OBJECTIVE: The aim of the study was to analyze treatments and outcome in depressed patients. METHOD: Patients with recurrent depressive disorder (n = 289), recruited for a prophylaxis study, were followed up in hospital settings for 6 months with diagnostic and depression ratings at baseline and monthly depression ratings. Data on psychotropic drugs were retrieved from hospital case records. Independent associations between baseline, treatment and outcome variables were examined by logistic regression models. RESULTS: Depressive symptoms subsided gradually. After 6 months, 21% had dropped out, 43% were rated as remitted (HAM-D-17 15). Patients once remitted rarely relapsed (
Divorce is associated with an increased probability of a depressive episode, but the causation of events remains unclear. Adaptive models of depression propose that depression is a social strategy in part, whereas non-adaptive models tend to propose a diathesis-stress mechanism. We compare an adaptive evolutionary model of depression to three alternative non-adaptive models with respect to their ability to explain the temporal pattern of depression around the time of divorce. Register-based data (304,112 individuals drawn from a random sample of 11% of Finnish people) on antidepressant purchases is used as a proxy for depression. This proxy affords an unprecedented temporal resolution (a 3-monthly prevalence estimates over 10 years) without any bias from non-compliance, and it can be linked with underlying episodes via a statistical model. The evolutionary-adaptation model (all time periods with risk of divorce are depressogenic) was the best quantitative description of the data. The non-adaptive stress-relief model (period before divorce is depressogenic and period afterwards is not) provided the second best quantitative description of the data. The peak-stress model (periods before and after divorce can be depressogenic) fit the data less well, and the stress-induction model (period following divorce is depressogenic and the preceding period is not) did not fit the data at all. The evolutionary model was the most detailed mechanistic description of the divorce-depression link among the models, and the best fit in terms of predicted curvature; thus, it offers most rigorous hypotheses for further study. The stress-relief model also fit very well and was the best model in a sensitivity analysis, encouraging development of more mechanistic models for that hypothesis.
Cites: Am J Psychiatry. 2007 Oct;164(10):1521-9; quiz 162217898343
To investigate the adequacy of pharmacotherapy received by psychiatric inpatients and outpatients with a research diagnosis of bipolar I or II disorder, including patients both with and without a clinical diagnosis of bipolar disorder.
In the Jorvi Bipolar Study (JoBS), 1630 psychiatric inpatients and outpatients in 3 Finnish cities were systematically screened between January 1, 2002, and February 28, 2003, for bipolar I and II disorders using the Mood Disorder Questionnaire. By using SCID-I and -II interviews, 191 patients were diagnosed with bipolar disorder (90 bipolar I and 101 bipolar II). Information was collected on clinical history, diagnosis, and treatment. The adequacy of treatment received was evaluated.
Of the 162 patients with previous bipolar disorder episodes, only 34 (20.9%) of all and 30 (55.5%) of those with a clinical diagnosis of bipolar disorder were using a mood stabilizer at onset of the index episode. Only 81 (42.4%) of all 191 patients and 76 (65.0%) of those diagnosed with bipolar disorder received adequate treatment for the acute index phase. The factor most strongly independently associated with adequate treatment was clinical diagnosis of bipolar disorder (OR = 25.34). In addition, rapid cycling (OR = 2.45), polyphasic index episode (OR = 2.41), or depressive index phase (OR = 3.36) independently predicted inadequate treatment. Outpatients received adequate treatment markedly less often than inpatients.
Clinical diagnosis of bipolar disorder is by far the most important prerequisite for adequate treatment. Problems in treatment are associated mostly with outpatient settings, where adequacy of treatment of bipolar depression is a major concern. Lack of attention to the longitudinal course of illness is another major problem area.
The study of medicine taking is controversial as it often reveals a discrepancy between healthcare professionals' advice and patients' actual behaviour. Qualitative researchers have examined depressed people's adherence to prescriptions of antidepressants by exploring the meaning they impute to the medicine and their use of the medicine in the wider context of their everyday lives. This paper contributes to this area of research by means of a prospective research study focussing on depressed patients' perspectives on taking medicine and how they change through time. The study included consecutive semi-structured interviews with 16 people four times during the year following an admission to hospital for depression. Data were collected in 2008-2009 in the Region of Southern Denmark. The study was based on an interactionist conception of social career and data were analysed thematically. Findings indicated that participants were confronted with recurrent challenges related to being depressed and taking medicine, and they learned how to manage these challenges in a post-admission career with two distinct stages: the basic restitution stage and the frustrated search stage. Medicine-taking depended on a number of career moving tensions and problems. The basic restitution stage was characterised by the participants' readiness to take medicine in accordance with healthcare professionals' prescriptions and advice. Half of the participants experienced being challenged by unacceptable prolonged mental, social, and/or physical distress, and they moved to the frustrated search stage, which was characterised by an alternative perspective on taking medicine that included increased self-regulation and less involvement of healthcare professionals and next of kin. Healthcare professionals played a very peripheral role in most participants' lives and unsatisfactory interactions often isolated participants and left them to solve their own problems.
The purpose of this study are to analyse adherence to antidepressant treatment over 2 years in Sweden among women and men who initiated treatment with citalopram and to identify groups at risk of non-adherence using trajectory models.
The study population, including individuals 18-85 years who initiated citalopram use between 1 July 2006 and 30 June 2007, was identified in the Swedish Prescribed Drug Register and followed for 2 years. Adherence was estimated with continuous measure of medication acquisition (CMA) and group-based trajectory modelling, a method which describes adherence patterns over time by estimating trajectories of adherence and the individual's probability of belonging to a specific trajectory.
The study population included 54,248 individuals, 64 % women. Mean CMA was 52 % among women and 50 % among men (p
Conventional estimates of antidepressant (AD) utilization in major depressive syndrome (MDS) have been low, but this may be partially because ongoing AD use by individuals with resolved MDS is not included. Valid estimates of AD utilization should include this ongoing use for MDS, but this is difficult since most surveys do not collect data on the reason for taking ADs. Only a proportion (f(dep)) of the nondepressed (nMDS) population taking ADs does so for depression. Published studies have not reported this proportion, and data required to estimate f(dep) are not usually available from surveys. The current study was performed to (1) estimate f(dep) by employing information on past history of depression, and (2) use the estimate to obtain an "adjusted" AD utilization rate, including resolved MDS subjects taking ADs. Data were collected in Calgary in 1998 and 1999 by random-digit dial telephone interview from consenting adults aged 18+ years. MDS was assessed using the Composite International Diagnostic Interview Short Form for Major Depression (CIDI-SFMD). Data were gathered on current medications, past depression, and current chronic physical illness. Of 2,542 respondents, 17.1% had MDS as defined by the CIDI-SFMD. A total of 20.2% of MDS and 3.2% of nMDS subjects were taking ADs. Of nMDS individuals taking ADs, 70.6% reported past depression (f(dep) = 70.6%). An "adjusted" AD utilization rate including this group was 28.2%. Physical illnesses that can be treated with ADs affected only 30.0% of nMDS subjects without past depression taking ADs. This study suggests that most individuals without active depression taking ADs do so for depression. AD utilization rates that ignore this group may be unrealistically low. AD use among nMDS subjects without previous depression is probably not primarily for physical illnesses. Limitations include the use of a brief predictive instrument for MDS, and self-report of past depression.
To examine if the suicide rate of older adults prescribed antidepressants varies with age and to assess the proportion of older adults who died by suicide that had recently been prescribed antidepressants.
A population-based cohort study using a nationwide linkage of individual-level records was conducted on all persons aged 50+ living in Denmark during 1996-2006 (1,215,524 men and 1,343,568 women). Suicide rates by treatment status were calculated using data on all antidepressant prescriptions redeemed at pharmacies.
Individual-level data covered 9,354,620 and 10,720,639 person-years for men and women, respectively. Men aged 50-59 who received antidepressants had a mean suicide rate of 185 (95% confidence interval [CI]: 160-211) per 100,000, whereas for those aged 80+ the rate was 119 (95% CI: 91-146). For women, the corresponding values were 82 (95% CI: 70-94) and 28 (95% CI: 20-35). Logistic regression showed a 2% and 3% decline in the rate for men and women, respectively, considered in treatment with antidepressants, with each additional year of age. An opposite trend was found for persons not in treatment. Fewer persons aged 80+ dying by suicide had received antidepressant prescriptions during the last months of life than younger persons.
An age-dependent decline in suicide rate for antidepressant recipients was identified. One reason could be that older adults respond better to antidepressants than younger age groups. Still, the increasing gap with age between estimated prevalence of depression and antidepressant prescription rate in persons dying by suicide underscores the need for assessment of depression in the oldest old.
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The purpose of the present study is to explore the relation between use of antidepressants and level of alcohol consumption among depressed and nondepressed men and women.
Random-digit dialling and computer-assisted telephone interviewing were used to survey a sample of 14,063 Canadian residents, aged 18-76 years. The survey included measures of quantity and frequency of drinking, the World Health Organization's Composite International Diagnostic Interview measure of depression, and a question as to whether respondents had used antidepressants during the past year.
Overall, depressed respondents drank more alcohol than did nondepressed respondents. This was not true, however, for depressed men who used antidepressants; they consumed a mean of 414 drinks during the preceding year, versus 579 drinks for depressed men who did not use antidepressants and 436 for nondepressed men. For women, the positive relation between depression and heavier alcohol consumption held true regardless of their use of antidepressants: 264 drinks during the preceding year for depressed women who used antidepressants; 235, for depressed women who did not use antidepressants; and 179, for nondepressed women.
Results of this cross-sectional study are consistent with a possible beneficial effect of antidepressant use upon drinking by depressed men. Further research is needed, however, to assess whether this finding results from drug effects or some other factor, and to ascertain why the effect was found among men but not women.
Cites: Addiction. 2002 May;97(5):583-9412033659
Cites: Alcohol Res Health. 2001;25(2):126-3511584551
Excess mortality of depression is established for various causes of death, but evidence is scarce on alcohol-related causes. It also remains unclear whether the magnitude of the excess varies by social factors. This study aimed to quantify the contribution of alcohol-related causes of death and to assess modifying effects of socioeconomic position, employment status, and living arrangements in the excess mortality of depression.
A 14% sample of community-dwelling Finns aged 40-64 at the end of 1997 was assessed for depression, using register data on psychiatric hospital care and antidepressant use in 1996-1997. Depressed in-patients (n=897), out-patients using antidepressants (n=13,658), and non-depressed individuals (n=217,140) were followed up for cause-specific mortality in 1998-2007, distinguishing between alcohol- and non-alcohol-related deaths, and testing for variation in the excess mortality according to baseline social factors.
Depressed in- and out-patients had significant excess mortality for suicide (age-adjusted rate ratios RR=3.77 for men and RR=6.35 for women), all accidental and violent causes (RR=3.47 and RR=4.43), and diseases (RR=1.67 and RR=1.41). Of the excess, alcohol-related causes accounted for 50% among depressed men and 30% among women. Excess mortality varied little by social factors, particularly in non-alcohol-related causes. Where variation was significant, the relative excess was larger among those with higher socioeconomic position and the employed. Absolute excess was, however, larger among those with lower socioeconomic position, the unemployed, and the unpartnered.
Depression was measured indirectly by hospital and antidepressant use.
The results highlight the major role of alcohol in depression mortality.