Antipsychotics and older people - new evidence on health risks

There has been much criticism in the past about the overuse of newer, atypical antipsychotic drugs to manage problem behaviour in elderly people with dementia. However, a new study by researchers from Brigham and Women's Hospital in Boston has suggested that alternative drugs may be just as dangerous. The researchers studied 10,900 people who were admitted to nursing homes in British Columbia between 1996 and 2006 and who received a psychotropic drug within 90 days of admission. The study found that people taking conventional antipsychotics, antidepressants and benzodiazepines were at higher risk of death and fractures of the femur. Levels of pneumonia and heart failure did not differ between those taking atypical antipsychotics and those taking other drugs.

Seniors, side effects and chemical cocktails

Older people who start taking antidepressants may already be taking other drugs for different problems. These drugs can interact with the antidepressants to create a number of side effects which can put people off taking antidepressants. Researchers from Thomson Reuters, the University of Southern California and Sanofi-Aventis studied 39,000 older people who started taking antidepressants between 2001 and 2006. More than 25% were prescribed antidepressants and another drug that could cause a major interaction and another 36% were at risk of less-severe drug interactions. The most common side effects caused by drug interactions were insomnia, somnolence and drowsiness which occurred in 2.6% of people with the next most common being dizziness (1.1%). Only 45% of people who had documented side effects refilled their prescription for the same antidepressant and a quarter stopped taking antidepressants altogether.

Most people don't stay the course with antidepressants

Most people who take antidepressants give them up before they are supposed to. Researchers from the Catalan Institute of Health studied 7,525 people who were starting antidepressant treatment. They found that 56% stopped taking their medication during the first four months and only 25% continued their treatment for more than 11 months. Only 22% of the sample completed their treatment although women were more likely to carry on taking the pills than men and those who took more than one kind of medication stuck with their pills better than those who just took antidepressants. Doctors recommend taking antidepressants for at least six months.

New research claims Reboxetine is useless

Reboxetine - sold as Edronax by Pfizer - is no more effective at countering major depression than a placebo. Researchers from the German Institute for Quality and Efficiency in Health Care reviewed trials of the drug and found that the risk of taking it far outweighed the benefits. The researchers found that three-quarters of the studies into the effectiveness of the drug - essentially the ones which showed it to be useless - were not published leading them to question the current National Institute for Health and Clinical Excellence (NICE) guidelines on its use in the U.K. which claim that "reboxetine is superior to placebo and as effective as other antidepressants."

Antidepressants and diabetes risk

Long-term use of antidepressants could be linked to an increased risk of developing type 2 diabetes. Researchers from University College London studied more than 150,000 Finnish adults over an average of five years. 1.1% of the participants who were not using antidepressants were diagnosed with type 2 diabetes during the course of the study compared to 1.7% of people who had taken between 200-400 daily doses of an antidepressant and 2.3% among those who had taken 400 or more daily doses. This could be because people taking the antidepressants have the poor health and lifestyle that often go hand-in-hand with type 2 diabetes. However, when the researchers looked at the participants who were suffering from severe depression those taking antidepressants were two-three times more likely than non users to be diagnosed with diabetes, even when taking into account the effects of long-term health conditions, high blood pressure, heart disease and cancer.

Antidepressants for psychosis

As well as suffering from delusions and hallucinations people with schizophrenia often experience so-called negative symptoms such as flat mood, lack of interest in being sociable and an inability to experience pleasure, as well as many cognitive problems. Psychiatrists often prescribe antidepressants for these symptoms but there are reports of negative effects as well as positive ones. Researchers from the University of Wolverhampton reviewed 23 studies into the use of antidepressants for people with psychosis. They found a moderate positive effect from the antidepressants and significant responses for the drugs fluoxetine, trazodone and ritanserin.

Singh, Surendra P., Singh, Vidhi and Chan, Kelvin - Efficacy of antidepressants in treating the negative symptoms of chronic schizophrenia: meta-analysis British Journal of Psychiatry September 2010, 197(3), 174-179

Antidepressants and self-poisoning risk - which are the riskiest?

Self-poisoning is a common way of killing oneself, especially among women. Because suicide is linked to depression, and antidepressants are often easily available, antidepressants are involved in around 25% of all poisoning suicides in the U.K. and 20-30% of non-fatal overdoses. It is therefore important to know if certain kinds of antidepressants are riskier than others. A team of researchers led by Keith Hawton from Oxford University compared numbers of prescriptions to numbers of deaths in cases of deaths by self-poisoning. They used data from six general hospitals in Oxford, Manchester and Derby between 2000 and 2006. The study found that older, tricyclic antidepressants were much riskier than the SNRI (Serotonin-Norepinephrine Reuptake Inhibitor) drug venlafaxine and the NaSSA (Noradrenergic and Specific Serotonin Antidepressant) drug mirtazapine. In turn these drugs were riskier than SSRIs (Serotonin Specific Reuptake Inhibitors). Among the tricyclic antidepressants dosulepin and doxepin were both riskier than amitriptyline while within the SSRIs citalopram was riskier than the other drugs.

Hawton, Keith ... [et al] - Toxicity of antidepressants: rates of suicide relative to prescribing and non-fatal overdose British Journal of Psychiatry May 2010, 196(5), 354-358

Psychiatrists underestimate antidepressant side effects

People suffering from depression may have far more side effects than psychiatrists think they do. Mark Zimmerman from Rhode Island Hospital asked 300 people being treated for depression to fill out the Toronto Side Effects Scale. The patients rated the frequency of 31 side effects and the degree of trouble they experienced and this was compared to what the psychiatrists had documented. The average number of side effects recorded by the patients using the questionnaire was 20 times higher than the number recorded by the psychiatrists. Even when limiting the side effects to those which were 'frequently occuring' or 'very bothersome' the rate was still found to be two or three times higher than that recorded by the psychiatrists. The results are important as side effects are one of the most frequent reasons patients stop taking their medication.

You can find out more about this research at

http://www.sciencedaily.com/releases/2010/04/100419151112.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

Combination therapy more effective for depression

Between 50% and 75% of people show some improvement on first taking an antidepressant but only about a third completely recover after taking just one drug. Previous research has shown that a combination of drugs can have a better effect and a team of researchers led by Pierre Blier of the University of Ottawa studied the effectiveness of adding mirtazapine to various different antidepressants. Mirtazapine belongs to a different class of drugs to most other antidepressants and is classified as a noradrenergic and specific serotonergic antidepressant (NaSSA). 105 people with major depression received either fluoxetine on its own, or mirtazapine combined with fluoxetine, venlafaxine or bupropion. The recovery rates were 25% for fluoxetine, 52% for mirtazapine and fluoxetine, 58% for mirtazapine and venlafaxine and 46% for mirtazapine and bupropion. There were no extra side effects from using a combination of different drugs.

Blier, Pierre ... [et al] - Combination of antidepressant medications from treatment initiation for major depressive disorder: a double-blind randomized study American Journal of Psychiatry March 2010, 167(3), 281-288

New study sheds light on prescribing patterns

In the U.S. the Substance Abuse and Mental Health Services Administration has been looking into the prescription of psychiatric drugs such as antipsychotics, antidepressants and anti-anxiety drugs. The study used data from the 2005 National Disease and Therapeutic Index, a national sample of around 4,000 doctors carried out by IMS health. It found that antipsychotic drugs were only actually used for schizophrenia/psychosis just over a third (35%) of the time and were actually used more often (39%) to treat mood disorders. The drugs - which can have serious side effects - were also used to treat dementia (7.4%), anxiety (6%) and ADHD (6%). Antidepressants were mostly used to treat mood disorders (65%) but they were also used to treat anxiety (16%) and schizophrenia/psychosis (2.6%). 28% of prescriptions for anti-anxiety drugs were used for non-psychiatric problems including anxiety related to medical treatment (6%), allergic reactions (4%) and back problems (2.5%).

You can find out more about this study at

http://www.medicalnewstoday.com/articles/183073.php

Antidepressants and premature birth

Some studies have found a link between premature births and the use of antidepressants during a mother's pregnancy. There is still a shortage of evidence on this topic but another study by researchers at the Hospital for Sick Children in Toronto has added to the evidence that there might be a link. The study compared 928 women who had taken antidepressants during their pregnancy with 928 women of similar health and background who had not. It found that 8.8% of the women who had taken antidepressants had had a premature baby, compared to only 5.4% of the women in the comparison group. However, women taking antidepressants were no more likely to give birth to babies who were small for their gestational age or who had a low birth weight.

Einarson, A. ... [et al] - Adverse effects of antidepressant use in pregnancy: an evaluation of fetal growth and preterm birth Depression and Anxiety January 2010, 27(1), 35-38

Anxiety does not affect effectiveness of duloxetine

Some studies have suggested that people who suffer from anxiety as well as depression respond less well to treatments with antidepressants. J. Craig Nelson from the University of California, San Francisco reviewed 11 studies into the effectiveness of duloxetine at treating depression. The studies covered a total of 2,841 people of whom 1,326 were classified as anxious. Duloxetine was found to be more effective than a placebo and have better response and remission rates, and the drug was just as effective for people with anxiety.

Nelson, J. Craig - Anxiety does not predict response to duloxetine in major depression: results of a pooled analysis of individual patient data from 11 placebo-controlled trials Depression and Anxiety January 2010, 27(1), 12-18

How effective are antidepressants?

Antidepressants could be little better than a placebo for all but the most severe depression. Researchers from the University of Pennsylvania in Philadelphia carried out a data analysis combining information from six different trials covering a total of 718 participants. They found that true advantages of antidepressants over placebos were 'non-existent to negligible' among depressed patients with mild, moderate and even severe symptoms. However, the drugs were very effective among patients with severe depression. The authors of the study pointed out that many studies used by drug companies to publicise the benefits of antidepressants only included severely-depressed people as participants.

You can find out more about this research at

http://www.sciencedaily.com/releases/2010/01/100105161538.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

Antidepressants and adolescents

In 2003 the U.S. Food and Drugs Administration issued a warning that some antidepressants could increase the risk of suicidal behaviour in children and adolescents. Since then the prescription of the drugs has gone down but a new study, by researchers at Ohio State University, has found that the drugs could have a beneficial effect on the whole. The study, of 318 adolescents, looked at readmission rates to psychiatric hospitals. It found that those teenagers treated with antidepressants were less likely to be re-hospitalised. However, hospitalised children who were prescribed three or more drugs, from different classes, were 2.6x more likely to be readmitted to hospital than other children and these children made up a quarter of the sample.

You can find out more about this research at

http://psychcentral.com/news/2009/12/18/antidepressants-help-suicidal-youth/10283.html

Antidepressants and stroke risk

Middle-aged women who take antidepressants may be at an increased risk of stroke. Researchers from Harvard Medical School compared six years' worth of data on 5,500 postmenopausal women who took the drugs with 130,000 people who did not take them. Women taking selective serotonin reuptake inhibitors (SSRIs) had a 45% increase in their risk of stroke and a 32% increase in risk of death from any cause and similar results were found for women taking tricyclic antidepressants. However, the overall risk of any one individual suffering a stroke remained very small - 0.3% in a year for women not taking the drugs and 0.4-0.5% for those taking them. The authors of the study advised people to take other steps to reduce their stroke risk such as losing weight, lowering their blood pressure and stopping smoking rather than running the risk of depression which itself can have adverse consequences on physical health. You can find out more about this research at http://www.mentalhelp.net/poc/view_doc.php?type=news&id=124399&cn=5

Drug use soars in Scotland

The number of drugs being prescribed for depression and dementia has soared in Scotland over the last few years as the country grapples with an ageing population and the global recession. Official figures estimate that 9.7% of people aged 15 and over take medication for depression with the total number of prescriptions rising to more than 4 million for the first time. The proportion of the Scottish population taking antidepressants has more than quadrupled over the last 15 years. Despite this the cost of the drugs fell from £40.4 million in 2007-8 to £35.8 million in 2008-9 as drug companies reduced their prices. The use of drugs for ADHD increased by 6.2% over the same period and the number of drugs for dementia rose by 13.2%. You can find out more about this issue at http://www.telegraph.co.uk/news/newstopics/politics/scotland/6818966/Recession-sees-antidepressant-use-soar.html

MAO-A and depression.

Monoamine oxidase A (MAO-A) is a chemical in the brain that breaks down other chemicals including serotonin. Serotonin is associated with good mood and high levels of MAO-A have been associated with depression. Researchers at the Centre for Addiction and Mental Health in Toronto used PET (positron emisssion tomography) scanning to look at the levels of MAO-A and serotonin in people's brains as they were being treated with antidepressants. The study found that the drugs raised serotonin levels but did nothing to decrease levels of MAO-A. Some early antidepressants did target MAO-A but they fell out of favour in the 1970s due to adverse reactions with certain foods. These problems have been overcome now so it could be time to look again at the effectiveness of MAO-A inhibitors.

http://www.sciencedaily.com/releases/2009/12/091208132724.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

Antidepressants and personality

Antidepressants could affect people's personalities as well as their moods. Researchers from Northwestern University, Evanston, Illinois studied 240 volunteers. They gave 120 the antidepressant paroxetine, 60 received cognitive behaviour therapy (CBT) and the other 60 took a placebo. The participants' personalities and depression symptoms were assessed before and after treatment. After 12 weeks all the participants showed a marked drop in their depression symptoms but only the ones taking paroxetine became much less neurotic and much more extrovert. Neuroticism is known to increase the risk of depression whereas extroversion decreases it suggesting that the antidepressants may work by changing the way people see the world and how they relate to others as much as by dealing with the depression itself.

You can find out more about this research at

http://uk.reuters.com/article/idUKTRE5B64BI20091207?feedType=RSS&feedName=healthNews&sp=true

Drugs and falling in older people

Researchers at the University of British Columbia have been looking into which drugs are linked to an increased number of falls in older people. They reviewed 22 studies on falls in people over 60 covering a total of 79,000 participants. They found that antidepressants had the strongest statistical link with falling but antipsychotics and benzodiazepines such as valium were also associated with an increased risk. Painkillers were found not to be linked to an increased risk of falling which is the fifth leading cause of death in the developed world.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/11/091123171410.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

Antidepressants and premature delivery

A study of over 3,000 women by researchers at the University of Washington, the University of Michigan and Michigan State University has found that using antidepressants during pregnancy could increase the risk of premature delivery. The study found that medication use and depression was strongly linked to delivery before 35 weeks gestation. However, in the women who had depression symptoms but who were not taking medication there was no increased risk of preterm delivery suggesting that it was the medication not the depression leading to premature birth.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/10/091029211543.htm