The course of depressive symptoms and prescribing patterns of antidepressants in schizophrenia in a one-year follow-up study (original) (raw)
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Depressed and a co-morbid condition: More psychotropics prescribed!
European Journal of General Practice, 2008
Background: Depression often occurs simultaneously with a variety of somatic, psychiatric, and social conditions. Knowledge about differences in the pharmacological treatment of depressed patients with and without co-morbidity is lacking. Objective: To compare GPs' pharmacological treatment of depressed patients with and without co-morbidity. Methods: Data were extracted from the computerized medical records of 77 general practices participating in the Dutch National Information Network of General Practice (LINH). We used diagnosis and prescription data of newly diagnosed depressed patients aged 18-65 years (n=4372). A mixed-model technique was used for analyzing the medical data. Results: During the year after diagnosing depression, depressed patients who also suffered from chronic somatic or psychiatric morbidity were prescribed more psychotropics than patients with depression only. Prescription patterns of psychotropic drugs for depressed patients with and without co-morbid social problems differed only during the first 3 months after diagnosis. For the whole 1-year period after diagnosis, the pharmacological treatment of depression in patients with and without co-morbid social problems did not differ. Conclusion: Our results indicate that chronic somatic or psychiatric co-morbidity in depressed patients leads to higher GP prescription levels of psychotropics, whereas co-morbid social problems do not seem to influence GPs' pharmacological treatment decisions for depression. This is a NIVEL certified Post Print, more info at http://www.nivel.eu Smolders, M., Laurant, M., Rijswijk, E. van, Mulder, J., Braspenning, J., Verhaak, P., Wensing, M., Grol, R. Depressed and a co-morbid condition: more psychotropics prescribed! European This is a NIVEL certified Post Print, more info at http://www.nivel.eu Smolders, M., Laurant, M., Rijswijk, E. van, Mulder, J., Braspenning, J., Verhaak, P., Wensing, M., Grol, R. Depressed and a co-morbid condition: more psychotropics prescribed! European This is a NIVEL certified Post Print, more info at http://www.nivel.eu Smolders, M., Laurant, M., Rijswijk, E. van, Mulder, J., Braspenning, J., Verhaak, P., Wensing, M., Grol, R. Depressed and a co-morbid condition: more psychotropics prescribed! European This is a NIVEL certified Post Print, more info at http://www.nivel.eu Smolders, M., Laurant, M., Rijswijk, E. van, Mulder, J., Braspenning, J., Verhaak, P., Wensing, M., Grol, R. Depressed and a co-morbid condition: more psychotropics prescribed! European Journal of General Practice: 2008, 14(1), 10-18 BOX AND TABLES This is a NIVEL certified Post Print, more info at http://www.nivel.eu Smolders, M., Laurant, M., Rijswijk, E. van, Mulder, J., Braspenning, J., Verhaak, P., Wensing, M., Grol, R. Depressed and a co-morbid condition: more psychotropics prescribed! European This is a NIVEL certified Post Print, more info at http://www.nivel.eu Smolders, M., Laurant, M., Rijswijk, E. van, Mulder, J., Braspenning, J., Verhaak, P., Wensing, M., Grol, R. Depressed and a co-morbid condition: more psychotropics prescribed! European
Depression Severity and Effect of Antidepressant Medications. Authors' reply
Jama the Journal of the American Medical Association, 2010
In their meta-analysis, Mr Fournier and colleagues 1 drew the important conclusion that antidepressant medication, compared with placebo, is effective for very severely depressed patients but not for those who are less severely depressed. The authors stated that "evidence concerning the effects of [antidepressant medication] in patients with mild to moderate MDD [major depressive disorder] has been sparse." They did not state that the 1995 study by Elkin et al 2 not only reported a significant effect for imipramine for more severely depressed patients (in this case, a Hamilton Depression Rating Scale 3 [HDRS] score Ն20), but also reported the lack of a significant difference between imipramine and placebo for those who were less severely depressed (HDRS Ͻ20). This omission is of particular concern because the data in the study by Elkin et al are used as one of the data sets in the study by Fournier et al. Thus, the effect the authors were hypothesizing had already been reported for 1 of the 6 data sets in their mega-analysis. The authors also suggested that "[f]uture efforts might use alternative symptom measures to examine the effects of baseline severity on treatment outcome." In the study by Elkin et al, significant effects were found for the more severe patients using the Global Assessment Scale 4 as the pretreatment severity measure. This measure includes impairment of functioning, as well as severity of depressive symptoms. In addition, the use of the self-report Beck Depression Inventory 5 as the measure of both initial severity and outcome produced results similar to those for the HDRS. The results with these measures of pretreatment severity support the conclusion that imipramine is not significantly superior to placebo for less severely depressed patients. However, this finding does not necessarily lead to the conclusion that these patients could not benefit from other, particularly nonpharmacological, treatments.
European Archives of Psychiatry and Clinical Neuroscience, 2021
Current treatment standards in psychiatry are oriented towards polypharmacy, that is, patients receive combinations of several antidepressants, antipsychotics, mood stabilizers, anxiolytics, hypnotics, antihistamines, and anticholinergics, along with other somatic treatments. In tandem with the beneficial effects of psychopharmacological drug treatment, patients experience significant adverse reactions which appear to have become more frequent and more severe with the rise of ubiquitous polypharmacy. In this study, we aimed to assess today’s acute inpatient treatment of depressive and schizophrenic disorders with focus on therapeutic strategies, medications, adverse side effects, time course of recovery, and efficacy of treatments. Of particular interest was the weighing of the benefits and drawbacks of polypharmacy regimens. We recruited a total of 320 patients hospitalized at three residential mental health treatment centers with a diagnosis of either schizophrenic (ICD-10: “F2x.x...
Depression in schizophrenia: Comparison of first- and second-generation antipsychotic drugs
Schizophrenia Research, 2008
The aim of this study was to compare the effects of different antipsychotics on depressive symptoms in schizophrenic patients. The data were drawn from a retrospective, naturalistic, observational study in which 222 subjects diagnosed as being affected by schizophrenia during a re-exacerbation phase received 6 weeks of monotherapy with fluphenazine decanoate, haloperidol decanoate, haloperidol, clozapine, olanzapine, quetiapine, risperidone or l-sulpiride. The Brief Psychiatric Rating Scale (BPRS), Extrapyramidal Side Effects Rating Scale (EPSE) and Anticholinergic Rating Scale (ACS) were administered at baseline and six weeks after the beginning of the study; depressive symptoms were evaluated using the BPRS items "depressive mood" and "guilt feelings". All of the antipsychotic drugs led to improvements in the depressive dimension, but this was statistically significant only in the case of fluphenazine decanoate, haloperidol, olanzapine, risperidone and l-sulpiride. A clinical improvement in the depressive dimension significantly correlated with the severity of the psychotic picture and its amelioration. Female patients were significantly more likely to show an improvement in depressive symptoms. In conclusion, our findings suggest that atypical antipsychotics as a class do not seem to be more effective on the depressive dimension during the course of schizophrenia than typical ones, at least as far as the collected BPRS data are concerned. The only factor that seemed to influence the improvement in depressive symptoms during our study was gender, as females were significantly more likely to improve although there were no between-gender differences in the baseline severity of the clinical picture.
Comprehensive Psychiatry, 2007
Objective: This study examined the patterns and predictors of medication use and 24-month course/outcome in first-admission patients with major depressive disorder with psychotic features (MDD/P). Method: An epidemiological sample of 87 first-admission patients with research diagnoses of MDD/P received intensive clinical assessments at baseline and at 6-and 24-month follow-ups and telephone assessments at 3-month intervals. Use of medications (antidepressant [AD], antipsychotic [AP], and antimanic agents) was determined from self-reports corroborated by external sources where possible. Outcome was assessed with the Global Assessment of Functioning and consensus evaluations of illness course and time in remission. Results: More patients received APs (77.0%) than ADs (57.5%) at discharge, with almost half (49.4%) receiving these in combination. At 24-month follow-up, 40.2% reported using no medications; 39.1% used ADs, and 32.2% used APs. Only early AD use predicted regular AD use during the 6-to 24-month follow-up. A minority (29%) achieved functional recovery (Global Assessment of Functioning score ≥71) by 24 months. Although about 60% of the sample achieved a period of complete remission by 24 months, only about 40% had a sustained remission for at least 19 months. Medication use was not predictive of these outcome measures. There was little evidence that changes in medication, augmentation strategies, or electroconvulsive therapy was used to reduce symptoms during the 24-month follow-up. Fewer than half of our subjects received a MDD/P clinical diagnosis at discharge, which appeared to influence medication use patterns over the 24-month follow-up. Conclusions: These findings suggest that for most of these patients with MDD/P, outcome was suboptimal for both functional and syndromal recovery. The lack of an association between medication use and outcome suggests that medication changing and augmentation strategies, electroconvulsive therapy use, and/or strategies to improve medication adherence might be considered in the treatment of patients with MDD/ P who remain low functioning and symptomatic even while receiving pharmacotherapy. Finally, our findings highlight the need for routine systematic diagnostic procedures to ensure appropriate diagnosis and treatment of MDD/P at first admission as well as the need for replication of our findings in a more contemporary sample.
Polypharmacy prevalence rates in the treatment of unipolar depression in an outpatient clinic
Journal of Affective Disorders, 2009
Unipolar depression is a complex illness with an ever increasing number of pharmacological treatments available. As the number of available medication options increases, so does the potential for polypharmacy, a practice with possible complications. Such complications include a greater number of side effects with the initiation of additional medications and the consequences of drug-drug interactions. Therefore, it is important to understand the effects of polypharmacy on efficacy of treatment as well as whether polypharmacy is instituted after appropriate initial monotherapy trials. This study attempts to answer these questions. Patient names for this investigation were provided by residents in the UMass Medical School Psychiatry Residency program. The charts of these patients were analyzed to collect data regarding demographics, clinical data about the illness, medication names, types, duration of use and to access efficacy using the Clinical Global Impression (CGI). Of 160 reviewed charts, 135 subjects were included in the final analyses (others excluded due to incomplete data or no depression diagnosis). Patients were on average on 2.0 medications (SD=0.5) with 2.1 past trials. A greater number of current antidepressant medications did not correlate with a greater improvement in CGI, implying that polypharmacy did not necessarily lead to greater efficacy. The impact of illness severity, as measured by comorbidities, substance abuse, and trauma history, were included in the analysis, and did not significantly change this outcome. Additionally, prescription patterns themselves were examined, including reasons for termination of medication trials, the impact of side-effects, and the number of patients that had complete monotherapy trials before transitioning to polypharmacy. Small sample size, retrospective review, one CGI rater. First, many patients did not receive an adequate monotherapy trial, as defined by dose and duration, before progressing to polypharmacy. Secondly, the use of two or more medications concurrently did not appear to increase efficacy as measured by CGI. Due to study limitations, direct comparison of the efficacy of one and two medications was not significant; however the study did demonstrate a general correlation between polypharmacy and greater depressive symptomatology. This suggests the need for optimizing monotherapy regimens before initiating polypharmacy that may not lead to improvement in symptoms.
Antidepressant prescribing patterns among VA patients with schizophrenia
Schizophrenia Research, 2012
Recent reviews have questioned the efficacy of adjuvant use of antidepressants for the treatment of depression or the treatment of primary negative symptoms among individuals with schizophrenia. Using administrative data from the VA's mid-Atlantic region this cross-sectional retrospective study provides estimates of receipt of prevalent and incident antidepressant medications in fiscal year 2007 (FY07) among 2412 veterans receiving treatment for schizophrenia. Multivariable logistic regression analyses were used to evaluate demographic, diagnostic and clinical characteristics associated with antidepressant receipt in FY07. Approximately four out of ten (37.4%) received an antidepressant prescription of which 26.7% were incident prescriptions. SSRI or SNRI were the most common antidepressants prescribed. For both incidence and prevalence analyses, receipt of an antidepressant was significantly associated with co-occurring diagnoses of depression, PTSD, anxiety, schizoaffective disorder and receipt of care in specialty outpatient mental health clinic. Receipt of antidepressant was significantly less likely among those who were homeless compared to those who were housed. Antidepressants are commonly prescribed among veterans with schizophrenia. Antidepressant receipt was associated with the use of specialty mental health care services and with concurrent clinical diagnoses for which antidepressant medication, in the absence of schizophrenia, are commonly prescribed. Further studies are needed to examine the reasons why clinicians prescribe antidepressant medications to persons with schizophrenia and whether the benefits associated with antidepressant use outweigh their health risks.