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

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.

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

Psychological Medicine ◽

10.1017/s0033291721001367 ◽

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.

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Tele-ECG consulting and outcomes on primary care patients in a low-to-middle income population: the first experience from Makassar telemedicine program, Indonesia

BMC Family Practice ◽

10.1186/s12875-020-01325-4 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Idar Mappangara ◽

Andriany Qanitha ◽

Cuno S. P. M. Uiterwaal ◽

Jose P. S. Henriques ◽

Bastianus A. J. M. de Mol

Keyword(s):

Primary Care ◽

Female Gender ◽

Middle Income ◽

Healthcare Facilities ◽

Primary Care Settings ◽

Lower Blood ◽

History Of ◽

Primary Care Patients ◽

Male Patients

Abstract Background Telemedicine has been a popular tool to overcome the lack of access to healthcare facilities, primarily in underprivileged populations. We aimed to describe and assess the implementation of a tele-electrocardiography (ECG) program in primary care settings in Indonesia, and subsequently examine the short- and mid-term outcomes of patients who have received tele-ECG consultations. Methods ECG recordings from thirty primary care centers were transmitted to Makassar Cardiac Center, Indonesia from January to July 2017. We cross-sectionally measured the performance of this tele-ECG program, and prospectively sent a detailed questionnaire to general practitioners (GPs) at the primary care centers. We performed follow-up at 30 days and at the end of the study period to assess the patient outcomes. Results Of 505 recordings, all (100%) ECGs were qualified for analysis, and about half showed normal findings. The mean age of participants was 53.3 ± 13.6 years, and 40.2% were male. Most (373, 73.9%) of these primary care patients exhibited manifested CVD symptom with at least one risk factor. Male patients had more ischemic ECGs compared to women (p < 0.01), while older age (> 55 years) was associated with ischemic or arrhythmic ECGs (p < 0.05). Factors significantly associated with a normal ECG were younger age, female gender, lower blood pressure and heart rate, and no history of previous cardiovascular disease (CVD) or medication. More patients with an abnormal ECG had a history of hypertension, known diabetes, and were current smokers (p < 0.05). Of all tele-consultations, GPs reported 95% of satisfaction rate, and 296 (58.6%) used tele-ECG for an expert opinion. Over the total follow-up (14 ± 6.6 months), seven (1.4%) patients died and 96 (19.0%) were hospitalized for CVD. Of 88 patients for whom hospital admission was advised, 72 (81.8%) were immediately referred within 48 h following the tele-ECG consultation. Conclusions Tele-ECG can be implemented in Indonesian primary care settings with limited resources and may assist GPs in immediate triage, resulting in a higher rate of early hospitalization for indicated patients.

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Antidepressant use in Alzheimer's disease patients: results of the REAL.FR cohort

International Psychogeriatrics ◽

10.1017/s1041610209990780 ◽

2009 ◽

Vol 22 (1) ◽

pp. 120-128 ◽

Cited By ~ 17

Author(s):

Christophe Arbus ◽

Virginie Gardette ◽

Eric Bui ◽

Christelle Cantet ◽

Sandrine Andrieu ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Depressive Symptoms ◽

Previous History ◽

Natural Setting ◽

Antidepressant Prescription ◽

History Of ◽

Antidepressant Use ◽

Clinically Significant ◽

History Of Depression

ABSTRACTBackground: Psychotropic medication is widely prescribed in clinical practice for the management of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD). However, there have been few pharmaco-epidemiological studies or studies conducted in a natural setting on the real use of antidepressants in AD. The aim of this survey was to assess the prevalence of antidepressant use in AD and to identify the clinical factors associated with antidepressant prescription.Methods: REAL.FR is a four-year, prospective, multi-center study. Baseline data including demographic characteristics, clinical variables and drug intake were obtained. Depressive symptoms were determined using the Neuropsychiatric Inventory (NPI).Results: A total of 686 AD patients were included. Antidepressant treatment was prescribed for 34.8% of patients. Clinically significant depressive symptoms (NPI ≥ 4) were observed in 20.5% of the total population. Although depressed subjects were significantly more likely to be treated with antidepressants than non-depressed subjects (p<0.0001), only 60% of depressed subjects overall were prescribed an antidepressant. In multivariate analysis, clinically significant depressive symptoms were associated with antidepressant prescription although this result was only observed in subjects without a previous history of depression.Conclusions: The available data on antidepressant efficacy in BPSD other than depression (in particular, agitation, aggression and, occasionally, psychotic symptoms) do not influence prescription choices. Depressive symptoms may be taken more seriously in the absence of a previous history of depression, leading to increased antidepressant prescription rates in individuals presenting with depression for the first time.

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Response style and severity and chronicity of depressive disorders in primary health care

European Psychiatry ◽

10.1016/j.eurpsy.2015.12.002 ◽

2016 ◽

Vol 33 (1) ◽

pp. 1-8

Author(s):

K. Riihimäki ◽

M. Vuorilehto ◽

P. Jylhä ◽

E. Isometsä

Keyword(s):

Primary Care ◽

Depressive Symptoms ◽

Depressive Disorders ◽

Rating Scale ◽

Response Styles ◽

Related Phenomenon ◽

Eysenck Personality Inventory ◽

Primary Care Patients ◽

Depressive Episodes

AbstractBackgroundResponse styles theory of depression postulates that rumination is a central factor in occurrence, severity and maintaining of depression. High neuroticism has been associated with tendency to ruminate. We investigated associations of response styles and neuroticism with severity and chronicity of depression in a primary care cohort study.MethodsIn the Vantaa Primary Care Depression Study, a stratified random sample of 1119 adult patients was screened for depression using the Prime-MD. Depressive and comorbid psychiatric disorders were diagnosed using SCID-I/P and SCID-II interviews. Of the 137 patients with depressive disorders, 82% completed the prospective five-year follow-up with a graphic life chart enabling evaluation of the longitudinal course of episodes. Neuroticism was measured with the Eysenck Personality Inventory (EPI-Q). Response styles were investigated at five years using the Response Styles Questionnaire (RSQ-43).ResultsAt five years, rumination correlated significantly with scores of Hamilton Depression Rating Scale (r = 0.54), Beck Depression Inventory (r = 0.61), Beck Anxiety Inventory (r = 0.50), Beck Hopelessness Scale (r = 0.51) and Neuroticism (r = 0.58). Rumination correlated also with proportion of follow-up time spent depressed (r = 0.38). In multivariate regression, high rumination was significantly predicted by current depressive symptoms and neuroticism, but not by anxiety symptoms or preceding duration of depressive episodes.ConclusionsAmong primary care patients with depression, rumination correlated with current severity of depressive symptoms, but the association with preceding episode duration remained uncertain. The association between neuroticism and rumination was strong. The findings are consistent with rumination as a state-related phenomenon, which is also strongly intertwined with traits predisposing to depression.

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Factors associated with smoking and smoking cessation among primary care patients with depression: a naturalistic cohort study

Advances in Dual Diagnosis ◽

10.1108/add-10-2014-0036 ◽

2015 ◽

Vol 8 (1) ◽

pp. 18-28

Author(s):

Gail Gilchrist ◽

Sandra Davidson ◽

Aves Middleton ◽

Helen Herrman ◽

Kelsey Hegarty ◽

...

Keyword(s):

Primary Care ◽

Smoking Cessation ◽

Depressive Symptoms ◽

Chronic Illness ◽

Suicidal Ideation ◽

Content Type ◽

Factors Associated ◽

Self Rated Health ◽

Primary Care Patients

Purpose – People with a history of depression are more likely to smoke and less likely to achieve abstinence from smoking long term. The purpose of this paper is to understand the factors associated with smoking and smoking cessation among patients with depression. Design/methodology/approach – This paper reports on smoking prevalence and cessation in a cohort of 789 primary care attendees with depressive symptoms (Centre for Epidemiologic Studies Depression Scale score of=16) recruited from 30 randomly selected Primary Care Practices in Victoria, Australia in 2005. Findings – At baseline, 32 per cent of participants smoked. Smokers were more likely to be male, unmarried, receive government benefits, have difficulty managing on available income, have emphysema, a chronic illness, poor self-rated health, to have more severe depressive and anxiety symptoms, to be taking anti-depressants, to be hazardous drinkers, to report suicidal ideation and to have experienced childhood physical or sexual abuse. At 12 months, 20 participants reported quitting. Females and people with good or better self-rated health were significantly more likely to have quit, while people with a chronic illness or suicidal ideation were less likely to quit. Smoking cessation was not associated with increases in depression or anxiety symptoms. Only six participants remained quit over four years. Practical implications – Rates of smoking were high, and long-term cessation was low among primary care patients with depressive symptoms. Primary care physicians should provide additional monitoring and support to assist smokers with depression quit and remain quit. Originality/value – This is the first naturalistic study of smoking patterns among primary care attendees with depressive symptoms.

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Improving the Recognition of Anxiety Disorders in Depressed Patients

CNS Spectrums ◽

10.1017/s1092852900028182 ◽

2006 ◽

Vol 11 (S1) ◽

pp. 2-4

Author(s):

Iwona Chelminski

Keyword(s):

Primary Care ◽

Anxiety Disorder ◽

Panic Disorder ◽

Anxiety Disorders ◽

Panic Attacks ◽

Depressed Patients ◽

Increased Risk ◽

History Of ◽

Primary Care Patients

There is considerable symptom overlap and high levels of comorbidity between anxiety disorders and depression. The recognition of this comorbidity has both academic interest and clinical significance. Epidemiological studies have demonstrated that depressed individuals with a history of anxiety disorders are at increased risk for hospitalization, suicide attempt, and greater impairment from the depression. These individuals also tend to have a more chronic course of depression, as observed in psychiatric patients, primary care patients, and epidemiological samples. Van Valkenberg and colleagues reported that depressed patients with anxiety had poorer outcome and greater psychosocial impairment than those without an anxiety disorder. In the National Institute of Mental Health Collaborative Depression Study, the presence of panic attacks predicted a lower rate of recovery during the first 2 years of the follow-up interval. Similarly, Grunhaus found poorer outcome in depressed patients with comorbid panic disorder than in depressed patients without panic. In an 8-month follow-up study, depressed primary care patients with a history of generalized anxiety disorder (GAD) or panic disorder were less likely to have recovered from their depressive episode.Gaynes and colleagues prospectively followed primary care patients with major depressive disorder (MDD) every 3 months for 1 year after their initial diagnostic evaluation. At baseline, half of the original 85 patients had a coexisting anxiety disorder, the most frequent being social phobia (n=38). Twelve months after intake, 68 of the patients were available for the final interview. Those with a comorbid anxiety disorder were significantly more likely to still be in an episode of depression (82% vs 57%; risk ratio=1.44; 95% CI 1.02-2.04), and they experienced more disability days during the course of the 12 months than the depressed patients without an anxiety disorder (67.1 days vs 27.5 days).

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Tele-ECG consulting and outcomes on primary care patients in a low-to-middle income population: The first experience from Makassar Telemedicine Program, Indonesia

10.21203/rs.3.rs-38623/v2 ◽

2020 ◽

Author(s):

Idar Mappangara ◽

Andriany Qanitha ◽

Cuno S. P. M. Uiterwaal ◽

Jose P. S. Henriques ◽

Bastianus A. J. M. de Mol

Keyword(s):

Primary Care ◽

Female Gender ◽

Middle Income ◽

Healthcare Facilities ◽

Primary Care Settings ◽

Lower Blood ◽

History Of ◽

Primary Care Patients ◽

Male Patients

Abstract Background: Telemedicine has been a popular tool to overcome the lack of access to healthcare facilities, primarily in underprivileged populations. We aimed to describe and assess the implementation of a tele-electrocardiography (ECG) program in primary care settings in Indonesia, and subsequently examine the short- and mid-term outcomes of patients who have received tele-ECG consultation.Methods: ECG recordings from thirty primary care centers were transmitted to Makassar Cardiac Center, Indonesia from January to July 2017. We cross-sectionally measured the performance of this tele-ECG program, and prospectively sent a detailed questionnaire to general practitioners (GPs) at the primary care centers. We performed follow-up at 30 days and at the end of study period to assess the patient outcomes. Results: Of 505 recordings, all (100%) ECGs were qualified for analysis, and about half showed normal findings. The mean age of participants was 53.3 ± 13.6 years, and 40.2% were male. Most (373, 73.9%) of these primary care patients exhibited manifested CVD symptom with at least one risk factor. Male patients had more ischemic ECGs compared to women (p<0.01), while older age (>55 years) was associated with ischemic or arrhythmic ECGs (p<0.05). Factors significantly associated with a normal ECG were younger age, female gender, lower blood pressure and heart rate, and no history of previous cardiovascular disease (CVD) or medication. More patients with an abnormal ECG had a history of hypertension, known diabetes, and were current smokers (p<0.05). Of all tele-consultations, GPs reported 95% of satisfaction rate, and 296 (58.6%) used tele-ECG for an expert opinion. Over the total follow-up (14 ± 6.6 months), seven (1.4%) patients died and 96 (19.0%) were hospitalized for CVD. Of 88 patients for whom hospital admission was advised, 72 (81.8%) were immediately referred within 48 hours following the tele-ECG consultation. Conclusions: Tele-ECG can be implemented in Indonesian primary care settings with limited resources and may assist GPs for immediate triage, resulting in higher rate of early hospitalization for indicated patients.

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Tele-ECG consulting and outcomes on primary care patients in a low-to-middle income population: The first experience from Makassar Telemedicine Program, Indonesia

10.21203/rs.3.rs-38623/v1 ◽

2020 ◽

Author(s):

Idar Mappangara ◽

Andriany Qanitha ◽

Cuno S. P. M. Uiterwaal ◽

Jose P. S. Henriques ◽

Bastianus A. J. M. de Mol

Keyword(s):

Primary Care ◽

Structural Changes ◽

Female Gender ◽

Middle Income ◽

Healthcare Facilities ◽

Primary Care Settings ◽

Lower Blood ◽

History Of ◽

Primary Care Patients

Abstract Background: Telemedicine has been a popular tool to overcome the lack access to healthcare facilities, primarily in underprevilaged populations. We aimed to describe and assess the implementation of tele-electrocardiography (ECG) program in primary care settings in Indonesia, and subsequently examine the short- and mid-term outcomes of patients those received tele-ECG consultation.Methods: A total of 505 ECG recordings from thirty primary care centers were transmitted to Makassar Cardiac Center, Indonesia from January to July 2017. We prospectively collected data by sending a detailed questionnaire to general practitioners (GPs). Follow-up was performed at 30 days and at the end of follow-up on October 2018.Results: Of 505 recordings, all (100%) ECGs were qualified for analysis, and about a half showed normal findings. Ischemia presented in 15.6%, arrhythmia in 23.6%, and abnormalities compatible with structural changes in 5.1%. The mean age of participants was 53.3 ± 13.6 years, and 40.2% were male. Most (73.9%) of these primary care patients turned up with a manifasted CVD symptom with at least one risk factor. More men had an ischemic ECG compare to women (p<0.01), while aged >55 years was associated with ischemic or arrhythmic ECG (p<0.05). Factors significantly associated with a normal ECG were younger age, female gender, lower blood pressure and heart rate, and no history of previous cardiovascular disease (CVD) or medication. More patients with an abnormal ECG had a history of hypertension, known diabetes, and were current smokers (p<0.05). Majority (95%) of GPs were satisfied with each tele-ECG consultation, and 58.6% used tele-ECG for an expert opinion. Over the total follow-up (14 ± 6.6 months), seven (1.4%) patients died and 96 (19.0%) were hospitalized for CVD. Of 88 patients for whom hospital admission was advised, 72 (81.8%) were immediately referred within 48 hours following the tele-ECG consultation. Conclusions: Tele-ECG can be implemented in Indonesian primary care settings with limited resources and may assist the GPs for immediate triage, results in higher rate of early hospitalization for indicated patients.

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Depression, depressive symptoms, and rate of hippocampal atrophy in a longitudinal cohort of older men and women

Psychological Medicine ◽

10.1017/s0033291714003055 ◽

2015 ◽

Vol 45 (9) ◽

pp. 1931-1944 ◽

Cited By ~ 29

Author(s):

M. Elbejjani ◽

R. Fuhrer ◽

M. Abrahamowicz ◽

B. Mazoyer ◽

F. Crivello ◽

...

Keyword(s):

Depressive Symptoms ◽

Age At Onset ◽

Hippocampal Volume ◽

Epidemiologic Studies ◽

Linear Regression Models ◽

Cerebral Magnetic Resonance Imaging ◽

Unit Increase ◽

History Of ◽

Antidepressant Use ◽

History Of Depression

BackgroundSeveral studies have reported smaller hippocampal volume (HcV) in depression patients; however, the temporality of the association remains unknown. One proposed hypothesis is that depression may cause HcV loss. This study evaluates whether previous depression and recent depressive symptoms are associated with HcV and HcV loss.MethodWe used a prospective cohort of older adults (n= 1328; age = 65–80 years) with two cerebral magnetic resonance imaging examinations at baseline and 4-year follow-up. Using multivariable linear regression models, we estimated, in stratified analyses by gender, the association between indicators of history of depression and its severity (age at onset, recurrence, hospitalization for depression), proximal depressive symptoms [Center for Epidemiologic Studies-Depression (CES-D) scale], baseline antidepressant use, and the outcomes: baseline HcV and annual percentage change in HcV.ResultsAt baseline, women with more depressive symptoms had smaller HcV [−0.05 cm3, 95% confidence interval (CI) −0.1 to −0.01 cm3per 10-unit increase in CES-D scores]. History of depression was associated with a 0.2% faster annual HcV loss in women (95% CI 0.01–0.36%). More baseline depressive symptoms and worsening of these symptoms were also associated with accelerated HcV loss in women. No associations were observed in men. Treatment for depression was associated with slower HcV loss in women and men.ConclusionsWhile only concomitant depressive symptoms were associated with HcV, both previous depression and more proximal depressive symptoms were associated with faster HcV loss in women.

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

Journal of Obesity ◽

10.1155/2011/459263 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 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.

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