[Show abstract][Hide abstract]ABSTRACT: To investigate whether antidepressants are over-used, under-used, or misused, by determining to what extent the depressed individuals in a defined population are treated with antidepressant medication and, from the other end, to what extent prescribed antidepressants are aimed for the treatment of depression.
From an individual based prescription database in the County of Jämtland, 2048 individuals representative for the general population were selected. The presence of current depression in these individuals was screened by a mailed self-screening questionnaire. Individuals with depression according to the questionnaire were interviewed by a psychiatrist using a structured interview (SCAN) to confirm the diagnosis. Their use of antidepressants was obtained from the prescription database.
Sixty-two (4.5%) out of 1375 were diagnosed with depression and 17 (27%) of these were taking an antidepressant. In addition 44 individuals, currently not depressed, were taking antidepressants. Twenty-five of these were interviewed per telephone and it was found that the indications for 18 of them were continuation treatment of depression, and for seven of them pain, sleep disturbance or anxiety.
Antidepressants appear to be under-used in the population. Only one in four of the depressed individuals was treated with antidepressant medication. Those who had antidepressant medication without being currently depressed had, with few exceptions, either continuation treatment for depression in remission or treatment on other approved indications.
[Show abstract][Hide abstract]ABSTRACT: To consider and evaluate a continuing medical education programme for general practitioners (GPs) on depression in Jämtland county, Sweden, inspired by the Gotland study.
Interactive seminars were conducted between 1995 and 2002 in Jämtland county. For evaluation, suicide rates and annual sales statistics of antidepressants were compared with national averages. Questionnaires were used for information about attitudes and prescribing habits.
The suicide rate in Jämtland decreased to the same level as the national average. The use of antidepressants increased from 25% below the Swedish average to the same level. The selective serotonin re-uptake inhibitors (SSRIs) were preferred because of their tolerability. Suicide issues were considered to be most important in the management of depressed patients.
A trend towards a greater prescription of antidepressants and fewer suicides after an educational programme on depression for GPs replicated the findings from the Gotland study. The educational programme will be conducted annually and could be a model for other regions.
Article · Oct 2006 · Acta Psychiatrica Scandinavica
[Show abstract][Hide abstract]ABSTRACT: To assess the possible relationship between treatment with selective serotonin-reuptake inhibitors (SSRIs) and the occurrence of nocturia.
An unselected group of adult men and women, living in the city of Ostersund, Sweden, were sent a postal questionnaire containing questions on somatic and mental health, sleep, sleepiness and nocturia. For depression diagnostics, the Major Depression Inventory (MDI) was used. Prescription data on antidepressant drugs were extracted from a register in the county of Jamtland, Sweden.
The questionnaire was completed by 1375 subjects, of whom 609 (44%) were men; the response rate was 69%. Prescription data were available for all respondents. The mean (sd) age of the men and women participating were 48.0 (18.2) and 50.1 (19.1) years, respectively. Two or more nocturnal micturition episodes were reported in 15.6% of the men and 16.5% of the women. In a multiple logistic regression analysis, independent correlates for two or more nocturnal voids vs no more than one were: age 45-59 years vs <45 (odds ratio 2.9; 95% confidence interval 1.9-4.7); age 60-74 vs <45 (6.0; 3.7-9.8); age > 75 vs <45 (13.4; 7.9-22.6); major depression, yes vs no (4.6; 2.8-7.5); and being on treatment with SSRI, yes vs no (2.2; 1.1-4.5). Gender was deleted by the logistic regression model.
Major depression has previously been found to be associated with increased nocturnal micturition. In the present study, twice as many men and women treated with SSRIs as those not so treated had two or more nocturnal voids, after adjusting for major depression and age. The implication for the risk of fall injuries is discussed.
[Show abstract][Hide abstract]ABSTRACT: To assess the possible relationship between major depression (MD) and nocturia.
An unselected group of adult men and women, living in the city of Ostersund, Sweden, were sent a postal questionnaire containing questions on somatic and mental health, sleep, sleepiness and nocturia. For depression diagnostics the Major Depression Inventory (MDI) was used.
The mean (sd) ages of the men and women were 48.0 (18.2) and 50.1 (19.1) years, respectively. Two or more nocturnal micturition episodes occurred in 15.6% of the men and 16.5% of the women. In a multiple logistic regression analysis independent correlates (with 95% confidence intervals) for >/= 2 nocturnal voids in men were: MD 6.5 (2.6-15.6); health, fair vs good, 1.8 (1.0-3.9); health, poor vs good, 2.7 (1.1-4.8); age, 60-74 vs 18-29, 3.6 (1.5-8.4) and age >/= 75 vs 18-29 6.7 (2.6-17.4); and in women: MD 2.8 (1.3-6.3); health, fair vs good, 1.9 (1.1-3.2); health, poor vs good, 4.3 (2.6-8.2); age, 60-74 vs 18-29, 3.8 (1.8-7.8), and age >/= 75 vs 18-29, 8.6 (4.0-18.6). Age < 60 years was deleted by the logistic model in both sexes.
MD is associated with a six-fold increase in nocturia in men and a three-fold increase in women, after accounting for age and health. Possible pathogenetic mechanisms of this relationship may involve both increased nocturnal diuresis via a disturbed 24-h rhythm of antidiuretic hormone secretion, and a decrease in nocturnal bladder capacity through a central and/or peripheral serotonergic effect.
[Show abstract][Hide abstract]ABSTRACT: To examine the indications for prescribing antidepressants and the clinical outcome when they are prescribed for the treatment of depression, and compare tricyclic antidepressants (TCAs) and selective serotonin re-uptake inhibitors (SSRIs) in these respects.
A naturalistic study of a prospective prescription monitoring database and medical records.
Depression was the indication for 23% of the tricyclic treatments and for 82% of the SSRI treatments. A successful treatment of the depression was found in 20% of the TCA cases and 41% of the SSRI cases (NS).
This study provides evidence that the main use of SSRIs in 1995 is the treatment of depression. The study implies that SSRIs have a more favourable outcome in "real life" than TCAs.
Article · Jan 2004 · Acta Psychiatrica Scandinavica
[Show abstract][Hide abstract]ABSTRACT: This study presents data relating to prospectively monitored treatment and post-mortem toxicology of individuals who committed suicide.
A case-control study of prospectively monitored pharmacological treatment in suicides and controls. Psychiatric records and post-mortem toxicology were also studied.
Fifty-nine subjects who committed suicide purchased twice the number of prescriptions as the 118 controls. Sixteen cases received psychiatric in-patient care compared to four of the controls. In the last 3 months prior to suicide, 38 cases (64%) were dispensed drugs: anxiolytics-hypnotics in 17 cases (29%), antipsychotics in six cases (10%) and antidepressants in seven cases (12%). More psychiatrists than GPs prescribed antidepressants. About one-third of psychotropic drugs were retrieved in post-mortem toxicology.
There is a frequent use of psychotropics and psychiatric care among suicides; however, few used antidepressants and complied. Many suicides are still misdiagnosed and are not adequately treated.
Article · May 2001 · Acta Psychiatrica Scandinavica
[Show abstract][Hide abstract]ABSTRACT: With the advent of the selective serotonin reuptake inhibitors (SSRIs), the use of antidepressants has increased drastically in Sweden. The use of tricyclic antidepressants (TCAs) has, however, decreased.
We surveyed a prescription database in the Swedish county of Jämtland and compared prescription patterns for patients prescribed SSRIs with those prescribed TCAs.
The incidence of treatments of antidepressants increased from 0.76% to 1.33% during the period 1991-1996. There were no significant differences between SSRIs and TCAs with regard to patients having only one prescription dispensed within three months from the index prescription, or patients who switched class of antidepressant. Only a minority of the treatments were continued for at least six months, but significantly more SSRI than TCA treatments (42% and 27%). A second treatment period suggesting recurrence was three-times more common in the TCA group than in the SSRI group.
Provided that the increased use of SSRIs is mainly for depression, these drugs appear, despite a lower efficacy in severe depression, to have enabled a broader utilisation of antidepressants with regard to incidence, dosage and duration, in accordance with recommendations. Further analyses of this phenomenon relative to diagnostic criteria and outcome measures are required.
Article · May 1999 · Journal of Affective Disorders