scholarly journals Usage, Risk, and Benefit of Weight-Loss Drugs in Primary Care

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Tomas Forslund ◽  
Pauline Raaschou ◽  
Paul Hjemdahl ◽  
Ingvar Krakau ◽  
Björn Wettermark
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Drug Treatment ◽  
Antidepressant Treatment ◽  
Patient Request ◽  
History Of ◽  
One Year ◽  
Risk And Benefit ◽  
History Of Depression ◽  
Weight Loss Drug

Purpose. To investigate the use of the weight-loss drugs rimonabant, sibutramine, and orlistat in primary care and to characterize the patients receiving the drugs.Methods. In this retrospective, descriptive study, 300 randomly selected patients having started weight-loss drug treatment at 15 primary care centres were investigated using the patient's medical records and their complete drug purchase data.Results. Even though 48% of the patients specifically demanded drug treatment, 77% continued treatment less than one year. 28% of rimonabant patients and 32% of sibutramine patients had a history of depression or antidepressant treatment. 41% of sibutramine patients had a history of hypertension and/or cardiovascular disease. 36% had no documented weight after treatment initiation.Conclusions. These results suggest that weight-loss drug treatment was often initiated upon patient request but was of limited clinical benefit as it was managed in a large portion of Swedish primary carecenters.

scholarly journals Antidepressant treatment for primary care patients with depressive symptoms: Data from the diamond longitudinal cohort study

2020 ◽  
Vol 54 (4) ◽  
pp. 367-381
Author(s):  
Sandra K Davidson ◽  
Helena Romaniuk ◽  
Patty Chondros ◽  
Christopher Dowrick ◽  
Jane Pirkis ◽  
...  
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Antidepressant Treatment ◽  
Factors Associated ◽  
History Of ◽  
Primary Care Patients ◽  
General Practices ◽  
Antidepressant Use ◽  
History Of Depression

Background: In light of emerging evidence questioning the safety of antidepressants, it is timely to investigate the appropriateness of antidepressant prescribing. This study estimated the prevalence of possible over- and under-treatment with antidepressants among primary care attendees and investigated the factors associated with potentially inappropriate antidepressant use. Methods: In all, 789 adult primary care patients with depressive symptoms were recruited from 30 general practices in Victoria, Australia, in 2005 and followed up every 3 months in 2006 and annually from 2007 to 2011. For this study, we first assessed appropriateness of antidepressant use in 2007 at the 2-year follow-up to enable history of depression to be taken into account, providing 574 (73%) patients with five yearly assessments, resulting in a total of 2870 assessments. We estimated the prevalence of use of antidepressants according to the adapted National Institute for Health and Care Excellence guidelines and used regression analysis to identify factors associated with possible over- and under-treatment. Results: In 41% (243/586) of assessments where antidepressants were indicated according to adapted National Institute for Health and Care Excellence guidelines, patients reported not taking them. Conversely in a third (557/1711) of assessments where guideline criteria were unlikely to be met, participants reported antidepressant use. Being female and chronic physical illness were associated with antidepressant use where guideline criteria were not met, but no factors were associated with not taking antidepressants where guideline criteria were met. Conclusions: Much antidepressant treatment in general practice is for people with minimal or mild symptoms, while people with moderate or severe depressive symptoms may miss out. There is considerable scope for improving depression care through better allocation of antidepressant treatment.

scholarly journals The contribution of depressive ‘disorder characteristics’ to determinations of prognosis for adults with depression: an individual patient data meta-analysis

2021 ◽  
pp. 1-14
Author(s):  
Joshua E. J. Buckman ◽  
Rob Saunders ◽  
Zachary D. Cohen ◽  
Phoebe Barnett ◽  
Katherine Clarke ◽  
...  
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Depressive Symptom ◽  
Panic Disorder ◽  
Symptom Severity ◽  
Individual Patient Data ◽  
Antidepressant Treatment ◽  
Patient Data ◽  
History Of ◽  
Depressive Symptom Severity

Abstract Background This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care. Methods We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted. Results Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3–4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3–4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions. Conclusions When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.

scholarly journals Dofetilide-induced anorexia in an older adult

2018 ◽  
Vol 9 (7) ◽  
pp. 367-372 ◽  
Author(s):  
Jerald V. Felipe ◽  
Danielle R. Fixen ◽  
Sunny A. Linnebur
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Body Weight ◽  
Primary Care Physician ◽  
Care Physician ◽  
Temporal Association ◽  
Appetite Loss ◽  
History Of ◽  
Medication Changes ◽  
Maximum Weight Loss

An 84-year-old woman presented to her primary care physician with an unexplained 4-month history of weight and appetite loss after initiation of dofetilide 125 mcg orally twice daily for atrial fibrillation. She was noted to have lost 2.5 kg, which was a 3.6% decrease from her initial body weight of 69.4 kg. After excluding other etiologies for her anorexia, such as medication changes or changes in other diseases or conditions, her primary care physician and cardiologists elected to continue dofetilide but monitor the patient’s appetite and body weight. After 7 months of dofetilide use with persistent appetite loss, the cardiology team discontinued dofetilide. Continued weight loss was observed until approximately 1 month after stopping dofetilide, with a maximum weight loss of 2.9 kg or a 4.2% decrease. Improvements in appetite were reported 2 months after discontinuing dofetilide, with minor increases in weight that eventually stabilized. In this case, while taking dofetilide, the patient experienced anorexia leading to weight loss that subsided after discontinuation of the drug. Based on the temporal association between the patient’s changes in appetite and body weight and treatment with dofetilide, the drug was most likely the cause of the patient’s anorexia. We are unaware of other reports of anorexia associated with dofetilide, but clinicians may want to consider the drug as a potential cause for otherwise unexplained changes in appetite or body weight.

Antidepressant Medication May Moderate the Effect of Depression Duration on Hippocampus Volume

2016 ◽  
Vol 30 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Mark A. Rogers ◽  
Hidenori Yamasue ◽  
Kiyoto Kasai
Keyword(s):  
Major Depression ◽  
Antidepressant Treatment ◽  
Antidepressant Medication ◽  
Healthy Controls ◽  
Detailed History ◽  
Treatment History ◽  
Left Hippocampus ◽  
History Of ◽  
History Of Depression ◽  
Hippocampus Volume

Abstract. Hippocampus volume has been frequently, but not universally reported to be reduced in people with major depression relative to age-matched healthy controls. Among the potential reasons for this discrepancy in finding across studies is the effect of antidepressant medication. Hippocampus volume was determined by MRI (1.5 Tesla) for 10 people diagnosed with major depression for who detailed history of depression and antidepressant treatment history were known, and 10 age-matched healthy controls with no history of depression. Left, but not right, hippocampus volumes were significantly smaller in the patient group compared to the controls. Furthermore, there was a significant correlation such that left hippocampus volume was smaller with increasing lifetime duration of depression. However, this relationship was moderated by a significant correlation such that greater lifetime duration of antidepressant medication was associated with larger left hippocampus volume. The findings support the contention that antidepressant medication may act to normalize hippocampus volume.

Five Risk Factors for Depression

1987 ◽  
Vol 150 (4) ◽  
pp. 536-541 ◽  
Author(s):  
A. Roy
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Young Children ◽  
Endogenous Depression ◽  
Degree Relative ◽  
History Of ◽  
One Year ◽  
Family History Of Depression ◽  
History Of Depression ◽  
At Home

Significantly more of 300 patients with non-endogenous depression compared with 300 matched controls were unemployed and had a poor marriage before the onset of depression, had a first-degree relative who had been treated for depression, had experienced separation for one year or more from a parent before 17 years of age and had three or more children under 14 years of age at home. However, significantly more of 44 patients with endogenous depression, than their 46 controls, also had a poor marriage before the onset of depression and 43% of them had a first-degree relative who had been treated for depression. Thus a family history of depression and a poor marriage before the onset of depression are associated with both non-endogenous and endogenous depression but unemployment, separation for one year or more from a parent before 17 years of age, and having three or more young children at home may be risk factors for non-endogenous depression.

scholarly journals Predictors of Treatments Acceptable to Patients for Late-Life Depression

2013 ◽  
Vol 2013 ◽  
pp. 1-8
Author(s):  
Gerald J. Jogerst ◽  
Shimin Zheng ◽  
Erik Vanderlip
Keyword(s):  
Primary Care ◽  
Older Patients ◽  
Past History ◽  
Treatment Options ◽  
Cross Sectional Study ◽  
Late Life Depression ◽  
Cross Sectional ◽  
History Of ◽  
Primary Physicians ◽  
History Of Depression

Objectives. Describe older patients’ perceptions about depression and characteristics associated with acceptance of treatments.Design. Cross-sectional study.Setting. Three primary care clinics in Iowa.Participants. Consecutive sample of 529 primary care patients.Measurements. Depression screening tool (a 9-item patient health questionnaire [PHQ-9]) and questionnaire including sociodemographic data, patient attitudes about depression, and acceptability of different treatments.Results. Mean age was 71.9 years (range 60–93 years), 314 (59%) female. Among the 529 participants, 93 (17.5%) had history of depression and 60 (11.3%) had PHQ-9 scores of 10 or greater. Participants believed depression is a disease for which they would use medication and counseling. Accepting medications from primary physicians was strongly associated with a past history of depression (P<0.01) and with agreeing that depression needs treatment (P<0.01). Counseling was not acceptable for those believing that they can control depression on their own (P<0.01). Older patients (P<0.001) and those with higher education levels (P<0.01) were less likely to accept herbs or supplements as treatment options. Willingness to discuss treatments with family was associated with not using alcohol as a treatment and acceptance of all other treatment options (P<0.001).Conclusions. Attitude that depression is a disease and the willingness to discuss depression with family may enhance treatment acceptance.

Tree analysis modeling of the associations between PHQ-9 depressive symptoms and doctor diagnosis of depression in primary care

2018 ◽  
Vol 49 (3) ◽  
pp. 449-457 ◽  
Author(s):  
Weng-Yee Chin ◽  
Eric Yuk Fai Wan ◽  
Christopher Dowrick ◽  
Bruce Arroll ◽  
Cindy Lo Kuen Lam
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Primary Care Physicians ◽  
Past History ◽  
Conditional Inference ◽  
Waiting Room ◽  
Tree Analysis ◽  
Depression Diagnosis ◽  
History Of ◽  
History Of Depression

AbstractBackgroundThe aim of this study was to explore the relationship between patient self-reported Patient Health Questionnaire-9 (PHQ-9) symptoms and doctor diagnosis of depression using a tree analysis approach.MethodsThis was a secondary analysis on a dataset obtained from 10 179 adult primary care patients and 59 primary care physicians (PCPs) across Hong Kong. Patients completed a waiting room survey collecting data on socio-demographics and the PHQ-9. Blinded doctors documented whether they thought the patient had depression. Data were analyzed using multiple logistic regression and conditional inference decision tree modeling.ResultsPCPs diagnosed 594 patients with depression. Logistic regression identified gender, age, employment status, past history of depression, family history of mental illness and recent doctor visit as factors associated with a depression diagnosis. Tree analyses revealed different pathways of association between PHQ-9 symptoms and depression diagnosis for patients with and without past depression. The PHQ-9 symptom model revealed low mood, sense of worthlessness, fatigue, sleep disturbance and functional impairment as early classifiers. The PHQ-9 total score model revealed cut-off scores of >12 and >15 were most frequently associated with depression diagnoses in patients with and without past depression.ConclusionsA past history of depression is the most significant factor associated with the diagnosis of depression. PCPs appear to utilize a hypothetical-deductive problem-solving approach incorporating pre-test probability, with different associated factors for patients with and without past depression. Diagnostic thresholds may be too low for patients with past depression and too high for those without, potentially leading to over and under diagnosis of depression.

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