Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011
ABSTRACT Objective:This study examined longitudinal trends in the dispensing of psychotropic medications in Australia from January 2000 to December 2011.Method:Dispensing data for the major classes of psychotropic medications (antidepressants, anxiolytics, sedatives, antipsychotics, mood stabilisers and attention-deficit hyperactivity disorder (ADHD) medications) were obtained from the Drug Utilisation Sub-Committee of the Australian Department of Health and Ageing. Results were expressed in terms of defined daily doses/1000 population/day (DDDs/1000/day).Results:There was a 58.2% increase in the dispensing of psychotropic drugs in Australia from 2000 to 2011, driven by major increases in antidepressants (95.3% increase in DDDs/1000/day), atypical antipsychotics (217.7% increase) and ADHD medications (72.9% increase). Dispensing of anxiolytics remained largely unchanged, while sedatives and typical antipsychotics decreased by 26.4% and 61.2%, respectively. Lithium dispensing remained static while valproate and lamotrigine increased markedly. In 2011, antidepressants accounted for 66.9% of total psychotropic DDDs/1000/day totals, far greater than anxiolytics (11.4%), antipsychotics (7.3%), mood stabilisers (5.8%), sedatives (5.5%), or ADHD medications (3.0%). Sertraline, olanzapine, valproate and methylphenidate were the most frequently dispensed antidepressant, antipsychotic, mood stabiliser and ADHD medication, respectively, while diazepam and temazepam were the most commonly dispensed anxiolytic and sedative.Conclusions:Psychotropic utilisation markedly increased in Australia between 2000 and 2011. Some potential concerns include: (1) the continuing high use of benzodiazepines, particularly alprazolam, despite their problematic effects; (2) the rapid increase in serotonin noradrenaline reuptake inhibitor (SNRI) use, given their more complex side-effect profile relative to selective serotonin reuptake inhibitors (SSRIs); and (3) the dramatic increase in antidepressant prescriptions despite questions about the efficacy of these drugs in mild to moderate depression. Finally, some limitations are identified regarding use of the DDDs/1000/day metric, which can distort estimates of utilisation of specific drugs when the defined daily dose is higher or lower than the formulation most commonly dispensed by pharmacies.
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ABSTRACT: Antipsychotic medications are increasingly used during pregnancy. Nevertheless, fetal risks are still not fully studied. It is currently unclear whether the antipsychotic treatment might induce a higher risk of fetal death. We aimed to determine if use of antipsychotic medication during pregnancy is associated with an increased risk of spontaneous abortion or stillbirth. In a historical cohort study, we identified all clinically recognized pregnancies registered in the nationwide Danish registries from 1997 to 2008 (N = 1,005,319). Exposure was defined as any prescription of antipsychotic medications redeemed by the pregnant women during the exposure window, and recorded in the Danish National Prescription Register. Outcome was defined as any spontaneous abortion or stillbirth recorded in the Danish National Hospital Register and the Danish Medical Birth Register respectively. Women exposed to antipsychotic medications during pregnancy had a 34% higher risk of spontaneous abortion (adjusted relative risk = 1.34; 95% confidence interval = 1.22; 1.46) compared to unexposed women, but a similar risk compared to women exposed prior to (but not during) pregnancy (adjusted relative risk = 1.04; 95% confidence interval = 0.93; 1.17). The risk of spontaneous abortion was not increased in exposed pregnancies when compared to unexposed pregnancies in the same women (adjusted hazard ratio = 1.11; 95% CI = 0.94; 1.31). A twofold higher risk of stillbirth was found in women exposed to antipsychotic medications compared with unexposed women (relative risk = 2.27; 95% confidence interval = 1.45; 3.55) and compared with women exposed only prior to pregnancy (relative risk = 2.06; 95% confidence interval = 1.01; 4.19). The increased risk of spontaneous abortion found in women treated with antipsychotic medications during pregnancy is most likely due to confounding factors. The risk of stillbirth was twofold higher in pregnancies exposed to antipsychotic medication during pregnancy. Treatment with antipsychotic medications during pregnancy requires careful consideration.PLoS ONE 10(7):e0132280. DOI:10.1371/journal.pone.0132280 · 3.53 Impact Factor
- Journal of Orthomolecular Medicine 01/2013; 28(1):17-32.
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ABSTRACT: RUNX3 (runt-related transcription factor-3) is a known tumor suppressor gene which exhibits potent antitumor activity in several carcinomas. However, little is known about the role of RUNX3 in human renal cell carcinoma (RCC). To investigate the clinical relevance of RUNX3 in RCC patients, immunohistochemistry was performed to detect the clinical relevance of RUNX3 in 75 RCC tissues and paired non-cancerous tissues by using tissue microarray (TMA). We also investigated the role of RUNX3 in RCC cell migration, invasion and angiogenesis. The RUNX3 expression was decreased dramatically in human RCC tissue. The RUNX3 expression was significantly correlated with tumor size (<0.001), depth of invasion (<0.001), and of TNM stage (<0.001). Restoration of RUNX3 significantly decreased renal carcinoma cell migration and invasion capacity compared with controls. In addition, we found that overexpression of RUNX3 reduced the proliferation and tube formation of human umbilical vascular endothelial cells (HUVECs). Gelatin zymography and Western blot showed that RUNX3 expression suppressed matrix metalloproteinase-9 (MMP-9) protein level and enzyme activity. Western blot and ELISA showed that RUNX3 restoration inhibited the expression and secretion of vascular endothelial growth factor (VEGF). Taken together, our studies indicate that decreased expression of RUNX3 in human RCC tissue is significantly correlated with RCC progression. Restoration of RUNX3 expression significantly inhibits RCC cells migration, invasion and angiogenesis. These findings provide new insights into the significance of RUNX3 in migration, invasion and angiogenesis of RCC.PLoS ONE 02/2013; 8(2):e56241. DOI:10.1371/journal.pone.0056241 · 3.53 Impact Factor