Benefits Of Antidepressant Use Research Articles

Antidepressants and risk of sudden sensorineural hearing loss: a population-based cohort study.

Increasing numbers of animal studies have found that sudden sensorineural hearing loss (SSNHL) is related to the mechanism of serotonergic modulation. However, the relationship between antidepressants and SSNHL is unclear in humans. Therefore, this study aimed to evaluate the association between antidepressant use and risk of SSNHL. Data from 218 466 antidepressant users and 1 116 518 nonusers were obtained from the Taiwan Longitudinal Health Insurance Database. We used propensity-score matching (PSM) and inverse-probability treatment weighting (IPTW) to eliminate any bias. Each patient was tracked for 5 years to ascertain whether or not they were diagnosed with SSNHL. Cox proportional-hazard regression analyses were performed to calculate the SSNHL risk. The adjusted hazard ratio (aHR) of SSNHL for antidepressant users was 1.36 compared with nonusers in the full cohort study. The aHR for antidepressant users was 1.44 and 1.49 compared with the nonusers in the IPTW and PSM cohorts, respectively. All classes of antidepressants consistently increased the SSNHL risk. Additionally, patients receiving four classes of antidepressants were associated with a much higher SSNHL risk (aHR, 2.05) and those receiving one or two classes of antidepressants had a relatively lower SSNHL risk. Antidepressants increased SSNHL risk, regardless of their class. Furthermore, patients who took a higher number of antidepressant classes showed an increased risk of developing SSNHL than those who took a lower number of antidepressant classes. Therefore, physicians should estimate the risks and benefits of antidepressant use and avoid prescribing antidepressants concurrently.

Using patient decision aids for antidepressants in pregnancy

A trial weighing up the risk and benefits of antidepressant use in pregnancy has shown that patient decision aids were feasible with high patient satisfaction

Use of Antidepressants During Pregnancy?: What to Consider when Weighing Treatment with Antidepressants Against Untreated Depression.

Introduction Mood disorders impact many pregnant women, particularly those who have experienced symptoms prior to conception, and there are significant barriers, including stigma and access, to seeking and receiving appropriate treatments. Antidepressants are a helpful option in treating perinatal depression, but research on risks and benefits of antidepressant use in pregnancy is difficult given lack of "gold standard" comparative trials. Methods This paper summarizes current state of knowledge on the safety of antidepressants during pregnancy by providing a summary of the literature published in the past 3 years (January 2013-October 2015). We identified 21 reviews and meta-analyses that were included in this summary report. This report is meant to provide a user-friendly, yet comprehensive guide summarizing the abundant, and in part contradicting, literature on risks and benefits of antidepressants during pregnancy, in order to assist busy primary care prescribers in educating their patients. Our goal is also to contrast the risks/benefits of untreated depression in pregnancy versus treatment with antidepressant medication in pregnancy, and in such support prescribers in their decision-making. Results The past 3 years have yielded an abundance of publications on the topic, in part, with conflicting findings adding to confusion and concern among providers, patients, and their families. Many reported studies have methodological problems limiting their impact. Data on adverse effects of medications on pregnancy and fetal outcomes have to be weighed against the impact of untreated illness and poor health habits associated with untreated illness on the same outcomes. Discussion Medical-decision making is often complex and seldom free of risks. Obviously, as providers we cannot guarantee that fetal exposure to antidepressants is totally free of risk, yet this is true for any medicine taken in pregnancy. However, to date, perinatal psychiatry has collected enough evidence to suggest that, if the clinical picture warrants it, the use of many antidepressants, especially the SSRIs, is favorable compared to exposing mother and child to untreated depressive illness.

Prenatal Antidepressant Exposure: Clinical and Preclinical Findings

Pharmacological treatment of any maternal illness during pregnancy warrants consideration of the consequences of the illness and/or medication for both the mother and unborn child. In the case of major depressive disorder, which affects up to 10-20% of pregnant women, the deleterious effects of untreated depression on the offspring can be profound and long lasting. Progress has been made in our understanding of the mechanism(s) of action of antidepressants, fetal exposure to these medications, and serotonin's role in development. New technologies and careful study designs have enabled the accurate sampling of maternal serum, breast milk, umbilical cord serum, and infant serum psychotropic medication concentrations to characterize the magnitude of placental transfer and exposure through human breast milk. Despite this progress, the extant clinical literature is largely composed of case series, population-based patient registry data that are reliant on nonobjective means and retrospective recall to determine both medication and maternal depression exposure, and limited inclusion of suitable control groups for maternal depression. Conclusions drawn from such studies often fail to incorporate embryology/neurotransmitter ontogeny, appropriate gestational windows, or a critical discussion of statistically versus clinically significant. Similarly, preclinical studies have predominantly relied on dosing models, leading to exposures that may not be clinically relevant. The elucidation of a defined teratological effect or mechanism, if any, has yet to be conclusively demonstrated. The extant literature indicates that, in many cases, the benefits of antidepressant use during pregnancy for a depressed pregnant woman may outweigh potential risks.

Antidepressant Use in Children, Adolescents, and Young Adults: 10 Years After the Food and Drug Administration Black Box Warning

Depression in children, adolescents, and young adults can jeopardize health status, well-being, and development. Almost a decade ago, risks and benefits of antidepressant use in this group prompted the Food and Drug Administration (FDA) to ask manufacturers to include black box warnings on antidepressant prescriptions. This article reviews initial FDA decisions related to black box warnings for antidepressants in youth, reviews effects of the warnings, and considers clinical implications of prescribing antidepressants for treatment of youth depression. Health care providers must consider the risks and benefits of initiating antidepressant medication treatment, closely monitoring adherence, patient outcomes, and suicidal ideation.

Use of antidepressants during pregnancy and lactation

The prevalence of depression among pregnant women has been estimated to be 7 to 19 percent. Untreated depression has been associated with poor outcomes for both the mother and neonate. Antidepressant use during pregnancy has been associated with similar outcomes. This review will evaluate the risks and benefits of antidepressant use during pregnancy and lactation.

Pregnancy and Psychiatric Disorders

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.Pregnancy is a risky endeavor. According to the Centers for Disease Control and Prevention, about 3% of pregnancies in the United States are complicated by birth defects, which is a substantial number per year (http://www.cdc.gov/NCBDDD/birthdefects/facts.html). The task of assessing the risks and benefits of antidepressant use for the treatment of depression during pregnancy is complicated.

Antidepressant use and gestational hypertension: does evidence support causality? Reply letter

We thank Grzeskowiak and colleagues [1] for their review of our paper published in the British Journal of Clinical Pharmacology [2]. We agree that our study adds to a growing body of evidence supporting the fact that antidepressant use during pregnancy is increasing the risk of pregnancy-induced hypertension (PIH). However, we strongly feel that further clarification of their comments is needed. Studies on the risk of medication use during pregnancy are observational in nature, and one study alone cannot determine causality; hence, our study was not designed for that purpose and was not interpreted in that way, contrary to what Grzeskowiak and colleagues [1] suggest. Causality is likely to be determined by repetition of the findings between multiple studies on the same or similar research questions. While comparing studies, however, adjusted findings, which reflect the best estimate of association between an exposure (here antidepressant) and an outcome (here PIH), taking into account potential confounders, including the indication for antidepressant use (here depression), should be used. On the contrary, Grzeskowiak and colleagues [1] have used crude estimates, hence biased estimates, to compare our findings with others, resulting in an invalid interpretation. Adjusting for potential confounders, including the underlying indication, our study showed a 53% (P < 0.05) overall increase in the risk of PIH associated with antidepressant use during pregnancy, which is in line with what has been previously reported by Toh et al. [3] (90% increase in risk; P < 0.05). We acknowledge, however, that given the observational nature of our study, residual confounding can remain due to underlying maternal depression. However, Palmsten et al. [4] have shown that depressed women not treated with antidepressants during pregnancy were at the same risk of PIH as pregnant women who were not depressed, and that the increase in the risk of PIH was observed only amongst depressed women treated with antidepressants, leading to the conclusion that the increase in risk is probably due to the antidepressants and not the depression, contrary to what Grzeskowiak and colleagues [1] put forward. It is true that we have no clinical data on the severity of PIH, but we have shown that the majority of cases are pregnant women with gestational hypertension. Stratifying our analyses on a subgroup of cases with pre-eclampsia would have rendered our estimates unstable, similar to what has been reported by Toh et al. [3]. Finally, we disagree with the argument of Grzeskowiak and colleagues [1] concerning the lack of validity of ICD-9 codes for the identification of PIH in the Quebec Pregnancy Registry. As mentioned by De Vera and Berard [2], Ros et al. [5] have reported good predictive values for PIH ICD-9 diagnostic codes in the context of ‘population-based’ data similar to the Quebec Pregnancy Registry. On the contrary, however, Geller et al. [6] have reported validation estimates using data from a single hospital in the USA. One needs to be vigilant when reporting such discrepancies. Indeed, the interpretation of validation estimates of diagnostic codes needs to take into account the population setting, managed care delivery and access to care (diagnoses). The Quebec Pregnancy Registry is very similar to the Swedish Birth Register in this regard, because healthcare is universal in Quebec, and thus the Quebec Pregnancy Registry is population based (contrary to the US system), Quebec has equal access to healthcare (contrary to the USA) and Quebec has standardized prenatal follow-up regardless of underlying disease and socio-economic status (contrary to the USA). The argument that depressed pregnant women are more likely to visit their healthcare provider and therefore obtain a diagnosis of PIH is very unlikely. Indeed, it is well known that depressed women are less likely to visit their physician during and outside of pregnancy. In addition, this argument is even less of an issue when studying an outcome that is intensely investigated during pregnancy, such as PIH, which is systematically scrutinized at every prenatal visit regardless of patient comorbidities. In conclusion, our study was designed to assess the risk of PIH during pregnancy associated with gestational antidepressant use and does not provide any information on benefits of antidepressant use during pregnancy. De Vera and Berard [2] provide one more piece of information useful in the evaluation of the risks of antidepressant use during pregnancy at the patient level. Given the consistency of results between studies published thus far on this topic, it is our belief that more attention should be given to this important maternal comorbidity when prescribing antidepressants to pregnant women.

Antidepressants May Mitigate the Effects of Prenatal Maternal Anxiety on Infant Auditory Sensory Gating

Prenatal maternal anxiety has detrimental effects on the offspring's neurocognitive development, including impaired attentional function. Antidepressants are commonly used during pregnancy, yet their impact on offspring attention and their interaction with maternal anxiety has not been assessed. The authors used P50 auditory sensory gating, a putative marker of early attentional processes measurable in young infants, to assess the impact of maternal anxiety and antidepressant use. A total of 242 mother-infant dyads were classified relative to maternal history of anxiety and maternal prenatal antidepressant use. Infant P50 auditory sensory gating was recorded during active sleep at a mean age of 76 days (SD=38). In the absence of prenatal antidepressant exposure, infants whose mothers had a history of anxiety diagnoses had diminished P50 sensory gating. Prenatal antidepressant exposure mitigated the effect of anxiety. The effect of maternal anxiety was limited to amplitude of response to the second stimulus, while antidepressant exposure had an impact on the amplitude of response to both the first and second stimulus. Maternal anxiety disorders are associated with less inhibition during infant sensory gating, a performance deficit mitigated by prenatal antidepressant exposure. This effect may be important in considering the risks and benefits of antidepressant use during pregnancy. Cholinergic mechanisms are hypothesized for both anxiety and antidepressant effects, although the cholinergic receptors involved are likely different for anxiety and antidepressant effects.

Potential Underuse, Overuse, and Inappropriate Use of Antidepressants in Older Veteran Nursing Home Residents

To examine prevalence and resident- and site-level factors associated with potential underuse, overuse, and inappropriate use of antidepressants in older Veterans Affairs (VA) Community Living Center (CLC) residents. Longitudinal study. One hundred thirty-three VA CLCs. Three thousand six hundred ninety-two veterans aged 65 and older admitted between January 1, 2004, and June 3, 2005, with long stays (≥ 90 days). Prevalence of potential underuse, inappropriate use, and overuse of antidepressants in residents with and without depression (as documented according to International Classification of Diseases, Ninth Revision, Clinical Modification, codes or Depression Rating Scale). Selective serotonin reuptake inhibitors were the most commonly prescribed antidepressant. Of the 877 residents with depression, 25.4% did not receive an antidepressant, suggesting potential underuse. Of residents with depression who received antidepressants, 57.5% had potential inappropriate use due primarily to problems seen with drug-drug and drug-disease interactions. Of the 2,815 residents who did not have depression, 1,190 (42.3%) were prescribed one or more antidepressants; only 48 (4.0%) of these had a Food and Drug Administration-approved labeled indication, suggesting potential overuse. Overall, only 17.6% of antidepressant use was appropriate (324/1,844). The only consistent resident factor associated with potential underuse and overuse use was taking an antipsychotic without evidence of schizophrenia (underuse: adjusted relative risk ratio (ARRR)=0.56, 95% confidence interval (CI)=0.33-0.94; overuse: adjusted odds ratio=1.52, 95% CI=1.21-1.91). Having moderate to severe pain (ARRR=1.54, 95% CI=1.08-2.20) and the prescribing of an anxiolytic or hypnotic (ARRR=1.33, 95% CI=1.02-1.74) increased the risk of potential inappropriate antidepressant use. Potential problems with the use of antidepressants were frequently observed in older U.S. veteran CLC residents. Future studies are needed to examine the true risks and benefits of antidepressant use in CLC and non-VA nursing homes.

Antidepressant use during pregnancy

Depression during pregnancy affects 10–20% of pregnant women and can have detrimental effects (short and long term) for the mother, fetus and family. The use of antidepressants during pregnancy has been the subject of much debate. Recent data suggest a possible risk to the fetus with maternal use of antidepressants. Selective serotonin reuptake inhibitors have been associated with congenital malformations, negative pregnancy outcomes, neonatal behavioral symptoms and persistent pulmonary hypertension of the newborn. Women with depression tend to discontinue their medication when trying to conceive or upon discovering they are pregnant, placing themselves at increased risk of recurrence of their affective illness. Therefore, it is important for clinicians to understand the risks and benefits of antidepressant use during pregnancy in order to appropriately counsel women. The purpose of this article is to review updated information regarding the use of antidepressants during pregnancy.

Exercise and Pharmacotherapy in Patients With Major Depression: One-Year Follow-Up of the SMILE Study

To examine a 1-year follow-up of a 4-month, controlled clinical trial of exercise and antidepressant medication in patients with major depressive disorder (MDD). In the original study, 202 sedentary adults with MDD were randomized to: a) supervised exercise; b) home-based exercise; c) sertraline; or d) placebo pill. We examined two outcomes measured at 1-year follow-up (i.e., 16 months post randomization): 1) continuous Hamilton Depression Rating Scale score; and 2) MDD status (depressed; partial remission; full remission) in 172 available participants (85% of the original cohort). Regression analyses were performed to examine the effects of treatment group assignment, as well as follow-up antidepressant medication use and self-reported exercise (Godin Leisure-Time Exercise Questionnaire), on the two outcomes. In the original study, patients receiving exercise achieved similar benefits compared with those receiving sertraline. At the time of the 1-year follow-up, rates of MDD remission increased from 46% at post treatment to 66% for participants available for follow-up. Neither initial treatment group assignment nor antidepressant medication use during the follow-up period were significant predictors of MDD remission at 1 year. However, regular exercise during the follow-up period predicted both Hamilton Depression Rating Scale scores and MDD diagnosis at 1 year. This relationship was curvilinear, with the association concentrated between 0 minute and 180 minutes of weekly exercise. The effects of aerobic exercise on MDD remission seem to be similar to sertraline after 4 months of treatment; exercise during the follow-up period seems to extend the short-term benefits of exercise and may augment the benefits of antidepressant use. clinicaltrials.gov Identifier: NCT00331305.

Depression, suicidality and antidepressants: A coincidence?

Byline: Vithyalakshmi. Selvaraj, Snehamala. Veeravalli, Sriram. Ramaswamy, Richard. Balon, Vikram. Yeragani Major depressive disorder is currently one of the leading causes of disability world-wide and projected by the World Health Organization (WHO) to become the second leading cause of disability after heart disease by the year 2020. Suicidal ideation and behavior are the most serious and common psychiatric emergencies among the depressed population. In 2004, suicide was the eleventh leading cause of death in the U.S.[sup] [1] The overall rate was 10.9 suicide deaths per 100,000 people. An estimated 8 to 25 attempted suicides occur per every suicide death. It is reassuring that depressed patients usually respond to treatment with antidepressants. In fact, population-based studies examining rates of antidepressant use and suicide over time, have generally found lower rates of suicide with increasing rates of antidepressant use.[sup] [2],[3],[4],[5],[6],[7],[8] However, in 2003, publication of data linking antidepressant use to suicide and suicidal behavior in children and teenagers sparked off worldwide public health concern. This prompted the US Food and Drug Administration (FDA) to mandate manufacturers of all antidepressants (including tricyclic antidepressants [TCAs] and monoamine oxidase inhibitors) to include a warning stating that antidepressants may increase the risk of suicidal ideation and behavior in children, adolescents and young adults less than 25 years old. The 'black box' warning, although meant to safeguard public health has had serious spillover effects on pharmacotherapy of depression. There have been recent reports of a rise in suicide rates among the youth and a decline in depression care among the older adults. We critically evaluate this association in order to provide more clarity while assessing the benefits of antidepressant use versus any risk of self-harm associated with them. Impact of Depression Depression is a pathological and pervasive state of mood. The lifetime risk of developing major depressive disorder is 16.2% in the United States. Recurrence is the rule, and about one-third of patients go on to develop chronic depression. Depression increases mortality because it worsens many medical conditions such as cardiovascular disease and diabetes and increases the risk of suicide. Depressed patients are high utilizers of healthcare services and typically perform poorly in the workplace. The mean age of onset, from a number of studies, is in the late 20s. Although twice as many females as males report or receive treatment for clinical depression, this gap has significantly narrowed in the recent past. Also, this difference disappears after the age of 50-55, when most females are post-menopausal. Suicidal ideation and attempts are common in depressed patients. Each year, about 30,000 people in the United States and one million worldwide die by suicide. Approximately 650,000 people in the United States receive emergency treatment each year after attempting suicide. Antidepressants Benefits and Risks Mono amine oxidase inhibitors (MAOI) and tricyclic antidepressants (TCA) were the mainstays of treatment for depression until the introduction of Serotonin Reuptake Inhibitors (SSRIs) in the late 1980's. Currently, SSRIs are the most commonly prescribed antidepressants. The therapeutic effects of antidepressants are believed to be related to their ability to facilitate serotonin, norepinephrine and/or dopamine neurotransmission. Despite the early increase in concentration of monoamine neurotransmitters at receptor sites, clinical antidepressant benefits are not evident until several weeks. One explanation for this therapeutic lag is the theory that down-regulation of neurotransmitter receptors is a consequence of excess signaling, a process that takes several weeks and ultimately responsible for the alleviation of depressive symptoms. Overall, antidepressants are very effective in treating depression and its associated complications. …

The risks and benefits of antidepressant use in patients with major depressive disorder (MDD) have been highlighted

The risks and benefits of antidepressant use in patients with major depressive disorder (MDD) have been highlighted

The risks and benefits of antidepressant use in patients with major depressive disorder (MDD) have been highlighted

The risks and benefits of antidepressant use in patients with major depressive disorder (MDD) have been highlighted