Diagnostic accuracy and adequacy of treatment of depressive and anxiety disorders: A comparison of primary care and specialized care patients

Castro-Rodríguez, José Ignacio; Olariu, Elena; Garnier-Lacueva, Carolina; Martín-López, Luis Miguel; Pérez‐Solà, Víctor; Alonso, Jordi; Forero, Carlos G.

doi:10.1016/j.jad.2014.10.020

Cited by 22 publications

(17 citation statements)

References 47 publications

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“…Compelling evidence indicates that a significant proportion of patients with MDD remain inadequately treated, especially in primary care settings [4,5]. Nonadherence and premature discontinuation of treatment are important factors that may significantly contribute to suboptimal outcomes [6].…”

Section: Introductionmentioning

confidence: 99%

The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature

Carvalho

Sharma²,

Brunoni³

et al. 2016

Psychother Psychosom

481

324

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Newer generation antidepressant drugs (ADs) are widely used as the first line of treatment for major depressive disorders and are considered to be safer than tricyclic agents. In this critical review, we evaluated the literature on adverse events, tolerability and safety of selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, bupropion, mirtazapine, trazodone, agomelatine, vilazodone, levomilnacipran and vortioxetine. Several side effects are transient and may disappear after a few weeks following treatment initiation, but potentially serious adverse events may persist or ensue later. They encompass gastrointestinal symptoms (nausea, diarrhea, gastric bleeding, dyspepsia), hepatotoxicity, weight gain and metabolic abnormalities, cardiovascular disturbances (heart rate, QT interval prolongation, hypertension, orthostatic hypotension), genitourinary symptoms (urinary retention, incontinence), sexual dysfunction, hyponatremia, osteoporosis and risk of fractures, bleeding, central nervous system disturbances (lowering of seizure threshold, extrapyramidal side effects, cognitive disturbances), sweating, sleep disturbances, affective disturbances (apathy, switches, paradoxical effects), ophthalmic manifestations (glaucoma, cataract) and hyperprolactinemia. At times, such adverse events may persist after drug discontinuation, yielding iatrogenic comorbidity. Other areas of concern involve suicidality, safety in overdose, discontinuation syndromes, risks during pregnancy and breast feeding, as well as risk of malignancies. Thus, the rational selection of ADs should consider the potential benefits and risks, likelihood of responsiveness to the treatment option and vulnerability to adverse events. The findings of this review should alert the physician to carefully review the appropriateness of AD prescription on an individual basis and to consider alternative treatments if available.

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Section: Introductionmentioning

confidence: 99%

The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature

Carvalho

Sharma²,

Brunoni³

et al. 2016

Psychother Psychosom

481

324

View full text Add to dashboard Cite

show abstract

“…The patient profile described in this study is comparable to previous evaluations. The increased percentage of female patients in primary care settings has been previously described in Spain [11,20]. On average, the patients that access specialised care are slightly younger and are mostly diagnosed with a severe disorder, which is not surprising given the low detection rate of mild forms of depression [21].…”

Section: Discussionmentioning

confidence: 83%

“…Despite the significant social and economic burden of depressive disorders, several studies suggest that an important percentage of patients receive inadequate treatment and that the adherence to guidelines is seemingly low [11], although improved treatment protocols have been proven useful in decreasing the economic burden associated to these disorders [12].…”

Section: Introductionmentioning

confidence: 99%

“…These guidelines specify diagnosis criteria and treatment options for the diverse presentations of depression, classifying treatment options in physiotherapy and drug therapy, and considering other options, as electroconvulsive therapy, for the treatment of severe disorders or treatment-resistant depression [15,16]. Yet, the management of these disorders is seemingly not optimised, as data suggests that the percentage of patients receiving inadequate treatment is especially significant in primary care, which is the first level of care that meets the most basic health care needs, and around 71% of patients could seek help exclusively in primary care settings without being admitted in specialised care centres (hospitals) [11,17].…”

Section: Introductionmentioning

confidence: 99%

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Characteristics, management and medical costs of patients with depressive disorders admitted in primary and specialised care centres in Spain between 2011 and 2016

Darbà

Marsà

2020

PLoS ONE

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More than 10% of the population will suffer from a depressive disorder during their lifetime, which represents a substantial economic and social burden for healthcare systems and societies. Nonetheless, studies suggest that an important percentage of patients receive inadequate treatment. This study aimed to evaluate the characteristics of patients with depressive disorder in Spain, the current management of these disorders and the costs of specialised care. A retrospective multicentre study was designed including admission records from patients admitted due to a depressive disorder between 2011 and 2016, extracted from a Spanish claims database. The records obtained corresponded to 306,917 patients attended in primary care centres and 27,963 patients registered in specialised care settings. The number of admissions per patient progressively increased over the study period. A correlation was found with socioeconomic factors as the unemployment rate, increased versus the general population (OR = 1.41; 95%CI = 1.38-1.43). Equally, comorbid conditions as hypertension, disorders of lipoid metabolism, diabetes type II, other mood disorders and thyroid disorders were associated with severe presentations of a depressive disorder. In terms of disease management, patients with a severe disorder were the majority in specialised care settings, and most admissions were urgent and inpatient admissions. The use of both electroconvulsive therapy and drug therapy increased during the study period. In terms of costs, specialised care represented an annual cost of €9,654 per patient, and a total annual cost of €44,839,196. Altogether, improved detection and treatment protocols could contribute in reducing the burden that depressive disorders represent for the Spanish National Healthcare System.

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“…Results must be interpreted in the light of their limitations. First, the sample is composed of patients seeking health care for mental symptomatology, all of them underwent at least minimally adequate treatment [49]. Therefore, our results cannot be generalized to non-treated cases.…”

Section: Discussionmentioning

confidence: 99%

Change in functioning outcomes as a predictor of the course of depression: a 12-month longitudinal study

Forero

Olariu²,

Álvarez

et al. 2018

Qual Life Res

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Diagnostic accuracy and adequacy of treatment of depressive and anxiety disorders: A comparison of primary care and specialized care patients

Cited by 22 publications

References 47 publications

The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature

The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature

Characteristics, management and medical costs of patients with depressive disorders admitted in primary and specialised care centres in Spain between 2011 and 2016

Change in functioning outcomes as a predictor of the course of depression: a 12-month longitudinal study

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