Efficacy and safety of ketamine for the treatment of depressive symptoms in palliative care: a systematic review

Objectives: Ketamine has a fast onset of action that may offer a paradigm change for depression management at the end of life. We aimed to synthesize evidence regarding the safety and efficacy of ketamine in depression treatment within a broad palliative care concept. Methods: We searched seven databases and included studies on the safety and efficacy of ketamine for depression treatment in patients diagnosed with any life-threatening disease. We also conducted a narrative review of the evidence. Results: Among 2,252 screened titles and abstracts, we included 32 studies in our final synthesis: 14 case reports, two case series, two quasi-experimental studies, and seven randomized clinical trials (RCTs), as well as data from three unpublished clinical trials and seven cases from four larger case series. Most case reports reported a robust effect; however, the larger studies reported conflicting findings. Five RCTs reported positive outcomes; however, four of them were focused on a perioperative setting. Two negative studies did not primarily focus on depression and did not apply severity cutoffs. Conclusion: Although ketamine is generally safe and potentially useful, its efficacy in palliative care settings remains unclear. It may be a reasonable alternative for perioperative depression in oncological patients.

Prevalence of psychotropic and antidepressant use in a Brazilian Amazon city: analysis of two cross-sectional studies / Prevalência de uso de psicotrópicos e antidepressivos em uma cidade da Amazônia brasileira: análise de dois estudos transversais

Abstract This article aims to assess the prevalence of psychotropic and antidepressant use and associated factors in a Brazilian Amazon city. Two cross-sectional studies conducted in Manaus in 2015 and 2019 with adults selected by probabilistic sampling. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated by Poisson regression with robust variance. 3,479 participants were included in 2015 and 2,321 in 2019; 2.0% used psychotropics in 2015 and 2.7% in 2019. Antidepressants were used by 0.4% (2015) and 1.4% (2019). Psychotropic use was lower in younger (PR = 0.41; 95%CI: 0.19-0.90), partnerless (PR = 0.64; 95%CI: 0.44-0.93), and informal workers (PR=0.47; 95%CI: 0.25-0.86), but higher in people with poor health (PR=2.86; 95%CI: 1.71-4.80), multimorbidity (PR = 3.24; 95%CI: 1.87-5.60), and who visited doctors (PR = 3.04; 95%CI: 1.45-6.38) or dentists (PR = 1.50; 95%CI: 1.08-2.10). Antidepressant use was higher in 2019 (PR = 2.90; 95%CI: 1.52-5.54), people with poor health (PR = 2.77; 95%CI: 1.16-6.62), and multimorbidity (PR = 8.72; 95%CI: 2.71-28.00), while lower in informal workers (PR = 0.33; 95%CI: 0.12-0.87) and unemployed (PR = 0.26; 95%CI: 0.08-0.81). Use of psychotropics remained stable in Manaus from 2015 to 2019, while antidepressant use more than tripled, which was marked by social inequalities.

Resumo O objetivo deste artigo é avaliar a prevalência do uso de psicotrópicos e antidepressivos e fatores associados em uma cidade da Amazônia. Dois estudos transversais foram realizados em Manaus, em 2015 e 2019, com adultos selecionados por amostragem probabilística. Razões de prevalência (RP) e intervalos de confiança de 95% (IC95%) foram calculados por regressão de Poisson. Foram incluídos 3.479 participantes em 2015 e 2.321 em 2019; 2,0% usaram psicotrópicos em 2015 e 2,7% em 2019. Antidepressivos foram usados por 0,4% (2015) e 1,4% (2019). O uso de psicotrópicos foi menor em jovens (RP = 0,41; IC95%: 0,19-0,90), sem companheiros (RP = 0,64; IC95%: 0,44-0,93) e trabalhadores informais (RP = 0,47; IC95%: 0,25-0,86), mas maior em pessoas com saúde ruim (RP = 2,86; IC95%: 1,71-4,80), multimorbidade (RP = 3,24; IC95%: 1,87-5,60) e que visitaram médico (RP = 3,04; IC95%: 1,45-6,38) ou dentista (RP = 1,50; IC95%: 1,08-2,10). O uso de antidepressivos foi maior em 2019 (RP = 2,90; IC95%: 1,52-5,54), e pessoas com saúde ruim (RP = 2,77; IC95%: 1,16-6,62) e multimorbidade (RP = 8,72; IC95%: 2,71-28,00), mas menor em trabalhadores informais (RP = 0,33; IC95%: 0,12-0,87) e desempregados (RP = 0,26; IC95%: 0,08-0,81). O uso de psicotrópicos permaneceu estável em Manaus de 2015 a 2019, enquanto o de antidepressivos triplicou, sendo marcados por desigualdades sociais.

Uso de Práticas Integrativas e Complementares em Saúde no tratamento da depressão / Use of integrative and complementary practices in the treatment of depression

Resumo A depressão está entre as doenças mais debilitantes do mundo. A dificuldade no tratamento dos sintomas e o abandono do uso de medicamentos têm-se tornado um desafio na saúde pública. Nessa perspectiva, o estudo buscou avaliar o uso das Práticas Integrativas e Complementares em Saúde (PICS) como ferramenta auxiliar no tratamento da depressão. Realizou-se uma revisão bibliográfica com informações coletadas nas plataformas de banco de dados científicos, utilizando as palavras-chave em português e inglês: depressão, antidepressivos, Práticas Integrativas e Complementares em Saúde e tratamentos convencionais. Dos 210 artigos encontrados, 35 foram selecionados e analisados. Os resultados revelaram maior uso da acupuntura, yoga e meditação no tratamento da depressão e na melhora dos sintomas de estresse, ansiedade, fadiga e efeitos adversos decorrentes do uso de medicamentos antidepressivos. Limitações como falta de profissionais habilitados e escassez de material científico de qualidade dificultam o uso disseminado das práticas. Por necessitarem de baixo custo de investimento em estruturas e materiais, as PICS apresentam grande potencial de crescimento no sistema de saúde.

Abstract Depression stands out as one of the most debilitating illnesses worldwide. The difficulty in treating symptoms and discontinue use of medication has become a public health challenge. From this perspective, the study sought to evaluate the use of Integrative and Complementary Therapies as an auxiliary tool in the treatment of depression. A review was carried out using information collected on scientific database platforms, using keywords in Portuguese and English: depression, antidepressants, Integrative and Complementary Therapies and conventional treatments. From 210 articles found, 35 were selected and analyzed. The results revealed greater use of acupuncture, yoga and meditation in the treatment of depression and improvement of stress, anxiety, fatigue and adverse effects resulting from use of antidepressant medications. Limitations such as lack of qualified professionals and quality scientific material hinder the widespread use of those practices. As they require low investment costs in structures and materials, they have great potential for growth in the health system.

Effects of tricyclic antidepressants, selective serotonin reuptake inhibitors, and selective serotonin-norepinephrine reuptake inhibitors on the ocular surface / Efeitos dos antidepressivos tricíclicos, inibidores seletivos da recaptação da serotonina e inibidores da recaptação de serotonina e noradrenalina na superfície ocular

ABSTRACT Purpose: This study aimed to investigate the effects of tricyclic antidepressants, selective serotonin reuptake inhibitors, and selective serotonin noradrenaline reuptake inhibitors on the ocular surface. Methods: The study included 330 eyes of 165 patients using antidepressants and 202 eyes of 101 controls. Tear fluid breakup time, Schirmer I test, and Ocular Surface Disease Index (OSDI) questionnaire were administered. Beck Depression Inventory and Beck Anxiety Inventory were applied to record drug use, dosages, psychiatric disease duration, and remission time. Results: Mean tear fluid breakup time was 14.29 ± 4.81 (4-26) sec, and Schirmer I test value was 16.05 ± 5.89 (2-28) mm in study group. Tear fluid breakup time was 18.16 ± 2.12 (15-24) sec and Schirmer I test value was 16.64 ± 2.31 (15-24) mm in control group (p<0.001 and p=0.005, respectively). In study group, 38.18% (n=63) of patients had dry eye, and 17% (n=18) of patients in control group had dry eye (p<0.001). The mean OSDI score was 82.56 ± 16.21 (66-100) in the tricyclic antidepressants Group, 60.02 ± 29.18 (10-100) in the serotonin reuptake inhibitors Group, and 22.30 ± 20.87 (0-75) in the serotonin-noradrenaline reuptake inhibitors Group (p<0.001). Mean tear fluid breakup time was 14.36 ± 3.35 (10-20) sec in tricyclic antidepressants Group, 13.94 ± 5.81 (4-26) sec in the serotonin reuptake inhibitors Group, and 14.93 ± 4.20 (6-20) sec in serotonin-noradrenaline reuptake inhibitors Group (p=0.730). The mean Schirmer I test value was 9.90 ± 7.22 (2-30) mm in tricyclic antidepressants Group, 15.55 ± 5.15 (2-25) mm in serotonin reuptake inhibitors Group and 17.71 ± 4.21 (10-30) mm in serotonin-noradrenaline reuptake inhibitors Group (p<0.001). There was no statistically significant difference between OSDI score, tear fluid breakup time, and Schirmer I test values in serotonin reuptake inhibitors and serotonin-no­radrenaline reuptake inhibitors subgroups. Conclusions: Dry eye is common in antidepressant users, but considering the ocular surface, serotonin-noradrenaline reuptake inhibitors may be more reliable than other antidepressants. Patients using serotonin-noradrenaline reuptake inhibitors have lower OSDI scores. Serotonin-noradrenaline reuptake inhibitors, which are useful in chronic pain syndromes, may also have a corrective effect on dry eye symptoms.

RESUMO Objetivo: O objetivo deste estudo é investigar os efeitos dos antidepressivos tricíclicos, dos inibidores da recaptação da serotonina e dos inibidores da recaptação da serotonina e noradrenalina na superfície ocular. Métodos: Foram incluídos no estudo 330 olhos de 165 pacientes em uso de antidepressivos e 202 olhos de 101 controles. Foi medido o tempo de ruptura do fluido lacrimal e foram administrados o teste de Schirmer I e o questionário Ocular Surface Disease Index (OSDI). Os Inventários de Depressão e de Ansiedade de Beck foram aplicados ao uso dos medicamentos e foram registrados as dosagens, a duração da doença psiquiátrica e o tempo de remissão. Resultados: No grupo de estudo, o tempo médio de ruptura do fluido lacrimal foi de 14,29 ± 4,81 segundos (intervalo de 4-26 segundos) e o valor médio do teste de Schirmer I foi de 16,05 ± 5,89 mm (intervalo de 2-28 mm). No grupo controle. o tempo médio de rompimento do fluido lacrimal foi de 18,16 ± 2,12 segundos (intervalo de 15-24 segundos) e o valor do teste de Schirmer I foi de 16,64 ± 2,31 mm (intervalo de 15-24 mm), com p<0,001 e p=0,005, respectivamente. No grupo de estudo, 38,18% (n=63) dos pacientes tinham olho seco, enquanto no grupo controle 17% (n=18) tinham olho seco (p<0,001). O escore médio no OSDI foi de 82,56 ± 16,21 (intervalo 66-100) no grupo dos antidepressivos tricíclicos, 60,02 ± 29,18 (10-100) no grupo dos inibidores da recaptação da serotonina e 22,30 ± 20,87 (0-75) no grupo dos inibidores da recaptação da serotonina e noradrenalina (p<0,001). O tempo médio de rompimento do fluido lacrimal foi de 14,36 ± 3,35 segundos (intervalo de 10-20 segundos) no grupo dos antidepressivos tricíclicos, 13,94 ± 5,81 segundos (intervalo de 4-26 segundos) no grupo dos inibidores da recaptação de serotonina e 14,93 ± 4,20 segundos (intervalo de 6-20 segundos) no grupo dos inibidores da recaptação de serotonina e noradrenalina (p=0,730). O valor médio do teste de Schirmer I foi de 9,90 ± 7,22 mm (intervalo de 2-30 mm) no grupo dos antidepressivos tricíclicos, 15,55 ± 5,15 mm (intervalo de 2-25 mm) no grupo dos inibidores da recaptação da serotonina e 17,71 ± 4,21 mm (intervalo de 10-30 mm) no grupo dos inibidores da recaptação da serotonina e noradrenalina (p<0,001). Não houve diferença estatisticamente significativa no escore OSDI, no tempo de ruptura do fluido lacrimal e nos valores do teste de Schirmer I entre os subgrupos de pacientes em uso de inibidores da recaptação de serotonina e de inibidores da recaptação de serotonina e noradrenalina. Conclusões: Olho seco é uma queixa comum em usuários de antidepressivos, mas no que diz respeito à superfície ocular, inibidores da recaptação de serotonina e noradrenalina podem ser mais confiáveis que outros antidepressivos. Pacientes em uso de inibidores da recaptação de serotonina e noradrenalina têm escores menores no questionário OSDI. Os inibidores da recaptação da serotonina e noradrenalina, úteis nas síndromes de dor crônica, também podem ter um efeito corretivo nos sintomas de olho seco.

Efficacy of bupropion and cognitive behavioral therapy in the treatment of methamphetamine use disorder: a systematic review and meta-analysis

Objectives: We assessed the efficacy of cognitive behavioral therapy and bupropion compared to cognitive behavioral therapy alone for methamphetamine use disorder. Methods: The selection criteria for this systematic review study with meta-analysis were randomized clinical trials on the efficacy of cognitive behavioral therapy and bupropion in the treatment for methamphetamine use disorder (assessed by urine metabolites). The search was conducted in PubMed, PubMed Central, LILACS, SciELO, Cochrane Library, SCOPUS, Google Scholar, Ovid Medline, Clinicaltrials.gov, and the International Clinical Trials Registry Platform. The primary outcome was relapse. Risk of bias was assessed with the RoB 2 tool. The results of each clinical trial were input into an Excel spreadsheet. We performed a meta-analysis using relative risk and a 95%CI. Results: Of the 597 initial articles (498 after removing duplicate records), five were included in the meta-analysis, with an aggregate sample of 539 patients. An overall relative risk of 0.91 (95%CI 0.78-1.05) was estimated for relapse. Conclusion: Our study limitations included publication bias and heterogeneous populations. We found no evidence that cognitive behavioral therapy and bupropion reduced the risk of relapse compared to cognitive behavioral therapy and placebo.

Influence of functional health literacy on adherence to antidepressant treatment / Influencia de la alfabetización funcional en salud en la adherencia al tratamiento con antidepresivos / Influência do letramento funcional em saúde na adesão ao tratamento com antidepressivos

ABSTRACT Objective To verify the influence of patients' level of functional health literacy on adherence to antidepressant treatment. Method Cross-sectional study, carried out in pharmacies of the Municipal Health Department of Marília-SP, in 2020/2021. The functional literacy questionnaire verified the numerical and interpretative skills of patients, in the face of texts related to the health area. The adherence to the treatment was verified using the Morisky therapeutic adherence scale, and the data were analyzed by Anova-one-way and Kruskal-Wallis tests. Results A total of 150 patients participated in the study, most of them showed failures in adherence and an inadequate level of functional health literacy. However, there was no correlation between functional health literacy and treatment adherence. Conclusion Although no correlation was found between the variables, there is a need for greater investments in terms of adherence to the treatment, with strategies that consider the level of functional health literacy in these patients.

RESUMEN Objetivo Verificar la influencia del nivel de alfabetización funcional en salud de pacientes en la adherencia al tratamiento con antidepresivos. Método Estudio transversal, realizado en farmacias de la Secretaría Municipal de Salud de Marília-SP, en 2020/2021. El cuestionario de alfabetización funcional verificó las habilidades numéricas de los pacientes y su capacidad para interpretar textos relacionados con la salud. La adherencia al tratamiento se verificó mediante la escala de adherencia terapéutica de Morisky. Los datos se analizaron mediante ANOVA-one-way y test de Kruskal-Wallis. Resultados 150 pacientes participaron en el estudio, la mayoría de los cuales presentaban fallos de adherencia y un nivel inadecuado de alfabetización funcional. Sin embargo, no hubo correlación entre alfabetización funcional sanitaria y adherencia al tratamiento. Conclusión Aunque no se encontró correlación entre las variables, es necesario invertir más en la adherencia al tratamiento, con estrategias que consideren el nivel de alfabetización funcional en salud de estos pacientes.

RESUMO Objetivo Verificar a influência do nível de letramento funcional em saúde dos pacientes na adesão ao tratamento com antidepressivos. Método Estudo transversal, realizado nas farmácias da Secretaria Municipal de Saúde de Marília-SP, em 2020/2021. O questionário de letramento funcional verificou as habilidades numéricas e de interpretação dos pacientes, diante de textos relacionados à área de saúde. A adesão ao tratamento foi verificada pela escala de adesão terapêutica de Morisky, e os dados foram analisados por Anova-one-way e teste de Kruskal-Wallis. Resultados Participaram do estudo 150 pacientes, cuja maioria apresentou falhas na adesão e nível inadequado de letramento funcional em saúde, entretanto, não houve correlação entre letramento funcional em saúde e adesão ao tratamento. Conclusão Embora não tenha sido encontrada correlação entre as variáveis, há a necessidade de maiores investimentos em relação à adesão ao tratamento, com estratégias que considerem o nível de letramento funcional em saúde, nestes pacientes.

Uso de ansiolíticos e antidepressivos entre estudantes de medicina de uma universidade / Antidepressant usage among medical students of an university / Uso de ansiolíticos y antidepresivos entre estudiantes universitarios de medicina

Objetivou-se identificar o uso de medicamento ansiolítico e/ou antidepressivo e associá-lo às características dos estudantes de medicina de uma universidade. Trata-se de um estudo com 449 estudantes de medicina no interior do estado de São Paulo. O uso de medicamento antidepressivo e/ou ansiolítico era feito por 24,3% dos estudantes, sendo a maior parte do sexo feminino e cursando os dois primeiros anos da faculdade. Não houve associação entre o uso de medicamento e os fatores como: idade, renda, morar com a família, horas de sono, relação com docentes e ter pai e mãe vivos. Observou-se maior chance de fazer terapia entre os estudantes que usavam medicamento (ß=1,12, OR=3,07, p<0,001) e uma menor chance de realizar exercício físico (ß=-0,051, OR=0,60, p=0,03). Estratégias para o manejo da depressão e da ansiedade devem ser incentivadas e ações para reduzir o estresse durante o curso devem fazer parte de um programa de apoio das universidades.

The objective was to identify the use of anxiolytic and/or antidepressant medication and to associate it with the characteristics of medical students at a university. This is a study with 449 medical students in the interior of the state of São Paulo. The use of antidepressant and/or anxiolytic medication was done by 24.3% of the students, most of them female and attending the first two years of college. There was no association between the use of medication and factors such as: age, income, living with the family, hours of sleep, relationships with teachers and having a father and mother alive. There was a greater chance of undergoing therapy among students who used medication (ß = 1.12, OR = 3.07, p <0.001) and a lesser chance of performing physical exercise (ß = -0.051, OR = 0.60, p = 0.03). Strategies for the management of depression and anxiety should be encouraged and actions to reduce stress during the course should be part of a university support program.

El objetivo fue identificar el uso de medicamentos ansiolíticos y/o antidepresivos y asociarlo con las características de los estudiantes de medicina en una universidad. Este es un estudio con 449 estudiantes de medicina en el interior del estado de São Paulo. El uso de medicamentos antidepresivos y/o ansiolíticos fue realizado por el 24,3% de los estudiantes, la mayoría de ellos mujeres y que asistieron a los primeros dos años de la universidad. No hubo asociación entre el uso de medicamentos y factores tales como: edad, ingresos, vivir con la familia, horas de sueño, relaciones con los maestros y tener un padre y una madre con vida. Hubo una mayor probabilidad de someterse a terapia entre los estudiantes que usaron medicamentos (ß = 1,12, OR = 3,07, p <0,001) y una menor probabilidad de realizar ejercicio físico (ß = -0,051, OR = 0,60, p = 0,03). Deben fomentarse las estrategias para el manejo de la depresión y la ansiedad y las acciones para reducir el estrés durante el curso deben formar parte de un programa de apoyo universitario.

Efficacy and mechanism of bifidobacterium tetralogy in the adjuvant treatment of depression / 中国基层医药

Objective:To investigate the clinical efficacy and possible mechanism of bifidobacterium tetralogy combined with escitalopram oxalate in the treatment of patients with depression and to provide evidence for further clinical research.Methods:A total of 100 patients with depression who received treatment in Taizhou Second People's Hospital from September 2019 to March 2021 were included in this study. They were randomly assigned to receive either escitalopram oxalate and placebo (control group, n = 50) or escitalopram oxalate and bifidobacterium tetralogy (observation group, n = 50). All patients received 9 weeks of treatment. Psychological status pre- and post-treatment was evaluated using the Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety. Serum cortisol, inflammatory factors interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) levels were detected using the enzyme-linked immunosorbent assay. Results:Physiological status scores in each group were significantly lower after treatment compared with before treatment. Scores of the Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety scores post-treatment in the observation group were (10.78 ± 2.03) points and (6.37 ± 2.58) points, which were significantly lower than those in the control group [(16.78 ± 2.85) points, (13.23 ± 2.95) points, t = 11.40, 13.38, both P < 0.001]. Serum levels of cortisol, inflammatory factors IL-1β and TNF-α in each group were significantly decreased after treatment compared with before treatment. Serum levels of cortisol, inflammatory factors IL-1β and TNF-α post-treatment in the observation group were (137.34 ± 63.29) μg/L, (14.38 ± 6.08)ng/L, (13.95 ± 6.46) ng/L, which were significantly lower than those in the control group [(181.22 ± 59.27) μg/L, (25.94 ± 6.92) ng/L, (20.44 ± 6.24) ng/L, t = 15.29, 6.16, 9.24, all P < 0.001). Conclusion:Bifidobacterium tetralogy combined with escitalopram oxalate is highly effective on depression. The combined therapy can remarkably reduce depression and anxiety symptoms and greatly decrease serum cortisol, IL-1β, and TNF-α levels.

El rol del placebo frente a los antidepresivos y aportes a la relación médico-paciente / Role of placebo versus antidepressants and contribution to the doctor-patient relationship

Resumen La literatura actual ofrece la posibilidad de aportar argumentos tanto a favor como en contra a la discusión sobre la eficacia de los medicamentos antidepresivos. Tanto la metodología, modelos de estudio y herramientas utilizadas para comparar la eficacia de los medicamentos plantean controversia. Este debate se agudiza al considerar la existencia del efecto placebo en resultados que promueven o cuestionan el uso de estos medicamentos. Entender los mecanismos de acción del placebo no solo permite una mejor comprensión de los resultados de la investigación con relación al uso de antidepresivos, sino que además respecto a la efectividad de los distintos tratamientos que hoy en día se utilizan en salud mental.

Current literature offers the possibility to contribute to the discussion about the effectiveness of antidepressants, with arguments both in favor and opposing it. Methodology, study models, and tools used to compare drug effectiveness, all raise controversy. This debate is intensified when involving the existence of placebo effect in results either promoting or questioning the use of these drugs. Understanding the mechanism of action of placebo not only allows for a better grasp of study results around antidepressant use but could also contribute to the effectiveness of distinct treatments used nowadays in mental health.

Evaluación del consumo en antidepresivos en la población uruguaya entre 2010 y 2014 / Evaluation of antidepressant use in the Uruguayan population between 2010 and 2014 / Avaliação do uso de antidepressivos na população uruguaia entre 2010 e 2014

Resumen: Objetivo: conocer el consumo de antidepresivos en la población uruguaya en el período 2010-2014. Material y método: se realizó un estudio de utilización de medicamentos para evaluar el consumo de antidepresivos utilizando el dato de dispensación de medicamentos de las farmacias de las instituciones participantes. Se utilizó la variable dosis diaria definida (DDD) por 1.000 habitantes/día (DHD). Resultados: se incluyó el 69% de la población uruguaya. Las DHD globales de antidepresivos para los años 2010, 2011, 2012, 2013 y 2014 fueron: 26,49, 29,71, 30,17, 30,79 y 32,55 (promedio en los 5 años: 30,04) siendo el aumento porcentual global en dicho período de 22,88%. Los ISRS fueron el grupo de antidepresivos más consumidos. Sertralina fue el antidepresivo más consumido en los 5 años de estudio (DHD 13,65), y el de mayor aumento porcentual fue duloxetina, seguido por escitalopram. Conclusión: el consumo de antidepresivos a nivel nacional en el período analizado es inferior al constatado en otros países, con una tendencia al aumento. Éste puede ser visto como una señal para la evaluación evolutiva en el periodo 2015-2020 y para realizar análisis de las prácticas de prescripción y actuales indicaciones, utilizando otras metodologías como los estudios de prevalencia o estudios de indicación-prescripción o de prescripción-indicación.

Abstract: Objective: to learn about antidepressant use in the Uruguayan population between 2010 and 2014. Method: the use of drugs was studied to evaluate the consumption of antidepressants by analysing the dispensing of drugs in the pharmacies that are part of the participating institutions. The study used the defined daily dose variable (DDD) by 1.000 inhabitants/day (DHD). Results: 69% of the Uruguayan population was included in the study. The global antidepressant dose by inhabitants per day for 2010, 2011, 2012, 2013 and 2014 was 26,49, 29,71, 30,17; 30,79 and 32,55 respectively (average in the five years 30,4) being the global increase of percentage 22,88%5 for that period. The SSRIs (selective serotonin reuptake inhibitor) were the most widely used group of antidepressants. Sertraline was the antidepressant of greatest consumption in the 5 years of the study (DHD 13,65), and the one that presented the highest percentage increase was duloxetine, followed by escitalopram. Conclusion: antidepressant use at the national level during the period analysed is lower than that seen in other countries, although a tendency to increase was found. This may be interpreted as a sign for the need to evaluate the evolution in the 2015-2020 period, and to conduct studies on prescription practices and current indications using other methodologies, such as prevalence studies or indication-prescription or prescription-indication studies.

Resumo: Objetivo: conhecer o consumo de antidepressivos na população uruguaia no período 2010-2014. Material e método: foi realizado um estudo sobre o uso de medicamentos para avaliar o consumo de antidepressivos a partir dos dados de dispensação de medicamentos nas farmácias das instituições participantes. Foi utilizada a variável dose diária definida (DDD) por 1.000 habitantes/dia (DHD). Resultados: 69% da população uruguaia foram incluídas. Os DHDs globais de antidepressivos para os anos de 2010, 2011, 2012, 2013 e 2014 foram: 26,49, 29,71, 30,17; 30,79 e 32,55 (média nos 5 anos, 30,04) sendo o aumento percentual global no referido período de 22,88%. Os inibidores seletivos da recaptação da serotonina foram o grupo de antidepressivos mais amplamente utilizado. A sertralina foi o antidepressivo mais utilizado nos 5 anos do estudo (DHD 13,65), e o que apresentou maior aumento percentual foi a duloxetina, seguida do escitalopram. Conclusão: o consumo de antidepressivos em nível nacional no período analisado é inferior ao encontrado em outros países, com tendência de aumento. Isto pode ser visto como um sinal para a avaliação evolutiva no período 2015-2020 e para a realização de análises das práticas de prescrição e indicações atuais, utilizando outras metodologias como estudos de prevalência ou estudos de indicação-prescrição ou prescrição-indicação.

Use of antidepressants and potential drug interactions in cancer patients treated at a hospital in the Southern Brazil / Uso de antidepressivos e potenciais interações medicamentosas em pacientes oncológicos atendidos em hospital do Sul do Brasil / Uso de antidepresivos y posibles interacciones farmacológicas en pacientes con cáncer tratados en un hospital en el Sur de Brasil

Background and Objectives: Cancer is a chronic degenerative disease and its diagnosis is often associated with mental distress, doubts and insecurities that can trigger depressive symptoms, causing the need for pharmacological treatment. However, cancer patients often use multiple medications (polypharmacy), thus increasing the chances of potential drug interactions. The objective of this study was to evaluate the use of antidepressant drugs in oncological inpatients and the potential drug interactions of their prescriptions. Methods: Prospective, descriptive, and analytical cross-sectional study conducted with cancer patients aged ≥ 18 years, admitted to a hospital in Southern Brazil, and aware of their diagnosis. Larger and contraindicated drug interactions were analyzed using the Micromedex® and Lexicomp® databases. Results: The sample consisted of 50 patients, 54% were female and the mean age was 53.6 (± 15.3) years. Antidepressant drugs were used in 42% of the patients, escitalopram (selective serotonin reuptake inhibitors) being the most prescribed. 90% of the patients had some potential interaction and they occurred with any drug prescribed for treatment. Out of the patients using antidepressants, 62% had contraindicated interactions and all had at least one case of major interaction. The drugs most related to contraindicated drug interactions were dipyrone and metoclopramide. Conclusion: The results of this study demonstrated a high number of contraindicated interactions involving antidepressant drugs. The significance of monitoring and adjusting the pharmacotherapy of these patients is crucial.(AU)

Justificativa e Objetivos: O câncer é uma doença crônico-degenerativa cujo diagnóstico constantemente está associado a sofrimento mental, dúvidas e inseguranças, podendo desencadear sintomas depressivos, de forma que às vezes são necessárias medidas farmacológicas para tratar desses sintomas. Entretanto, pacientes oncológicos frequentemente utilizam vários medicamentos (polifarmácia), aumentando as chances de potenciais interações medicamentosas. Este estudo pretendeu avaliar o uso de antidepressivos nos pacientes em tratamento oncológico hospitalizados e as potenciais interações medicamentosas de suas prescrições. Métodos: Estudo transversal, prospectivo, descritivo e analítico realizado com pacientes oncológicos com idade superior a 18 anos, internados em um hospital do Sul do Brasil e cientes de seu diagnóstico. As interações medicamentosas maiores e as contraindicadas foram analisadas por meio das bases de dados Micromedex® e Lexicomp®. Resultados: Na amostra, composta de 50 pacientes, 54% eram do sexo feminino, e a média de idade foi de 53,6 (±15,3) anos. Além disso, dentre a amostra, 42% dos pacientes utilizavam medicamentos antidepressivos, sendo o escitalopram (inibidor seletivo da recaptação de serotonina) o mais prescrito; e 90% dos pacientes apresentaram algum tipo de potencial interação, que ocorreram com quaisquer medicamentos prescritos para o tratamento. Dos pacientes que utilizavam antidepressivos, 62% tiveram interações contraindicadas e todos apresentaram pelo menos um caso de interação maior. Os medicamentos mais relacionados a interações medicamentosas contraindicadas foram a dipirona e a metoclopramida. Conclusão: Os resultados deste estudo demonstraram um elevado número de interações medicamentosas contraindicadas envolvendo medicamentos antidepressivos. Nesse contexto, verifica-se a importância de monitorar e adequar a farmacoterapia desses pacientes.(AU)

Justificación y objetivos: El cáncer es una enfermedad crónico-degenerativa, que tiene su diagnóstico frecuentemente asociado a angustia mental, dudas e inseguridad, lo que puede resultar síntomas depresivos, que necesitarán, a menudo, medidas farmacológicas para tratarlos. Sin embargo, los pacientes con cáncer muchas veces usan varios medicamentos (polifarmacia), lo que aumenta las posibilidades de interacciones farmacológicas. Este estudio propone evaluar el uso de antidepresivos en pacientes con cáncer hospitalizados y las posibles interacciones farmacológicas que proceden de sus prescripciones. Métodos: Estudio transversal, prospectivo, descriptivo y analítico realizado con pacientes con cáncer de edad superior a 18 años, ingresados en un hospital en el Sur de Brasil y conscientes de su diagnóstico. Las interacciones farmacológicas más grandes y contraindicadas se analizaron utilizando las bases de datos Micromedex y Lexicomp. Resultados: La muestra consistió en 50 pacientes, el 54% eran mujeres y el promedio de edad fue de 53,6 (±15,3) años. El 42% de los pacientes utilizaban fármacos antidepresivos, de los cuales el escitalopram (inhibidor selectivo de la recaptación de serotonina) fue el más recetado; el 90% de los pacientes tuvieron alguna interacción que ocurrió con cualquier medicamento recetado para el tratamiento. De los pacientes que usaban antidepresivos, el 62% tuvieron interacciones contraindicadas y todos presentaron, al menos, un caso de interacción mayor. Los fármacos más relacionados con las interacciones farmacológicas contraindicadas fueron dipirona y metoclopramida. Conclusión: Los resultados de este estudio demostraron un alto número de interacciones farmacológicas contraindicadas que involucran fármacos antidepresivos. En este contexto, se verifica la importancia de monitorear y ajustar la farmacoterapia de estos pacientes.(AU)

Tratamento medicamentoso para depressão e prevenção quaternária / Drug treatment for depression and quaternary prevention / Tratamiento farmacológico para la depresión y la prevención cuaternaria

O uso generalizado de antidepressivos tem aumentado progressivamente nos últimos anos. No entanto, as evidências para o tratamento medicamentoso da depressão são pouco consistentes, sendo restritas as formas mais graves do transtorno e com modesta melhora clínica. Além disso, os efeitos adversos e os riscos relacionados ao uso crônico dessas medicações estão bem estabelecidos na literatura científica. Assim, é importante que os médicos de família tenham uma abordagem crítica deste problema e se questionem qual a melhor forma de ajudar seus pacientes. Os autores deste artigo levantam algumas hipóteses para explicar a prescrição excessiva de antidepressivos e, principalmente, trazem orientações para médicos de família e comunidade no cuidado das pessoas com depressão, com sugestões práticas de orientar o cuidado pela prevenção quaternária, utilizando ferramentas como o compartilhamento de decisão, o cuidado colaborativo e a busca dos suportes sociais durante a consulta.

The widespread use of antidepressants has increased steadily in recent years. However, the evidence for drug treatment of depression is not very consistent, with the most severe forms of the disorder being restricted and with modest clinical improvement. In addition, the adverse effects and risks related to the chronic use of these medications are well established in the scientific literature. Thus, it is important that family doctors take a critical approach to this problem and ask themselves how best to help their patients. The authors raise some hypotheses to explain the excessive prescription of antidepressants and, mainly, bring guidelines for family and community doctors in the care of people with depression, with practical suggestions to guide care for quaternary prevention, using tools such as sharing of decision, collaborative care, and the search for social supports during the consultation.

El uso generalizado de antidepresivos ha aumentado de manera constante en los últimos años. Sin embargo, la evidencia para el tratamiento farmacológico de la depresión no es muy consistente, ya que las formas más graves del trastorno están restringidas y con una modesta mejoría clínica. Además, los efectos adversos y los riesgos relacionados con el uso crónico de estos medicamentos están bien establecidos en la literatura científica. Por lo tanto, es importante que los médicos de familia adopten un enfoque crítico de este problema y se pregunten cuál es la mejor manera de ayudar a sus pacientes. Los autores plantean algunas hipótesis para explicar la prescripción excesiva de antidepresivos y, principalmente, traen pautas para los médicos de familia y comunitarios en la atención de personas con depresión, con sugerencias prácticas para orientar la atención para la prevención cuaternaria, utilizando herramientas como el intercambio de decisiones, colaborativo atención y búsqueda de apoyos sociales durante la consulta.

Use of psychotropic drugs among workers on leave due to mental disorders / Uso de psicofármacos entre trabalhadores em afastamento laboral por transtornos mentais

ABSTRACT Objective To describe the use of psychotropic drugs among civil servants with registered absenteeism due to mental disorders, and to investigate associations with duration of leave of absence. Methods A cross-sectional study with civil servants on leave of absence due to mental disorders, between January and December 2017. Demographic, occupational and clinical variables were extracted from secondary data. Non-parametric tests were used to investigate correlations between use of psychotropic drugs and leave duration. Cluster analysis was used to investigate associations between occupational characteristics and illness profile. Results Antidepressants were the most commonly used drugs (82.9%). Central tendency values for days on leave differed according to the number of psychotropic drugs used. In cluster analysis, a particular cluster (servants of intermediate age group and work experience - mean of 46 years and 15 years, respectively) stood out regarding use of antidepressants, severity of depression and frequency and duration of leave of absence. Conclusion Leave of absence due to mental disorders was associated with higher rates of psychotropic drug use. The group of servants identified in this study may be a primary target for health promotion, prevention and recovery actions at the organization.

RESUMO Objetivo Descrever a utilização de psicofármacos por servidores públicos com registro de absenteísmo por transtornos mentais, e analisar sua associação com a duração do afastamento do trabalho. Métodos Estudo transversal com servidores públicos em afastamento laboral por transtornos mentais, entre janeiro a dezembro de 2017. Variáveis demográficas, ocupacionais e clínicas foram obtidas a partir de dados secundários. Foram empregados testes não paramétricos para avaliar a correlação entre o uso de psicofármacos e o tempo de afastamento. A análise de cluster foi utilizada para verificar a associação entre as características ocupacionais e o perfil de adoecimento do servidor. Resultados Os antidepressivos foram os medicamentos mais utilizados (82,9%). Observaram-se diferenças nos valores centrais de dias de afastamentos por número de psicofármacos utilizados. Na análise de cluster , um dos conglomerados (servidores com idade e tempo de trabalhos intermediários - média 46 anos de idade e 15 anos de trabalho) destacou-se em relação à utilização de antidepressivos, gravidade do quadro depressivo, frequência e duração do afastamento. Conclusão O afastamento laboral por transtornos mentais esteve associado à maior utilização de psicofármacos. O grupo de servidores identificado pode ser alvo prioritário de ações de promoção, prevenção e recuperação da saúde na instituição.

Diagnosis and treatment of post-stroke depression / 国际脑血管病杂志

Post-stroke depression (PSD) seriously affects the long-term prognosis of patients with stroke. The pathophysiological mechanism and risk factors for PSD have not been fully understood. Importantly, the diagnosis rate of PSD is low, and the corresponding antidepressant treatment is not timely or systematic, resulting in an increased risk of stroke recurrence or death. This article reviews the progress of screening, diagnosis and treatment of PSD.

Consumo de psicofármacos: una problemática de salud actual / Psychotropic drug consumption: a current health problem

RESUMEN Los psicofármacos son frecuentemente consumidos por la población; su uso irracional atenta contra la calidad de vida de los pacientes que los toman regularmente sin supervisión médica. El objetivo de esta investigación es caracterizar el consumo de psicofármacos en un Grupo Básico de Trabajo en el área de salud del Policlínico Docente Universitario Martha Abreu de Estévez. Frecuentemente, se toman por automedicación, son prescriptos por complacencia y aunque tengan una indicación médica precisa, en ocasiones no se cumplen las normas establecidas para su uso correcto. Entre las variables epidemiológicas predominaron: las edades entre 50 y 64 años y el sexo femenino. Las principales causas del consumo fueron: para disminuir la tensión arterial y aliviar problemas familiares y laborales. Se concluyó que existió un alto índice de consumo de psicofármacos de manera automedicada; los entrevistados accedieron a estos a través de vías no convencionales, no relacionadas con el sistema de salud.

ABSTRACT Psychotropic drugs are frequently consumed by the population; their irrational use threatens the quality of life of patients who take them regularly without medical supervision. The objective of this research is to characterize the consumption of psychotropic drugs in a Basic Work Group from the health area of ‟Martha Abreu de Estevez" University Teaching Polyclinic. These drugs are often taken for self-medication, prescribed for complacency, and although they have a precise medical indication, sometimes the established norms for their correct use are not met. Ages between 50 and 64 years and female gender predominated among the epidemiological variables. Lower blood pressure and alleviate family and work problems were the main causes of consumption. We concluded that there was a high rate of self-medicated use of psychotropic drugs; the interviewees had access to them through unconventional ways, not related to the health system.

Medication exposure and predictors of first mood episode in offspring of parents with bipolar disorder: a prospective study

Objectives: To prospectively investigate whether baseline clinical characteristics and medication exposure predict development of major depressive disorder or bipolar disorder in offspring of parents with bipolar disorder. Methods: Youth aged 9-20 years with at least one biological parent with bipolar disorder and no prior history of mood or psychotic episodes (n=93) were prospectively evaluated and treated naturalistically during the study. Participants were divided into two groups: converters, defined as those who met DSM-IV criteria for a mood episode during follow-up (n=19); or non-converters (n=74). Logistic regression models were used to investigate associations between baseline clinical variables and medication exposure during follow-up and risk of developing a first mood episode (conversion). Results: Multivariate regression analyses showed that baseline anxiety disorders and subsyndromal mood disorders were associated with increased risk of conversion during follow-up. Adding medication exposure to the multivariate model showed that exposure to antidepressants during follow-up was associated with increased risk of conversion. Conclusions: Caution should be used when treating bipolar offspring with anxiety and/or emerging depressive symptoms using antidepressant agents, given the increased risk of developing a major mood disorder.

Disfunción tiroidea y trastornos del ánimo: revisión del estado del arte / Thyroid dysfunction and mood disorders: review of the state of the art

La relación entre función tiroidea y trastornos del ánimo se ha observado desde hace más de 50 años. Las hormonas tiroideas, actúan en el cerebro modulando génicamente proteínas asociadas a la fisiopatología de los trastornos del ánimo y potenciando los sistemas de neurotransmisión serotoninérgica y noradrenérgica. En el tratamiento de un episodio depresivo, la normalización de hormonas tiroideas es fundamental, y debe realizarse en todo paciente con sintomatología anímica, especialmente en aquellos con respuestas insuficientes a tratamiento, que requieren niveles de hormonas más estrictos que lo recomendado para población general. En pacientes eutiroideos, la potenciación con triyodotironina ha sido probada, pero también se ha utilizado T4 en altas dosis en casos resistentes, en que se postula que pudiese existir un estado de resistencia a hormonas tiroideas, no reflejado en los niveles hormonales periféricos evaluados rutinariamente. Las enzimas deiodasas, el receptor de hormona tiroidea, y el transportador de hormona tiroidea en la barrera hematoencefálica son blancos a investigar. Los objetivos de la presente revisión son ofrecer orientaciones respecto del uso de hormonas tiroideas en pacientes con trastornos del ánimo, una puesta al día sobre la relación entre hormonas tiroídeas y sistema nervioso central, y las interacciones entre psicofármacos y función tiroidea.

The relationship between thyroid function and mood disorders has been observed for more than 50 years. Thyroid hormones act in the brain genetically modulating proteins associated with the pathophysiology of mood disorders and potentiating the serotonergic and noradrenergic neurotransmission systems. In the treatment of a depressive episode, the normalization of thyroid hormones is essential, and should be performed in all patients with mood symptoms, especially in those with insufficient responses to treatment, which require more stringent hormone levels than recommended for the general population. In euthyroid patients, potentiation with triiodothyronine has been proven, but T4 has also been used in high doses in resistant cases, in which it is postulated that there might be a state of resistance to thyroid hormones, not reflected in the peripheral hormonal levels evaluated routinely. The enzymes deiodasas, the thyroid hormone receptor, and the thyroid hormone transporter in the blood brain barrier are white to investigate. The objectives of this review are to provide guidance regarding the use of thyroid hormones in patients with mood disorders, an update on the relationship between thyroid hormones and central nervous system, and the interactions between psychoactive drugs and thyroid function.

Use of psychiatric drugs in Dermatology

Abstract Patients with psychocutaneous disorders often refuse psychiatric intervention in their first consultations, leaving initial management to the dermatologist. The use of psychotropic agents in dermatological practice, represented by antidepressants, antipsychotics, anxiolytics, and mood stabilizers, should be indicated so that patients receive the most suitable treatment rapidly. It is important for dermatologists to be familiar with the most commonly used drugs for the best management of psychiatric symptoms associated with dermatoses, as well as to manage dermatologic symptoms triggered by psychiatric disorders.

Pattern evolution of antidepressants and benzodiazepines use in a cohort

ABSTRACT OBJECTIVE In recent decades there has been an increase in the use of antidepressants (AD) and a decrease in the use of benzodiazepines (BDZ). Prevalence, cumulative incidence, and factors associated with the incidence of AD and BDZ use in a Brazilian population were estimated in this article. METHODS Data were collected with a self-administered questionnaire in a cohort of employees from a university in Rio de Janeiro. The prevalence of the use of AD and BDZ was calculated for 1999 (4,030), 2001 (3,574), 2006-07 (3,058), and 2012 (2,933). The cumulative incidences of the use of AD and BDZ between 1999 and 2007 were estimated by the Poisson models with robust variance estimates. RESULTS In 1999, the prevalence of the use of AD and BDZ were 1.4% (95%CI: 1.1-1.8) and 4.7% (95%CI: 4.1-5.4), respectively; in 2012, they were 5.4% (95%CI: 5.5-6.2) and 6.8% (95%CI: 6.0-7.8). The incidence of use, between 1999 and 2007, was 4.9% (95%CI: 4.2-5.7) for AD and 8.3% (95%CI: 7.3-9.3) for BDZ. The incidences of AD and BDZ use were higher among women and participants with a positive General Health Questionnaire. CONCLUSION In this population, the increase in the use of AD was not accompanied by a decrease in the use of BDZ, showing the prescriptions for psychotropic medication do not follow the currently recommended guidelines for treatment of common mental health disorders.

Pharmacokinetics of antidepressants in patients undergoing hemodialysis: a narrative literature review

We conducted a narrative literature review on studies that specifically addressed the pharmacokinetics of antidepressants in patients on hemodialysis. The search included the MEDLINE, LILACS, and Web of Knowledge databases and combined Medical Subject Headings and free-text search terms for chronic kidney disease, end-stage renal disease, renal replacement therapy, depression, and antidepressants; it was limited to studies conducted in humans, with no language or time constraints. The search yielded 212 studies. After screening titles and abstracts, 32 studies were read in full and 11 ultimately met the inclusion criteria and were included in the review. Most of the studies showed no difference in the pharmacokinetics of antidepressant drugs between patients with normal renal function and patients undergoing hemodialysis. However, studies with fluvoxamine and amitriptyline showed that variations in albumin levels might affect serum concentrations of these agents. The included studies have several limitations, and there are many obstacles to the adequate treatment of depression in patients undergoing hemodialysis. Further studies on this topic are needed to support proper treatment of these patients, improving their quality of life and reducing mortality.