Assess effects of antidepressant compliance on healthcare and workplace costs.

Using workplace survey data for 2 large employers’ healthcare claims (2004-2006), patient selection criteria considered depression diagnosis and antidepressant claims history. Employed respondents working in the past month were categorized by Medication Possession Ratio into compliance groups by quartiles; bottom/top quartiles were defined as compliant/non-compliant. Direct (medical/drug) costs were measured as insurer payments to providers; indirect (absenteeism/presenteeism) costs were based on one-month recall of workplace performance (hours worked/missed, self-rated performance), estimated as (hours missed x self-reported hourly income). Annualized, inflation-adjusted (2006) costs were compared between compliant/non-compliant groups using multivariate models controlling for baseline characteristics. Analyses were conducted for all patients and a subsample of diagnosed depression patients.

Among all patients (n=1,224), medical costs were numerically lower for compliant vs. non-compliant patients ($4,857 vs. $5,926, p=0.221); drug costs were significantly higher for compliant patients ($2,329 vs. $1,570, p=0.001). Indirect costs were not statistically different between compliant/non-compliant patients ($22,278 vs. $20,714, p=0.237). Among the depression subgroup (N=488), medical costs were numerically lower for compliant vs. non-compliant patients ($5,005 vs. $7,630, p=0.152) while drug costs were numerically higher for compliant patients ($2,550 vs. $1,829, p=0.153). Absenteeism costs were 30% lower for compliant patients ($7,725 vs. $11,040, p=0.038); presenteeism costs were not significantly different ($19,079 vs. $17,457, p=0.441).

Absenteeism costs decrease significantly with compliance among depressed patients as do medical costs (not significantly). Further research is warranted regarding reason for poor antidepressant compliance and influence of compliance on costs.

Sexual dysfunction is an important under-estimated side effect of antidepressant drugs. Patients, in fact, if not directly questioned, tend to scarcely report them. Thus, the aim of the present meta-analysis is to quantify sexual dysfunction caused by antidepressants on the basis of studies where sexual functioning was purposely investigated through direct inquiry and specific questionnaires.

A literature search was conducted using Medline, Isi web of Knowledge and references of selected articles. Selected studies performed on patients without previous sexual dysfunction were entered in the Cochrane Collaboration Review Manager Software (RevMan version 4.2). Our primary outcome measure was the rate of total treatment emergent sexual dysfunction. Our secondary outcome measures were the rates of treatment emergent desire, arousal and orgasm dysfunction.

Our analyses indicated significantly higher rates of treatment emergent sexual dysfunction as well as specific phases dysfunction compared to placebo for the following drugs: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, duloxetine, venlafaxine, clomipramine, imipramine and phenelzine, whereas no significant difference with placebo was found for the following antidepressants: amineptine, bupropion, moclobemide, mirtazapine and nefazodone. Nonetheless sufficient evidences (>100 subjects) are available only for bupropion, citalopram, fluoxetine, paroxetine, sertraline and venlafaxine.

Present evidence on treatment emergent sexual dysfunction caused by antidepressant is sufficiently studied only for few drugs. Furthermore some statistical limiting assumptions, as the inclusion of open label or small studies and the presence of an evident publication bias, could reduce the significativity of our findings. Thus, treatment emergent sexual dysfunction should be more deeply investigated.

The aim of the present review and meta analysis is to evaluate the efficacy of new noradrenergic antidepressants (NAD) in the treatment of panic disorder (PD).

A literature search was conducted using MEDLINE, ISI web of knowledge and references of selected articles. Data from fourteen papers focusing on venlafaxine, mirtazapine and reboxetine were entered in RevMan 4.2.10 Our primary outcome measures were the rate of response, remission and side effects of NAD compared to placebo. Further analysis included the end-point mean number of panic attacks, the Panic and Anticipatory Anxiety Scale and the Hamilton Scale for Anxiety’ values.

We found a significant higher rate of response (OR = 3.2, 95% CI=2.61 to 3.92), remission (OR = 2.14, 95% CI=1.72 to 2.66) and side effects (OR = 1.41, 95% CI=1.11 to 1.78) for NAD compared to placebo, even though the studies were very heterogeneous. Analysis performed on the three drugs individually showed higher rate of response for patients treated with venlafaxine and mirtazapine whereas no statistical difference was found between reboxetine and placebo. The number of panic attacks and the values of all scales measuring the intensity of panic disorder at the end of trial were significantly lower for patients treated with a NAD.

Although the small sample size of some studies and limiting statistical assumptions could reduce the significativity of our findings, both venlafaxine and mirtazapine showed a significant efficacy for the treatment of PD which was comparable to selective serotonine reuptake inhibitors. Further studies on reboxetine are needed.

To evaluate the effectiveness and tolerability of escitalopram in patients suffering from depression with or without comorbid mental and/or physical disorders in a naturalistic setting.

Open-label 3-month study, conducted in 186 investigational sites in Greece. Efficacy assessment was based on CGI-S, MADRS and CGI-I scales. Tolerability was evaluated by spontaneously reported adverse events and treatment discontinuation rates. Statistical analysis was based on a modified intent-to-treat dataset (at least one valid post-baseline CGI-S measurement) and the per protocol dataset (valid CGI-S measurements at all 3 visits).

The analysis dataset of the study included 3,931 patients (mean age 45.5±10.8, 65.8% women, 37.4% with any comorbidity, and baseline mean MADRS 26.7±8.4). Patients with comorbid mental disorders were more severely ill at baseline (p< 0.001, both MADRS and CGI-S). Patients showed significant improvement (p< 0.001) during the treatment period based on both MADRS and CGI-S scores. There was no significant difference between the four groups (no comorbidity, comorbid mental disorder, comorbid physical disorders, comorbid mental and physical disorders). However, for both scales, the change from baseline increased with the severity of illness. Patients in the comorbidity groups had slightly higher overall discontinuation rates (8.2% to 10%) than patients without comorbidity (6.9%), with a total of 7.8% (n=308) Discontinuation due to adverse events was 2.3% (n=92).

Escitalopram was comparably effective and well tolerated in depressed patients with and without mental and/or somatic comorbidity.

To evaluate the efficacy and safety of venlafaxine hydrochloride(HCL) sustained release capsules in treating juvenile with depressive disorder.

A randomized, double blind dummy clinical trial enrolled 60 adolescent patients with depression, who were randomizedly designed to administer venlafaxine HCL sustained release capsules 150 mg or fluoxetine 20 mg daily for 8 weeks. The efficacies of both treatment groups was evaluated based on the Hamilton Depression Scale and Clinical General impression Scale pre and post-treatment.

The scores of Hamilton Depression Scale at the end of therapy were significantly reduced compared with the baseline in both gtnups (P< 0.O1). The effective rate of venlafaxine HCL sustained release capsules versus fluoxetine treatmlent was 70.0% and 65.5%, respectively, the P value showed no statistical difference (P>0. OS). The common adverse reactions included dry mouth, insomnia, dizziness, and loss of appetite.

Venlafaxine HCl sustained release capsules is an effective agent for juvenile with major depression.

The examination has shown that the possible side effects of sertraline are rare and mainly of temporary nature, and confirm the effectiveness and safety of sertraline in routine clinical practice.

Depression as a common psychiatric disorder can occur in two types: Endogenous or genetic and exogenous or Reactional. These two types of depression, from the point of view of response speed to treatment and type of appropriate drug for treatment are different. This study has been executed to compare therapeutic effects of different classes of anti-depressant drugs in treatment of genetic and Reactional depression.

Present survey is a clinical-trial study, a completely randomly block type, that has performed on 30 patients (male and female). Selection of study sample accomplished randomly among unipolar depressed patients that has referred to Ardabil’s psychiatry clinic diagnosed based on DSM-IV criteria. Researcher - Made questionnaire, Beck, and Catelle depression test were used to collect data. To analyze data, for completely randomly blocked designs, two-factor variance analysis method and F test were used.

This study showed that Genetical depression does not response treatment Rapidly and its response type is not good and persistent. From the point of view of time, Reactional depression has a delaying response but its response type is good and persistent. In addition, no difference was observed in efficacy of different classes of drugs for treatment of these two types of depression. The results of this research showed that there is no difference between treatment response of two types of depression (Genetical and Reactional).

There is no preference in efficacy of different classes of drugs in treatment of these two types of depression.

Infection with the hepatitis C virus is a global problem with the prevalence of around 3%and a tendency of becoming chronic with 75% of the infected people.

The latest research indicates that chronic hepatitis C is connected with a higher risk of the beginning of depression.It also indicates that depression is more common with patients who have a chronic HCV infegtion as compared with other liver diseases.

The aim of this study was to evaluate the efficiency of tianeptine in depression treatment of people with chronic hepatitis C.

A total of 3o patients with serologically affirmed diagnosis of hepatitis C,aged 30 to 55 years,were included in this study.The level of depression with these patients was measured using MADRS scale.The minimal score value on the MADRS scale during the initial rounds was 25.The patients received 37.5 mg of tianeptine for 8 weeks without the concomitant therapy.Rounds were organized at the beginning of the treatment, after 3 weeks,and after 8 weeks of treatment for all patients.

There is a significant improvement in terms of reduction in depression on the MADRS scale with patients treated with tianeptine after 3 and 8 weeks of treatment as compared with the initial rounds.70% of patients treated with tianeptine reduced the score on the MADRS scale, to 15 and lower after 8 weeks of treatment.

Tianeptine shows considerably useful effects in reduction of depression symptoms with patients with chronic hepatitis C infection.

Akathisia is a side effect generally associated with antipsychotic drugs. However, akathisia is also reported as a side effect of antidepressants, especially of the selective serotonin reuptake inhibitor group. Mirtazapine is an antidepressant that has a special role in relation with akathisia. There have been randomized controlled studies reporting that mirtazapine is effective in treatment of antipsychotic-induced akathisia. However, there have also been few cases in which acute akathisia are induced by mirtazapine. We would like to report a case of mirtazapine induced tardive akathisia.

Mrs. A is a 43-year old woman who applied to psychiatrist four years ago for complaints such as depressive mood, anhedonia, reduced sleep and poor appetite. She was diagnosed as having a major depressive disorder and prescribed 15 mg mirtazapine at night. Mrs. A benefited from the treatment within 1-2 months, complied with medication but did not attend follow-up examinations. About a year later, she started to have severe restlessness, shaking and need to move about one hour after mirtazapine intake. Therefore, patient started use mirtazapine once every three days for the following three years. Akathisia starting after mirtazapine intake disappeared about 8-10 hours later and patient did not have akathisia during two days that she did not have mirtazapine intake.

Mirtazapine might be effective both in treatment and precipitation of akathisia. These effects might be determined by multiple interactions among factors such as duration of mirtazapine treatment, presence of concomitant treatment, neurological basis of the disorder.

Depressive symptoms present quite frequently in in-patients in general hospitals with a variety of organic conditions. The main aim of treatment is to manage the symptoms and prevent them from recurring.

The primary endpoint for this study was to assess the effectiveness of treatment with duloxetine in a group of in-patients with depressive symptoms in the general hospital.

This was an observational study with duloxetine, in which a total of 40 patients were included who presented depressive symptoms while in-patients in a general hospital and who had the established inclusion criteria.

The clinical effectiveness of the treatment was assessed with the Hamilton scale and the Clinical Global Impression scales for severity and change.

A total of 40 patients were treated with duloxetine, 6 of whom (15%) dropped out of the study. The average maintenance dose administered at the baseline visit was 60 mg/day and at discharge was 75 mg/day. At the end of follow-up, there was a reduction with respect to the baseline values of 13.6 points on the Hamilton scale and 2.4 points on the CGI of severity scale. 63.4% of the patients felt “much better” at the final visit, according to the CGI of change scale.

According to the results, it seems that DULOXETINE may be a good treatment option for patients admitted to general hospital for different conditions of organic origin who present depressive symptoms while in hospital, both for its therapeutic effectiveness and for its good tolerability profile.

There is a lot of interference between depression and diabetes - mellitus and vice versa. Therefore, control of blood glucose levels in depressive patients and also to knowing the effect of antidepressants on blood glucose levels is important.

This study was performed to determine the effect of 4 and 8 weeks treatment with Fluoxetine and Imipramine on the fasting blood sugar (FBS) of patient with major depressive disorder.

This study was a parallel randomized clinical trial that was performed in 2006 on out - patients, of the psychiatric ward of Hashemi Senejani Hospital of Arak - Iran, for major depression treatment; there were 40 subjects in each group. These patients had their F.B.S. tested three times, before beginning and 4 and 8 weeks after treatment, respectively.

There were not significant statistical differences between first and second time mean F.B.S. values in group A, but we had a significant decrement in first and third times mean F.B.S. values (p < 0.05). There was also a significant increment in second and third times mean F.B.S. values versus first time mean F.B.S. values in group B (p > 0.05).

In this study, we have found that there is a decrement in F.B.S. mean value after 8 weeks of treatment with Fluoxetine and increment in FBS after 4 and 8 weeks of treatment with Imipramine. Therefore, we recommended Fluoxetine for hyperglycemic depressive patients and Imipramine for hypoglycemic one.

Medication compliance is associated with the treatment outcomes. The reported consequences of non-compliance are chronification, poor psychosocial outcomes and increased suicide rates. We measured the drug compliance using medication event monitoring system (MEMS) and several compliance measures in the outpatients with depressive disorders. In addition, we tried to find out the relationship of antidepressant compliance with other clinical correlates including insight in depressive disorders.

This study was performed in Korea university medical center, Guro hospital. Outpatients diagnosed as having depressive disorders were enrolled. Monitoring was performed in 76 depressive patients who were taking the mono-antidepressant therapy during the at least 4-week evaluation period. 17 item Hamilton Rating Scale for Depression (HRSD), Multidimensional Scale of Perceived Social Support (MSPSS) and the mood disorders insight scale (MDIS) were investigated. Compliance was measured using MEMS, clinician rating scale of antidepressant compliance, pill count, and patient's self-report.

A total of 76 outpatients were enrolled in this study. As the severity of depression increases, patients tended to perceive poor social support from others in the correlation analysis. Level of depression by HRSD was significantly correlated with MDIS scores. Compliance rates for MEMS, pill count, clinician rating scale of compliance and self-report were 51.9%, 71.4%, 79.2% and 75.3% respectively. We did not find any statistical significance between compliance variables and other clinical scale scores (MDIS, HRSD, and MSPSS).

More severely depressed patients have higher scores of insight in case of depression. However, increased perception of insight in depressive patients was not directly related with the increase in treatment compliance. Further investigation is needed to understand other factors affecting the drug compliance especially in depressive patients.

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As practice guidelines recommend to maintain antidepressant treatments for a long duration after improvement of symptoms in order to prevent relapse or recurrence, our objectives were to explore the duration of the antidepressant drug treatment in France and to characterise the antidepressant users with a short duration of treatment.

An observational retrospective cohort study was conducted in the community-dwelling population 18 year-old and over through claims databases of the public health insurance. A random sample of 34.663 outpatients who initiated an antidepressant treatment between the 1st January 2005 and the 31st December 2006 were selected. The dependent variable was the duration of the first episode of antidepressant treatment, categorised a priori in short duration [1-6 months[ versus long duration [6 months and more] according to guidelines. Characteristics independently associated with the treatment duration were investigated using logistic regressions.

Nearly two thirds of the individuals were females. Most patients were not on welfare. Three quarters of them did not present with chronic conditions. The duration of the antidepressant treatment complied with the international recommendations for only one patient of six. Adequate treatment duration was associated with being a female, being older, not being on welfare, presenting with a chronic condition and a treatment introduction by a psychiatrist or a hospital practitioner.

The recommendations concerning the duration of an antidepressant treatment are rarely respected in a real-life setting in France. Further analyses should be conducted to characterise the patterns of prescription according to antidepressant classes and associated treatments.

This paper reviews the novel usage of riluzole, an antiglutamatergic and neuroprotective agent, for affective and behavioral stabilization in autism.

A review of the English-language literature on riluzole usage for pediatric and adult psychopathology, combined with the author's experience with two autistic patients who demonstrated prominent affective stabilization and reduction in self-injury with riluzole.

Riluzole was developed for usage in amyotrophic lateral sclerosis, and is the only drug to slow the progression of this devastating neurological disease. Riluzole inhibits release of glutamate, the primary excitatory amino acid in the brain, and enhances GABA-A receptor function. Riluzole has demonstrated efficacy in open-label trials of adult unipolar and bipolar depression as well as pediatric and adult obsessive-compulsive disorder. Case reports have additionally documented benefit in trichotillomania and self-injury. There is not yet published literature on riluzole usage in autism, but the following cases are presented:

Pt 1: A 20 year-old male with autism, depression with suicidality and self-injury who demonstrated a partial response to electroconvulsive therapy and traditional adjunctive psychopharmacology. Riluzole addition provided sustained remission of residual symptoms.

Pt 2: A 9 year-old male with autism, cyclical mood disturbance and extreme self-injury towards the head requiring extensive protective equipment for safety. Riluzole conferred both affective stabilization and prominent reduction in self-injury.

Riluzole is a new psychopharmacological agent. Efficacy has been demonstrated for mood and anxiety disorders in the typically-developing population. Similar positive benefit may be seen for psychopathology in autism, and merits further investigation.

Hyponatremia (HPN) is a potentially lethal electrolytic disturbance. Certain medical treatments are integrated in the etiology of that sodium disorder. We retrospectively studied the rate of HPN in patients examined in the emergency room (ER) of Alexandra Hospital receiving a selective serotonin reuptake inhibitor (SSRI).

17,410 patients, 55.54% women and 44.46% men were examined in the ER over a one year period. 281 patients (1,61% of total) presented with HPN, 162 were women (57.6%) and 121 (42.3%) men. Plasma Sodium values ≤ 133mEq/l defined HPN. 13 of the 281 patients with HPN (4.6%) with no renal, heart or hepatic impairment were on an SSRI regimen.

11 of 162 women (6.8%) presented with HPN were receiving concurrently SSRI and either thiazide diuretic (3 ) or furosemide (2 ). 2 of 121 men (1.65%) were on SSRI regimen and furosemide. SSRI dosage was in all cases within suggested therapeutic limits. Table 1 demonstrates mean values and standard deviation of all the parameters examined.

SSRI therapy presents a potential cause for HPN principally in women older than 65 years old with increasing risk when diuretic is used concomitantly. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and expression conversion of aquaporin-2 receptors of the collecting ducts are two possible pathophysiologic mechanisms of HPN occurrence.