Use of Antidepressants by General Practitioners and Psychiatrists in Australia

McManus, Peter; Mant, Andrea; Mitchell, Philip B.; Britt, Helena; Dudley, John

doi:10.1046/j.1440-1614.2003.01132.x

Cited by 45 publications

(44 citation statements)

References 4 publications

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“…Possibly due to their lesser experience in managing depression, general physicians revealed a preference for prescribing SSRIs, which are safer drugs with fewer side effects. This finding was also described in a study carried out by McManus et al (2003).…”

Section: Discussionsupporting

confidence: 82%

“…A number of studies in the international literature have demonstrated that the main factors related to the choice of antidepressants are patient profile (especially with regard to age and the presence of co-morbidities), the safety of different classes of medication (which varies significantly in terms of the frequency and severity of adverse reactions), treatment cost and specialty of the prescriber (McManus et al, 2003;Sleath, Shih, 2003;Poluzzi et al, 2004). Further factors considered important in the choice of medication include the training to which the physician has been submitted, access to treatment protocols and pressure from the patients themselves for particular antidepressants (Sleath, Shih, 2003).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Factors associated to antidepressant prescription for civil servants of Belo Horizonte, MG

Hurtado

Magalhães

Ribeiro

et al. 2010

Braz. J. Pharm. Sci.

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Selecting the most suitable drug for the treatment of depression has clinical and economic implications, since both safety and cost of antidepressants (AD) vary among therapeutic subgroups. This study aimed to evaluate the prescription of antidepressants for users of the pharmacy for civil servants of PBH (FARMASERV) in 2005. Univariate, bivariate and multivariate analyzes using logistic regression were performed. Of the total prescriptions analyzed (652), the majority were for women (81.7%) and individuals aged between 19 and 59 years (81.7%). The variables independently associated with the selection of AD were gender, age and the specialty of the prescriber. Women and young adults were more likely to be prescribed an SSRI compared to their congeners, with statistically significant differences. Psychiatrists were more likely to prescribe an SSRI than neurologists or general physicians. The determinant factors for selecting antidepressants may aid the planning of interventions aimed at patients and prescribers which can enable rationalization of the use of antidepressants.Uniterms: Antidepressants/rational use. Depression/ treatment . Medicines/rational use.A seleção adequada do medicamento para o tratamento da depressão tem implicações clínicas e econômicas, visto que a segurança e o custo dos antidepressivos (AD) variam entre as subclasses terapêuticas. Esse estudo avaliou prescrições de AD dispensadas em 2005 para usuários da Farmácia da Clínica dos Servidores da PBH (FARMASERV). Foram realizadas análises univariada, bivariada e multivariada dos dados, utilizando-se regressão logística. Do total de prescrições (652), a maioria era para mulheres (81,7%) e para indivíduos com idade entre 19 e 59 anos (81,7%). As variáveis independentemente associadas à seleção de AD foram gênero, faixa etária e especialidade do prescritor. Mulheres e adultos jovens têm maior chance de receber prescrição de ISRS, em comparação aos seus congêneres, sendo as diferenças estatisticamente significativas. A chance dos psiquiatras prescreverem ISRS é maior do que neurologistas e clínicos gerais. Os fatores determinantes da seleção do antidepressivo podem subsidiar o planejamento de intervenções dirigidas aos pacientes e prescritores de forma a permitir a racionalização de sua utilização.Unitermos: Antidepressivos/uso racional. Depressão/terapia. Medicamentos/uso racional.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Factors associated to antidepressant prescription for civil servants of Belo Horizonte, MG

Hurtado

Magalhães

Ribeiro

et al. 2010

Braz. J. Pharm. Sci.

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“…The pre-review average PDDs of the majority of antidepressants are higher than previously reported in literature, 4,[15][16][17] with SSRI doses 10-30% higher.…”

Section: Discussionmentioning

confidence: 56%

“…11 In response, the NHS Greater Glasgow and Clyde (NHS GG&C) Health Board committed to GPs reviewing long-term antidepressant prescribing in four community health and care partnerships (CHCPs), as medication review demonstrably reduces inappropriate prescribing and costs. [12][13][14][15] NHS GG&C also knew that six GP practices had higher average prescribed daily doses (PDD) of selective serotonin re-uptake inhibitors (SSRIs) than reported in current literature, 4,[15][16][17] therefore PDDs were also of interest as SSRIs account for half of all antidepressant prescriptions. 5 The aim of this study was to review general practice patients prescribed the same antidepressant for ≥2 years, and describe prescribing and management pre and post-review.…”

Section: Introductionmentioning

confidence: 99%

Reviewing long-term antidepressants can reduce drug burden: a prospective observational cohort study

Johnson¹,

Macdonald²,

Atkinson³

et al. 2012

Br J Gen Pract

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BackgroundAntidepressant prescribing continues to rise. Contributing factors are increased long-term prescribing and possibly the use of higher selective serotonin re-uptake inhibitor (SSRI) doses. AimTo review general practice patients prescribed the same antidepressant long-term (≥2 years) and evaluate prescribing and management pre and post-review. Design and settingProspective observational cohort study using routine data from 78 urban general practices, Scotland. MethodAll patients prescribed antidepressants (excluding amitriptyline) for ≥2 years were identified from records November 2009 to March 2010. GPs selected patients for face-to-face review of clinical condition and medication, December 2009 to September 2010. Pre-and post-review data were collected; average antidepressant doses and changes in prescribed daily doses were calculated. Onward referral to support services was recorded. Results8.6% (33 312/388 656) of all registered patients were prescribed an antidepressant, 47.1% (15 689) were defined as long-term users and 2849 (18.2%) were reviewed. 811 (28.5%) patients reviewed had a change in antidepressant therapy: 7.0% stopped, 12.8% reduced dose, 5.3% increased dose, and 3.4% changed antidepressant, resulting in 9.5% (95% CI = 9.1% to 9.8% P<0.001) reduction in prescribed daily dose and 8.1% reduction in prescribing costs. 6.3% were referred onwards, half to NHS Mental Health Services. Pre-review SSRI doses were 10-30% higher than previously reported. ConclusionAlmost half of all people prescribed antidepressants were long-term users. Appropriate reductions in prescribing can be achieved by reviewing patients. Higher SSRI doses may be contributing to current antidepressant growth.

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“…A large proportion of depression sufferers fail to respond fully to standard antidepressant therapy making it imperative to identify and rectify, where possible, factors contributing to this debilitating condition. 15 It may be that the overlap between depressive symptoms and OSA is due to chance, as both conditions are common in the community. Both depression and OSA are frequently associated with disturbed sleep, fatigue, and irritability.…”

Section: Depressive Symptoms Are Common Among People With Osamentioning

confidence: 99%

Depressive Symptoms before and after Treatment of Obstructive Sleep Apnea in Men and Women

Edwards

Mukherjee

Simpson

et al. 2015

Journal of Clinical Sleep Medicine

113

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Study Objectives: To determine prevalence of depressive symptoms in obstructive sleep apnea (OSA) and the impact of OSA treatment on depression scores. Methods: Consecutive new patients referred for investigation of suspected OSA were approached. Consenting patients completed a patient health questionnaire (PHQ-9) for depressive symptoms when attending for laboratory polysomnography. Those with moderate/severe (apneahypopnea index [AHI] ≥ 15 events/h) and/or symptomatic mild OSA (AHI 5-14.99 events/h) were offered continuous positive airway pressure (CPAP) therapy. PHQ-9 was repeated after 3 months of CPAP with compliance recorded. Of a maximum PHQ-9 score of 27, a cut point ≥ 10 (PHQ-9 ≥ 10) was used to indicate presence of clinically signifi cant depressive symptoms. Results: A total of 426 participants (243 males) were recruited. Mean ± standard deviation body mass index (BMI) was 32.1 ± 7.1 kg/m 2 and AHI 33.6 ± 28.9 events/h. PHQ-9 was 10.5 ± 6.1 and independently related to AHI (p < 0.001) and BMI (p < 0.001). In those without OSA, PHQ-9 ≥ 10 was more common in women, but no gender difference was evident with OSA. Of 293 patients offered CPAP, 228 were compliant (mean nightly use > 5 h) over 3 months of therapy. In them, with therapy, AHI decreased from 46.7 ± 27.4 to 6.5 ± 1.6 events/h, PHQ-9 from 11.3 ± 6.1 to 3.7 ± 2.9 and PHQ-9 ≥ 10 from 74.6% to 3.9% (p < 0.001 in each case). Magnitude of change in PHQ-9 was similar in men and women. Antidepressant use was constant throughout. Conclusions: Depressive symptoms are common in OSA and related to its severity. They improve markedly with CPAP, implying a relationship to untreated OSA. Keywords: patient health questionnaire, depression, depressive symptoms, obstructive sleep apnea, continuous positive airway pressure. Citation: Edwards C, Mukherjee S, Simpson L, Palmer LJ, Almeida OP, Hillman DR. Depressive symptoms before and after treatment of obstructive sleep apnea in men and women. J Clin Sleep Med 2015;11(9):1029-1038.pii: jc-00354-14 http://dx.doi.org/10.5664/jcsm.5020 P ersistent sleep loss causes symptoms that are similar to those of depression, in part because frontal lobe centers responsible for emotional modulation are sensitive to disturbed sleep.1 Consistent with this observation, obstructive sleep apnea (OSA), a condition characterized by fragmented sleep, is commonly associated with depressive symptoms.2 Conversely, depression is often associated with disturbed sleep. Further, depression and OSA are prevalent in the community and, hence, could be expected to coexist in a signifi cant proportion of patients. The multidirectional relationships between depression, disturbed sleep, and OSA are a source of potential diagnostic confusion, which may explain why OSA, a generally under-recognized condition, is particularly under-diagnosed among people with depression.3 Failure to recognize and treat OSA in depressed patients may lead to inappropriate prescription of antidepressant therapy and/or persistence of depressive symptoms despite such therapy....

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Use of Antidepressants by General Practitioners and Psychiatrists in Australia

Cited by 45 publications

References 4 publications

Factors associated to antidepressant prescription for civil servants of Belo Horizonte, MG

Factors associated to antidepressant prescription for civil servants of Belo Horizonte, MG

Reviewing long-term antidepressants can reduce drug burden: a prospective observational cohort study

Depressive Symptoms before and after Treatment of Obstructive Sleep Apnea in Men and Women

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