Antidepressants for neuropathic pain: a Cochrane review.

Helsinki University Central Hospital, Department of Oncology, Helsinki, Finland.
Journal of neurology, neurosurgery, and psychiatry (Impact Factor: 4.87). 12/2010; 81(12):1372-3. DOI: 10.1136/jnnp.2008.144964
Source: PubMed
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    ABSTRACT: Background Under-prescription of antidepressants (ADs) among people meeting the criteria for major depressive episodes and excessive prescription in less symptomatic patients have been reported. The reasons influencing general practitioners’ (GPs) prescription of ADs remain little explored. This study aimed at assessing the influence of GP and patient characteristics on AD prescription. Methods This cross-sectional study was based on a sample of 816 GPs working within the main health care insurance system in the Seine-Maritime district of France during 2010. Only GPs meeting the criteria for full-time GP practice were included. The ratio of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP, using the defined daily dose (DDD) concept. Associations of this AD prescription ratio with GPs’ age, gender, practice location, number of years of practice, number of days of sickness certificates prescribed, number of home visits and consultations, number and mean age of registered patients, mean patient income, and number of patients with a chronic condition were assessed using univariate and multivariate analysis. Results The high prescribers were middle-aged (40–59) urban GPs, with a moderate number of consultations and fewer low-income and chronic patients. GPs’ workload (e.g., volume of prescribed drug reimbursement and number of consultations) had no influence on the AD prescription ratio. GPs with more patients with risk factors for depression prescribed fewer ADs, however, which could suggest the medications were under-prescribed among the at-risk population. Conclusions Our study described a profile of the typical higher AD prescriber that did not include heavy workload. In future work, a more detailed assessment of all biopsychosocial components of the consultation and other influences on GP behavior such as prior training would be useful to explain AD prescription in GP’s practice. Electronic supplementary material The online version of this article (doi:10.1186/s12991-015-0041-7) contains supplementary material, which is available to authorized users.
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    ABSTRACT: Le polymorphisme génétique des enzymes impliqués dans la pharmacocinétique et la pharmacodynamie des antidépresseurs est l’une des causes de la variabilité interindividuelle observée sous ces traitements. Les résultats des études demeurent cependant contradictoires s’agissant des enzymes du métabolisme ou des enzymes cibles des antidépresseurs. L’influence des variantes alléliques des cytochromes P450 fait l’objet de recommandations d’adaptation des posologies en fonction de l’activité prédite de l’enzyme. Ces adaptations n’ont cependant pas fait l’objet d’évaluations prospectives systématiques.
    Douleur et Analgésie 12/2013; 26(4). · 0.09 Impact Factor
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