Browsing by Subject "Antidepressant"

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    Antidepressant treatment persistence in low-income, insured pregnant women.
    (Academy of Managed Care Pharmacists (AMPC), 2014-06) Wu, Jun; Davis-Ajami, Mary
    Background: Pregnant women with depression face complicated treatment decisions, either because of the risk associated with not treating depression or because of the risks associated with antidepressant use. Approximately 1 in 5 women experience depressive symptoms during pregnancy. This information suggests that many women may take an antidepressant at some time during pregnancy. Once pregnant women initiate antidepressant prescription pharmacotherapy, medication treatment persistence plays an important role in managing depression, yet little is known regarding antidepressant use behavior in pregnant women. Objective: To determine antenatal antidepressant treatment nonpersistence and associated factors in low-income, insured pregnant women. Methods: We identified eligible pregnant women (≥ 18 years) diagnosed with major depression who initiated antidepressant medications during pregnancy from South Carolina Medicaid claims data (2004-2009). Our main outcome measure was treatment nonpersistence to antidepressant therapy during pregnancy. We defined treatment nonpersistence to antidepressant pharmacotherapy as having a gap between 2 consecutive prescriptions lasting at least 15 days during pregnancy. We applied a proportional hazards model to identify predictors associated with the risk for antidepressant nonpersistence during pregnancy. Results: Of 804 pregnant women meeting study criteria, nearly 45% of this cohort did not continue to use antidepressant pharmacotherapy, showing a gap ≥ 15 days between 2 prescriptions, after initiating antidepressant therapy during pregnancy. Women reporting nonwhite race were 36% more likely to show a gap in antidepressant medication use during pregnancy than white women. Women with a history of antidepressant use before pregnancy were 44% more likely to discontinue the antidepressant therapy during pregnancy. Conclusions: Treatment persistence to antidepressant medications was poor during pregnancy in low-income, insured pregnant women. Individualized treatment might be considered to reduce the risks of untreated depression and antenatal antidepressant use in vulnerable women.
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    Treatment-Resistant Depression in Adolescents: Clinical Features and Measurement of Treatment Resistance
    (Mary Ann Liebert, Inc., 2020-05) Strawn, Jeffrey R.; Aaronson, Scott T.; Elmaadawi, Ahmed Z.; Schrodt, G. Randolph; Holbert, Richard C.; Verdoliva, Sarah; Heart, Karen; Demitrack, Mark A.; Croarkin, Paul E.; Psychiatry, School of Medicine
    Objective: To describe the clinical characteristics of adolescents with antidepressant treatment-resistant major depressive disorder (MDD) and to examine the utility of the Antidepressant Treatment Record (ATR) in categorizing treatment resistance in this population. Methods: Adolescents with treatment-resistant MDD enrolled in an interventional study underwent a baseline evaluation with the ATR, Children's Depression Rating Scale-Revised (CDRS-R), and Clinical Global Impressions-Severity (CGI-S) scales. Demographic and clinical characteristics were examined with regard to ATR-defined level of resistance (level 1 to ≥3) using analysis of variance and χ2 tests. Results: In adolescents with treatment-resistant MDD (N = 97), aged 12-21 years, most were female (65%), white (89%), and had recurrent illness (78%). Patients were severely ill (median CGI-S score of 5), had a mean CDRS-R score of 63 ± 10, and 17.5% had been hospitalized for depression-related symptoms. Fifty-two patients were classified as ATR 1, whereas 32 were classified as ATR level 2 and 13 patients as ≥3, respectively. For increasing ATR-defined levels, illness duration increased from 12.0 (range: 1.5-31.9) to 14.8 (range: 1.8-31.7) to 19.5 (range: 2.5-36.2) months and the likelihood of treatment with serotonin norepinephrine reuptake inhibitors (SNRIs) and dopamine norepinephrine reuptake inhibitors (DNRIs) similarly increased (p = 0.006 for both SNRIs and DNRIs) as did the likelihood of treatment with mixed dopamine serotonin receptor antagonists (χ2 = 17, p < 0.001). Conclusions: This study underscores the morbidity and chronicity of treatment-resistant MDD in adolescents. The present characterization of related clinical features describes the use of nonselective serotonin reuptake inhibitors in adolescents with treatment-resistant depression and raises the possibility that those with the greatest medication treatment resistance are less likely to have had recurrent episodes. The study also demonstrates the utility of the ATR in categorizing treatment resistance in adolescents with MDD.