[Treatment with antidepressants in geriatric departments. Occurrence and record keeping]

[Article in Danish]

Rosholm JU, Mortensen HH, Svensson BH, Horwitz N, Florescu IN, Munk B, Pedersen H, Levring AM, Matzen LE.

Geriatrisk afdeling G, Odense Universitetshospital, Sdr. Boulevard 29, DK-5000 Odense C. rosholm dadlnet.dk

INTRODUCTION: The aim of the present study was to describe the occurrence of antidepressant treatment in geriatric departments in Denmark and assess the notes of the patient records in connection with prescription. MATERIAL AND METHODS: Patient records for consecutively referred patients in seven geriatric departments were examined and basic information was noted. For users of antidepressants further information about the treatment was noted. RESULTS: A total of 1211 patients records were examined and out of these 338 patients were in treatment with antidepressants (29.7%). The users of antidepressants used more drugs on their discharge from the hospital. For 61.8% (209/338) of the users the treatment had started before the admission and in more than three-fourths the treatment remained unchanged at their discharge, in 9% the treatment was discontinued. 38.2% (129/338) started their treatment during the admission. Depression was stated as being the main reason in 54% of those who continued an ongoing treatment, and in 78% of those who started their treatment during admission. In 98.4%, the beginning of treatment with antidepressants was based upon the file notes. In 34.8% of the records of ongoing treatment no file notes were given. DISCUSSION: Treatment with antidepressants is common in geriatric departments and most often it is a question of continuation of a treatment that had started before the admission. The study shows that there is a need for an optimization of the file notes.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12608023&dopt=Abstract antidepressant




Recent trends in the use of antidepressant drugs in Australia, 1990-1998.

McManus P, Mant A, Mitchell PB, Montgomery WS, Marley J, Auland ME.

Department of Health and Aged Care, Canberra, ACT. peter.mcmanus health.gov.au

OBJECTIVE: To determine the pattern of use of antidepressant drugs in the Australian community, 1990-1998, and to compare this with those of other developed countries. DESIGN: Retrospective analyses of prescription and sales data, together with information about patient encounters for depression (from an ongoing survey of service provision by general practitioners) and population-based prevalence estimates for affective disorders (from community health surveys). MAIN OUTCOME MEASURES: National and international consumption of antidepressants, expressed in defined daily doses (DDDs) per 1000 population per day. Changes in both the frequency of general practice patient encounters for depression and population-based prevalence estimates for affective disorders. RESULTS: Dispensing of antidepressant prescriptions through community pharmacies in Australia increased from an estimated 12.4 DDDs/1000 population per day in 1990 (5.1 million prescriptions) to 35.7 DDDs/1000 population/day in 1998 (8.2 million prescriptions). There has been a rapid market uptake of the selective serotonin reuptake inhibitors (SSRIs), accompanied by a decrease of only 25% in the use of tricyclic antidepressants (TCAs). In 1998, the level of antidepressant use in Australia was similar to that of the United States, while the rate of increase in use between 1993 and 1998 was second only to that of Sweden. In Australia, depression has risen from the tenth most common problem managed in general practice in 1990-91 to the fourth in 1998-99, and the number of people reporting depression in the National Health Surveys (1995 v 1989-90) has almost doubled. Of the prescriptions dispensed in 1998 for antidepressant drugs subsidised by the Pharmaceutical Benefits Scheme, 85% were written by general practitioners, and 11.2% by psychiatrists. CONCLUSIONS: As in most developed countries, antidepressant use increased between 1990 and 1998. The rapid market uptake of the new antidepressants, particularly SSRIs, is likely to have been driven by increased awareness of depression, together with availability and promotion of new therapies.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11149300&dopt=Abstract antidepressant




Determinants of antidepressant treatment outcome.

Sood N, Treglia M, Obenchain RL, Dulisse B, Melfi CA, Croghan TW.

Department of Economics, Indiana University, Purdue University at Indianapolis, USA.

OBJECTIVE: To understand the determinants of the outcome of an episode of major depression, including factors that affect receipt of guideline-consistent care and their subsequent effect on treatment outcomes, particularly relapse or recurrence. Results of previous studies are generalized to a population typical of depressed individuals in the United States, i.e., a cohort of antidepressant users with employer-provided health benefits. STUDY DESIGN: A quasi-experimental design was used to assess the determinants of the outcome of an episode of major depression. Healthcare utilization-based measures of treatment characteristics and outcomes were used. PATIENTS AND METHODS: The final analytical file for this study contained data on 2917 patients who had an antidepressant prescription associated with an indicator of a depressive disorder. We identified relapse or recurrence of depression by (1) a new episode of antidepressant therapy, (2) suicide attempt, (3) psychiatric hospitalization, (4) mental health-related emergency department visits, or (5) electroconvulsive therapy. Antidepressant use patterns were used to construct a measure for adherence to treatment guidelines. Multivariate Cox proportional hazard and logit regression models were used to predict relapse/recurrence and adherence with treatment guidelines, respectively, for each patient. RESULTS: Factors that affect relapse/recurrence include comorbidities, demographics, and adherence to treatment guidelines. Factors that affect adherence to treatment guidelines include choice of initial antidepressant drug, comorbidities, psychotherapy, and frequency of physician visits. CONCLUSIONS: Adherence to treatment guidelines was associated with a significant reduction in the likelihood of relapse or recurrence of depression. Choice of initial antidepressant drug affects adherence to treatment guidelines.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11151810&dopt=Abstract antidepressant




Are there gender differences in the temperature profile of mice after acute antidepressant administration and exposure to two animal models of depression?

David DJ, Nic Dhonnchadha BA, Jolliet P, Hascoet M, Bourin M.

JE 2029 Neurobiologie de l'Anxiete, Faculte de Medecine, BP 53508, 1 rue Gaston Veil, F44035, cedex 01, Nantes, France.

Numerous studies have reported gender differences in the rates of depression in humans, but few behavioural observations of antidepressant drug effects have been investigated in female mice. The forced swimming test (FST) is widely used as a predictor of antidepressant activity in rodents, as is the tail suspension test (TST), where immobility is objectively measured and in this last test, no hypothermia is induced by immersion in cold water. The present study investigated gender differences in the temperature profile of mice after acute antidepressant administration (imipramine and paroxetine) and exposure to two animal models of depression. Imipramine and paroxetine were active at 32 mg/kg in male mice in the FST, whereas they were active at 8, 16 and 32 mg/kg in female mice. In the TST, for both antidepressants immobility duration was reduced at a dose of 16 and 32 mg/kg in male mice and at 32 mg/kg in female mice. No significant difference was observed between male and female mice for immobility duration. Imipramine administration, but not paroxetine, decreased the temperature at the higher dose (32 mg/kg) in male and female mice in the FST. The body temperature was reduced in male and female mice for all treatment groups after FST challenge. Imipramine (16 and 32 mg/kg in male and 32 mg/kg in female mice), paroxetine (4, 16 and 32 mg/kg in male and 4 to 32 mg/kg in female mice) attenuated the reduction in temperature due to the FST. In the TST, imipramine tends to decrease the temperature in male and female mice, even though only imipramine at a dose of 32 mg/kg in female mice significantly decreases the temperature. Paroxetine had no effect on temperature. The TST enhanced the body temperature in male and female mice. In mice, there was no difference between the sexes after imipramine or paroxetine administration in the FST and TST. Both tests can be used to predict the activity of antidepressants as the decrease or enhancement of temperature is not correlated with a reduction in immobility duration.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11165336&dopt=Abstract antidepressant




Physical activity-antidepressant treatment combination: impact on brain-derived neurotrophic factor and behavior in an animal model.

Russo-Neustadt A, Ha T, Ramirez R, Kesslak JP.

Department of Biology and Microbiology, California State University, 5151 State University Drive, Los Angeles, CA 90032, USA. arusson calstatela.edu

The mechanism of antidepressant action, at the cellular level, is not clearly understood. It has been reported that chronic antidepressant treatment leads to an up-regulation of brain-derived neurotrophic factor (BDNF) mRNA levels in the hippocampus, and that physical activity (voluntary running) enhances this effect. We wished to investigate whether BDNF expression brought about by these interventions may overcome deficits caused by acute stress, and might impact behavior in an animal model. In this report, we have tested the hypothesis that the combination of the antidepressant, tranylcypromine, and physical exercise could lead to decreased neurotrophin deficits and enhanced swimming time in animals that have been forced to swim in an inescapable water tank. Rats were either treated with tranylcypromine, engaged in voluntary running, or both for one week. After these treatments, the animals underwent a two-day forced swimming procedure. BDNF mRNA levels were significantly depressed in untreated animals subjected to forced swimming. Animals that either underwent prior activity or received antidepressant showed BDNF mRNA levels restored to baseline. Animals receiving the combined intervention showed an increase in hippocampal BDNF mRNA well above baseline. Swimming time during a five-minute test was significantly enhanced in animals receiving the combined intervention over untreated animals. Swimming time was not significantly enhanced over that of animals receiving antidepressant alone, however. Enhanced swimming time correlated with increased levels of BDNF mRNA in one hippocampal sub-region (CA4-hilus). These results suggest that the combination of exercise and antidepressant treatment may have significant neurochemical, and possibly behavioral, effects. In addition, these results support the possibility that the enhancement of BDNF expression may be an important element in the clinical response to antidepressant treatment. The induction of BDNF expression by activity/pharmacological treatment combinations could represent an important intervention for further study, to potentially improve depression treatment and management.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11173088&dopt=Abstract antidepressant




Weight outcomes among antidepressant users in nursing facilities.

Rigler SK, Webb MJ, Redford L, Brown EF, Zhou J, Wallace D.

Center on Aging, University of Kansas Medical Center, Kansas City 66160-7376, USA.

OBJECTIVES: Depression is a common and treatable condition among nursing facility residents, with low body weight being a frequent concomitant concern. A common prescribing dictum is that older tricyclic antidepressants (TCAs) enhance appetite and may facilitate weight gain, while newer selective serotonin reuptake inhibitors (SSRIs) cause anorexia and resultant weight loss in older adults. Evidence is lacking on whether the small weight changes noted during short-term antidepressant efficacy trials translate into larger weight changes during prolonged treatment periods. Our main objective was to compare weight outcomes at 6 months among users of three different antidepressant groups with a control group of non-antidepressant users. A secondary objective was to determine whether antidepressant selection was associated with weight pattern before drug initiation, to capture possible prescribing bias that would affect study inferences. DESIGN: Retrospective cohort design using the Minimum Data Set--Plus (MDS+). SETTING: Kansas nursing facilities. PARTICIPANTS: 1,157 antidepressant users age 65 and older who started an antidepressant after admission and remained on the same single agent for at least 6 months, and 4,852 persons meeting the same inclusion/exclusion criteria but not receiving an antidepressant. MEASUREMENTS: Antidepressant use was identified by drug code data and divided into four groups for analysis: TCAs, SSRIs, others, and none. (Amitriptyline and trazodone were excluded because of frequent use for nondepression purposes.) Rates of clinically important loss and gain (assigned for a 10% change from baseline weight or presence of the significant loss or gain markers on the 6-month MDS assessment) and mean weight changes were compared across the four groups. Regression models were used to control for age, gender, baseline weight, confounding comorbidity, and functional variables related to eating. Previous weight patterns (loss, gain, neither, or unknown) before antidepressant initiation were compared across drug groups. RESULTS: Clinically important weight loss and gain occurred at 6 months in 14.8% and 14.4% of the sample, respectively. In unadjusted analyses, an increased likelihood of loss was found for users of SSRIs (Odds Ratio 1.57; CI 1.30, 1.90) and others (OR 1.89; CI 1.18, 3.03), compared with none. In logistic models accounting for potential confounding factors, however, SSRI use showed a modest association with gain (OR 1.31, CI 1.01, 1.70) and a trend toward a similarly modest association with loss (OR 1.28; CI 0.995, 1.64). TCA use was not associated with weight gain. When weight was examined as a continuous variable, all groups demonstrated a broad range of both loss and gain with mean-unadjusted weight changes < 3 pounds. Pairwise comparisons of adjusted differences in weight change at 6 months for SSRIs (mean loss of 1.6 pounds) and TCAs (mean gain of 0.4 pounds) were of marginal importance (P = .046) given the large sample size. No evidence was found for prescribing bias based on prior weight pattern. CONCLUSIONS: TCAs do not facilitate weight gain more than other antidepressant groups and SSRIs are not associated disproportionately with weight loss when other important clinical variables are accounted for. Small but statistically significant differences in mean weight changes between groups are largely a reflection of large sample size rather than clinically important differences. Clinicians may wish to reconsider the widely held notions that TCAs facilitate weight gain and that SSRIs place depressed older nursing facility residents at disproportionate risk for weight loss.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11207842&dopt=Abstract antidepressant




The utilization of antidepressants in community-dwelling and institutionalized elderly--results form a representative survey in Germany.

Riedel-Heller SG, Matschinger H, Schork A, Angermeyer MC.

Department of Psychiatry, University of Leipzig, Germany. ries server3.medizin.uni-leipzig.de

Given its widespread occurrence and consequences, old-age depression has to be regarded as a major public health problem. Drug treatment has been proven effective in the majority of elderly individuals suffering from depression. This study presents pharmacoepidemiological data regarding the use of prescribed antidepressants and those purchased over the counter in the elderly. Furthermore, it links the data to simultaneously assessed depressive symptomatology. A representative survey on the utilization of prescription and over-the-counter antidepressant drugs and depressive symptomatology in community-dwelling (n = 1193) and institutionalized elderly individuals (n = 470) aged 75 and over was conducted in an urban region of Germany. Antidepressant use was found to be remarkably low (synthetic antidepressants: 2.2% of community dwelling individuals, 3.6% of institutionalized individuals; phytopharmaca containing hypericum perforatum: 4.2% of community dwelling individuals, 2.8% of institutionalized individuals). Two-thirds of the individuals treated with synthetic antidepressants received tri- and tetracyclic drugs, which were given at lower dosages than recommended for depression treatment. Selective serotonin reuptake inhibitors (SSRIs) were introduced in community-dwelling individuals only; none of the individuals cared for in residential and nursing homes received SSRIs. Only a minority of individuals with depressive symptoms were treated with antidepressants. The data suggests underutilization of antidepressants in the elderly, in which institutionalized elderly seem especially disadvantaged. The results call for increased efforts to discuss mental health issues in the public and to share scientific knowledge about symptoms, course and treatment options for depression. Furthermore, geronto-psychiatric competence of medical professionals, especially GPs, has to be systematically developed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11229623&dopt=Abstract antidepressant




Comparison of antidepressant activity in 4- and 40-week-old male mice in the forced swimming test: involvement of 5-HT1A and 5-HT1B receptors in old mice.

David DJ, Bourin M, Hascoet M, Colombel MC, Baker GB, Jolliet P.

Neurobiologie de lanxiete, Faculte de Medecine, Nantes, France.

RATIONALE: A recent study suggested that selective serotonin reuptake inhibitors were inactive in 40-week-old male mice in the mouse forced swimming test, possibly because of alteration of 5-HT1 receptors. OBJECTIVES: The present study was aimed at investigating the action of various antidepressant drugs in 4- and 40-week-old male mice using the mouse forced swimming test and determining the involvement of 5-HT1A and 5-HT1B receptors mediating the effects. METHODS: Different classes of antidepressants [imipramine (tricyclic), maprotiline (noradrenline reuptake inhibitor), venlafaxine (mixed serotonin and noradrenaline reuptake inhibitors), fluvoxamine and sertraline (selective serotonin reuptake inhibitor)] were tested in the same randomised experimental session, alone and in combination with 5-HT1A and 5-HT1B receptor agonists [buspirone (partial 5-HT1A agonist), anpirtoline (5-HT1B agonist)] in the mouse forced swimming test. RESULTS: All antidepressants were found to be active in the mouse forced swimming test in 4-week-old mice and 40-week-old mice, with the exception of fluvoxamine in the 40-week-old mice. The anti-immobility effect after antidepressant administration was higher in 4-week-old male mice than in 40-week-old male mice. Venlafaxine is the most active antidepressant drug in 40-week-old mice. Prior administration of buspirone (0.06 mg/kg, i.p.) or anpirtoline (1 mg/kg, i.p.) enhanced the antidepressant-like effects in 4-week-old mice (except in the case of sertraline, 8 mg/kg). In elderly mice, only prior administration of buspirone enhanced the antidepressant-like effects of fluvoxamine. A neurochemical study showed that significantly higher serotonin and dopamine concentrations were found in 40-week-old control mice brains than 4-week-old control mice brains but that the noradrenaline concentration is higher in 4-week-old mice. CONCLUSION: Tricyclic, noradrenaline reuptake inhibitors and serotonin reuptake inhibitors are more active in 4-week-old mice than 40-week-old mice. Our results suggested that 5-HT1B receptors may be more altered than 5-HT1A receptors in 40-week-old mice.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11243491&dopt=Abstract antidepressant