Depression Treatment: THE ASSOCIATION BETWEEN ANTIDEPRESSANT DOSAGE TITRATION and MEDICATION ADHERENCE AMONG PATIENTS WITH DEPRESSION.
THE ASSOCIATION BETWEEN ANTIDEPRESSANT DOSAGE TITRATION AND MEDICATION ADHERENCE AMONG PATIENTS WITH DEPRESSION.
Filed under: Depression Treatment
Depress Anxiety. 2012 May 2;
Wu CH, Farley JF, Gaynes BN
BACKGROUND: To evaluate the association between upward dose titration of antidepressants and medication adherence during the first 6 months of a newly initiated antidepressant treatment for patients with major depressive disorder (MDD). METHODS: We conducted a retrospective observational cohort study using Thomson Reuters MarketScan Commercial Claims and Encounters Claims data. We identified 40,873 patients aged 18-64 with MDD newly initiating a selective serotonin reuptake inhibitor, serotonin-norepinephrine reuptake inhibitor, or bupropion between July 1, 2005 and June 30, 2007. Patients with titration (defined as antidepressant initiation at doses equal or lesser than American Psychiatric Association treatment guidelines with a dosage increase in the first 60 days of treatment) were compared to patients with no titration. Adherence was measured as the proportion of days covered (PDC) on antidepressant treatment. Patients with PDC ? 80% were considered adherent. Persistence was measured as the duration of time from initiation to a 30-day gap in antidepressant treatment. Multivariate logistic regression and Cox-proportional hazard models examined the influence of titration on adherence and persistence, respectively. RESULTS: Adherence was greater in the titration group than in the nontitration group (67.5% versus 45.2%, P < .01). After adjustment for selected covariates, patients in the titration group were more likely to adhere to antidepressant treatments (odds ratio = 2.60, 95% confidence interval (CI) = 2.47-2.74) and less likely to have a 30-day gap in treatment (hazard ratio = 0.48, 95% CI = 0.45-0.51). CONCLUSIONS: Upward dose titration on antidepressant treatments was associated with improved medication adherence and persistence. For clinicians initiating antidepressant treatment, titrating antidepressant doses may improve patient outcomes. HubMed – depression
COMPARATIVE EFFECTIVENESS OF SECOND-GENERATION ANTIDEPRESSANTS FOR ACCOMPANYING ANXIETY, INSOMNIA, AND PAIN IN DEPRESSED PATIENTS: A SYSTEMATIC REVIEW.
Filed under: Depression Treatment
Depress Anxiety. 2012 May 2;
Thaler KJ, Morgan LC, Van Noord M, Gaynes BN, Hansen RA, Lux LJ, Krebs EE, Lohr KN, Gartlehner G
BACKGROUND: Patients with major depressive disorder (MDD) often suffer from accompanying symptoms that influence the choice of pharmacotherapy with second-generation antidepressants (SGAs). We conducted a systematic review to determine the comparative effectiveness of citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, desvenlafaxine, duloxetine, venlafaxine, bupropion, mirtazapine, nefazodone, and trazodone, for accompanying anxiety, insomnia, and pain in patients with MDD. METHODS: We conducted searches in multiple databases including MEDLINE®, Embase, the Cochrane Library, International Pharmaceutical Abstracts, and PsycINFO, from 1980 through August 2011 and reviewed reference lists of pertinent articles. We dually reviewed abstracts, full-text articles, and abstracted data. We included randomized, head-to-head trials of SGAs of at least 6 weeks’ duration. We grouped SGAs into three classes for the analysis: selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors, and others. We graded the strength of the evidence as high, moderate, low, or very low based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group (GRADE) approach. RESULTS: We located 19 head-to-head trials in total: 11 on anxiety, six on insomnia, and four on pain. For the majority of comparisons, the strength of the evidence was moderate or low: evidence is weakened by inconsistency and imprecision. For treating anxiety, insomnia, and pain moderate evidence suggests that the SSRIs do not differ. CONCLUSIONS: Evidence guiding the selection of an SGA based on accompanying symptoms of depression is limited. Very few trials were designed and adequately powered to answer questions about accompanying symptoms; analyses were generally of subgroups in larger MDD trials.
HubMed – depression
THE IMPORTANCE OF ANXIETY IN BOTH MAJOR DEPRESSION AND BIPOLAR DISORDER.
Filed under: Depression Treatment
Depress Anxiety. 2012 May 2;
Goldberg D, Fawcett J
BACKGROUND: Generalized anxiety disorder (GAD) is frequently co-morbid with major depression (MDD), and this becomes more so when the duration requirement is relaxed. Both anxiety diagnoses and anxious symptoms are more common in both unipolar and bipolar depression. This paper explores the relationship between anxious symptoms and GAD with both unipolar and bipolar depression. METHOD: MDD and bipolar disorder (BPD) are compared in three important respects: the extent of their co-morbidity with anxious symptoms and GAD, the effects that anxiety has on outcome of MDD and BPD, and the effects that anxiety has on the probability of suicide in each disorder. RESULTS: Anxious diagnoses occur frequently in association with depressive disorders, albeit to a different extent in the various subtypes of depression. In both disorders, anxiety affects the outcome and makes suicidal thoughts, and completed suicide more likely. CONCLUSIONS: Anxious phenomena should be assessed whenever a depressive disorder is diagnosed. It is likely that the raised expectancy of anxious phenomena is related to an individual’s premorbid level of negative affect, and it is possible that suicidal phenomena are related to subthreshold hypomanic symptoms.
HubMed – depression
Signs, Symptoms, and Treatment of Depression – Video from the National Institute of Mental Health (NIMH) about the causes, symptoms, and treatments of depression. We accept comments in the spirit of our comment policy: www.nimh.nih.gov NIMH Privacy Policy: www.nimh.nih.gov
Depression: Treatment Strategies and Management (Medical Psychiatry Series)Guiding clinicians toward the most effective treatment regimens, this reference offers detailed coverage of the symptomatology, di…
Amoryn – Depression & AnxietyAMORYN works by increasing the levels of all four of the brain’s “feel good” neurotransmitters. By providing an all-natural boost …
Midwest Center! Lucinda Basset, Attacking Stress, Anxiety and Depression! Master Kit, 2008 Edition!Attacking Stress Anxiety & Depression The Midwest Center Master Kit! 2008 Edition Product Reatails for over 500 Dollars! Get it he…
Find More Depression Treatment Information…