A systematic review of measures of medication adherence in consumers with unipolar depression

Srimongkon, Pornchanok; Aslani, Parisa; Chen, Timothy

doi:10.1016/j.sapharm.2018.02.008

Cited by 8 publications

(8 citation statements)

References 54 publications

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“…Overall, 61% of the patients included in our analysis failed to refill their antidepressants after the initial 30‐day supply. This discontinuation rate appears high but is not unprecedented because previous investigations demonstrated that up to 60% of patients are no longer adherent with antidepressant medications after 10 weeks of therapy 47 . A variety of explanations has been suggested for nonadherence to antidepressant regimens including reluctance to start treatment, poor tolerability, limited effectiveness, and delays in obtaining refills 48, 49 …”

Section: Discussionmentioning

confidence: 99%

Combining Antidepressants with β‐Blockers: Evidence of a Clinically Significant CYP2D6 Drug Interaction

2020

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BACKGROUND The b-blockers and antidepressants are two of the most commonly prescribed drug classes in the United States. Several antidepressants are potent inhibitors of cytochrome P450 2D6 liver enzymes (CYP2D6) and can increase the plasma concentrations of certain b-blockers when administered concomitantly, potentially leading to serious medical consequences such as hypotension, bradycardia, and falls. OBJECTIVE The primary objective of this investigation was to determine whether initiating an antidepressant in patients receiving b-blockers increased the risk of hemodynamic adverse events. Our primary outcome was time to hospital admissions or emergency department (ED) visits for an International Classification of Diseases-9 diagnosis suggestive of excessive b-blockade. METHODS We conducted a survival analysis for adults continuously enrolled in the California Medicaid system (Medi-Cal) between 2004 and 2012. Eligible patients were required to be receiving b-blocker medications that are primarily CYP2D6 substrates (e.g., metoprolol, propranolol, or carvedilol). Univariate and multivariable analyses were performed for patients who concurrently received antidepressants with b-blockers. An additional multivariable analysis analyzed the association of this combination upon hospitalizations or ED visits for all causes. RESULTS A total of 21,292 beneficiaries met the inclusion criteria, and 4.3% of patients required hospitalization or ED visits within 30 days of co-medication. In multivariable analysis, patients receiving antidepressants with moderate to strong CYP2D6 inhibitory potential (fluoxetine, paroxetine, duloxetine, or bupropion) had a greater risk for hospitalization or ED visits for hemodynamic events than those initiated on antidepressants with weak CYP2D6 inhibition for 30 days or less when each was compared with patients receiving no antidepressants (hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.03-2.81; p=0.04 vs HR 1.24; 95% CI 0.82-1.88; p=0.30). Other demographic variables associated with increased morbidity included advanced age, male sex, higher b-blocker doses, and African American race or Hispanic ethnicity. CONCLUSIONS Results of this analysis suggest that initiation of certain antidepressants was associated with an increased risk for serious medical sequelae among patients concurrently receiving b-blockers. Greater risk was observed with antidepressants that potently inhibit the CYP2D6 enzyme, implying that increased morbidity may be mediated by a metabolic drug interaction. KEY WORDS b-blockers, antidepressants, drug interactions, cytochrome P450 2D6, pharmacoepidemiology.

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Section: Discussionmentioning

confidence: 99%

Combining Antidepressants with β‐Blockers: Evidence of a Clinically Significant CYP2D6 Drug Interaction

2020

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“…Data extracted included (1) author, year and country, (2) study design; (3) number of caregiver participants; (4) mean age; (5) tool/survey name, description and focus of medication management; and (6) key findings in relation to caregiver medication management. A content analysis of the tools and surveys within the included studies was undertaken to extract reliability and validity information 20 …”

Section: Methodsmentioning

confidence: 99%

“…A content analysis of the tools and surveys within the included studies was undertaken to extract reliability and validity information. 20 …”

Section: Methodsmentioning

confidence: 99%

Tools to evaluate medication management for caregivers of people living with dementia: A systematic review

Gench

Sawan

Langford

et al. 2021

Health Expectations

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Background Caregivers often undertake medication management for people living with dementia without formal training. There is a need to evaluate caregiver medication management practices for people living with dementia to identify and address the key issues that contribute to caregiver burden. Objectives This study aimed to identify and summarize approaches that evaluate medication management for caregivers of people living with dementia and appraise caregiver's involvement in aspects of medication management. Search Strategy A systematic search was undertaken in five databases: Medline, Embase, PsycINFO, Scopus and International Pharmaceutical Abstracts. Studies written in English that contained tools and surveys that evaluated aspects of medication management for caregivers of PWD were included. Results A total of 10 studies were included. Medication selection was assessed in six studies, supply and monitoring/review was captured in seven studies, with administration assessed in nine studies. Caregivers were commonly involved in decision‐making for medication changes (77.1%–86.8%) and in the ordering (55.9%–86.0%) and collection (87.0%–92.4%) of medications. Reported caregiver involvement in medication administration showed a wide range (44%–94.7%) between the studies. Challenges in administration were commonly related to polypharmacy and dosage regimen complexity. Conclusions Current tools capture specific aspects of medication management, with medication administration the most evaluated aspect of medication management. Future research is needed to develop a tool to holistically evaluate the complexities of medication management for caregivers of people living with dementia to minimize adverse events at transitions of care. Public Contribution From the authors' previous research, caregivers highlighted the need to address key issues in medication management for people living with dementia.

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“…19,20 Nonadherence and poor persistence with ADMs are recognised as key causes of treatment failure in mood disorders. 20,21 Nonadherence is particularly common in Chinese populations, where stigmatisation around depression and mood disorders often results in discontinuation of ADMs. 22,23 Sertraline is a first-line SSRI approved for the management of MDD and OCD in many countries, including China, and has a wellestablished safety and efficacy profile in different patient populations.…”

Section: Introductionmentioning

confidence: 99%

“… 16 , 17 Despite the availability of multiple ADMs, at least 30%‐40% of patients fail to adequately respond to initial pharmacotherapy, 18 and 50%‐60% of patients prematurely discontinue treatment. 19 , 20 Nonadherence and poor persistence with ADMs are recognised as key causes of treatment failure in mood disorders. 20 , 21 Nonadherence is particularly common in Chinese populations, where stigmatisation around depression and mood disorders often results in discontinuation of ADMs.…”

Section: Introductionmentioning

confidence: 99%

Impact of sertraline daily treatment regimen on adherence, persistence and healthcare resource utilisation in patients with major depressive disorder or obsessive‐compulsive disorder: A real‐world evidence analysis from the United States

Wang

Imperato

et al. 2021

Int J Clin Pract

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A systematic review of measures of medication adherence in consumers with unipolar depression

Cited by 8 publications

References 54 publications

Combining Antidepressants with β‐Blockers: Evidence of a Clinically Significant CYP2D6 Drug Interaction

Combining Antidepressants with β‐Blockers: Evidence of a Clinically Significant CYP2D6 Drug Interaction

Tools to evaluate medication management for caregivers of people living with dementia: A systematic review

Impact of sertraline daily treatment regimen on adherence, persistence and healthcare resource utilisation in patients with major depressive disorder or obsessive‐compulsive disorder: A real‐world evidence analysis from the United States

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