubMed
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Antidepressants and suicide among young women in Sweden 1999-2013.

https://arctichealth.org/en/permalink/ahliterature292235
Source
Int J Risk Saf Med. 2017; 29(1-2):101-106
Publication Type
Journal Article
Date
2017
Author
Jan Larsson
Author Affiliation
Reporter/Researcher, Snöbollsgränd 22, 129 45 Hägersten, Sweden. E-mail: jan.olov.larsson@telia.com.
Source
Int J Risk Saf Med. 2017; 29(1-2):101-106
Date
2017
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Antidepressive Agents - administration & dosage
Female
Humans
Suicide - statistics & numerical data
Sweden - epidemiology
Young Adult
Abstract
To establish whether the young women (15-24 year old) who committed suicide in Sweden (1999-2013) received antidepressant treatment or not, and to what extent, prior to and/or at the time of suicide. To investigate the belief that increased prescription of antidepressants would drastically reduce the number of suicides.
An analysis of data from the Swedish Prescribed Drug Register, the Causes of Death Register, with registers cross checked, and from the National Board of Forensic Medicine.
This analysis shows a covariance between increased prescription of antidepressants and an increasing trend in the number of suicides among young women. In the period 1999-2003 antidepressants were found in toxicological analyses done in 23% of the young women who committed suicide, and in 39% of cases for 2009-2013.
An increasingly larger proportion of young women who later committed suicide, had in the last few years been treated with antidepressants, prior to and at the time of the suicide. The previous assumptions that treatment with antidepressants would lead to a drastic reduction in suicide rates, are incorrect for the population of young women. On the contrary, it was found that an increasing tendency of completed suicides follow the increased prescription of antidepressants.
Notes
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PubMed ID
28885220 View in PubMed
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Antidepressant treatment in general practice--an interview study.

https://arctichealth.org/en/permalink/ahliterature46481
Source
Scand J Prim Health Care. 1995 Dec;13(4):281-6
Publication Type
Article
Date
Dec-1995
Author
J U Rosholm
L F Gram
N. Damsbo
J. Hallas
Author Affiliation
Department of Clinical Pharmacology, Odense University, Denmark.
Source
Scand J Prim Health Care. 1995 Dec;13(4):281-6
Date
Dec-1995
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antidepressive Agents - administration & dosage - adverse effects - therapeutic use
Cross-Sectional Studies
Denmark
Depressive Disorder - drug therapy
Drug Utilization - standards
Family Practice
Female
Humans
Male
Middle Aged
Physician's Practice Patterns
Research Support, Non-U.S. Gov't
Substance-Related Disorders
Time Factors
Abstract
OBJECTIVE: To elucidate potential problems concerning the use of antidepressants (AD) in general practice. DESIGN: Cross-sectional, descriptive interview study. SETTING: General practices, Odense, Denmark. SUBJECTS: Random sample consisting of 98 AD users from 12 general practices. MAIN OUTCOME MEASURES: Indication for AD treatment, justification of the treatment, duration of AD treatment, daily dose of AD, side effects, Hamilton depression rating, WONCA score. RESULTS: The primary indication for AD treatment was depression (72 patients), partly regular depression (therapeutic/prophylactic treatment) (n = 39), partly depressive tendencies (n = 32) (1 unknown). Median treatment duration was 3 years; 25% had been in treatment for more than 10 years. The general practitioners judged the treatment problematic/unacceptable in 23 cases, largely because of uncertain indication or because other or no treatment was considered better for the patient. The daily doses of AD were generally low. Side effects were modest. The patients often had a relatively high depression score and poor status according to the WONCA-scale. CONCLUSIONS: The use of low doses, long duration of treatment, and uncertainty about the relevance of the treatment are important features of the use of AD by general practitioners. There seems to be a discrepancy between the use of AD in general practice and the scientifically-based recommendations.
PubMed ID
8693213 View in PubMed
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135 records – page 1 of 14.