Stoppen Met Antidepressiva

Department of Pharmaceutical Sciences

Antidepressivagebruikers stoppen er mee

3 Juli 2009Dr. E.R. Heerdink


Rob Heerdink

Pharmacoepidemiology & PharmacotherapyUtrecht Institute for Pharmaceutical SciencesUniversiteit UtrechtThe Netherlands

www.pharm.uu.nl/epithera


Depression in The Netherlands

Year prevalence depression: – 6% of the population – 900.000 patients per year

Average episode 6 months– In 70-80% relapse– 15-20% is chronically depressed

Depression related costs:– 660 Mil € direct– 3.8 Bil € indirect per year

Trimbos Instituut 2006; Andrade L et al , Bull World Health Organ 78:413-426


0,0

1,0

2,0

3,0

4,0

5,0

6,0

7,0

8,0

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Prevalence SSRI

Incidence SSRI

Prevalence TCAIncidence TCA

Indexed prevalence and incidence per year of antidepressant use during 1992-2001 (1992=1).

Meijer et al. Eur J Clin Pharmacol (2004) 60: 57–61


Are Subjects in Pharmacological Treatment Trials of Depression Representative of Patients in Routine Clinical Practice?Mark Zimmerman, M.D., Jill I. Mattia, Ph.D., and Michael A. Posternak, M.D

Am J Psychiatry 159:469-473, March 2002

‘Of 346 patients with ‘major depression’ only 14% are eligible according to inclusioncriteria for trials with antidepressants’


Depression treatment guidelines

1st episode: At least 6 months continued use following disappearance of symptoms

relapse or chronic:At least 1 year continued use following remission

937.020

Gip databank 2007

937.020

702.765

Meijer et al 2004

234.255Chronic users

937.020

702.765

Van Geffen et al 2008

30.200primary defaulting

+

937.020

702.765

541.130


161.636only 1 prescription

937.020

702.765

541.130

189.750


175.690< 6 months

175.690>12 months

937.020

702.765

541.130

189.750

68.310Van Geffen et al 2008

121.440no tapering

937.020

68.310


937.020

702.765

541.130

541.130 189.750

68.310

68.310189.750

541.130

702.765

541.130

541.130 189.750

68.310 937.020

702.765 702.765

702.765


Apotheker

=

Geneesmiddelen informatie specialist


Initiation phase

Goal:

Estimate incidence of:

primary defaulting;

filling only one prescription

Identification of patient characteristics


Initiation phase

965 patients with a first prescription for a treatment with an antidepressant:

4.2% (42) do not pick up the antidepressant

23.7% (229) picks up only 1 prescription


Characteristics of non-starters

OR* 95% CI

Non-specific indication 2.67 1.82-3.91

Niet-western immigrants 4.80 2.05-11.3

>60 years of age 1.81 1.18-2.78

Precollege education level 1.40 0.83-2.36

Poor/moderate self-rated health 1.11 0.76-1.63

Paroxetine 0.78 0.53-1.13

Van Geffen et al Br J Gen Pract (feb 2009)

Reasons for not starting therapy

57 patients with a single prescription

17 non-starters (29,8%)

Fear of side effects (8)

Aversion towards medication use (3)

Pregnancy (2)

Feeling better (2)

Fear of addiction (1)

Practical reasons (1)

40 (70,2%) stopped within 14 days

Side effect (25)

Aversion towards medication use (7)

Feeling better (6)

Medication ineffective (1)

disagree with diagnosis (1)Ann Pharmacother 2008; 42:218-25


“al dat gepraat.. Geef mij maar een pil”


Patient A (female, 34, paroxetine 1dd)


Patient B (male, 41, paroxetine 1dd)


• 46 stage apotheken gevraagd

• 37 deelnemers

• September – December 2008

• 12-15 antidepressivagebruikers per apotheek

• 46.2% response (245/530)


Female gender129 (62.9)

Age 18-30 years 25 (12.2)

31-45 years 61 (29.8)

45-60 years 87 (42.4)

>60 years 32 (15.6)

EducationLow 57 (27.8)

Middle 83 (40.5)

High 60 (29.3)

Having a partner 118 (57.6)

Employment or in school 105 (51.2)

Living with others 141 (68.8)


Type of antidepressant Paroxetine 88 (42.9)

Citalopram 48 (23.4)

Fluoxetine 24 (11.7)

Other 45 (22.0)

Reason for use Depression 154 (75.1)

Anxiety 100 (48.8)


• 71% gat in de medicatiehistorie

•27% overlap

•2% precies op tijd


MARS

•Ik vergeet mijn medicijnen in te nemen

•Ik verander de dosis

•Ik stop tijdelijk

•Ik sla een dosis over

•Ik gebruik minder dan voorgeschreven


Adherent (MARS)

All patients (n=205) 153 (74.6)

Gap days

Any (n=147) 107 (72.8)

<5% of OTT (n=40) 38 (95.0)*

5%-19.9% of OTT (n=45) 36 (80.0)*

≥20% of OTT (n=62) 33 (53.2)

Overlapping days

Any (n=53) 41 (77.4)

<5% of OTT (n=20) 18 (90.0)

5%-19.9% of OTT (n=18) 13 (72.2)

≥20% of OTT (n=15) 10 (66.7)

No overlap or gap days (n=5) 5 (100.0)


Meldt u dat uw geneesmiddelen anders gebruikt?

Geen gaten

Aan arts: 65%

Aan apotheker: 40%

Wel gaten

Aan arts: 40%

Aan apotheker: 19%


Stopping 21% (14) stop abruptly

42% (28) stop with a homemade tapering scheme

30% (20) use a tapering scheme from the GP

6% (4) use a tapering scheme from psychiatrist

Eur J Clin Pharmacol 2005; 61:303-307


Discontinuation symptoms

patients DESS-events Gem. (SEM)

P-value

Overall 66 7.2 (0,9)

stopping

tapering 52 5.9 (0.9) 0.006

Abrupt 14 12.0 (2.6)

Eur J Clin Pharmacol 2005; 61:303-307


Who fills the need?

pharmacist doctor patient


email: [email protected]

slides: slideshare.net/robheerdink

twitter: @knutmo

Stoppen Met Antidepressiva

Health & Medicine

Transcript of Stoppen Met Antidepressiva