Estudio sobre el uso y seguimiento del tratamiento con antidepresivos realizado por los médicos de Atención Primaria

Quintana, E. Villalva; Martínez, Luis Caballero

doi:10.1016/s1138-3593(06)73310-x

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…The timing of adopting a new pharmacological approach in our study was greater than recommended: mean duration of AD treatment at baseline was 12.0 weeks (SD 11.1). The variability observed by psychiatrists in their clinical attitude towards patients with major depression has previously been described at primary care level [24,25]. A recent publication by Chang et al found little active management among MDD patients treated in primary care centres in the USA [26].…”

Section: Discussionmentioning

confidence: 99%

Treatment patterns in major depressive disorder after an inadequate response to first-line antidepressant treatment

et al. 2012

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BackgroundThe aim of the study was to determine the most common pharmacological strategies used in the management of major depressive disorder (MDD) after an inadequate response to first-line antidepressant treatment in clinical practice.MethodsMulticenter, non-interventional study in adult outpatients with a DSM-IV-TR diagnosis of MDD and inadequate response to first-line antidepressant medication. Multiple logistic regression analyses were performed to identify independent factors associated with the adoption of a specific second-line strategy.ResultsA total of 273 patients were analyzed (mean age: 46.8 years, 67.8% female). Baseline mean Montgomery-Asberg Depression Rating Scale total score was 32.1 (95%CI 31.2-32.9). The most common strategies were: switching antidepressant medication (39.6%), augmentation (18.8%), and combination therapy (17.9%). Atypical antipsychotic drugs were the most commonly used agent for augmenting antidepressant effect. The presence of psychotic symptoms and the number of previous major depressive episodes were associated with the adoption of augmenting strategy (OR = 3.2 and 1.2, respectively).ConclusionThe switch to another antidepressant agent was the most common second-line therapeutic approach. Psychiatrists chose augmentation based on a worse patients’ clinical profile (number of previous episodes and presence of psychotic symptoms).

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Section: Discussionmentioning

confidence: 99%

Treatment patterns in major depressive disorder after an inadequate response to first-line antidepressant treatment

et al. 2012

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“…In a study conducted in Spain, 23% of general practitioners (GPs) referred patients with major depression to the psychiatrist [11]. In a survey conducted by Villava and Caballero (2006) among more than 1,000 GPs in Spain, the mean referral rate was 24%, being higher in physicians who reported poorer training and greater demand for care [12]. As regards referral criteria, the main reasons reported were severity of the episode (87%), lack of response to treatment (41%), and express request by the patient (37%).…”

Section: Introductionmentioning

confidence: 99%

Assessment of pharmacological strategies for management of major depressive disorder and their costs after an inadequate response to first-line antidepressant treatment in primary care

et al. 2012

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BackgroundThe aim of the study was to determine the most common treatment strategies and their costs for patients with an inadequate response to first-line antidepressant treatment (AD) in primary care.MethodA retrospective cohort study of medical records from six primary care centers was conducted. Adults with a major depressive disorder diagnosis, at least 8 weeks of AD treatment after the first prescription, and patient monitoring for 12 months were analyzed. Healthcare (direct cost) and non-healthcare costs (indirect costs; work productivity losses) were described.ResultsA total of 2,260 patients were studied. Forty-three percent of patients (N = 965) presented an inadequate response to treatment. Summarizing the different treatment approaches: 43.2% were switched to another AD, 15.5% were given an additional AD, AD dose was increased in 14.6%, and 26.7% remained with the same antidepressant agent. Healthcare/annual costs were 451.2 Euros for patients in remission vs. 826.1 Euros in those with inadequate response, and productivity losses were 991.4 versus 1,842.0 Euros, respectively (p < 0.001).ConclusionAntidepressant switch was the most common therapeutic approach performed by general practitioners in naturalistic practice. A delay in treatment change when no remission occurs and a significant heterogeneity in management of these patients were also found.

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“…The change in the psychiatric care model, now incorporated into the rest of specialties, within primary care (PC) and closer to the patients, has been associated with an increase in the diagnoses of depression [2] as well as the indication for antidepressants –which are used to treat depression and other disorders in 36% and 64% of cases, respectively [3]. …”

Section: Introductionmentioning

confidence: 99%

Follow up of patients who start treatment with antidepressants: treatment satisfaction, treatment compliance, efficacy and safety

et al. 2013

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BackgroundMeasuring satisfaction with treatment has proved useful to ascertain the treatment features that are most important to the patients, and to explain increased treatment compliance. However, there are few studies that relate satisfaction to other clinical or self-perceived health status indicators. Recent studies have shown the close relationship between satisfaction with treatment, treatment compliance, and effectiveness. This study attempts to design and validate a scale to evaluate satisfaction with antidepressant drug therapy, assess treatment compliance (self-reported, validated questionnaire, drug accountability and electronic monitorization system), assess efficacy in reducing depressive symptoms and safety in patients who initiate antidepressant drug therapy, as well as to establish predictors of satisfaction, compliance and effectiveness with these drugs.Methods/designThis is an observational longitudinal study with a cohort of adults initiating treatment with antidepressant drugs. A multi-centre study will be performed in which 20 Primary Care practices from Castilla-La Mancha are expected to participate. An initial interview and follow-up visits at 15 days, 1, 3, 6, 9 and 12 months will be conducted with all study participants. 706 subjects will be studied (95% confidence interval, precision ± 3%, expected rate of non-compliance 50%, expected non-responders and lost to follow up rate 15%). The following measurements will be performed: development and validation of a scale of satisfaction with antidepressant therapy, participant and antidepressant characteristics, treatment compliance evaluation (Haynes-Sackett Test, Morisky-Green Test, drug accountability and Medication Event Monitoring System), depression symptom reduction (Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale), observation of adverse effects, and beliefs about treatment (The Beliefs about Medicines Questionnaire).DiscussionAntidepressant drugs are an extraordinarily important therapeutic group in the pharmacy composition; economic repercussions and social impact associated to their use is clear. Despite their well-established efficacy in clinical trials, treatment non-compliance is a major obstacle to their effectiveness in clinical practice. The proposed study brings about useful conclusions to improve the results of these drugs. Additionally, devising a scale specifically designed to evaluate satisfaction with antidepressant treatment could be of interest in healthcare outcomes research.

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Estudio sobre el uso y seguimiento del tratamiento con antidepresivos realizado por los médicos de Atención Primaria

Cited by 5 publications

References 12 publications

Treatment patterns in major depressive disorder after an inadequate response to first-line antidepressant treatment

Treatment patterns in major depressive disorder after an inadequate response to first-line antidepressant treatment

Assessment of pharmacological strategies for management of major depressive disorder and their costs after an inadequate response to first-line antidepressant treatment in primary care

Follow up of patients who start treatment with antidepressants: treatment satisfaction, treatment compliance, efficacy and safety

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