Prescription Of Antidepressant Medication Research Articles

Patterns of antidepressant use among older adults in Northern Ireland: An administrative data study.

ObjectiveOver recent decades, there has been a noticeable increase in the prescription of antidepressant medications, particularly among older adults. This study examines the relationship between health outcomes and patterns of antidepressant use among older adults in Northern Ireland (NI). ApproachParticipants included all (General Practitioner) GP-registered hospital patients aged fifty-five years and above on 01/01/2010 (n =395,872). Administrative data linkage included demographic information (age, sex; urbanicity); data on antidepressant use from the NI Enhanced Prescribing Database (EPD); and hospital patient admissions/discharges. Repeated measures latent class analysis (RMLCA) identified patterns of antidepressant use (2010 to 2020) in relation to the association between these patterns and health-related outcomes in 2021. ResultsRMLCA identified four latent classes : long-term antidepressant use (17.4%); decreasing antidepressant use (7.1%); increasing antidepressant use (8.4%); no-antidepressant use (67.1%). Those in the long-term and increasing antidepressant use’ classes had the highest average number of hospital visits and recorded chronic conditions in 2021. ConclusionFindings show that two distinct subgroups (comprising 26% of the hospital population) were disproportionately impacted by increased antidepressant prescription rates. Because of their increased likelihood of experiencing higher ill-health, these people are crucial targets for additional psychosocial support. ImplicationsAnalyses of this kind emphasize the importance of widening access to administrative data, enabling researchers to identify and examine at-risk groups allowing more targeted policymaking to better address their needs. Data for this project was provided by the HSC Honest Broker Service; any views or opinions presented are solely those of the author.

Seasonality and sun exposure in incidence of major depression, bipolar disorder, and first-time use of antidepressant medication

Introduction Seasonality in depressive and bipolar disorders, are recognized in the ICD-10/11 and DSM-5 diagnostic systems. The existence of a seasonal pattern of hospital diagnosis of major depression, bipolar disorder and prescription of antidepressant medications has not been evaluated in the Danish population. Methods We retrieved date and year for all first-time hospital contacts with depression or bipolar disorder between 1999 and 2019, registered in the Danish National Patient Registry. Depression was defined using the ICD-10 F32-F33 codes, and for bipolar disorder the F30 or F31 codes. Date and year of all first-time purchases of antidepressant medications with ATC codes (N06A) between 1999 and 2021 were retrieved from the Danish National Prescription Registry, containing information on all prescribed drugs dispensed at pharmacies since 1995. Data on sunlight hours from 2012 to 2021 were retrieved from the Danish Metrological Institute. Results Incidences of hospital diagnoses as well as purchases of medication varied with month and season. The monthly variations were larger for antidepressant medication and smallest for bipolar disorder. The multiple linear regression analysis showed that number of first-time diagnoses of depression or bipolar disorder did not correlate with season. For antidepressant medication the number of first-time prescriptions was significantly lower in summer compared to the winter season. Conclusion This study found a seasonal variation of first-time prescriptions of antidepressant medication. We did not find a seasonal variation in first-time hospital diagnoses. Further research looking into depression severity, polarity of bipolar illness episodes, lag-time for sunlight exposure, and specific parts of the yearly photoperiods should be conducted.

Antidepressant prescription patterns and polypharmacy in outpatient psychiatry: a cross-sectional study.

Background and aim: Prescription patterns of antidepressants have changed over the years with a shift towards newer antidepressants with better tolerability and safety. Polypharmacy is common in psychiatry settings. The study aimed to evaluate the antidepressant drug prescription pattern and polypharmacy in a psychiatry outpatient setting. Investigations: This prospective observational study was conducted in a psychiatric outpatient clinic. The medication use data of eligible patients were collected. In addition, the rationale of antidepressant medication prescription, the defined daily dosage (DDD), the prescribed daily dose (PDD), and the PDD to DDD ratio were assessed. The assessment of prescription polypharmacy was conducted utilizing the framework provided by the National Association of State Mental Health Program Directors. Results: Data from 131 patients was analyzed. Major depressive disorder (32.8%) was the most common disorder for which antidepressants were prescribed. The majority, 91 (69.4%), received monotherapy. Selective serotonin reuptake inhibitors were the most frequently prescribed drugs in 69 (52.7%). Mirtazapine was the most frequently 32(24.4%) prescribed drug. Escitalopram and mirtazapine were the most commonly prescribed combination therapy (4.6%). Antipsychotic medications (37.4%) were the most widely co-prescribed medications, along with antidepressants. The PDD to DDD ratio was less than 1 for mirtazapine and imipramine; they were ≥1 for others. Psychiatric polypharmacy was documented in 87.1% of prescriptions. The total polypharmacy was not significantly (p>0.05) associated with demographic, illness, and treatment-related variables. Conclusion: Selective serotonin reuptake inhibitors were the most commonly prescribed antidepressants, monotherapy, and combination therapy. A substantial amount of patients received concomitant administration of antidepressants or psychotropic drugs, warranting careful monitoring.

Implementation of CYP2C19 and CYP2D6 genotyping to guide antidepressant use in a large rural health system.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. We describe the implementation and ongoing maintenance of CYP2C19 and CYP2D6 focused pharmacogenetic (PGx) testing to guide antidepressant and antianxiety medication prescriptions in a large rural, nonprofit health system. Depression and anxiety are common psychiatric conditions. Sanford Health implemented PGx testing for metabolism of cytochrome P450 (CYP) isozymes 2C19 and 2D6 in 2014 to inform prescribing for multiple medications, including antidepressant and antianxiety therapies. As guidelines, genotype to phenotype translation, panel offerings, and other resources are updated, we adapt our approach. We make educational and informational materials available to providers and patients. Pharmacogenomic clinical pharmacists review PGx results with discrete values and provide guidance documentation in the electronic medical record. A robust clinical decision support system is in place to provide interruptive alerts, noninterruptive alerts, and genomic indicators. A referral-based interdisciplinary clinic is also available to provide in-depth education to patients regarding PGx results and implications. Additionally, partnering with our health plan has expanded access to PGx testing for patients with anxiety or depression. The implementation and maintenance of Sanford Health's PGx program to guide antidepressant and antianxiety medication use continues to evolve and requires a multipronged approach relying on both human and informatics-based resources.

Impact of Mental Health Treatment on Outcomes in Patients With Heart Failure and Ischemic Heart Disease.

There is conflicting evidence as to the impact of mental health treatment on outcomes in patients with heart disease. The aim of this study was to examine whether individuals who received mental health treatment for anxiety or depression after being hospitalized for ischemic disorders or heart failure had a reduced frequency of rehospitalizations, emergency department visits, or mortality compared with those who did not receive treatment. A population-based, retrospective, cohort design was used to examine the association between psychotherapy or antidepressant medication prescription and health service utilization and mortality in patients with coronary artery disease or heart failure and comorbid anxiety or depression. Those receiving versus not receiving mental health treatment were compared based on the frequency of rehospitalization, emergency department visits, and mortality. The study sample included 1563 patients who had a mean age of 50.1 years. Individuals who received both forms of mental health treatment for anxiety or depression were 75% less likely to be rehospitalized, 74% less likely to have an emergency department visit, and 66% less likely to die from any cause. Mental health treatment for anxiety or depression has a significant impact on outcomes in patients with cardiovascular disease consisting of reduced hospitalizations, emergency department visits, and in some conditions improved survival.

Time trends in self-reported depressive symptoms, prescription of antidepressants, sedatives and hypnotics and the emergence of social media among Norwegian adolescents.

Research has shown increased mental health problems and use of prescription drugs among adolescents in recent years and social media use has been linked to poorer mental health. However, trend studies concerning these topics are scarce. The purpose of this study was to analyze gender-specific trends in a) symptoms of depression and loneliness, and b) prescription of antidepressants, hypnotics and sedatives, in relation to the emergence of social media among adolescents in Norway. This is an ecological study using data from the 'Young in Oslo' surveys from 1996 to 2021. The surveys included approximately 110 000 students, 14-17 years of age, and yielded a response rate varying from 95% in 1996 to 64% in 2021. A self-report questionnaire was used to collect information on symptoms of depression and loneliness. Information on antidepressant and sleep medication prescription was retrieved from the Norwegian Prescription Database for the age group 15 to 19 years. A graphical approach and logistic regression models were used to examine gender-specific time-trends between 1996 to 2021. We found a doubling in self-reported symptoms of depression and loneliness among girls between 1996 and 2021, with the steepest increase in the period from 2006 to 2012, when Facebook and other social media were introduced. A similar trend was observed in the prescription of antidepressants among girls, with the steepest increase between 2011 and 2013. Among both boys and girls, 'worried too much about things' and 'had sleep problems' were the two symptoms with the greatest changes. A significant upward trend in self-reported depressive symptoms and medication use was observed over the past 25 years, with variations in the rate of increase, including a steeper trajectory during certain periods immediately after the introduction of social media platforms in Norway.

Mapping the Relationship of White Matter Lesions to Depression in Multiple Sclerosis

BackgroundMultiple sclerosis (MS) is an immune-mediated neurological disorder, and up to 50% of patients experience depression. We investigated how white matter network disruption is related to depression in MS. MethodsUsing electronic health records, 380 participants with MS were identified. Depressed individuals (MS+Depression group; n = 232) included persons who had an ICD-10 depression diagnosis, had a prescription for antidepressant medication, or screened positive via Patient Health Questionnaire (PHQ)-2 or PHQ-9. Age- and sex-matched nondepressed individuals with MS (MS−Depression group; n = 148) included persons who had no prior depression diagnosis, had no psychiatric medication prescriptions, and were asymptomatic on PHQ-2 or PHQ-9. Research-quality 3T structural magnetic resonance imaging was obtained as part of routine care. We first evaluated whether lesions were preferentially located within the depression network compared with other brain regions. Next, we examined if MS+Depression patients had greater lesion burden and if this was driven by lesions in the depression network. Primary outcome measures were the burden of lesions (e.g., impacted fascicles) within a network and across the brain. ResultsMS lesions preferentially affected fascicles within versus outside the depression network (β = 0.09, 95% CI = 0.08 to 0.10, p < .001). MS+Depression patients had more lesion burden (β = 0.06, 95% CI = 0.01 to 0.10, p = .015); this was driven by lesions within the depression network (β = 0.02, 95% CI = 0.003 to 0.040, p = .020). ConclusionsWe demonstrated that lesion location and burden may contribute to depression comorbidity in MS. MS lesions disproportionately impacted fascicles in the depression network. MS+Depression patients had more disease than MS−Depression patients, which was driven by disease within the depression network. Future studies relating lesion location to personalized depression interventions are warranted.

Depression in Patients with Peripheral Artery Disease: An Underdiagnosis with Increased Mortality

Among patients with peripheral artery disease (PAD), depression is diagnosed in 17-25% and negatively impacts wound healing, quality of life, and survival. We hypothesized that depression is underdiagnosed in patients with PAD. Additionally, given the associations between depression and mortality in PAD patients, there is an increased need to investigate the strength of this relationship. The present analysis includes 2 studies to address the following aims: (1) Investigation of the prevalence of concomitant PAD and depression in a cohort from the Southeastern United States, and (2) Examination of the association between depression and all-cause mortality in a cohort of Canadian patients with PAD. STUDY 1: From June-August 2022, the Patient Health Questionnaire Module 9 (PHQ-9) was administered to all patients seeking PAD-related care including medical, wound/podiatric, or vascular interventional/surgical treatment, in the University of North Carolina-Chapel Hill Vascular, Wound, and Podiatry clinics. The PHQ-9 assesses symptoms over 2weeks and is scored 0-27, with higher scores indicating increasingly severe depression. Demographics, primary diagnosis, depression history, and antidepressant prescription were determined through chart review. We compared the proportion of positive depression screenings (PHQ-9≥5) to known depression. Among those treated for depression, the PHQ-9 score severity was evaluated. T-tests and χ2 tests were used to compare means and proportions. STUDY 2: From July 2015 to October 2016, the Geriatric Depression Scale Short Form was administered to adult patients with PAD undergoing revascularization. The Geriatric Depression Scale Short Form is a self-report measure of depression with a score >5 consistent with depression. The prevalence of depression was determined; primary outcome was all-cause mortality at 6months. STUDY 1: In 104 PAD patients (mean age 66.6±11.3years, 37% female), 37% of respondents scored ≥5 on the PHQ-9 survey, indicating at least mild depression. Only 18% of PAD patients had a history of depression, demonstrating a significant difference between the PHQ-9 findings and documented medical history. While depression was underdiagnosed in both men and women, men were more likely to have unrecognized depression (chi-squared statistic=35.117, df=1, P<0.001). Among those with a history of depression, 74% had a current prescription for antidepressant medication, but 57% still had an elevated PHQ-9 score indicating possible undertreatment. STUDY 2: In 148 patients (mean age 70.3±11.0years, 39% female) the prevalence of screened depression was 28.4%, but only 3.3% had a documented history of depression suggesting significant underdiagnosis. Patients with depression were significantly more likely to die within 6months of revascularization (9.5% vs. 0.9%; odds ratio 1.48, 95% confidence interval: 1.08 to 2.29). There was no association between depression and risk of length of stay, reintervention, or readmission. Depression is underdiagnosed and undertreated among patients with PAD, which has grave consequences as it is associated with 1.5 times the odds of mortality within 6months of revascularization. There is a critical need for more robust screenings and comprehensive mental health treatment for patients with concomitant depression and PAD.

Hormonal Contraceptive Use and Risk of Depression Among Young Women With Attention-Deficit/Hyperactivity Disorder

Women with attention-deficit/hyperactivity disorder (ADHD) have an increased risk of becoming teenage mothers. Adverse effects of hormonal contraception (HC), including depression, may affect adherence to user-dependent contraception and increase the risk for unplanned pregnancies and teenage births in women with ADHD. The current study analyzed whether girls and young women with ADHD are at increased risk for depression during HC use compared with women without ADHD. A linkage of Swedish national registers covering 29,767 girls and young women with ADHD aged 15 to 24 years and 763,146 without ADHD provided measures of ADHD and depression diagnoses (International Classification of Diseases [ICD] code) and prescription of stimulant medication, HC, and antidepressant medication (Anatomical Therapeutic Chemical [ATC] code). Cox regression models applying an interaction term (ADHD diagnosis× HC use) evaluated the excess risk of HC-induced depression in women with ADHD. Women with ADHD had a 3-fold higher risk of developing depression, irrespective of HC use (adjusted hazard ratio [aHR]= 3.69, 95% CI= 3.60-3.78). Oral combined HC users with ADHD had a 5 times higher risk of depression compared with women without ADHD who were not using oral combined HC (aHR= 5.19, 95% CI= 4.94-5.47), and a 6 times higher risk in comparison with women without ADHD who were on oral combined HC (aHR= 6.10 (95% CI= 5.79-6.43). The corresponding risk of depression in women with ADHD who used a progestogen-only pill (aHR= 5.00, 95% CI= 4.56-5.49). The risk of developing depression when using non-oral HC was similarly moderately increased in both groups. Girls and young women with ADHD have an increased risk of developing depression when using oral HC compared with their unaffected peers. Information on risks with HCs as well as potential benefits with long-acting reversible contraceptives needs to be an integrated part of the shared decision making and contraception counseling for young women with ADHD.

Predicting the effect of antidepressant treatment on relief from anxiety symptoms

IntroductionDepression and anxiety disorders are among the most prevalent forms of mental illness, with antidepressants frequently used to treat them. Unfortunately, prescription of antidepressant medication is often inexact and relies on a long trial-and-error process.ObjectivesUsing machine Learning (ML) algorithms on readily obtainable clinical and demographic data of individuals diagnosed with depression with anxiety symptoms, we hypothesized that we will be able to derive models which will enable a more accurate treatment selection, focusing on relief from anxiety symptoms.MethodsPatients’ data from the Sequenced Treatment Alternatives to Relieve Depression (START*D) were filtered to include only those who have considerable anxiety symptoms. We then analyzed these patients’ response patterns, focusing on their anxious symptomology. Then, feature selection algorithms were applied to select the most predictive features for anxiety relief. Finally, we trained three ML models for three antidepressants: citalopram, sertraline and venlafaxine, using a training set of participants, and validated them on naïve validation and test datasets. These ML models were then compiled to create a predictive algorithm.ResultsValidating the algorithm on the validation and test sets, our algorithm achieved a balanced accuracy of 64.8% (p&lt;0.001), 79.2% (p&lt;0.001) and 78.03% (p&lt;0.001) for citalopram, sertraline and venlafaxine, respectively.ConclusionsOur findings support applying ML to accumulating data to achieve an improvement in the treatment of mood disorders. The algorithm we developed may be used as a tool to aid in the choice of antidepressant medication, specifically for depressed patients who exhibit prominent anxiety symptoms.DisclosureDekel Taliaz is the founder and CEO of Taliaz and reports stock ownership in Taliaz. Amit Spinrad and Roni Zoller serve as data scientists in Taliaz.

Association between Attention Deficit Hyperactivity Disorder Medication and Depression: A 10-year Follow-up Self-controlled Case Study.

ObjectiveThere is clinical concern that the stimulant methylphenidate (MPH) might increase the risk of depression, particularly in children. This study aimed to investigate the association between MPH use and the risk of depression.MethodsA population-based electronic medical records database was used. We obtained claims data for prescription of ADHD medication, diagnosis of depression, and prescription of antidepressant medication between January 2007 and December 2016 for 43,259 individuals aged 6 to 19 who were diagnosed with ADHD between July 1, 2007 and December 31, 2007. The final analysis was based on 2,330 eligible participants. A self-controlled case series design was used to identify risk factors for major depressive disorder (MDD).ResultsAn elevated MDD risk was found during the 90 days before MPH exposure, with an incidence rate ratio (IRR) of 12.12 (95% confidence interval [95% CI] 10.06−14.61, p < 0.0001). During methylphenidate treatment, the IRR was 18.06 with a 95% CI of 16.67 to 19.56 (p < 0.0001), but it returned to baseline levels after day 31 of MPH treatment discontinuation. The IRR for patients aged 6 to 9 years was 13.11 (95% CI 9.58−17.95) during the 90 days before MPH exposure, and 17.7 (95% CI 15.6−20.08) during MPH treatment, but returned to baseline levels after discontinuation of MPH treatment.ConclusionWe confirmed the temporal relationship between depression and methylphenidate use in young people with ADHD. Though the absolute risk is low, the risk of depression should be carefully considered, particularly in the period directly following the start of methylphenidate treatment.

Effects of COVID-19 pandemic on anxiety and depression in primary care: A cohort study in Ontario, Canada.

Many people have experienced poorer mental health and increased distress during the COVID-19 pandemic. It is unclear to what extent this has resulted in increases in the number of patients presenting with anxiety and/or depression in primary care. To determine if there are more patients are visiting their family doctor for anxiety/depression during the COVID-19 pandemic compared to before the pandemic, and to determine whether these effects varied based on patient demographic characteristics. A retrospective cohort study of family medicine patients from 2017-2020. Electronic medical records (EMRs) from the University of Toronto Practice Based-Research Network (UTOPIAN) Data Safe Haven. The majority of physicians in the UTOPIAN EMR database practice in the Greater Toronto Area, a high-COVID region of Canada. Active family practice patients aged 10 and older with at least 1 year of EMR data. Visits for anxiety and/or depression; prescriptions for antidepressant medications. Changes in visits for anxiety and depression during the COVID-19 pandemic were consistent with an increased demand for mental healthcare and an increase in the number of individuals with anxiety and depression. Increases in visits for anxiety and depression were larger for younger patients, women, and later in the pandemic. Among younger patients, prescriptions for antidepressants were substantially reduced during the first few months of the pandemic (April-May 2020) but incidences rates increased later in 2020. Increases in visit volume during the pandemic were consist with more frequent visits for anxiety/depression and more new patients presenting with anxiety or depression. The COVID-19 pandemic has resulted in an increased demand for mental health services from family physicians. Increases in anxiety and depression were especially pronounced among younger female patients and increased throughout the pandemic. Our findings highlight the need for continued efforts to support and addresses mental health concerns in primary care.

Diabetes, antidiabetic medications and risk of depression – A population-based cohort and nested case-control study

ObjectiveDiabetes type 2 is associated with depression, but the impact of antidiabetic drugs is not clear. The objective was to analyze the association between diabetes type 2, antidiabetic drugs, and depression. MethodsThis register-based study included 116.699 patients with diabetes type 2 diagnosed from 2000 to 2012 and an age, gender, and municipality matched reference group of 116.008 individuals without diabetes. All participants were followed for a diagnosis of depression or prescription of antidepressant medication. Based on this, a case-control study was nested within the cohort, using risk set sampling. Antidiabetic medication was categorized into insulin, metformin, sulfonylureas and glinides combined, glitazones, dipeptidyl peptidase 4 (DPP4) inhibitors, glucagon-like peptide 1 (GLP1) analogs, sodium-glucose transport protein 2 (SGLT2) inhibitors and acarbose. The association between diabetes and depression was analyzed using Cox proportional hazards regression, whereas conditional logistic regression was used to analyze the association between use of antidiabetic drugs and depression. ResultsPatients with diabetes had higher risk of depression compared to individuals without diabetes (hazard ratio 1.14 (95% confidence interval 1.14–1.15)). Low doses of metformin, DPP4 inhibitors, GLP1 analogs, and SGLT2 inhibitors were associated with lower risk of depression in patients with diabetes compared to non-users, with the lowest risk for sodium-glucose transport protein 2 inhibitor users (odds ratio 0.55 (0.44–0.70)). Use of insulin, sulfonylurea and high doses of metformin were associated with higher risk of depression. ConclusionPatients with diabetes had increased risk of depression. However, users of specific antidiabetic drugs had lower risk of depression compared to non-users.

Baseline data of a sequential multiple assignment randomized trial (STEP study).

Research has shown that preventative intervention in individuals at ultra-high risk of psychosis (UHR) improves symptomatic and functional outcomes. The staged treatment in early psychosis (STEP) trial aims to determine the most effective type, timing and sequence of interventions in the UHR population by sequentially studying the effectiveness of (1) support and problem solving, (2) cognitive-behavioural case management and (3) antidepressant medication with an embedded fast-fail option of (4) omega-3 fatty acids or low-dose antipsychotic medication. This paper presents the recruitment flow and baseline clinical characteristics of the sample. STEP is a sequential multiple assignment randomized trial. We present the baseline demographics, clinical characteristics and acceptability and feasibility of this treatment approach as indicated by the flow of participants from first contact up until enrolment into the trial. Recruitment took place between April 2016 and January 2019. Of 1343, help-seeking young people who were considered for participation, 402 participants were not eligible and 599 declined/disengaged, resulting in a total of 342 participants enrolled in the study. The most common reason for exclusion was an active prescription of antidepressant medication. Eighty-five percent of the enrolled sample had a non-psychotic DSM-5 diagnosis and symptomatic/functional measures showed a moderate level of clinical severity and functional impairment. The present study demonstrates the acceptability and participant's general positive appraisal of sequential treatment. It also shows, in line with other trials in UHR individuals, a significant level of psychiatric morbidity and impairment, demonstrating the clear need for care in this group and that treatment is appropriate.

Chronic prescription of antidepressant medication in patients with chronic kidney disease with and without kidney replacement therapy compared with matched controls in the Dutch general population.

ABSTRACTBackgroundChronic kidney disease (CKD) is associated with a higher prevalence of depression, neuropathic pain and insomnia. These conditions are often treated pharmaceutically. In this study we aimed to determine the prevalence of chronic antidepressant use among CKD patients with and without kidney replacement therapy (KRT).MethodsBy using the Dutch health claims database, we were able to determine the prevalence, type and dosage of chronic antidepressant prescriptions in patients with CKD Stage G4/G5 without KRT (n = 14 905), patients on dialysis (n = 3872) and patients living on a functioning graft (n = 8796) and compared these to age-, sex- and socio-economic status (SES)-matched controls from the general population.ResultsOur data show that the prevalence of chronic antidepressant prescription is 5.6%, 5.3% and 4.2% in CKD Stage G4/G5, dialysis and kidney transplant patients, respectively, which is significantly higher than in matched controls. Although our data revealed more prescriptions in female patients and in the age category 45–64 years, our data did not show any association between antidepressant prescriptions and SES. Selective serotonin reuptake inhibitors were the most prescribed drugs in all patient groups and controls. Tricyclic antidepressants were more often used in patients compared with controls.ConclusionThis nationwide analysis revealed that chronic antidepressant prescription in the Netherlands is higher in CKD patients with and without KRT than in controls, higher in middle-aged patients and women, unrelated to socio-economic status and lower than chronic use reported in other countries.

Sexual Desire, Depressive Symptoms and Medication Use Among Women With Fibromyalgia in Flanders.

BackgroundFibromyalgia (FM) is associated with sexual dysfunction, though much less is known about the sexual desire, and especially dyadic and solitary sexual desire, among women with fibromyalgia.AimTo investigate on the one hand the global sexual desire, the dyadic sexual and solitary sexual desire, and on the other hand the association with depressive symptoms, fibromyalgia symptoms and medication use among women with fibromyalgia in Flanders, Belgium.MethodsAn online survey was spread through the Flemish league for Fibromyalgia Patients to be completed by women with fibromyalgia. The sexual desire inventory-2 (SDI-2) was used to measure sexual desire (global, dyadic, solitary), the VASFIQ for fibromyalgia symptoms, and the PHQ-2 for depressive symptoms, while also including questions on demographic factors (time since FM, age) and medication usage (antidepressants, pain medication, sleeping medication).Main Outcome MeasureGlobal sexual desire, dyadic sexual desire and solitary sexual desire were studied in relation to depressive symptoms, medication use and fibromyalgia symptoms.ResultsOne hundred and three women with FM answered the survey. Depressive symptoms were significantly associated with a lower global, dyadic and solitary sexual desire, as was the use of antidepressant medication. The association between solitary sexual desire and depressive symptoms disappeared when controlled for antidepressant medication. Age, fibromyalgia symptoms nor time since diagnosis were significantly associated with any form of sexual desire.ConclusionDepressive symptoms and antidepressant medication, and not fibromyalgia symptoms, were associated with decreased sexual desire of women with FM. As antidepressant medication and depressive symptoms are associated with a decreased sexual desire, more attention should be paid towards the mental health issues associated with fibromyalgia, as well as the prescription of antidepressant medication. This study is the first to investigate sexual desire among women with fibromyalgia in Flanders, and one of the few internationally to have done so. It is limited by its cross-sectional design, and for not providing information on men with FM.Van Overmeire R, Vesentini L, Vanclooster S, et al. Sexual Desire, Depressive Symptoms and Medication Use Among Women With Fibromyalgia in Flanders. Sex Med 2022;10:100457.

Using Real World Data (RWD) to Identify Care Needs in an Adolescent and Young Adult (AYA) Lymphoma Population: A Match Cohort Study

Adolescent and young adult (AYA) patients with malignancies are a unique population within oncology with differences in survivorship outcomes as compared to adult and pediatric counterparts. The National Comprehensive Cancer Network (NCCN) identified eight critical domains in AYA care: mental health, cognitive function, physical exercise, fatigue, immunizations/infection prevention, pain, sexual function and sleep disorders. However, it can be difficult to establish a clinical benchmark of these domains at an institutional level without time-consuming chart review. With the advent of real-world data generated from the electronic medical record (EMR), feasible large scale data assessment can be used to identify care needs and direct future prospective studies and interventions.Here we demonstrate the feasibility of a match cohort study using EMR comparing metrics in the above NCCN domains in AYA lymphoma patients within the University of Rochester Medical Center. We identified 172 AYA lymphoma patients diagnosed between 2013 and 2019 and compared them to 516 controls over that time period using 3:1 control matching, both at time of diagnosis and one year post-diagnosis. Controls were identified within the EMR with exclusion criteria of no cancer diagnoses and fewer than an average of ten medical visits per year over the study period to control for other chronic disorders.Demographic characteristics for both groups were matched for age at diagnosis date, sex, and race. The resultant populations had an average age of 29 (SD 6), male predominance (58.72%), and Caucasian predominance (82.56%). The lymphoma group had a slightly higher rate of federally funded insurance as compared to controls (25% vs. 20%).In mental health domains, lymphoma group had a higher rate of depression at baseline (19.77% vs. 1.16%; p <0.0001) but anxiety was at comparable rates (8.72% vs. 10.85% p <0.46) with similar rates of antidepressant medication prescriptions (27.33% vs. 25.97% p < 0.75). At one year post-diagnosis, anxiety and depression rates were near identical but rates of antidepressant prescriptions had increased in the lymphoma group (30.81% vs. 22.65% p < 0.03.)In physical health domains, lymphoma group had similar rates of BMI in the overweight and obese range as compared to controls and less than five percent of the group had a sleep medicine, nutrition, or cognitive assessment at baseline or one year post-diagnosis. Vaccination rates, as measured by influenza and pneumovax adherence, were low both at diagnosis and at one year post- diagnosis in the lymphoma group (18.6% and 21.5%, respectively).In the pain domain, the lymphoma group had similarly low rates of alcohol abuse, opiate abuse and chronic pain diagnoses as compared to controls (between 1 and 4% without statistically significant differences). Interestingly, pain scores recorded at visits on the 0 to 10 scale were noticeably lower for the lymphoma group both at diagnosis and one year post-diagnosis (4.65% vs 11.24% p=0.009; 5.23% vs 11.43% p=0.02) however prescription of any analgesic medication was higher in the lymphoma group (76.16% vs. 40.98% p<0.0001; 63.95% vs. 30.62 p<0.0001).Lastly, in the reproductive and sexual health domain, the lymphoma group had high rates of consultation with reproductive endocrinology at diagnosis as compared to controls (31.40% vs. 1.74% p<0.0001) suggestive of early referral between initial suspicion of cancer and tissue diagnosis. The overall use of the services however were still at relatively low rates. Additionally, long-acting removable contraception rates, while higher in the lymphoma population (11.27% vs. 4.23 p<0.02) were still relatively low. Finally, rates of erectile dysfunction diagnoses were similar in lymphoma cases as compared to controls (0.99 vs. 0.66 p< 0.7128) without significant differences in tadalafil/sildenafil prescriptions at one year post-diagnosis (2.97% vs. 1.32% p<0.15)These data support the feasibility of using the electronic medical record to track institutional level ancillary markers of care for prospective study and population-specific interventions. Future studies will be directed at collaborations to address these care gaps and a prospective survey of AYA patients to identify patient-centered interventions improving care for this critical population. DisclosuresCasulo: Genentech: Research Funding; BMS: Research Funding; Gilead: Research Funding; Verastem: Research Funding.

Age effects on treatment patterns in 138,097 patients with unipolar depression followed in general practices in Germany

BackgroundRisk factors and comorbidities associated with depression vary with age and must be considered when selecting appropriate anti-depressant medication for patients. Studies are lacking which focus both on treatments prescribed and include a broad age spectrum. The goal of this study was to investigate whether age of patients at diagnosis impact the type of antidepressant drug class prescribed. MethodsThis retrospective cohort study based on the Disease Analyzer database (IQVIA) included 138,097 patients with depression followed in 1188 general practices from date of first depression diagnosis given between 2015 and 2018 (index date). Patients aged 18–30, 31–65 and > 65 were compared in homogeneous groups based on gender and insurance type. Odds ratios adjusted by gender, insurance type, treatment site and Charlson-Comorbidity-Index were used to assess the difference in probability of receiving prescription for antidepressant drug classes as well as individual treatment drugs by age group. ResultsThe cohort included 13,553 (9.8%), 82,524 (59.8%) and 42,020 (30.4%) patients aged 18–30 years (young), 31–65 years (middle-aged) and >65 years (older). Less than half of patients received anti-depressant medication, with 4717 (34.8%) aged 18–30, 35,014 (42.4%) aged 31–65, and 20,294 (48.3%) aged 65 or older receiving at least one anti-depressant medication. Tri- and tetra-cyclic mediations were prescribed to 65.8% of patients aged >65, and 59.0% of patients aged 31–65. Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) were prescribed to 55.5% of patients. Older patients showed an increased probability (OR: 1.3 [1.26–1.34 95% CI], p < 0.0001) for tri- and tetra-cyclic medication, while younger patients showed an increased probability for SSRIs and SNRIs (OR: 1.23 [1.16–1.30 95% CI], p < 0.0001). ConclusionAge-related differences in anti-depressant medication prescription were shown, with older patients above 65 years predominantly receiving tri- and tetra-cyclic medication, while younger patients aged 18–30 received SSRIs more frequently. Further studies with homogeneous groups relating to comorbidity profile and disease severity are needed to fully understand age effects on treatment patterns.

Increasing Depression Treatment for Safety‐Net Patients: A Five‐Year Evaluation of Integrated Mental Health Services in Primary Care across Los Angeles County

Research ObjectiveSocioeconomic disparities in mental health care use can be mitigated by interventions to systematically improve disease diagnosis and treatment. Beginning 2010, Los Angeles County Departments of Health Services (DHS) and Mental Health (DMH) collaborated to increase access to effective mental health treatment. Implemented in staggered fashion among select safety‐net clinics, the Mental Health Integration Program (MHIP) embedded behavioral health specialists to co‐manage primary care patients (e.g., psychiatric consultation support for medication prescription, brief problem‐focused psychotherapy). This study examined whether clinic MHIP implementation was associated with higher treatment initiation (medication receipt and/or specialist follow‐up [for psychotherapy]) in safety‐net clinic sites.Study DesignThis retrospectively cohort study examined 33,537 primary care patients who were newly diagnosed with depression from June 30, 2009 to July 1, 2014 (n = 39,066 person‐years), using merged medical and pharmacy records from DHS and DMH. Patients were seen in one of 19 clinics that were either: (1) before, (2) after, or (3) had never implemented MHIP. We followed patients for 90 days after a new diagnosis, defined as having no diagnoses in the prior year. Then, we determined whether patients received antidepressant medication (prescription filled per pharmacy records) and/or mental health specialist follow‐up (completed referral documented in medical records). In multilevel regression models, we used MHIP implementation status to predict odds of treatment initiation, controlling for time and patient demographic and clinical characteristics (e.g., comorbidity).Population Studied255,840 safety‐net patients seen in LA County.Principal FindingsIn 30.1% of episodes, primary care patients received any treatment within 90 days of a new depression diagnosis (38.7% [after] vs 36.2% [before] vs 25.0% [never implemented MHIP in clinic]). 27.9% received medication within 90 days, while only 3% reached specialists. In multivariate analyses (n = 30,347 person‐years), we found that there was 2.35‐times odds of treatment initiation among patients in clinics after MHIP implementation (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 2.18–2.55; p &lt; 0.001), compared to patients in clinic before implementation. This program effect was driven by medication treatment (OR = 2.42; CI = 2.24–2.63; p &lt; 0.001), as opposed to specialist follow‐up (OR = 1.14; CI = 0.88–1.47; p = 0.32). Odds of treatment initiation were higher among minority (Asian &gt; Latino &gt; Black) than White patients, Spanish‐ than English‐speaking patients, and uninsured than insured patients in the study sample.ConclusionsCollaboration between two large, distinct health systems and its resulting integrated care programs were associated with greater odds of treatment initiation among patients newly diagnosed with depression, compared to patients in clinics before implementation or in clinics that did not implement. Findings suggest potential positive effects of targeted outreach (to minority and Spanish‐speaking patients) and possible leakage of insured patients to private sectors for depression treatment.Implications for Policy or PracticeThis evaluation is one of few to document effects from widescale implementation of integrated mental health care, in particular within the country's second largest public health system. Observed mental health integration programs may need further innovation to address current access gaps in mental health specialty care, such that evidence‐based psychotherapy options are also available to safety‐net primary care patients.Primary Funding SourceDepartment of Veterans Affairs.

Effect of relative age on childhood mental health: A cohort of 9,548,393 children and adolescents.

The effect of relative age on the diagnoses of attention deficit hyperactivity disorder (ADHD), disruptive behavior disorder (DD), anxiety disorder, and depressive disorder and the prescription for ADHD and antidepressant medications remains unclear. To clarify the impact of relative age in a school year with the diagnoses of ADHD, DD, anxiety disorder, and depressive disorder and the prescription for ADHD and antidepressant medications. The annual cutoff birthdate for entry to school in Taiwan is August 31. The Taiwan National Health Insurance Research Database was used to enroll 9,548,393 children and adolescents aged 3-17years during the study period (September 1, 2001, to August 31, 2011). The Poisson regression model was performed to examine the likelihood of receiving diagnoses of ADHD, DD, anxiety disorder, and depressive disorder, as well as the prescription of ADHD and antidepressant medications among children born in August (the youngest) and September (the oldest). Both boys and girls born in August had a higher risk of being diagnosed as having ADHD (odds ratio [OR]=boys: 1.65, girls: 1.80), DD (1.29, 1.45), anxiety disorder (1.49, 1.33), and depressive disorder (1.10, 1.10). Furthermore, children born in August were more likely to be prescribed ADHD medication (1.71, 1.72) and antidepressants (1.18, 1.09) compared with those born in September. Relative age, as an indicator of neurocognitive maturity, is a critical factor for the likelihood of being diagnosed as having ADHD, DD, anxiety disorder, and depressive disorder among children and adolescents.