Users Of Antidepressant Medications Research Articles

Patterns, predictors, and patient-reported reasons for antidepressant discontinuation in the WHO World Mental Health Surveys.

Despite their documented efficacy, substantial proportions of patients discontinue antidepressant medication (ADM) without a doctor's recommendation. The current report integrates data on patient-reported reasons into an investigation of patterns and predictors of ADM discontinuation. Face-to-face interviews with community samples from 13 countries (n = 30 697) in the World Mental Health (WMH) Surveys included n = 1890 respondents who used ADMs within the past 12 months. 10.9% of 12-month ADM users reported discontinuation-based on recommendation of the prescriber while 15.7% discontinued in the absence of prescriber recommendation. The main patient-reported reason for discontinuation was feeling better (46.6%), which was reported by a higher proportion of patients who discontinued within the first 2 weeks of treatment than later. Perceived ineffectiveness (18.5%), predisposing factors (e.g. fear of dependence) (20.0%), and enabling factors (e.g. inability to afford treatment cost) (5.0%) were much less commonly reported reasons. Discontinuation in the absence of prescriber recommendation was associated with low country income level, being employed, and having above average personal income. Age, prior history of psychotropic medication use, and being prescribed treatment from a psychiatrist rather than from a general medical practitioner, in comparison, were associated with a lower probability of this type of discontinuation. However, these predictors varied substantially depending on patient-reported reasons for discontinuation. Dropping out early is not necessarily negative with almost half of individuals noting they felt better. The study underscores the diverse reasons given for dropping out and the need to evaluate how and whether dropping out influences short- or long-term functioning.

Symptom Change during Waitlist for Medicated and Nonmedicated Patients with Chronic Depression

Introduction: Patients seeking psychotherapy often spend time on waitlist (WL), the effect of which is largely unknown. WL patients may forego alternative non-psychotherapeutic assistance and thus do more poorly than had they not been placed on a WL. The course of symptoms might also be influenced by use of antidepressant medication (ADM), an issue that remains unexplored in the literature. Objective: In a naturalistic setting, WL symptom change before inpatient psychotherapy (mean weeks of waiting = 22.6) was assessed in a sample (N = 313) of chronically depressed patients. Methods: Using the Beck Depression Inventory-II, patients’ symptoms were tracked at assessment, when admitted to treatment (i.e., after WL), at posttreatment and 1-year follow-up. Multilevel growth curve analysis was used to examine waitlist change for the whole sample as well as for ADM users and nonmedicated patients. Results: Symptoms were reduced significantly from assessment to admittance (Cohen’s d = 0.47). Symptoms reduced less for ADM users (d = 0.39) than for nonmedicated patients (d = 0.65). Conclusion: The findings indicate that chronically depressed patients experience a decrease in symptoms during WL, quite likely due to treatment expectations. We discuss whether less symptom improvement for ADM users could be attributed to iatrogenic comorbidity and a higher degree of demoralization in this group.

Trajectories of change in chronic depression: Differences in self-criticism and somatic symptoms between users of antidepressants and nonmedicated patients.

Depression is typically seen as composed of several factors (i.e., cognitive, affective, somatic) which may be targeted by different interventions (i.e., pharmacotherapy, psychotherapy, or combination treatment). Successfully targeting these factors may contribute to improved treatment response in depression. A previous study identified two subfactors on Beck Depression Inventory-II (BDI-II) in a sample of chronically depressed patients: (a) self-criticism and (b) somatic symptoms (sleep disturbance, fatigue, changes in appetite). Prior research indicates that these symptoms may respond differently to psychotherapy and pharmacotherapy. In this study, we examined whether patients who were on antidepressant medication (ADM) had different outcomes on these factors than patients not using medication while undergoing intensive inpatient psychotherapeutic treatment. After adjusting for baseline difference with propensity score matching, a total of 238 patients with chronic depression were included in the analysis of which 119 patients were using ADM during treatment while 119 were not. We analyzed whether the two groups had different trajectories of change on the factors "self-criticism" and "somatic symptoms" using multilevel growth curve modeling. Patients not using medication during treatment had significantly larger symptom reduction than ADM users on the self-criticism factor, while there was no difference between groups on the somatic factor. There seems to be a difference in outcomes on self-criticism depending on the use of ADM for this patient group. This may suggest that the simultaneous use of ADM while in psychotherapy could make patients less accessible to the effects of psychotherapeutic interventions on this factor. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

S3198 Antidepressant Use Is Associated With Poor Clinical Outcomes in the Setting of Inflammatory Bowel Disease

INTRODUCTION: Antidepressant medications (AMs) are frequently used in inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC). Many AMs are designed to enhance serotonin (5-HT) signaling. Increased 5-HT availability is associated with inflammation in animal models and human studies of IBD. We hypothesized that use of 5-HT-enhancing AMs would be associated with poor clinical outcomes in IBD. METHODS: We performed a retrospective cohort study using the Truven Health Marketscan® commercial claims database between 1/1/06 and 12/31/12. Participants (18–64 years) had at least 2 appropriate ICD-9 diagnoses for IBD, concurrent use of IBD medications, no other auto-inflammatory disease, at least 1 year of continuous enrollment before index diagnosis and 2 years after, during the study period. We identified new prescriptions of AM (includingselective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic, tetracyclics, monoamine oxidase inhibitors and other varieties) using the medication possession ratio (MPR; 80% adherence).Primary outcomes were: corticosteroid use, IBD-related complication (intestinal stricture and/or fistula), hospitalization, emergency room (ER) visit, IBD-related surgery and death within 2 years of IBD diagnosis or starting AM. We performed descriptive statisticsand calculatedadjusted hazard ratios (aHRs) comparing 2 groups (AM use vs. no AM use) for each of the outcomes above (adjusting for age, sex, comorbidity, IBD medication use and clinic visits). We also performed subgroup analyses considering IBD and AM subtype. RESULTS: 117,255 people had IBD (51.3% male; 55.6% UC). 7.1% used at least one AM during the follow-up period [most often a SSRI (4.9%) and/or SNRI (1.1%)]. AM users were younger, more likely female and to have several comorbidities, and used IBD-targeted medications more often (Table 1). Corticosteroid use, hospitalizations, ER visits and death were independently associated with AM use (Table 2).In the UC cohort, AM users were more likely to have complications [aHR = 1.90 (1.42–2.54), P < 0.0001)]. SSRIs were the only group independently associated with death [aHR = 7.93 (3.62–17.36), P < 0.0001]. CONCLUSION: We demonstrated that AM use is independently associated with an increased risk of many poor outcomes in IBD (including death). While further study is warranted, providers should exercise caution when using AM in IBD, particularly SSRIs.Table 1.: Demographic and Clinical Characteristics of Antidepressant Medication Users and Non-Users. AM = antidepressant medication; SD = standard deviation.Table 2.: Cox Proportional Hazards Model Evaluating Clinical Outcomes Associated with Antidepressant Use in the full IBD cohort.

Genome-wide association study of depressive symptoms in the Hispanic Community Health Study/Study of Latinos

Although genome-wide association studies (GWAS) have identified several variants linked to depression, few GWAS of non-European populations have been performed. We conducted a genome-wide analysis of depression in a large, population-based sample of Hispanics/Latinos. Data came from 12,310 adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Past-week depressive symptoms were assessed using the 10-item Center for Epidemiological Studies of Depression Scale. Three phenotypes were examined: a total depression score, a total score modified to account for psychiatric medication use, and a score excluding anti-depressant medication users. We estimated heritability due to common variants (h2SNP), and performed a GWAS of the three phenotypes. Replication was attempted in three independent Hispanic/Latino cohorts. We also performed sex-stratified analyses, analyzed a binary trait indicating probable depression, and conducted three trans-ethnic analyses. The three phenotypes exhibited significant heritability (h2SNP = 6.3–6.9%; p = .002) in the total sample. No SNPs were genome-wide significant in analyses of the three phenotypes or the binary indicator of probable depression. In sex-stratified analyses, seven genome-wide significant SNPs (one in females; six in males) were identified, though none were supported through replication. Four out of 24 loci identified in prior GWAS were nominally associated in HCHS/SOL. There was no evidence of overlap in genetic risk factors across ancestry groups, though this may have been due to low power. We conducted the largest GWAS of depression-related phenotypes in Hispanic/Latino adults. Results underscore the genetic complexity of depressive symptoms as a phenotype in this population and suggest the need for much larger samples.

Study of the alteration of gustatory perception in users of antidepressant drugs

The use of antidepressant drugs has increased alarmingly in society, it is noteworthy that some drugs when used chronically and / or associated with other drugs may result in changes in taste. The palate provides essential information about the food, avoiding, for example, the intake of food unfit for consumption. In this context, this study aimed to verify the taste sensitivity users of antidepressant medications, measuring the threshold index for sweet and salty tastes. The survey was conducted with 80 individuals, 40 users of antidepressant medications and other nonusers of antidepressants. In the study group, we applied a structured sociodemographic and lifestyle questionnaire, conducted a nutritional assessment, and analyzed the medical records concerning medication use. The evaluation of sensitivity was performed by the taste perception threshold test, i.e., the rapid method of type-3 Alternative Forced Choice for the test and control group. It was observed that the perception of sweet and salty tastes limits are increased in users of antidepressant drugs compared to the control group, showing significant difference between the threshold levels of the groups. Therefore, it was noted that users of antidepressant medications by determining the threshold index, have a lower sensitivity to taste sweet and salty tastes.

Plasma insulin-like growth factor I levels are higher in depressive and anxiety disorders, but lower in antidepressant medication users

It has been postulated that many peripheral and (neuro)biological systems are involved in psychiatric disorders such as depression. Some studies found associations of depression and antidepressant treatment with insulin-like growth factor 1 (IGF-I) – a pleiotropic hormone affecting neuronal growth, survival and plasticity – but evidence is mixed. We therefore studied whether depressive and anxiety disorders were associated with plasma IGF-I, and explored the role of antidepressant medication in this association in a large observational study.The sample consisted of 2714 participants enrolled in The Netherlands Study of Depression and Anxiety, classified as healthy controls (n=602), antidepressant users (76 remitted and 571 with current depressive and/or anxiety disorder(s), n=647), persons having remitted depressive and/or anxiety disorder(s) without antidepressant use (n=502), and persons having current depressive and/or anxiety disorder(s) without antidepressant use (n=963). Associations with IGF-I concentrations were studied and adjusted for socio-demographic, health, and lifestyle variables.Relative to healthy controls, antidepressant-free individuals with current disorders had significantly higher IGF-I levels (Cohen’s d=0.08, p=0.006), whereas antidepressant-free individuals with remitted disorders had a trend towards higher IGF-I levels (d=0.06, p=0.09). Associations were evident for depressive and for anxiety disorders. In contrast, antidepressant users had significantly lower IGF-I levels compared to healthy controls (d=−0.08, p=0.028).Our findings suggests that antidepressant medication use modifies the association between depressive/anxiety disorders and plasma IGF-I. These results corroborate with findings of some previous small-scale case-control and intervention studies. The higher IGF-I levels related to depression and anxiety might point to a compensatory mechanism to counterbalance the impaired neurogenesis, although future studies are needed to support this hypothesis.

Characteristics of antidepressant medication users in a cohort of mid-age and older Australians.

We aimed to investigate antidepressant use, including the class of antidepressant, in mid-age and older Australians according to sociodemographic, lifestyle and physical and mental health-related factors. Baseline questionnaire data on 111,705 concession card holders aged ⩾45 years from the 45 and Up Study-a population-based cohort study from New South Wales, Australia-were linked to administrative pharmaceutical data. Current- and any-antidepressant users were those dispensed medications with Anatomical Therapeutic Chemical classification codes beginning N06A, within ⩽6 months and ⩽19 months before baseline, respectively; non-users had no antidepressants dispensed ⩽19 months before baseline. Multinomial logistic regression was used to calculate adjusted relative risk ratios (aRRRs) for predominantly self-reported factors in relation to antidepressant use. Some 19% of the study population (15% of males and 23% of females) were dispensed at least one antidepressant during the study period; 40% of participants used selective serotonin reuptake inhibitors (SSRIs) only and 32% used tricyclic antidepressants (TCAs) only. Current antidepressant use was markedly higher in those reporting: severe versus no physical impairment (aRRR 3.86(95%CI 3.67-4.06)); fair/poor versus excellent/very good self-rated health (4.04(3.83-4.25)); high/very high versus low psychological distress (7.22(6.81-7.66)); ever- versus never-diagnosis of depression by a doctor (18.85(17.95-19.79)); low-dose antipsychotic use versus no antipsychotic use (12.26(9.85-15.27)); and dispensing of ⩾10 versus <5 other medications (5.97(5.62-6.34)). Sociodemographic and lifestyle factors were also associated with use, although to a lesser extent. Females, older people, those with lower education and those with poorer health were more likely to be current antidepressant users than non-users and were also more likely to use TCAs-only versus SSRIs-only. Use of antidepressants is substantially higher in those with physical ill-health and in those reporting a range of adverse mental health measures. In addition, sociodemographic factors, including sex, age and education were also associated with antidepressant use and the class of antidepressant used.

Understanding Treatment Experiences of Long-Term Users of Antidepressant Medications

within the period 1-Oct-2011 to 29-Feb-2012 in several countries in five regions; Western, Northern and Eastern Europe, North and South America and Australia. Pregnant women and women with a child aged %1 year were eligible to participate. Data was analysed using IBM SPSS Statistics 20. The study was approved by the relevant Ethics Boards in each country, whenever applicable. Preliminary Results: In total, 9,459 women were included, whereof 6,941 (73.4%) had experienced nausea during pregnancy. Both the prevalence of nausea and its treatment varied between regions. Of these women, 1,913 (27.6%) had used some form of treatment against nausea. Conventional medicines were used against nausea by 1,274 (18.4%) of the women, and herbal medicines by 568 (8.2%) women. Region of residence and folic acid use are factors that were significantly associated with use of treatment in general, and also with use of both conventional and herbal medicines. However, the factors’ influence varied according to type of treatment. Compared to untreated women both users of conventional and herbal medicines showed significant differences according to beliefs about medicines. Women who had nausea did also show a high burden of co-morbidity. Preliminary Conclusions: Regional differences of both the extent of nausea and its treatment were identified. Users of conventional or herbal medicines both differed from untreated women with regard to region of residence, folic acid use and beliefs about medicines. Understanding these factors could form an International basis for treatment strategies.

An electronic health record driven algorithm to identify incident antidepressant medication users.

ObjectiveWe validated an algorithm designed to identify new or prevalent users of antidepressant medications via population-based drug prescription records.Patients and methodsWe obtained population-based drug prescription records for the entire Olmsted County, Minnesota, population from 2011 to 2012 (N=149 629) using the existing electronic medical records linkage infrastructure of the Rochester Epidemiology Project (REP). We selected electronically a random sample of 200 new antidepressant users stratified by age and sex. The algorithm required the exclusion of antidepressant use in the 6 months preceding the date of the first qualifying antidepressant prescription (index date). Medical records were manually reviewed and adjudicated to calculate the positive predictive value (PPV). We also manually reviewed the records of a random sample of 200 antihistamine users who did not meet the case definition of new antidepressant user to estimate the negative predictive value (NPV).Results161 of the 198 subjects electronically identified as new antidepressant users were confirmed by manual record review (PPV 81.3%). Restricting the definition of new users to subjects who were prescribed typical starting doses of each agent for treating major depression in non-geriatric adults resulted in an increase in the PPV (90.9%). Extending the time windows with no antidepressant use preceding the index date resulted in only modest increases in PPV. The manual abstraction of medical records of 200 antihistamine users yielded an NPV of 98.5%.ConclusionsOur study confirms that REP prescription records can be used to identify prevalent and incident users of antidepressants in the Olmsted County, Minnesota, population.

Weight and metabolic effects of dietary weight loss and exercise interventions in postmenopausal antidepressant medication users and non-users: A randomized controlled trial

ObjectiveAntidepressants may attenuate the effects of diet and exercise programs. We compared adherence and changes in body measures and biomarkers of glucose metabolism and inflammation between antidepressant users and non-users in a 12-month randomized controlled trial. MethodsOverweight or obese, postmenopausal women were assigned to: diet (10% weight loss goal, N=118); moderate-to-vigorous aerobic exercise (225min/week, N=117); diet+exercise (N=117); and control (N=87) in Seattle, WA 2005–2009. Women using antidepressants at baseline were classified as users (N=109). ANCOVA and generalized estimating equation approaches, respectively, were used to compare adherence (exercise amount, diet session attendance, and changes in percent calorie intake from fat, cardiopulmonary fitness, and pedometer steps) and changes in body measures (weight, waist and percent body fat) and serum biomarkers (glucose, insulin, homeostasis assessment-insulin resistance, and high-sensitivity C-reactive protein) between users and non-users. An interaction term (intervention×antidepressant use) tested effect modification. ResultsThere were no differences in adherence except that diet session attendance was lower among users in the diet+exercise group (P<0.05 vs. non-users). Changes in body measures and serum biomarkers did not differ by antidepressant use (Pinteraction>0.05). ConclusionDietary weight loss and exercise improved body measures and biomarkers of glucose metabolism and inflammation independent of antidepressant use.

Short-Term Exposure to Antidepressant Drugs and Risk of Acute Angle-Closure Glaucoma Among Older Adults

Acute angle-closure glaucoma (AACG) is an ocular emergency that may be precipitated by certain types of medications. Antidepressant drugs can affect a number of neurotransmitters, which are involved in the regulation of the iris, which may precipitate AACG. We used a case-crossover study design to investigate the association between recent exposure to antidepressant drugs and AACG. We identified patients with AACG among adults aged 66 years or older between 1998 and 2010 in Ontario using linked population-based administrative databases. We identified intermittent users of antidepressant medications through prescription drug claims in the year preceding AACG. We determined antidepressant exposure in the period immediately before AACG and compared it with antidepressant exposure in 2 earlier control periods. We used conditional logistic regression to determine the odds ratio for antidepressant exposure in the hazard period compared with the control periods. A total of 6470 patients with AACG occurred during the study period. The mean age of the patients was 74.3 years, and 66% were female. Overall, 5.6% of individuals were intermittent users of antidepressant drugs in the year preceding AACG. The odds ratio for any antidepressant exposure in the period immediately preceding AACG was 1.62 (95% confidence interval, 1.16-2.26). An increased risk of AACG was also observed in several subgroups. We conclude that recent exposure to antidepressant drugs is associated with an increased risk of AACG. Clinicians should remain vigilant for the development of this uncommon but potentially serious adverse event after initiating antidepressant therapy.

Inconsistent Data Link Antipsychotic Use, Diabetes

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessInconsistent Data Link Antipsychotic Use, DiabetesLeslie SinclairLeslie SinclairSearch for more papers by this authorPublished Online:20 Jan 2012https://doi.org/10.1176/pn.47.2.psychnews_47_2_22-aAbstractDo second-generation antipsychotic medications cause diabetes in children and adolescents? That’s the question a team of researchers based at the Meyers Primary Care Institute of the University of Massachusetts School of Medicine recently sought to assess.“Numerous case reports and studies have suggested a link between the use of antipsychotic medications and diabetes mellitus, impaired glucose tolerance, and insulin resistance in adult populations, although the evidence has been inconsistent,” said Susan Andrade, Sc.D., a senior research associate at the Meyers Primary Care Institute and a research associate professor of medicine at the University of Massachusetts Medical School, and colleagues. Their results were published in the December 2011 Pediatrics.Is there a link between diabetes and the use of antipsychotic medications in children? The jury is still out.Credit: jordache/ ShutterstockIn light of dramatic increases in use of second-generation antipsychotics in children and adolescents, Andrade and colleagues evaluated the risk of incident diabetes mellitus associated with the use of these medications in a large diverse cohort of children who had received treatment in a typical clinical practice.To do so, they conducted a retrospective study using the administrative databases of three health plans participating in the Health Maintenance Organization Research Network. Children aged 5 to 18 who began second-generation antipsychotic therapy from January 2001 through December 2008 were compared with two control groups: nonusers of psychotropic drugs and users of antidepressant medications. “This approach allowed us to select children more likely to be similar to second-generation antipsychotic users in terms of treatment for mental health conditions and the potential for detection/diagnosis of diabetes,” explained the researchers. Diagnoses from inpatient and outpatient records, pharmacy dispensings, and outpatient laboratory results were used to identify incident cases of diabetes.Looking at information on more than 9,000 children who had received second-generation antipsychotics, and comparing them with more than 38,000 who had received no psychotropics, and more than 26,000 who had received antidepressants, the researchers found their results to be inconsistent.A total of 57 children were identified as having incident diabetes during the follow-up period. “The findings differed depending on the comparison group and the definition of the outcome of interest,” the researchers noted. “We found a potentially fourfold increased rate of diabetes among children exposed to second-generation antipsychotics in comparison with children not exposed, but no statistically significantly increased rate in comparison with children exposed to antidepressant medication.”The researchers also noted the existence of previous evidence suggesting that youths receiving second-generation antipsychotics experience adverse changes in body composition and metabolic parameters even after short-term therapy.Limitations of the present study, including the small number of cases, they said, suggest that additional research is needed to define the nature and magnitude of the diabetes risk associated with second-generation antipsychotic use among children.The study received funding from the Agency for Healthcare Research and Quality.An abstract of “Antipsychotic Medication Use Among Children and Risk of Diabetes Mellitus” is posted at http://pediatrics.aappublications.org/content/128/6/1135. ISSUES NewArchived

Antipsychotic Medication Use Among Children and Risk of Diabetes Mellitus

To assess whether the risk of incident diabetes was increased with the use of second-generation antipsychotics (SGAs) in a large diverse cohort of children. A retrospective study was conducted by using the administrative databases of 3 health plans participating in the Health Maintenance Organization Research Network. Children 5 to 18 years of age who initiated SGA therapy between January 2001 and December 2008 and 2 comparison groups, namely, nonusers of psychotropic drugs and users of antidepressant medications, were identified. Diagnoses from inpatient and outpatient records, pharmacy dispensings, and outpatient laboratory results were used to identify incident cases of diabetes. The crude incidence rate of diabetes for the SGA-exposed cohort was 3.23 cases per 1000 person-years (95% confidence interval [CI]: 1.67-5.65), compared with 0.76 cases per 1000 person-years (95% CI: 0.49-1.12) among nonusers of psychotropic medications and 1.86 cases per 1000 person-years (95% CI: 1.12-2.90) among antidepressant users. The risk of incident diabetes was significantly increased among SGA users (unadjusted incidence rate ratio: 4.24 [95% CI: 1.95-8.72]) in comparison with nonusers of psychotropic medications but was not significantly increased in comparison with antidepressant medication users (unadjusted incidence rate ratio: 1.74 [95% CI: 0.77-3.78]). Although we found a potentially fourfold increased rate of diabetes among children exposed to SGAs, the findings were inconsistent and depended on the comparison group and the outcome definition.

Use of antidepressant medication and risk of type 2 diabetes: results from three cohorts of US adults.

The results of several studies have suggested a potential positive association between use of antidepressant medication (ADM) and incident type 2 diabetes mellitus. We examined this association in three cohorts of US adults. We followed 29,776 men in the Health Professionals Follow-up Study (HPFS, 1990-2006), 61,791 women in the Nurses' Health Study I (NHS I, 1996-2008) and 76,868 women in NHS II (1993-2005), who were free of diabetes mellitus, cardiovascular disease or cancer at baseline. The mean baseline ages for participants from the HPFS and NHS I and II were 56.4, 61.3 and 38.1 years, respectively. ADM use and other covariates were assessed at baseline and updated every 2 years. A time-dependent Cox proportional hazards model was used, and HRs were pooled together across the three cohorts. During 1,644,679 person-years of follow-up, we documented 6,641 new cases of type 2 diabetes. ADM use was associated with an increased risk of diabetes in all three cohorts in age-adjusted models (pooled HR 1.68 [95% CI 1.27, 2.23]). The association was attenuated after adjustment for diabetes risk factors and histories of high cholesterol and hypertension (1.30 [1.14, 1.49]), and further attenuated by controlling for updated BMI (1.17 [1.09, 1.25]). Use of selective serotonin reuptake inhibitors and other antidepressants (mainly tricyclic antidepressants) were both associated with an elevated risk of diabetes, with pooled multivariate-adjusted HRs of 1.10 (1.00, 1.22) and 1.26 (1.11, 1.42), respectively. The results suggest that ADM users had a moderately elevated risk of type 2 diabetes mellitus compared with non-users, even after adjustment for BMI.

New users of antidepressant medications: first episode duration and predictors of discontinuation

Clinical guidelines recommend that antidepressant treatment should be continued for at least 6 months. We examined persistence in patients initiated on an antidepressant medication and factors associated with treatment cessation. We conducted a cohort study of antidepressant initiators in the Australian veteran population. Patients included were those who had filled at least one prescription for an antidepressant between 2005 and 2008 but had no antidepressants in the preceding 12 months. Kaplan-Meier was used to assess the treatment duration and Cox regression estimated the hazard ratio (HR) of ceasing antidepressant therapy. There were 91,183 antidepressant users of which more than 50% were prevalent users. Among new users (n = 28,585), 50% discontinued within 6 months, and 61% within 12 months. The median duration for antidepressant treatment was 175 days [95% confidence interval (CI), 168-180]. Patients who received psychological or psychiatrist care around the time of initiation had higher persistence (HR: 0.86, CI: 0.77-0.95 and HR: 0.67, CI: 0.61-0.75 respectively), those with psychiatric disorders and dementia were also more persistent (HR: 0.82, CI: 0.77-0.88 and HR: 0.77, CI: 0.72-0.83 respectively). In contrast, patients with cancer and multi-morbidities had a higher risk of discontinuation (HR: 1.10, CI: 1.03-1.18 and HR: 1.16, CI: 1.05-1.28 respectively). This analysis indicates persistence with antidepressants in the Australian veteran patients is inconsistent with clinical guidelines, with the majority of initiating patients provided with insufficient duration. Enhanced management of patients with characteristics associated with shorter persistence, including cancer and multi-morbidities, may improve antidepressant use.

Health Advisories and Patterns of Patient Monitoring Among New Users of Antidepressant Medications

In 2003, more intense monitoring of patients initiating antidepressants was advised because of emerging concerns of suicidality. We sought to identify patterns of patient monitoring after antidepressant initiation in British Columbia before and after issuance of health advisories. We conducted a cohort study of antidepressant initiators between 1999 and 2005 using healthcare utilization data of all British Columbia residents. For the periods before (1999-2001) and after (2004-2005), health advisories concerning suicidality associated with antidepressants, we assessed monitoring intensity by calculating weekly physician and psychotherapy visit rates since antidepressant initiation. We also estimated monitoring patterns as the proportion of individuals who received weekly in-person contact during the first 4 weeks of treatment, then biweekly visits for 4 weeks, and then a visit at 12 weeks, as a proxy for intensive monitoring. Patterns of monitoring intensity were similar before and after the health advisories, but the level of intensity was lower after the advisory period. Overall, monitoring intensity peaked in the 4 weeks after antidepressant initiation. Weekly numbers of visits per subject during these 4 weeks were between 0.44 and 0.49 before the advisory and from 0.39 to 0.44 after the advisory. Among all initiators stratified by year of initiation, between 21% and 25% received intensive monitoring, and this proportion generally decreased on a yearly basis. Monitoring intensity for patients with depression initiating antidepressants decreased after the period of emergence and greater awareness of the association between antidepressants and suicidality.

Estimating ethnic differences in self‐reported new use of antidepressant medications: results from the Multi‐Ethnic Study of Atherosclerosis

There is evidence that the utilization of antidepressant medications (ADM) may vary between different ethnic groups in the United States population. The Multi-Ethnic Study of Atherosclerosis (MESA) is a population-based prospective cohort study of 6814 US adults from 4 different ethnic groups. After excluding baseline users of ADM, we examined the relation between baseline depression and new use of ADM for 4 different ethnicities: African-Americans (n = 1822), Asians (n = 784) Caucasians (n = 2300), and Hispanics (n = 1405). Estimates of the association of ethnicity and ADM use were adjusted for age, study site, gender, Center for Epidemiologic Studies Depression Scale (CES-D), alcohol use, smoking, blood pressure, diabetes, education, and exercise. Non-random loss to follow-up was present and estimates were adjusted using inverse probability of censoring weighting (IPCW). Of the four ethnicities, Caucasian participants had the highest rate of ADM use (12%) compared with African-American (4%), Asian (2%), and Hispanic (6%) participants. After adjustment, non-Caucasian ethnicity was associated with reduced ADM use: African-American (HR: 0.42; 95% Confidence Interval (CI): 0.31-0.58), Asian (HR: 0.14; 95%CI: 0.08-0.26), and Hispanic (HR: 0.47; 95%CI: 0.31-0.65). Applying IPCW to correct for non-random loss to follow-up among the study participants weakened but did not eliminate these associations: African-American (HR: 0.48; 95%CI: 0.30-0.57), Asian (HR: 0.23; 95%CI: 0.13-0.37), and Hispanic (HR: 0.58; 95%CI: 0.47-0.67). Non-Caucasian ethnicity is associated with lower rates of new ADM use. After IPCW adjustment, the observed ethnicity differences in ADM use are smaller although still statistically significant.

Tricyclic Antidepressants and Non-Hodgkin Lymphoma

An increased risk of non-Hodgkin lymphoma (NHL) has been reported among long-term users of tricyclic antidepressants. The incidence of NHL among 43,932 users of any antidepressant medication (2 or more prescriptions) in the county of North Jutland, Denmark, during 1989-2003 was compared with NHL incidence in all those not using antidepressants (0 or 1 prescription). We used Poisson regression analysis adjusted for age, sex, period, use of immunosuppressive drugs, corticosteroids, or nonsteroidal anti-inflammatory drugs. Use of tricyclic antidepressants was associated with an overall increased incidence of NHL (adjusted incidence rate ratio [IRR] = 1.53; 95% confidence interval [CI] = 1.06-2.21) compared with nonuse. The IRR in users with > or =10 prescriptions and 5 or more years of follow-up was 2.50 (CI = 1.43-4.34). Users of other types of antidepressants were not at increased risk of NHL. Our results indicate an increased risk of non-Hodgkin lymphoma specifically among long-term users of tricyclic antidepressant medications.

Breast Cancer Risk Among Users of Antidepressant Medications

Breast cancer is the most common cancer in women. Laboratory studies suggest that antidepressants may promote breast cancer tumor growth. Several epidemiologic studies have evaluated this association with conflicting results. We conducted a cohort study with a secondary nested case-control analysis based on the General Practice Research Database. Our goal was to assess the association between the risk of breast cancer and use of serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and other antidepressants. We calculated adjusted estimates controlling for breast cancer risk factors using unconditional logistic regression. A total of 3708 cases of breast cancer were ascertained. Overall, antidepressant use was not associated with an increased risk of breast cancer. Current users of SSRIs had an odds ratio (OR) of 0.98 (95% confidence interval=0.81-1.19), whereas current users of TCAs had an OR of 0.86 (0.73-1.00). When only use for longer than 1 year was considered, the corresponding estimates for SSRIs and TCAs were 0.76 (0.53-1.09) and 0.87 (0.70-1.09), respectively. None of the individual drugs was associated with breast cancer risk. Use of antidepressants was not associated with an increased risk of breast cancer regardless of duration of use, daily dose, or specific drug being used. These results, together with evidence from prior studies, support the lack of a clinically meaningful association between breast cancer risk and antidepressants.