Antidepressant and anticonvulsant prescription rates in patients with osteoarthritis: a population-based cohort study

Driest, Jacoline J van den; Schiphof, D.; Wilde, Marcel de; Bindels, Patrick J E; Lei, Johan van der; Bierma-Zeinstra, Sita M A

doi:10.1093/rheumatology/keaa544

Cited by 30 publications

(6 citation statements)

References 47 publications

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“…To our best knowledge, this is the first study to investigate the effect of COVID-19 lockdowns on a national sample of psychopharmacologic prescription data. However, attempts to make assumptions on illnesses and to estimate health parameters by analyzing prescription rates of psychopharmacologic drugs [17][18][19][20] and studies on the effect of COVID-19 restrictions on the utilization of the health system [21] have been done before.…”

Section: Discussionmentioning

confidence: 99%

Prescriptions of psychopharmacologic drugs in Austria in 2019 and 2020 – Implications of the COVID-19 pandemic

et al. 2022

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Background: Measures to reduce the spread of the SARS-CoV-2 virus have an impact on the mental health of the general population. Drug prescription rates can be used as a surrogate marker to estimate help seeking and health parameters of a population. The aim of this study was to compare psychopharmacologic drug prescriptions in Austria from the start of the pandemic in 2020 over time and with the previous year and to investigate the impact of the COVID-19 lockdowns in 2020.Methods: Data of the three largest public health insurances in Austria, covering over 98% of the general population, were analyzed. 1 365 294 patients with a prescription of a psychopharmacologic drug in the months March to December in 2019 and 2020 were selected.Results: There was no significant change in prescribed DDD (defined daily doses) during the lockdowns. However, there was a stockpiling effect before and at the beginning of lockdown 1. The number of new patients initiating psychopharmacologic treatment was significantly reduced during lockdown 1 but not during lockdown 2. Conclusions:The first COVID-19 lockdown in 2020 functioned as a barrier for new psychiatric patients seeking help, while patients with ongoing treatments did not have significant problems. These results have to be taken into account for future planning, but follow-up studies are needed, as our results could be indicative of a change in the effect of the protective measures on the utilization of the healthcare system over time.

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Section: Discussionmentioning

confidence: 99%

Prescriptions of psychopharmacologic drugs in Austria in 2019 and 2020 – Implications of the COVID-19 pandemic

et al. 2022

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“… 11 In the Netherlands, prescription of the tricyclic antidepressants amitriptyline for people with osteoarthritis has increased by 17% over the past decade. 12 In that study, long term use (≥3 months) was also observed in 40% of those prescribed an antidepressant.…”

Section: Introductionmentioning

confidence: 76%

Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews

Ferreira

Shaheed

Underwood

et al. 2023

BMJ

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Objective To provide a comprehensive overview of the efficacy, safety, and tolerability of antidepressants for pain according to condition. Design Overview of systematic reviews. Data sources PubMed, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials from inception to 20 June 2022. Eligibility criteria for selecting studies Systematic reviews comparing any antidepressant with placebo for any pain condition in adults. Data extraction and synthesis Two reviewers independently extracted data. The main outcome measure was pain; for headache disorders it was frequency of headaches. Continuous pain outcomes were converted into a scale of 0 (no pain) to 100 (worst pain) and were presented as mean differences (95% confidence intervals). Dichotomous outcomes were presented as risk ratios (95% confidence intervals). Data were extracted from the time point closest to the end of treatment. When end of treatment was too variable across trials in a review, data were extracted from the outcome or time point with the largest number of trials and participants. Secondary outcomes were safety and tolerability (withdrawals because of adverse events). Findings were classified from each comparison as efficacious, not efficacious, or inconclusive. Certainty of evidence was assessed with the grading of recommendations assessment, development, and evaluation framework. Results 26 reviews (156 unique trials and >25 000 participants) were included. These reviews reported on the efficacy of eight antidepressant classes covering 22 pain conditions (42 distinct comparisons). No review provided high certainty evidence on the efficacy of antidepressants for pain for any condition. 11 comparisons (nine conditions) were found where antidepressants were efficacious, four with moderate certainty evidence: serotonin-norepinephrine reuptake inhibitors (SNRIs) for back pain (mean difference −5.3, 95% confidence interval −7.3 to −3.3), postoperative pain (−7.3, −12.9 to −1.7), neuropathic pain (−6.8, −8.7 to −4.8), and fibromyalgia (risk ratio 1.4, 95% confidence interval 1.3 to 1.6). For the other 31 comparisons, antidepressants were either not efficacious (five comparisons) or the evidence was inconclusive (26 comparisons). Conclusions Evidence of efficacy of antidepressants was found in 11 of the 42 comparisons included in this overview of systematic reviews—seven of the 11 comparisons investigated the efficacy of SNRIs. For the other 31 comparisons, antidepressants were either inefficacious or evidence on efficacy was inconclusive. The findings suggest that a more nuanced approach is needed when prescribing antidepressants for pain conditions. Systematic review registration PROSPERO CRD42022311073.

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“…Furthermore, we interviewed general practitioners about their attitude toward duloxetine in patients with OA pain. General practitioners were relatively unfamiliar with duloxetine, since duloxetine is not often prescribed (48,49), and were concerned about the occurrence of side effects. Some general practitioners stated that duloxetine may be an option for patients in whom other therapies have proven unsuccessful.…”

Section: Discussionmentioning

confidence: 99%

No Added Value of Duloxetine in Patients With Chronic Pain due to Hip or Knee Osteoarthritis: A Cluster‐Randomized Trial

Driest

Schiphof

Koffeman

et al. 2022

Arthritis & Rheumatology

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Objective To assess the effectiveness of duloxetine in addition to usual care in patients with chronic osteoarthritis (OA) pain. The cost‐effectiveness and whether the presence of symptoms of centralized pain alters the response to duloxetine were secondary objectives. Methods We conducted an open‐label, cluster‐randomized trial. Patients with chronic hip or knee OA pain who had an insufficient response to acetaminophen and nonsteroidal antiinflammatory drugs were included. Randomization took place at the general practice level, and patients received duloxetine (60 mg/day) in addition to usual care or usual care alone. The presence of centralized pain was defined as a modified PainDETECT Questionnaire score >12. The primary outcome measure was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores (scale 0–20) at 3 months after the initiation of treatment. Our aim was to detect a difference between the groups of a clinically relevant effect of 1.9 points (effect size 0.4). We used a linear mixed model with repeated measurements to analyze the data. Results In total, 133 patients were included, and 132 patients were randomized into treatment groups. A total of 66 patients (at 31 practices) were randomized to receive duloxetine in addition to usual care, and 66 patients (at 35 practices) were randomized to receive usual care alone. We found no differences in WOMAC pain scores between the groups at 3 months (adjusted difference –0.58 [95% confidence interval (95% CI) –1.80, 0.63]) or at 12 months (adjusted difference –0.26 [95% CI –1.86, 1.34]). In the subgroup of patients with centralized pain symptoms, we also found no effect of duloxetine compared to usual care alone (adjusted difference –0.32 [95% CI –2.32, 1.67]). Conclusion We found no effect of duloxetine added to usual care compared to usual care alone in patients with chronic knee or hip OA pain. Another trial including patients with centralized pain symptoms should be conducted to validate our results.

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Antidepressant and anticonvulsant prescription rates in patients with osteoarthritis: a population-based cohort study

Cited by 30 publications

References 47 publications

Prescriptions of psychopharmacologic drugs in Austria in 2019 and 2020 – Implications of the COVID-19 pandemic

Prescriptions of psychopharmacologic drugs in Austria in 2019 and 2020 – Implications of the COVID-19 pandemic

Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews

No Added Value of Duloxetine in Patients With Chronic Pain due to Hip or Knee Osteoarthritis: A Cluster‐Randomized Trial

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