Soumya Shraddhya Paul, Amity University, Noida
In 2017, depressive disorders were the third biggest cause of non-fatal illness burden worldwide. In the treatment of depressive disorders, pharmacotherapy is an essential component. As of now, the treatment consists of monotherapy using second-generation antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and other neurotransmitter-targeting medicines. The majority of individuals do not achieve remission after starting antidepressant monotherapy. Guidelines propose a variety of second-step therapies, including moving to a new monotherapy, augmenting with antipsychotics, or combining two antidepressants.
The use of several antidepressants, as well as the use of other medications, carries the danger of potential drug-drug interactions (pDDI). Adverse medication responses are frequently caused by pDDI (ADR). One of the biggest risk factors for pDDI and potentially improper medication (PIM) in the elderly is the number of medicines used at the same time.
Pharmacokinetics and pharmacodynamics fluctuate in older individuals as the functional reserve of many organs and systems declines, which has an impact on drug disposition. If the dangers of medication surpass the advantages of better alternatives, it is classified as PIM. These factors must be considered in the treatment of depressive disorders in older individuals for drug safety reasons.
The pharmaceutical treatment of depressive illnesses is complicated, and the pDDI and PIM scores that go along with it might hurt patient outcomes and raise expenses. A recent study was conducted by Jan Wolff along with others (Wolff et al) to understand the quantity and types of medications used in inpatient psychiatry to treat depressive disorders, as well as the patient- and treatment-specific determinants of the pDDI and PIM.
The Study:
The research was carried out as part of a wider pharmacovigilance effort supported by German Innovation Funds. It comprised all inpatients released from eight mental institutions in Germany between 1 October 2017 and 30 September 2018 or between 1 January and 31 December 2019 with a primary diagnosis of depressive episodes (F32, ICD-10) or recurrent depressive disorders (F33). These patients were being constantly monitored and the data was being collected from them. In order to explain the association between type of antidepressant therapy and patient-specific variables, the result of at least one pDDI and at least one PIM during the hospital stay, multivariate logistic regression models were used.
Results:
A total of 14,418 inpatient patients were included in the research. The average daily drug intake was 3.7 (psychotropic substances = 1.7; others = 2.0). In 31% of instances, at least five medications were given at the same time (polypharmacy). Almost half of all patients have been treated with a combination of antidepressant medications (24.8 percent, 95 percent CI 24.1 percent –25.5 percent) or antidepressant drugs plus antipsychotics (21.9 percent, 95 percent CI 21.3 percent –22.6 percent).
It was found that each new medication, when correlated with the severity of illness, increased the probability of any pDDI and PIM in older individuals.
Conclusion:
This research revealed possible sources and drivers of safety concerns in depressive disorder medication, as well as providing previously inaccessible information. The majority of inpatients with depressive disorders are treated with psychotropic and non-psychotropic medications. It is important that patients who take a lot of different medications be closely watched when it comes to managing their drug-related risk-benefit profiles.
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References:
- Wolff, J., Reißner, P., Hefner, G., Normann, C., Kaier, K., Binder, H., Hiemke, C., Toto, S., Domschke, K., Marschollek, M., & Klimke, A. (2021). Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders. PLOS ONE, 16(7), e0255192. https://doi.org/10.1371/journal.pone.0255192
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Author info:
Soumya Shraddhya Paul is an undergrad biotechnology student who worked in building 3D prosthetics in Base Hospital Delhi Cantt, and holds a key interest in nutraceuticals and enzymology.
Publications:
- https://bioxone.in/news/worldnews/understanding-b-cell-genomics-to-fight-against-covid-19/
- https://bioxone.in/news/worldnews/the-current-ebola-epidemic-comes-to-an-end/
Social Media Info: www.linkedin.com/in/soumya-shraddhya-paul-858229203
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