Reviewing Discontinuation Rates of Antidepressant Use by Dutch Soldiers

Research Paper Title

Discontinuation Rates of Antidepressant Use by Dutch Soldiers.

Background

Soldiers have a higher risk for developing psychiatric disorders that require treatment; often with antidepressants.

However, antidepressants as well as the psychiatric disorder, may influence military readiness in several ways.

In the general population, early discontinuation of antidepressant treatment is often seen. It is yet unknown whether this occurs to a similar extent in soldiers.

The objective of this study was to evaluate discontinuation of antidepressant use by Dutch soldiers in the first 12 months after start and determinants thereof.

Methods

Data were obtained from the military pharmacy. All Dutch soldiers who started using an antidepressant between 2000 and 2014 were included.

Kaplan-Meier curves were constructed to estimate the discontinuation rate over time and the influence of each determinant on discontinuation rate was estimated using Cox regression.

Results

About 25.9% of de 2479 starters had discontinued their antidepressant use after 1 month; after 3 and 6 months this number increased to 52.7% and 70.3%, respectively.

Early discontinuation was higher in soldiers who received their first prescription from a neurologist or rehabilitation specialist (HR 1.85, 95% CI 1.55-2.21, HR 2.66 95% CI 1.97-3.58) compared to soldiers with a first prescription from a general practitioner.

In addition, early discontinuation was lower in soldiers who were prescribed serotonin reuptake inhibitors and other antidepressants (HR 0.57, 95% CI 0.51-0.60, HR 0.63, 95% CI 0.55-0.73) and in soldiers between 40 and 50 years of age (HR 0.79, 95% CI 0.70-0.89).

Conclusions

More than half of the soldiers discontinued their prescribed antidepressant within 3 months and after 6 months, only 30% were still on antidepressants.

Reference

Janssen, D.G.A., Vermetten, E., Egberts, T.C.G. & Heerdink, E.R. (2019) Discontinuation Rates of Antidepressant Use by Dutch Soldiers. Military Medicine. 184(11-12), pp.868-874. doi: 10.1093/milmed/usz060.

Have Antidepressant Prescriptions, Including Tricyclics, Increased in Canadian Children?

Research Paper Title

Antidepressant Prescriptions, Including Tricyclics, Continue to Increase in Canadian Children.

Background

Few studies have longitudinally followed trends in antidepressant prescribing for Canadian children following the Black Box warning issued in 2004.

Using a national data source, we aim to describe trends in antidepressant recommendations for Canadian children ages 1-18 during 2012 to 2016.

Methods

A database called the Canadian Disease and Therapeutic Index (CDTI), provided by IQVIA, was used to conduct analyses. The CDTI dataset collects a quarterly sample of paediatric antidepressant recommendations, projected using a weight procedure from a dynamic sample of 652 Canadian office-based physicians.

The term “recommendations” is used because nonprescription drugs may be recommended and there is no confirmation in the database that the prescriptions were filled or medications taken.

The data were collected from 2012 to 2016 and the sample population was projected by IQVIA to be representative of the entire Canadian paediatric population.

Results

The total number of projected antidepressant recommendations for children increased from 2012 to 2016. Selective serotonin reuptake inhibitors were the most recommended class of antidepressants.

Analysis indicated that fluoxetine was the most frequently recommended drug.

Findings also suggest that recommendations for tricyclic antidepressants (TCAs) are increasing, but predominantly for reasons other than treatment of depression.

Conclusions

Overall, antidepressant use in Canadian children increased over the study period.

Unsurprisingly, fluoxetine was the most recommended antidepressant for Canadian children.

However, the observed increase in TCA use for a paediatric population is unexpected.

The data source is descriptive and lacks detailed measures supporting comprehensive explanation of the findings, therefore, further research is required.

Reference

Lukmanji, A., Pringsheim, T., Bulloch, A.G., Stewart, D.G., Chan, P., Tehrani, A. & Patten, S.B. (2020) Antidepressant Prescriptions, Including Tricyclics, Continue to Increase in Canadian Children. Journal of Child and Adolescent Psychopharmacology. doi: 10.1089/cap.2019.0121. [Epub ahead of print].

Reduction of Plasma Procoagulant Activity in Patients with Schizophrenia during Pharmacotherapy

Research Paper Title

[Reduction of plasma procoagulant activity in patients with schizophrenia during pharmacotherapy: thrombodynamic parameters of coagulation before and after treatment].

Background

To detect plasma procoagulant activity in patients with schizophrenia at admission to the hospital in a state of exacerbation before (point 1) and after (point 2) pharmacotherapy and evaluate plasma and platelet hemostasis abnormalities.

Methods

The study included 80 women, aged from 16 to 57 years, median age 28 years, with schizophrenia with continuous, paroxysmal-progressive or paroxysmal course (F20.00, F20.01, F20.02 according to ICD-10).

In 42 of 80 patients, depressive disorders in the structure of schizophrenia were observed. The thrombodynamic test (TD) was performed on T-2 Trombodynamis device according to the manufacturer’s instructions (Hemacore LLC, Moscow, Russia).

Blood for the TD test was taken in admission to the hospital (point 1) and on discharge (point 2). All patients received standard pharmacotherapy according to their condition.

Results

For the first time, it was established that in the whole group of patients (n=46) thrombodynamic indicators of the rate of growth of the clot: initial velocity (Vin), stationary velocity (Vst) and adjusted for spontaneous clots velocity (V) and the amount of clot for 30 minutes test TD (ClotSize, CS) were significantly higher compared to normal values.

The mean time of occurrence of spontaneous thrombosis (Tsp) was significantly less than 30 min (p<0.0001), indicating rapid, spontaneous thrombosis. Other parameters of TD did not differ significantly from the norm.

As a result of treatment, the initial growth rate of the clot from the activator (Vi) decreased from 58,5 μm/min to 54,5 μm/min; V speed from 37,4 μm/min to 33,5 μm/min; CS clot size from 1249 μm to 1219 μm; clot density – from 24 874 units up to 23 658 units. All these changes are significant.

Such dynamics of plasma haemostasis clearly indicates a significant decrease in the coagulation activity of the blood plasma of patients as a result of treatment.

An increase in the time of appearance of spontaneous clots after treatment (from 23.5 minutes to 30.5 minutes) indicates a decrease in the procoagulant activity of platelet microparticles after treatment, i.e. the reduction of platelet activation as a result of treatment.

Conclusions

The study has shown for the first time that treatment of patients with antidepressants and antipsychotics reduces the generation of spontaneous clots. The treatment of patients with schizophrenia is accompanied by a decrease in the activity of plasma and platelet haemostasis. This is of great practical importance, since hypercoagulation of spontaneous clots in schizophrenic patients aggravates their chronic inflammatory disorders and affects their resistance to treatment.

Reference

Brusov, O.S., Karpova, N.S., Faktor, M.I., Sizov, S.V. & Oleichik, I.V. (2019) [Reduction of plasma procoagulant activity in patients with schizophrenia during pharmacotherapy: thrombodynamic parameters of coagulation before and after treatment]. In Russian. Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova. 119(10):51-55. doi: 10.17116/jnevro201911910151.