Determination of side effects and medication adherence in major depression patients utilized antidepressants

Abstract

The aim of the study is to determine side effects, and medication  adherence in patients who were diagnosed with major  depression utilized antidepressants. This study was conducted  in outpatient psychiatry clinic between February 2013 and May  2013. ‘Toronto Side Effects Scale’ and 4-item Morisky-Green-  Levine Medication Adherence Scale were evaluated. Fifty-six  major depression patients (mean of age: 40.82 ± 14.28 years  old; male/female: 13/43) were included in this study. Patients  were treated with escitalopram (46.4%), sertraline (26.8%),  venlafaxine (10.7%), citalopram (8.9%) and paroxetine (7.1%).  The most common side effects that patients reported were  drowsiness/ daytime somnolence (57.1%), dry mouth (46.4%)  and increased sleep (46.4%), increased appetite (37.5%) and  malaise or fatigue (30.4%). The most severity side effects that  patients experienced were drowsiness/ daytime somnolence  (25%), increased sleep (19.6%) and decreased libido (14.3%).  Only fifteen (26.8%) patients were found high adherent to their  medication. It was concluded that although the frequency and  severity of side effects have been found high, the percentage of  patients’ medication adherence has been obtained low. Patient  education and monitoring regarding side effects and medication  adherence providing by pharmacists would be contributed to  prevent possible drug induced problems in these patients besides  the routine services they are taken from outpatient clinic.  

Keywords

• Depression,Side Effects,Patient adherence

Antidepresan Kullanan Majör Depresyon Hastalarında Yan Etkilerin ve Hasta Uyuncunun Değerlendirilmesi

Abstract

Bu çalışmanın amacı, antidepresan kullanan majör  depresyon hastalarında yan etkilerin ve hasta uyuncunun  değerlendirilmesidir. Çalışma Şubat-Mayıs 2013 tarihleri  arasında bir psikiyatri polikliniğinde yürütülmüştür. Yan  etkilerin tespiti için “Toronto Yan Etki Ölçeği”, tedaviye  uyuncun belirlenmesi için ise “Morisky Green Levine Uyunç  Ölçeği” kullanılmıştır. Çalışma 56 majör depresyon tanısı alan  hasta ile (yaş ortalaması: 40,82 ± 14,28; erkek/kadın: 13/43)  tamamlanmıştır. Hastalar depresyon tedavisi için essitalopram  (% 46,4), sertralin (% 26,8), venlafaksin (% 10,7), sitalopram  (% 8,9) ve paroksetin (%7,1) kullanmaktaydı. Hastaların en  yaygın bildirdiği yan etkilerin sersemlik/gündüz uykuya eğilim  (% 57,1), ağız kuruluğu (% 46,4), uykuda artış (% 46,4), iştah  artması (% 37,5) ve halsizlik veya yorgunluk (% 30,4) olduğu  tespit edilmiştir. Hastaların yaşadıkları bu yan etkiler şiddet  derecesine göre değerlendirildiğinde ilk sıraları sersemlik/  gündüz uykuya eğilim (% 25,0), uykuda artış (% 19,6) ve libido  azalması (% 14,3) yan etkilerinin aldığı gözlenmiştir. Çalışmaya  katılan hastaların sadece % 26,8’inin ilaçlarına uyunç oranlarının  yüksek olduğu saptanmıştır. Antidepresan kullanan hastalarda  görülen yan etki sıklığının ve şiddetinin yüksek olduğu ve  ayrıca hastaların ilaç uyunç oranlarının düşük olduğu sonucuna  varılmıştır. Bu hastaların poliklinikten aldıkları rutin hizmetin  yanısıra eczacılar tarafından yan etkiler ve uyunç konusunda  eğitilmeleri ve izlenmeleri, ilaç kaynaklı olası sorunların önüne  geçilmesine katkı sağlayacaktır.  

Keywords

• Depresyon,Yan Etkiler,Hasta uyumu

References

1. Weızman S, Gonda X, Dome P, Faludı G. Pharmacogenetics of antidepressive drugs: A way towards personalized treatment of majör depressive disorder. Neuropsychopharmacol Hung, 2012; 14(2):87-101
2. Serretti A, Drago A, Spina E. Pharmacogenomics of depression. In: Pharmacogenomics in Psychiatry. Eds:Schwab M, Kaschka WP, Spina E, Adv Biol Psychiatry, Basel, Karger, 2010; pp. 58-74.
3. Vergouwen ACM, Bakker A, Katon WJ, Verheij TJM, Koerselman F. İmproving adherence to antidepressants: a systematic review of interventions. J Clin Psychiatry, 2003; 64: 1415-1420.
4. Hunot VM, Horne R, Leese MN, Churchill RC. A cohort study of adherence to antidepressants in primary care: The influence of antidepressant concerns and treatment preferences. Prim Care Companion J Clin Psychiatry, 2007; 9(2):91-99.
5. Gabrial A, Violato C. Knowledge of and attitudes towards depression and adherence to treatment: The antidepressant adherence scale (AAS). Journal of affective disorders, 2010; 126:388-394.
6. Vanderkooy JD, Kennedy SH, Bagby RM. Antidepressant side effects in depression patients in a naturalistic setting: A study of bupropion, moclobemide, paroxetine, sertraline, and venlafaxine. Can J Psychiatry, 2002; 47: 174-180
7. Yılmaz S. Psikiyatri hastalarında ilaç yan etkileri ve ilaç uyumu. İ.Ü. Sağlık Bilimleri Enstitüsü, Yüksek Lisans Tezi, İstanbul, (Danışman: Doç. Dr. Sevim Buzlu). 2004.
8. Morisky DE, Green LW, Levine DM. Concurrent and Predictive Validity of a Self-Reported Measure of Medication Adherence and Long-Term Predictive Validity of Blood Pressure Control. Med Care, 1986; 24(1): 67–74.

9. Marques LAM, Galduroz JCF, Noto AR. Pharmaceutical care to patients treated with antidepressants. Rev Calid Asist, 2012; 27:55-64.
10. Dewan MJ, Anand VS. Evaluating the tolerability of the newer antidepressants. J Nerv Ment Dis, 1999; 187:96-101.
11. Goethe JW, Woolley SB, Cardoni AA, Woznicki BA, Piez DA. Selective serotonin reuptake inhibitor discontinuation side effects and other factors that influence medication adherence. J Clin Psychopharmacol, 2007; 27:451-458.
12. Ashton A, Jamerson B, Wagoner C. Antidepressant related adverse effects impacting treatment compliance: results of a patient survey. Curr Ther Res Clin Exp, 2005; 66:96-106.
13. Kostev K, Rex J, Eith T, Heilmaier C. Which adverse effects influence the dropout rate in selective serotonin reuptake inhibitor (SSRI) treatment? Results for 50,824 patients. Ger Med Sci, 2014; 12:15
14. Sawada N, Uchida H, Suzuki T, Watanabe K, Kikuchi T, Handa T, Kashima H. Persistence and compliance to antidepressant treatment in patients with depression: A chart review. BMC Psychiatry, 2009; 9:38-47.
15. Adler DA, Bungay KM, Wilson IB, Pei Y, Supran S, Peckham E,Cynn DJ, Rogers WH. The impact of a pharmacist intervention on 6 month outcomes in depressed primary care patients. Gen Hosp Psychiatry, 2004; 26: 199-209.
16. Bungay KM, Adler DA, Rogers WH, McCoy C, Kaszuba M, Supran S, Pei Y, Cynn DJ, Wilson IB. Description of a clinical pharmacist intervention administered to primary care patients with depression. Gen Hosp Psychiatry, 2004; 26: 210-218.
17. Cappocia KL, Boudreau DM, Blough DK, Ellsworth AJ, Clark DR, Stevens NG, Katon WJ, Sullıvan SD. Am J Health Syst Pharm, 2004; 61: 364-372.
18. Al-Saffar N, Abdulkareem A, Abdulhakeem A, Salah AQ, Heba M. Depressed patients’ preferences for education about medications by pharmacists in Kuwait, Patient Educ Couns, 2008; 72: 94-101
19. Rubio-Valera M, Serrano-Blnaco A, Magdalena-Belio J, Fernandez A, Garcia-Campayo J, Pujol MM, Del Hoyo YL. Effectiveness of pharmacist care in the improvement of adherence to antidepressants: A systematic review and meta-analysis. Ann Pharmacother, 2011; 45:39-48
20. Murata A, Kanbayashi T, Shimizu T, Miura M. Risk factors for drug nonadherence in antidepressant-treated patients and implications of pharmacist adherence instructions for adherence improvement. Patient Preference and Adherence, 2012; 6: 863-869.
21. Al-Jumah KA, Qureshi NA. Impact of pharmacist interventions on patients’ adherence to antidepressants and patient-reported outcomes: A systematic review. Patient Preference and Adherence, 2012; 6:87-100