Browsing by Subject "masennuslääke"

The long-term use of antidepressants has increased significantly worldwide in recent decades. Deprescribing and the expertise related to it is an important part of the individual drug treatment optimization, the management of long-term diseases, the avoidance of adverse drug effects and the improvement of treatment outcomes. The aim of this thesis was to examine the information found in the statutory Summary of Product Characteristics (SmPC) and other key information sources for healthcare professionals about antidepressant deprescribing. A qualitative content analysis was conducted on SmPC (n=15) of the antidepressants (escitalopram, mirtazapine, sertraline, citalopram, venlafaxine) selected for the study, three national depression treatment guidelines (Suomalainen Lääkäriseura Duodecim: Depressio Käypä hoito -suositus, American Psychological Association APA: Practice Guideline for the Treatment of Patients with Major Depressive Disorder, United States and National Institute for Health and Care Excellence NICE: Depression in Adults: Treatment and Management, United Kingdom) and one decision supporting deprescribing tool (MedStopper). The content, quantity, and quality of information about antidepressant deprescribing varied between the information sources included in the study. However, the information found in the SmPC and the MedStopper -tool was mostly in line with the information found in the clinical practice guidelines included in the study. Most general information about antidepressant deprescribing or measures that can be used to guide deprescribing was found in the clinical practice guidelines. In all examined sources, antidepressants were recommended to be discontinued in a controlled manner by gradually reducing the dose. However, the recommended duration of the dose reduction varied in different information sources. A detailed dose reduction program was not found in most of the information sources. A detailed dose reduction program was found in only one clinical practice guideline (NICE) and the MedStopper -tool. The continuation of antidepressant treatment after remission and the timing of stopping the medication was discussed in only two clinical practice guidelines (APA and Käypä hoito). However, instructions for action if severe or intolerable discontinuation symptoms appears were found in almost all information sources. Only the clinical practice guidelines mentioned the recurrence of depression as a possible harm when stopping the medication and instructed how to act in the event of a possible relapse. Benefits related to antidepressant discontinuation was not mentioned in any of the examined information sources and only one clinical practice guideline (NICE) discussed barriers related to stopping antidepressants. The information found in individual information sources was insufficient and provided little support for healthcare professionals to guide deprescribing. Current key sources of information for healthcare professionals provide limited information and relatively imprecise guidance on antidepressant deprescribing and how to support the antidepressant discontinuation process. Better randomized clinical trials are needed to develop clearer and more extensive evidence-based guidelines for healthcare professionals on antidepressant deprescribing and to prevent unnecessary long-term antidepressant treatment and patient exposure to possible adverse drug effects.

Osalla masennuspotilaista masennusjaksot osuvat pääosin aina samalle vuodenajalle. Tätä masennuksen alatyyppiä kutsutaan vuodenaikamasennukseksi. Myös syömishäiriöihin, kuten laihuus-, ahmimis- ja ahmintahäiriöön, liittyy toisinaan mielialan laskua ja oireiden voimistumista vuodenaikojen mukaan. Vuodenaikamasennukseen puolestaan liittyy oireena lisääntynyt ruokahalu ja lihominen useammin kuin tavalliseen masennukseen. Näiden yhtäläisyyksien vuoksi syömishäiriöiden ja vuodenaikamasennuksen yhteyttä toisiinsa on tutkittu paljon. Tässä tutkielmassa selvitettiin masennusjaksojen vuodenaikaisvaihtelua HUS:n syömishäiriöpoliklinikan potilaista (N=1588) ja kaltaistetuista verrokeista (N=6290) koostuvassa tutkimuspopulaatiossa analysoimalla tutkimushenkilöiden masennuslääkereseptien lunastamismääriä eri vuodenaikoina. Kansaneläkelaitoksen lääkekorvausrekisteristä saatiin tutkimushenkilöiden reseptitiedot tutkimusajalta vuosina 2000-2010. Masennuslääkkeiden lisäksi selvitettiin myös tulehduskipu- ja allergialääkkeiden käyttömääriä. Tuloksista selvisi, että syömishäiriöpotilaat käyttävät masennuslääkkeitä moninkertaisesti verrokkeja enemmän, eikä heillä masennuslääkitysten aloitusmäärissä näkynyt merkitseviä eroja eri vuodenaikojen suhteen. Sen sijaan verrokit aloittivat lääkityksiä talvella ja syksyllä merkitsevästi enemmän kuin kesällä ja keväällä. Verrokkipopulaatiossa masennuslääkitysten aloitusmäärissä tapahtui vuosien 2003 ja 2010 välillä kasvua noin 50%, kun taas syömishäiriöpotilailla aloitusmäärät laskivat.

Divorces have been relatively common in Finland since the 1980s. In 2005–2016 the crude divorce rate varied between 2.4 and 2.6 per 1000 whereas in Europe the rate was on average 1.8–2.1 during the same years. Due to the high divorce rates, it is important to study the consequences of parental separation on child psychological well-being. Most studies from recent decades have found significant but usually modest associations between parental separation and child behavioral and emotional problems, malaise, anxiety and forms of depression. Also some evidence for causal links between parental separation and child’s mental health has been found, but the effects are likely to vary a lot. Firstly, due to selection effect, the poorer mental health outcomes among children from separated families are also affected by other family circumstances than the separation. Secondly, based on the so-called compensation theory, recent research has discussed the potential compensating role of parents’ socioeconomic resources. However, only a limited amount of register-based studies have investigated how the impacts of parental separation for child mental health vary by parents’ socioeconomic resources. This Master’s thesis studies the association between parental separation and depressive symptoms, measured by antidepressant use, in adolescence and young adulthood. It also provides an extensive analysis of how families are selected into separation by early family circumstances, and how strongly these circumstances contribute to the risk of depressive symptoms. Finally, the study examines whether the parental education, an indicator of social and economic resources, modifies the association between parental separation and depressive symptoms. The study uses register-linked panel data that is based on a 20 % random sample of Finnish households with at least one child aged 0–14 at the end of 2000. The final study population included birth cohorts 1990–97 (N=70,478) that were followed for antidepressant use between ages 15–21 in years 2005–2012. The data comprises information on social, demographic and economic characteristics of the families together with data on psychotropic drug purchases among both parents and offspring. The associations between parental separation and antidepressant use were analyzed with Cox regression model. In line with most of the previous research, parental separation was moderately associated with depressive symptoms in adolescence and young adulthood. In the unadjusted model children with an experience of parental separation had 1.6 times (HR) higher risk of antidepressant use at age of 15–21. Considering selection, the fully adjusted model showed a significant association, almost as strong as the unadjusted model (HR 1.45). For the risk of antidepressant use, the early family circumstances were on average less favorable in the families that separated. However, the family socioeconomic circumstances, previous psychotropic drug use, parental age and marital status and child’s sex explained a minor part of the increased risk of antidepressant use among children from separated families. In the moderation analysis, the association between parental separation and child depression was moderately stronger in families where parents had completed only basic education. The result is in line with the compensation theory, but cannot be generalized to a larger population, because the differences between educational groups in the main association were not statistically significant. The study suggests that the increased risk for depressive symptoms after parental separation is partly caused by the measured and unmeasured selection. The increased risk is also likely to be partly caused by the parental separation itself. In the study population the parental separation appears to have been less detrimental to children whose separating parents have more socioeconomic resources that compensate and obviate the negative consequences for child mental health.