Older Patients' Aversion to Antidepressants. A Qualitative Study

Givens, Jane L.; Datto, Catherine; Ruckdeschel, Katy; Knott, Kathryn; Zubritsky, Cynthia; Oslin, David W.; Nyshadham, Soumya; Vanguri, Poornima; Barg, Frances K.

doi:10.1111/j.1525-1497.2005.00296.x

Cited by 71 publications

(64 citation statements)

References 37 publications

(39 reference statements)

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“…[12][13][14][15] Contrary to this finding, this study suggests that at least those patients who are on long-term medication have little apprehension in taking antidepressants. As attitudes to antidepressants are not fixed and can change over time, it is possible that any initial apprehension is forgotten as antidepressants become an accepted treatment.…”

Section: Comparison With Existing Literaturecontrasting

confidence: 53%

Long-term prescribing of antidepressants in the older population: a qualitative study

Dickinson

Knapp²,

House³

et al. 2010

Br J Gen Pract

124

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MethodThirty-six patients aged ≥75 years and 10 GPs were interviewed. Patients were sampled to ensure diversity in age, sex, antidepressant type, and home circumstances. ResultsParticipants perceived significant benefits and expressed little apprehension about taking long-term antidepressants, despite being aware of the psychological and social factors involved in onset and persistence of depression. Barriers to discontinuation were identified following four themes: pessimism about the course and curability of depression; negative expectations and experiences of ageing; medicine discontinuation perceived by patients as a threat to stability; and passive (therapeutic momentum) and active (therapeutic maintenance) decisions to accept the continuing need for medication. ConclusionThere is concern at a public health level about high rates of long-term antidepressant prescribing, but no evidence was found of a drive for change either from the patients or the doctors interviewed. Any apprehension was more than balanced by attitudes and behaviours supporting continuation. These findings will need to be incorporated into the planning of interventions aimed at reducing long-term antidepressant prescribing in older people. Keywordsantidepressants; prescribing; attitudes. INTRODUCTIONA previous study of antidepressant prescribing in the UK reported high rates of long-term prescribing. For patients aged ≥75 years, 14% were being prescribed an antidepressant, while the rate in those aged <75 years was less than half that (6%). 1Among patients aged ≥75 years prescribed an antidepressant, almost half (48%) had been in receipt of a prescription for more than 2 years. Few patients' records had evidence of medication review or discussion of possible withdrawal.Depression is common in later life, 2,3 but it is not clear why the rates of prescribing, and of long-term prescribing in particular, appear to be so much higher in patients aged ≥75 years. 4 Most older patients with depression are managed in primary care by their GP. Guidance regarding the management of depression in the UK is provided by the National Institute for Health and Clinical

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Section: Comparison With Existing Literaturecontrasting

confidence: 53%

Long-term prescribing of antidepressants in the older population: a qualitative study

Dickinson

Knapp²,

House³

et al. 2010

Br J Gen Pract

124

View full text Add to dashboard Cite

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“…Older adults may hesitate to take antidepressants for reasons such as fear of dependency and the attribution of depression to social rather than medical causes (Givens et al, 2006). Antidepressants also carry the risk of harmful side effects for older adults, such as increased risk of falls, gastrointestinal bleeding, and insomnia (Thakur & Blazer, 2008), as well as potentially serious interactions with other medications (Mark et al, 2011).…”

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confidence: 99%

Behavioral activation for depression in older adults: Theoretical and practical considerations

Polenick

Flora

2013

BEHAV ANALYST

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Late-life depression (LLD) is a major public health concern that can have devastating effects on older individuals and their families. Behavioral theories predict that decreases in responsecontingent positive reinforcement and increases in negatively reinforced avoidance behaviors, often accompanied by aversive life events, result in the selection and maintenance of depression. Based on these theories, behavioral activation treatments for depression are designed to facilitate structured increases in enjoyable activities that increase opportunities for contact with positive reinforcement. We discuss the applicability of behavioral models for LLD, and we briefly review current behavioral activation interventions for LLD with an emphasis on implications for future behavior-analytic research. Behavioral activation has been demonstrated to be effective in reducing depression and increasing healthy behavior in older adults. Potential challenges and considerations for future research are discussed. We suggest that applied behavior analysts and clinical behavior analysts are particularly well suited to improve and expand on the knowledge base and practical application of behavioral activation interventions with this population.

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“…Os antidepressivos não impedem altos índices de recorrência da doença 3,4 , produzem efeitos adversos freqüentes e clinicamente relevantes 5 , sendo até evitados por pacientes mais idosos após uma experiência negativa com seu uso 6 .…”

Section: Introductionunclassified

Tratamento homeopático da depressão: relato de série de casos

Adler¹,

Paiva²,

César³

et al. 2008

Rev. psiquiatr. clín.

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ResumoContexto: Não há estudos metodologicamente adequados sobre a eficácia da homeopatia na depressão. Relatos de casos clínicos são os primeiros degraus da evidência clínica, a caminho de estudos controlados. Objetivos: Relatar resultados preliminares do tratamento homeopático de pacientes com depressão no SUS de Jundiaí. Métodos: Revisão dos prontuários dos casos novos, atendidos entre março e dezembro de 2006. O diagnóstico foi confirmado por entrevista estruturada. Os pacientes receberam homeopatia individualizada e a evolução foi avaliada pela escala de Montgomery & Åsberg (MADRS). Resultados: Foram tratados 15 casos e observou-se resposta terapêutica (redução maior que 50% dos escores de depressão) em 14 pacientes (93%), após uma média de sete semanas de tratamento; um paciente apresentou piora clínica e foi encaminhado ao tratamento convencional. O escore média (± dp) na Escala de Avaliação de Depressão de Montgomery-Åsberg diminuiu de 24,9 (± 5,8) a 9,7 (± 8,2, p < ,0001) na segunda avaliação, resultados mantidos no decorrer da terceira e quarta consultas. Conclusões: Os resultados sugerem que a homeopatia pode ser uma alternativa terapêutica no tratamento da depressão, mas estudos randomizados e controlados são necessários para se testar a eficácia e segurança do tratamento homeopático dos transtornos depressivos.Adler U.C. et al. / Rev. Psiq. Clín 35 (2); 74-78, 2008 Palavras-chave: Homeopatia, depressão, SUS, relato de série de casos. AbstractBackground: Evidence for the efficacy of homeopathy for depression is limited due to lack of clinical trials of high quality. Case reports are the first steps of clinical evidence, towards controlled trials. Objectives: To report preliminary results of homeopathic treatment of depression in Jundiai's public health system, Sao Paulo. Methods: Review of the medical records of new patients, treated between March and December 2006. Their diagnosis was confirmed by a semi-structured interview. Patients received individualized homeopathy and their response was measured by the Montgomery & Åsberg depression scale (MADRS). Results: Fifteen patients were treated and response (more than 50% decrease of MADRS scores) was observed in 14 patients (93%), after an average of seven weeks of treatment; one patient had clinical worsening and was refered to conventional antidepressant therapy. The MADRS mean scores (± dp) decreased from 24.9 (± 5.8) to 9.7 (± 8.2, p < .0001) in the 2 nd evaluation, and these results signifcance were sustained through the 3 rd and 4 th assessments. Discussion: these results suggest that homeopathy may be an alternative therapeutics for depression, but randomized and controlled studies are needed to test the efficacy and safety of the homeopathic treatment of the depressive disorders.

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Older Patients' Aversion to Antidepressants. A Qualitative Study

Abstract: BACKGROUND: Depression is common among older patients yet is often inadequately treated. Patient beliefs about antidepressants are known to affect treatment initiation and adherence, but are often not expressed in clinical settings.

Cited by 71 publications

References 37 publications

Long-term prescribing of antidepressants in the older population: a qualitative study

Long-term prescribing of antidepressants in the older population: a qualitative study

Behavioral activation for depression in older adults: Theoretical and practical considerations

Tratamento homeopático da depressão: relato de série de casos

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