Initiation Of Antidepressant Medication Research Articles

Meta-analysis on QEEG Changes to Antidepressant Treatment Among Patients with Depression

Introduction: Diagnostic and treatment accuracy of depression can lead to a better and possibly earlier response and remission in patients. The literature, though scanty, seems to suggest that quantitative electroencephalography (QEEG) can predict the outcome of antidepressant effects. Methodology: Articles published between January 1990 and July 2019, including those dealing with QEEG recordings before and after the initiation of antidepressant medication, were included. The pooled effect size and subgroup analysis of waveforms were calculated to predict response to antidepressants. Result: In all, 572 results were retrieved from the searches, of which 20 studies were included. Pooled data using a random-effects model (REM) calculated an effect size of 0.80 (95% CI [0.64–0.97]). Heterogeneity of the sample was low with Tau² = 0.02; df = 18 ( P = .30); I² = 12%. Moreover, subgroup analysis showed that theta band frequencies were better at predicting response than alpha band frequencies (the standard mean difference [SMD] for theta was 0.91 compared to 0.68 for alpha waves). Conclusions: QEEG is a valuable predictor of the antidepressant response. Among the EEG frequencies, the theta band showed the most significant change with treatment.

Rumination in patients with major depressive disorder before and after antidepressant treatment

BackgroundRumination is a maladaptive response to distress characteristic of Major Depressive Disorder (MDD). It is unclear to what degree rumination is associated with depression severity prior to treatment and how it responds to antidepressant treatment. Therefore, we evaluated the association between rumination and depression severity in 92 untreated patients with MDD and explored the changes in rumination after initiation of antidepressant medication. MethodWe measured rumination using the Rumination Response Scale (RRS) and depression severity with the Hamilton Depression Rating Scale (HDRS17 or HDRS6) before and after initiation of 12 weeks of antidepressant treatment. The association between RRS and pre-treatment HDRS17 was evaluated using a linear regression model. RRS at week 4, 8, and 12 across treatment response categories (remission vs. non-response) were evaluated using a mixed effect model. ResultsRRS was positively associated with depression severity prior to treatment at a trend level (p = 0.06). After initiation of treatment RRS decreased significantly (p < 0.0001) and remitters exhibited lower rumination compared to non-responders at week 4 (p = 0.03), 8 (p = 0.01), and 12 (p = 0.007). LimitationsThe study had no placebo group. ConclusionsAlthough pre-treatment rumination did not significantly associate with depressive symptoms, rumination was closely connected to change in depressive symptoms. Tormented patients could be reassured that rumination symptoms may be alleviated over the course of antidepressant treatment.

Factors Associated With Initiation of Antidepressant Medication in Adults With Type 1 and Type 2 Diabetes: A Primary Care Retrospective Cohort Study in Ontario, Canada

ObjectivesDepression in patients with diabetes mellitus is common and associated with poorer outcomes. This study aims to identify demographic, socioeconomic and medical factors associated with the initiation of antidepressant medication after a diagnosis of diabetes in adult patients without a previous prescription for antidepressants. We also examined frequency of primary care visits in the year after antidepressant initiation compared with the year before treatment began. MethodsThis was a retrospective cohort study using routinely collected electronic medical record data spanning January 2011 to December 2019 from the University of Toronto Practice-based Research Network (UTOPIAN) Data Safe Haven. Our primary outcome was a first prescription for an antidepressant in patients with diabetes. We used a mixed-effects logistic regression model to identify sociodemographic and medical factors associated with this event. ResultsAmong 22,750 patients with diabetes mellitus, 3,055 patients (13.4%) began taking an antidepressant medication. Increased odds of antidepressant initiation were observed in younger patients (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.39 to 2.26), females (OR, 1.60; 95% CI, 1.46 to 1.7), those receiving insulin treatment (OR, 1.59; 95% CI, 1.43 to 1.78) and cases of polypharmacy (OR, 3.67; 95% CI, 3.29 to 4.11). There was an increase in the mean number of primary care visits from 4.6 to 5.9 per year after antidepressant initiation. ConclusionsIn patients with diabetes, age, sex and medical characteristics were associated with the initiation of antidepressants. These patients accessed primary care more frequently. Screening and prevention of depression, particularly in these subgroups, could reduce its personal and systemic burdens.

Incidence of suicidal behaviour and violent crime following antidepressant medication: a Danish cohort study.

To examine the incidence of suicidal and violent behaviour following initiation of antidepressant medication. Cohorts of 997911 conscripts and 95794 patients with a first-time affective disorder were followed for purchase of antidepressant medication, suicide, suicide attempts and conviction for violent crime in Danish registries between 1997 through 2015. Incidence of outcomes was estimated for the first 28days, 28-365days or later after initiation of antidepressants or study entry. Of 16.5% of conscripts and 73.7% of patients with affective disorders initiated antidepressant medication. Incidence of suicide was 3-4 times higher during the first 28days after initiation compared to the rates in the following year in both cohorts. A similar trend was seen among the untreated patients with affective disorders, whereas suicide incidence was stable at a low level among conscripts not treated with antidepressants. Incidence of attempted suicide was highest during the 28days before and after initiation of antidepressants, while rates of violent crime were similar before and after initiation. These trends in incidence were independent of class of antidepressant. Higher rates of suicidal behaviour in the weeks following initiation of antidepressant medication probably reflect disease severity and a delay in mood response.

Initiation of antidepressant medication and risk of incident stroke: using the Adult Changes in Thought cohort to address time-varying confounding

PurposeDepression strongly predicts stroke incidence, suggesting that treating depression may reduce stroke risk. Antidepressant medications, however, may increase stroke risk via direct pathways. Previous evidence on antidepressant medication and stroke incidence is mixed. We evaluated associations between antidepressant use and incident stroke. MethodsFor 2302 Adult Changes in Thought cohort participants with no stroke at study entry, we characterized antidepressant use from pharmacy records, biennial depressive symptoms with a 10-item Centers for Epidemiologic Study–Depression scale, and incident strokes from ICD codes. We used discrete-time survival models with inverse probability weighting to compare stroke risk associated with filling antidepressant prescriptions and by medication category: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors, or other. ResultsOver an average 8.4-year follow-up, 441 incident strokes occurred. Filling antidepressant medications 3+ times versus 0–2 times predicted 35% increased odds of stroke (OR = 1.35; 95% CI: 0.98, 1.66). Use of TCAs was associated with stroke onset (OR per 10 fills = 1.28; CI: 1.04, 1.57), but use of selective serotonin reuptake inhibitors (OR = 0.98; CI: 0.80, 1.20) or other antidepressants (OR = 0.99; CI: 0.67, 1.45) was not. ConclusionsAlthough patients who received antidepressant medication were at higher risk of stroke, this association appeared specific to TCA prescriptions.

Seasonality of antidepressant prescriptions and sick leaves

The aim of the present study was to estimate the number of patients with a seasonal prescription pattern of antidepressants, which might be taken as a surrogate marker for medicated patients with seasonal affective disorder (SAD). Furthermore, we examined the time course of sick leaves for patients with seasonal and non-seasonal prescriptions of antidepressants. A retrospective analysis of prescription data of all patients insured by the Sickness Fund Burgenland (BGKK) between 2005 and 2016 was performed. Patients with treatment initiation of an antidepressant in the last and first quarter of the year for at least two consecutive years were selected (SAD-med). Patients with continuation treatment in the third quarter and patients with initiation of antidepressant medication in the second and third quarter of the year were excluded. The mean yearly prescription rate for antidepressants was 9.6% in the insured population. 3.0% of patients treated with antidepressants and 0.9% of insured cases satisfied the definition of SAD-med. The mean number of yearly sick leave days was similar for SAD-med patients and those with non-seasonal prescriptions. Time series analysis showed that sick leaves in SAD-med were influenced by seasonal fluctuations for several years after the first antidepressant prescription. Our study sheds light on antidepressant prescription and sick leave patterns in the general population. Compared to the prevalence of SAD, the estimated rate of SAD-med is substantial. Sick leaves appear to be closely linked to antidepressant prescriptions, and show a characteristic time course before and after the initial prescription.

Association Between Cognitive Function and Health Care Costs 3 Months and 6 Months After Initiating Antidepressant Medication for Depressive Disorders.

Major depressive disorder is one of the most common and disabling mental health disorders and is associated with substantial costs in terms of direct health care utilization and workplace productivity. Cognitive dysfunction, which alone substantially increases health care costs, is commonly associated with major depressive disorder. However, the health care costs of cognitive dysfunction in the context of depressive disorder are unknown. Recovery from mood symptoms is not always associated with resolution of cognitive dysfunction. Thus, cognitive dysfunction may contribute to health care burden even with successful antidepressant therapy. To compare health care utilization and costs for patients with a depressive disorder with and without cognitive dysfunction, at 3 and 6 months after initiation of antidepressant medication. This was an observational study, combining a cross-sectional patient survey, administered during a telephone interview, with health care claims data from a large, geographically diverse U.S. health plan. Included patients had at least 1 pharmacy claim for an antidepressant medication between August 1 and September 30, 2012, and no claim for any antidepressant during the 6 months prior to the index date. In addition to other criteria assessed in the claims data, patients confirmed a diagnosis of depression or major depressive disorder and the absence of any exclusionary neurological diagnoses possibly associated with cognitive impairment. Eligible patients were administered validated cognitive function assessments of verbal episodic memory (Hopkins Verbal Learning Test-Revised, Delayed and Total); attention (Digit Span Forward Maximum Sequence Length); working memory (Digit Span Backward Maximum Sequence Length); and executive function (D-KEFS-Letter Fluency Test). Based on comparison of scores with normative data, patients were assigned to cognitive dysfunction or cognitive normal cohorts. All-cause (all diagnoses) and depressive disorder-related health care utilization and costs (all from a payer perspective) were assessed 6 months prior (baseline) to antidepressant initiation and 3 months and 6 months after (follow-up) initiation of antidepressant medication. Health care utilization and costs included ambulatory (office and hospital outpatient), emergency room, inpatient hospital, pharmacy, other medical (e.g., laboratory and diagnostics), and total (all categories combined). All-cause and depressive disorder-related total costs during the 3- and 6-month follow-up periods were modeled with generalized linear modeling with gamma distribution and log link, while adjusting for potential confounders (age, race, gender, education, employment, and comorbidities). Of the 13,537 patients who were mailed an invitation, 824 (6%) were eligible and agreed to participate. Of these, 563 patients provided informed consent, completed the interview, maintained eligibility, and were included in the 3-month calculations. Among these, 255 (45%) were classified as having cognitive dysfunction. Mean patient age was 41.3 (± 12.5) years; 80% were female. Most patients were white and employed. More patients in the cognitive normal cohort were white (P less than 0.001) and employed full time (P = 0.029), had higher education attainment (P less than 0.001), and had fewer comorbidities (P = 0.007) than those in the cognitive dysfunction cohort. Over the first 3 months, patients with cognitive dysfunction had higher adjusted all-cause costs ($3,309 vs. $2,157, P = 0.002) and higher adjusted depressive disorder-related costs ($718 vs. $406, P less than 0.001) than patients without cognitive dysfunction. At 6 months, data from 4 patients were removed from the analysis because of exclusionary diagnoses. Over 6 months, patients with cognitive dysfunction had higher adjusted all-cause costs ($4,793) than patients without cognitive dysfunction ($3,683, P = 0.034). Over 6 months, depressive disorder-related costs did not significantly differ between patients with ($771) and without cognitive dysfunction ($594, P = 0.071). The main drivers of all-cause costs were office visits, outpatient hospital visits, and inpatient costs, and the main driver of depressive disorder-related costs was inpatient costs. Cognitive dysfunction was associated with higher adjusted all-cause and depressive disorder-related costs 3 months after initiation of an antidepressant medication. This difference persisted for all-cause costs through 6 months. Identification and treatment of cognitive dysfunction in patients with depressive disorder might reduce health care costs.

Initiation of Antidepressant Medication After Hip Fracture in Community-Dwelling Older Adults.

To evaluate the incidence, characteristics, and correlates of antidepressant drug therapy initiation among community-dwelling older adults following hip fracture. Retrospective cohort study using linked, population-based administrative data. Province of Ontario, Canada. Older adults, aged 65 years or older, with a hip fracture and hip fracture surgery between April 1, 2003, and February 28, 2011. The study sample was restricted to individuals who returned home following surgery and who had not been dispensed an antidepressant in the year prior to their fracture (N=25,436). We determined the incidence of new antidepressant use defined by the dispensing of antidepressant drug therapy within 90 days of discharge home. We identified independent correlates of antidepressant initiation using multivariate regression. Overall, antidepressants were newly initiated in 8.8% of older adults with hip fracture in the 90 days following hospital discharge. There was a statistically significant, 1.3-fold increase in incidence of antidepressant prescribing from 2003 to 2010. Trazodone, frequently prescribed at a low dose, accounted for 39.0% of newly dispensed antidepressants, followed by selective serotonin reuptake inhibitors (36.9%). Rehabilitation admission, psychiatric evaluation, a diagnosis of dementia, and baseline benzodiazepine use were the strongest independent correlates of antidepressant initiation. The period after a hip fracture is associated with a high rate of initiation of antidepressant therapy. The data raise the possibility that antidepressants are frequently prescribed off-label in these patients. Further research is needed to investigate the safety and efficacy of antidepressant use in this vulnerable population.

Initiation of Antidepressant Medication after Hip Fracture in Community-Dwelling Elderly

Depression is common in older adults after hip fracture and can impact participation in rehabilitation. Accordingly, there is a concern that depressive symptoms after hip fracture may result in increased disability, an increased rate of institutionalization, and increased mortality. Clinicians may consider treating depressive symptoms to maximize rehabilitation potential and minimize distress. Although there is evidence for use of antidepressants to treat depressive disorders in older adults, their benefits and safety in the post-hip fracture period have not been established.

Plasma fibrinogen: now also an antidepressant response marker?

Major depressive disorder (MDD) is one of the leading causes of global disability. It is a risk factor for noncompliance with medical treatment, with about 40% of patients not responding to currently used antidepressant drugs. The identification and clinical implementation of biomarkers that can indicate the likelihood of treatment response are needed in order to predict which patients will benefit from an antidepressant drug. While analyzing the blood plasma proteome collected from MDD patients before the initiation of antidepressant medication, we observed different fibrinogen alpha (FGA) levels between drug responders and nonresponders. These results were replicated in a second set of patients. Our findings lend further support to a recently identified association between MDD and fibrinogen levels from a large-scale study.

DÉPRESSION ET HÉPATITE C: DIAGNOSTIC ET TRAITEMENT

Interferon-alpha combined with Ribavirin is currently the standard treatment for chronic hepatitis C. Although frequently effective, IFN-α induces has a series of psychiatric side effects responsible for the breakdown the treatment. Depression induced by IFN-α is the most common manifestation. It covers approximately one third of patients. Its symptoms are often overlooked during routine clinical interviews. For the diagnosis of this depression, it is recommended to use diagnostic tools such as the Mini-International Neuropsychiatric Interview for DSM-IV, translated and validated in moroccan arabic. The psychiatric evaluation before treatment, the initiation of antidepressant medication at the onset of the depressive episode and close monitoring of patients are needed to ensure safety and promote compliance to antiviral treatment. Although controversial, the preventive treatment with antidepressant medication might be beneficial for patients with significant depressive symptoms prior to antiviral therapy.

Psychosocial Functioning of Medicaid Recipients With Major Depression

Back to table of contents Previous article Next article LettersFull AccessLettersSteven C. Marcus Ph.D.Mark Olfson M.D., M.P.H.Steven C. Marcus Ph.D.Search for more papers by this authorMark Olfson M.D., M.P.H.Search for more papers by this authorPublished Online:1 Jul 2006https://doi.org/10.1176/ps.2006.57.7.1046AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Psychosocial Functioning of Medicaid Recipients With Major DepressionTo the Editor: Confounding of treatment selection by illness severity threatens many nonexperimental observational research designs that use administrative data to study mood disorders ( 1 , 2 ). In a study of antidepressants and suicide, for example, if depressed patients who receive antidepressants are more severely ill than ostensibly similar depressed patients who do not receive antidepressants, an observed association between antidepressant treatment and suicide may simply reflect this underlying selection bias. Because measures of illness severity are not routinely available in administrative data sets, it is unclear whether or to what extent this bias exists. We sought to evaluate whether psychosocial functioning differs among patients with major depressive disorder on the basis of their use of antidepressant medications or psychotherapy. We merged a 1993-1994 Medicaid claims database containing patient diagnostic and service use data with a community-tracking database that includes a clinician-administered Global Assessment of Functioning (GAF) ( 3 ) rating. During this period, there was a low level of managed care penetration and a high level of data completeness. Patients selected had received a diagnosis of major depressive disorder ( ICD-9 codes 296.2 or 296.3) that was preceded by a period of at least 60 days without antidepressant treatment and had also received a GAF rating within 60 days preceding the first noted diagnosis of major depressive disorder. Filled prescriptions for antidepressant medications were noted in the 60 days after the diagnosis of major depression. A similar algorithm was used to examine GAF ratings and use of psychotherapy. A total of 472 patients were identified for the antidepressant analysis; 159 (34 percent) had filled a prescription for an antidepressant in the 60 days after the diagnosis of major depressive disorder. The mean±SD GAF score of the group that initiated antidepressant medications (49.6±13.1) did not significantly differ from that of the group that did not initiate antidepressants (50.1±11.7). The GAF score of the 341 patients who received psychotherapy (50.3±12.2) was similar to that of the 175 patients who did not receive psychotherapy (49.7±12.0). The findings stratified by age (six to 20 years and 21 years and older) directly mirrored the overall findings for both antidepressant and psychotherapy use.Under these conditions, neither initiation of antidepressant medication nor psychotherapy treatment was significantly related to illness severity as measured by a clinician-administered GAF. The study's limitations include relatively small samples, a concern that clinician-administered GAF ratings are only weakly related to function and outcome ( 4 ), an absence of documented standardization of the GAF ratings, and temporal delays between the GAF ratings and treatment. Within the context of these limitations, the similarities in mean GAF ratings for these groups may help to reduce concern over confounding of treatment initiation and illness severity. Dr. Marcus is affiliated with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Dr. Olfson is with the Department of Psychiatry, College of Physicians and Surgeons of Columbia University and the New York State Psychiatric Institute, New York.

A randomised, double-blind comparison of milnacipran and imipramine in the treatment of depression

This multicentre, double-blind, randomised trial in 109 patients compared the efficacy and tolerance of the novel selective serotonin and noradrenaline reuptake inhibitor (SNRI) antidepressant milnacipran (50 mg twice daily, n=53) with the established tricyclic agent imipramine (75 mg twice daily, n=56) over a period of 6 weeks, in patients with major depression (Montgomery–Åsberg depression rating score (MADRS)≥25). Initiation of antidepressant medication was conducted during a 2-week period of hospitalisation, after a 3- to 7-day washout period. Concomitant psychiatric medication was limited to lorazepam, cyamemazine, chloral hydrate and long-term uncomplicated lithium therapy. Assessment for efficacy using the MADRS and Hamilton rating scales of depression, a visual analogue scale and global evaluation revealed both agents to be highly effective ( P=0.0001) in this group of patients. Milnacipran was found to be of similar efficacy to imipramine. Tolerance, assessed by physiological and biochemical examinations with routine inventory and spontaneous report of adverse events, revealed a clear advantage for milnacipran. The incidence of anticholinergic events with milnacipran was about half that with imipramine and the overall incidence of adverse events by either reporting method was markedly lower with milnacipran than with imipramine. Furthermore, the patient drop-out rate with imipramine was double that experienced with milnacipran. Milnacipran appears to possess equal antidepressant efficacy to imipramine but with markedly superior tolerance. Therefore, milnacipran constitutes an important new treatment option in major depression.