ABSTRACT
INTRODUCTION: A major determinant of response to antidepressant drugs is how the patients use them. Our objective is to take a look over the antidepressants use in a real sample. METHODS: In determining which factors may be relevant for treatment good use, social, demographic, disease and treatment-related data were gathered from 550 patients, who were currently taking antidepressants for any motive. The questionnaire included two items, the patients' perceived difficulty of following treatment and the level of acknowledged non-compliance by the patient, which may be considered as both an indirect and guiltless way of approximating the patients' real use of treatment. RESULTS: Compliance was poor among the less educated, as well as those living in rural areas and in patients receiving concomitant treatment for organic diseases. Use was good in 61.5% and was particularly good among those with an affective disorder (69.8%). Among patients who did not respond to treatment, the incidence of non-compliance (49.1%) was higher than for those achieving improvement (31.2%). CONCLUSIONS: It's important to explore and reinforce a good use of antidepressants in clinical settings and to be sure this type of treatment is necessary if the indication is not clear.
Subject(s)
Antidepressive Agents/therapeutic use , Medication Adherence/statistics & numerical data , Humans , Surveys and QuestionnairesABSTRACT
Introducción. Un determinante fundamental de la respuesta al tratamiento antidepresivo es cómo el paciente lo toma. Nuestro objetivo es observar el uso de los antidepresivos en una muestra real de pacientes. Métodos. Para determinar que factores pueden ser relevantes para un buen uso del tratamiento se recogieron datos sociales, demográficos, relativos a la enfermedad y al tratamiento de 550 pacientes que estaban siendo tratados con antidepresivos por cualquier motivo. El cuestionario elaborado incluía dos ítems, la dificultad percibida por el paciente para seguir las indicaciones del tratamiento y el nivel de reconocimiento de falta de cumplimiento, lo que puede ser considerado como una forma indirecta y poco culpabilizadora de aproximarse al uso real del medicamento por parte del paciente. Resultados. El cumplimiento fue peor en el grupo con un nivel inferior de educación, así como en aquellos que vivían en zonas rurales y en los que recibían otro tratamiento concomitante para enfermedades orgánicas. El uso era bueno en el 61,5 % y, particularmente bueno, entre aquellos diagnosticados de un trastorno afectivo (69,8%). Entre los pacientes que no respondían al tratamiento, la incidencia del no-cumplimiento (49,1%) era superior a aquellos que sí referían haber mejorado (31,2%).Conclusiones. Es importante explorar y reforzar un buen uso del tratamiento antidepresivo en todos los dispositivos asistenciales y estar seguro de que este tipo de tratamiento es necesario si la indicación no está clara (AU)
Introduction. A major determinant of response to antidepressant drugs is how the patients use them. Our objective is to take a look over the antidepressants use in a real sample. Methods. In determining which factors may be relevant for treatment good use, social, demographic, disease and treatment-related data were gathered from 550 patients, who were currently taking antidepressants for any motive. The questionnaire included two items, the patients perceived difficulty of following treatment and the level of acknowledged non-compliance by the patient, which may be considered as both an indirect and guiltless way of approximating the patients real use of treatment. Results. Compliance was poor among the less educated, as well as those living in rural areas and in patients receiving concomitant treatment for organic diseases. Use was good in 61.5% and was particularly good among those with an affective disorder (69.8%). Among patients who did not respond to treatment, the incidence of non-compliance (49.1%) was higher than for those achieving improvement (31.2%).Conclusions. Its important to explore and reinforce a good use of antidepressants in clinical settings and to be sure this type of treatment is necessary if the indication is not clear (AU)
Subject(s)
Humans , Antidepressive Agents/therapeutic use , Depressive Disorder/drug therapy , Patient Satisfaction , Patient Compliance , Patient Dropouts , Life StyleABSTRACT
Los Servicios de Farmacia hospitalaria han tenido y tienen un papel clave en la implantación y desarrollo de los procesos de selección de medicamentos, desarrollando sistemas y procedimientos de evaluación y selección. En este artículo se analiza el estado de la cuestión apuntando estrategias para la buena selección y dispensación de medicamentos en el hospital (AU)
The hospital pharmacy services have had and continue to have a key role in the introduction and development of medicine selection processes, developing evaluation and selection system and procedures. This article analyses the state of the question, indicating strategies for the good selection and dispensing of medicines in the hospital (AU)
Subject(s)
Humans , Male , Female , Pharmacy Service, Hospital/classification , Pharmacy Service, Hospital/organization & administration , Pharmacy Service, Hospital/supply & distribution , Drug Evaluation, Preclinical/methods , Drug Evaluation, Preclinical/trends , Pharmaceutical Preparations/classification , Pharmaceutical Preparations/standards , Medicamentous Diagnosis/methods , Medicamentous Diagnosis/trends , Pharmacology/organization & administration , Pharmacology/trendsABSTRACT
Burst-suppression anesthesia (BSA) has been previously compared with electroconvulsive therapy (ECT) in drug-resistant depression, with promising results. We have carried out a double-blind randomized clinical trial comparing BSA with sham-BSA in 20 patients meeting DSM-IV criteria for major depression with inadequate response to antidepressant drugs and who chose BSA as an alternative to ECT. After withdrawing antidepressant drugs, patients were randomized to receive four sessions of either BSA (induction with propofol followed by the anesthetic agent sevoflurane, achieving BSA for 1 hour) or sham-BSA (induction with propofol until loss of consciousness, followed by spontaneous awakening in 5-10 minutes). Decrease in the Hamilton Rating Depression Scale was larger with BSA (-6.0 +/- 7.3) than with sham-BSA (-2.5 +/- 4.5), but differences did not reach statistical significance ( t = -1.08, p = 0.3). In our sample, we have not found BSA to be superior to sham-BSA and therefore cannot consider BSA as an alternative to ECT.
Subject(s)
Anesthesia/methods , Anesthetics, Intravenous/pharmacology , Depressive Disorder/therapy , Propofol/pharmacology , Adult , Anesthetics, Intravenous/administration & dosage , Antidepressive Agents/pharmacology , Double-Blind Method , Drug Resistance , Electroencephalography , Female , Humans , Male , Middle Aged , Propofol/administration & dosage , Unconscious, PsychologyABSTRACT
Most drug use takes place in primary health care, under circumstances which are very different from those of the clinical trials where drugs are studied. If clinical pharmacology is to have a meaningful influence on the way drugs are used, it cannot afford to remain absent from this setting. We are clinical pharmacologists working in primary care. In this paper, we describe our activities and discuss our experience in this field.
