Original Paper
259
Authors
R. Tarumi1, T. Suzuki1, 2, H. Tani1, 3, R. Den4, N. Sawada5, 6, H. Sakurai1, 2, C. Tsutsumi-Ozawa1, 4, A. Ohtani1, M. Mimura1, H. Uchida1, 7, 8
Affiliations
Affiliation addresses are listed at the end of the article
Key words ▶ antidepressants ● ▶ adjunctive therapy ● ▶ depression ●
Abstract
received 01.07.2014 revised 05.08.2014 accepted 11.08.2014 Bibliography DOI http://dx.doi.org/ 10.1055/s-0034-1387784 Published online: September 2, 2014 Pharmacopsychiatry 2014; 47: 259–262 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0176-3679 Correspondence H. Uchida, MD, PhD Department of Neuropsychiatry Keio University School of Medicine 35 Shinanomachi Shinjuku-ku Tokyo 160-8582 Japan [email protected]
Introduction: The objective of this study was to examine the evolution of antidepressant switch and adjunctive therapy. Methods: This chart review was conducted at 6 primary psychiatric clinics or hospitals, in Tokyo, Japan. A chart review of longitudinal prescriptions was conducted regarding 633 outpatients with major depressive disorder for up to 2 years after their first visit. Patients who had already received antidepressants prior to the visit were excluded. Results: 22.6 % (N = 143) of the patients completed or continued the outpatient treatment
over the 2 years while 27 (4.3 %), 23 (3.6 %), and 439 (69.4 %) patients discontinued it due to hospitalization, referral to another clinic, and loss to follow-up, respectively. A total of 597 episodes of antidepressant treatment were identified. Among them, 482 episodes (80.7 %) were associated with the suggested dose ranges while antidepressant drugs were under-dosed in 19.3 % (N = 115) of the episodes. 50 patients (7.9 %) received adjunctive therapy; it was employed after a median of only one antidepressant had been tried. Conclusion: Psychiatrists may be hasty in prescribing an adjunctive therapy in the treatment of depression.
Introduction
Patients and Methods
The evolution of antidepressant switch or adjunctive therapy represents an important clinical issue but has been rarely addressed [1]. When a series of monotherapies with antidepressant drugs are not successful, recent guidelines suggest the use of adjunctive therapy with another psychotropic drug such as antipsychotics and mood stabilizers [2–4]. Those medications used for adjunctive therapy could cause a variety of side effects [5–8], which are often problematic. On the other hand, how such an adjunctive strategy is developed has not yet been systematically addressed from a longitudinal viewpoint. In order to examine the evolution of antidepressant switch and adjunctive therapy for the treatment of depression in the real-world, we conducted a systematic chart review that assessed psychotropic medications prescribed for patients with depression over the 2 years after their first visit.
Subjects
▼
▼
▼
This systematic chart review was conducted at Ohizumi Hospital, Asakadai Mental Clinic, Ohizumi Mental Clinic, Inokashira Hospital, Umesato Mental Clinic, and Komagino Hospital, primary psychiatric clinics or hospitals, in Tokyo, Japan. Outpatients were included if they (i) visited one of the participating sites for the first time between July 1, 2010 and June 30, 2011, (ii) were diagnosed with depressive episode or recurrent depressive disorder (F32 or F33 according to the International Classification of Diseases, 10th edition) [9], (iii) were maintained in the initial diagnosis throughout the follow-up period, and (iv) had not received any antidepressant treatment for the index episode prior to the visit. Outpatients who only sought a second opinion were excluded. The follow-up period was set at 2 years after the initial contact.
Tarumi R et al. Timing of Adjunctive Therapy … Pharmacopsychiatry 2014; 47: 259–262
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Timing of Adjunctive Therapy in the Treatment of Depression: A Chart Review
260 Original Paper
The collected information included baseline age, sex, psychotropic medications prescribed for up to 2 years since their first visit, reasons for prescription change, durations of illness and current depressive episode, and the dates of their first visit, and dropout during the 2 years if applicable. Details of prescribed antidepressant medications and drugs used for adjunctive therapy included drug names and daily doses, and start and stop dates of these prescriptions. Adjunctive therapy was defined as the concomitant use of another class of psychotropic drug in addition to antidepressant treatment. Here, concomitant use of benzodiazepines was not considered as an adjunctive therapy since they were usually temporarily prescribed to relieve transient symptoms such as anxiety, without any intention to enhance the antidepressant effects of the ongoing regimen. Moreover, when patients received more than one antidepressant at the same time (i. e., antidepressant combination therapy), those details on individual antidepressants were extracted as different episodes and separately analyzed. When patients did not complete a 2-year outpatient treatment, reasons for dropout were examined and then sorted to one of the following categories: “hospitalization”, “referral to another clinic/hospital”, and “loss to follow-up”. Maximum prescribed doses of antidepressants for individual episodes of antidepressant therapy were compared with the recommended dose ranges in local package inserts in Japan. The study was approved by the institutional review board or equivalent committee at all participating sites and exempted from the requirement for informed consent because the study dealt with anonymous de-identified data which had been acquired during routine care.
Statistics
Statistical analyses were carried out using the IBM SPSS Statistics Version 20 (IBM Corporation, Armonk, NY). An episode of antidepressant treatment or adjunctive therapy was defined as the continuous use of the same medication irrespective of its dosage given. Differences between groups or among drugs were tested using χ2 test or analysis of variance. A p-value
259
Authors
R. Tarumi1, T. Suzuki1, 2, H. Tani1, 3, R. Den4, N. Sawada5, 6, H. Sakurai1, 2, C. Tsutsumi-Ozawa1, 4, A. Ohtani1, M. Mimura1, H. Uchida1, 7, 8
Affiliations
Affiliation addresses are listed at the end of the article
Key words ▶ antidepressants ● ▶ adjunctive therapy ● ▶ depression ●
Abstract
received 01.07.2014 revised 05.08.2014 accepted 11.08.2014 Bibliography DOI http://dx.doi.org/ 10.1055/s-0034-1387784 Published online: September 2, 2014 Pharmacopsychiatry 2014; 47: 259–262 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0176-3679 Correspondence H. Uchida, MD, PhD Department of Neuropsychiatry Keio University School of Medicine 35 Shinanomachi Shinjuku-ku Tokyo 160-8582 Japan [email protected]
Introduction: The objective of this study was to examine the evolution of antidepressant switch and adjunctive therapy. Methods: This chart review was conducted at 6 primary psychiatric clinics or hospitals, in Tokyo, Japan. A chart review of longitudinal prescriptions was conducted regarding 633 outpatients with major depressive disorder for up to 2 years after their first visit. Patients who had already received antidepressants prior to the visit were excluded. Results: 22.6 % (N = 143) of the patients completed or continued the outpatient treatment
over the 2 years while 27 (4.3 %), 23 (3.6 %), and 439 (69.4 %) patients discontinued it due to hospitalization, referral to another clinic, and loss to follow-up, respectively. A total of 597 episodes of antidepressant treatment were identified. Among them, 482 episodes (80.7 %) were associated with the suggested dose ranges while antidepressant drugs were under-dosed in 19.3 % (N = 115) of the episodes. 50 patients (7.9 %) received adjunctive therapy; it was employed after a median of only one antidepressant had been tried. Conclusion: Psychiatrists may be hasty in prescribing an adjunctive therapy in the treatment of depression.
Introduction
Patients and Methods
The evolution of antidepressant switch or adjunctive therapy represents an important clinical issue but has been rarely addressed [1]. When a series of monotherapies with antidepressant drugs are not successful, recent guidelines suggest the use of adjunctive therapy with another psychotropic drug such as antipsychotics and mood stabilizers [2–4]. Those medications used for adjunctive therapy could cause a variety of side effects [5–8], which are often problematic. On the other hand, how such an adjunctive strategy is developed has not yet been systematically addressed from a longitudinal viewpoint. In order to examine the evolution of antidepressant switch and adjunctive therapy for the treatment of depression in the real-world, we conducted a systematic chart review that assessed psychotropic medications prescribed for patients with depression over the 2 years after their first visit.
Subjects
▼
▼
▼
This systematic chart review was conducted at Ohizumi Hospital, Asakadai Mental Clinic, Ohizumi Mental Clinic, Inokashira Hospital, Umesato Mental Clinic, and Komagino Hospital, primary psychiatric clinics or hospitals, in Tokyo, Japan. Outpatients were included if they (i) visited one of the participating sites for the first time between July 1, 2010 and June 30, 2011, (ii) were diagnosed with depressive episode or recurrent depressive disorder (F32 or F33 according to the International Classification of Diseases, 10th edition) [9], (iii) were maintained in the initial diagnosis throughout the follow-up period, and (iv) had not received any antidepressant treatment for the index episode prior to the visit. Outpatients who only sought a second opinion were excluded. The follow-up period was set at 2 years after the initial contact.
Tarumi R et al. Timing of Adjunctive Therapy … Pharmacopsychiatry 2014; 47: 259–262
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Timing of Adjunctive Therapy in the Treatment of Depression: A Chart Review
260 Original Paper
The collected information included baseline age, sex, psychotropic medications prescribed for up to 2 years since their first visit, reasons for prescription change, durations of illness and current depressive episode, and the dates of their first visit, and dropout during the 2 years if applicable. Details of prescribed antidepressant medications and drugs used for adjunctive therapy included drug names and daily doses, and start and stop dates of these prescriptions. Adjunctive therapy was defined as the concomitant use of another class of psychotropic drug in addition to antidepressant treatment. Here, concomitant use of benzodiazepines was not considered as an adjunctive therapy since they were usually temporarily prescribed to relieve transient symptoms such as anxiety, without any intention to enhance the antidepressant effects of the ongoing regimen. Moreover, when patients received more than one antidepressant at the same time (i. e., antidepressant combination therapy), those details on individual antidepressants were extracted as different episodes and separately analyzed. When patients did not complete a 2-year outpatient treatment, reasons for dropout were examined and then sorted to one of the following categories: “hospitalization”, “referral to another clinic/hospital”, and “loss to follow-up”. Maximum prescribed doses of antidepressants for individual episodes of antidepressant therapy were compared with the recommended dose ranges in local package inserts in Japan. The study was approved by the institutional review board or equivalent committee at all participating sites and exempted from the requirement for informed consent because the study dealt with anonymous de-identified data which had been acquired during routine care.
Statistics
Statistical analyses were carried out using the IBM SPSS Statistics Version 20 (IBM Corporation, Armonk, NY). An episode of antidepressant treatment or adjunctive therapy was defined as the continuous use of the same medication irrespective of its dosage given. Differences between groups or among drugs were tested using χ2 test or analysis of variance. A p-value
