Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders.

<h4>Introduction</h4>The aim of this study was to describe the number and type of drugs used to treat depressive disorders in inpatient psychiatry and to analyse the determinants of potential drug-drug interactions (pDDI) and potentially inappropriate medication (PIM).<h4>Methods&l...

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Autores principales:	Jan Wolff, Pamela Reißner, Gudrun Hefner, Claus Normann, Klaus Kaier, Harald Binder, Christoph Hiemke, Sermin Toto, Katharina Domschke, Michael Marschollek, Ansgar Klimke
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/b223070b369c4631a898dc5665c88fd9
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spelling	oai:doaj.org-article:b223070b369c4631a898dc5665c88fd92021-12-02T20:04:55ZPharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders.1932-620310.1371/journal.pone.0255192https://doaj.org/article/b223070b369c4631a898dc5665c88fd92021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0255192https://doaj.org/toc/1932-6203<h4>Introduction</h4>The aim of this study was to describe the number and type of drugs used to treat depressive disorders in inpatient psychiatry and to analyse the determinants of potential drug-drug interactions (pDDI) and potentially inappropriate medication (PIM).<h4>Methods</h4>Our study was part of a larger pharmacovigilance project funded by the German Innovation Funds. It included all inpatients with a main diagnosis in the group of depressive episodes (F32, ICD-10) or recurrent depressive disorders (F33) discharged from eight psychiatric hospitals in Germany between 1 October 2017 and 30 September 2018 or between 1 January and 31 December 2019.<h4>Results</h4>The study included 14,418 inpatient cases. The mean number of drugs per day was 3.7 (psychotropic drugs = 1.7; others = 2.0). Thirty-one percent of cases received at least five drugs simultaneously (polypharmacy). Almost one half of all cases received a combination of multiple antidepressant drugs (24.8%, 95% CI 24.1%-25.5%) or a treatment with antidepressant drugs augmented by antipsychotic drugs (21.9%, 95% CI 21.3%-22.6%). The most frequently used antidepressants were selective serotonin reuptake inhibitors, followed by serotonin and norepinephrine reuptake inhibitors and tetracyclic antidepressants. In multivariate analyses, cases with recurrent depressive disorders and cases with severe depression were more likely to receive a combination of multiple antidepressant drugs (Odds ratio recurrent depressive disorder: 1.56, 95% CI 1.41-1.70, severe depression 1.33, 95% CI 1.18-1.48). The risk of any pDDI and PIM in elderly patients increased substantially with each additional drug (Odds Ratio: pDDI 1.32, 95% CI: 1.27-1.38, PIM 1.18, 95% CI: 1.14-1.22) and severity of disease (Odds Ratio per point on CGI-Scale: pDDI 1.29, 95% CI: 1.11-1.46, PIM 1.27, 95% CI: 1.11-1.44), respectively.<h4>Conclusion</h4>This study identified potential sources and determinants of safety risks in pharmacotherapy of depressive disorders and provided additional data which were previously unavailable. Most inpatients with depressive disorders receive multiple psychotropic and non-psychotropic drugs and pDDI and PIM are relatively frequent. Patients with a high number of different drugs must be intensively monitored in the management of their individual drug-related risk-benefit profiles.Jan WolffPamela ReißnerGudrun HefnerClaus NormannKlaus KaierHarald BinderChristoph HiemkeSermin TotoKatharina DomschkeMichael MarschollekAnsgar KlimkePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0255192 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jan Wolff Pamela Reißner Gudrun Hefner Claus Normann Klaus Kaier Harald Binder Christoph Hiemke Sermin Toto Katharina Domschke Michael Marschollek Ansgar Klimke Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders.
description	<h4>Introduction</h4>The aim of this study was to describe the number and type of drugs used to treat depressive disorders in inpatient psychiatry and to analyse the determinants of potential drug-drug interactions (pDDI) and potentially inappropriate medication (PIM).<h4>Methods</h4>Our study was part of a larger pharmacovigilance project funded by the German Innovation Funds. It included all inpatients with a main diagnosis in the group of depressive episodes (F32, ICD-10) or recurrent depressive disorders (F33) discharged from eight psychiatric hospitals in Germany between 1 October 2017 and 30 September 2018 or between 1 January and 31 December 2019.<h4>Results</h4>The study included 14,418 inpatient cases. The mean number of drugs per day was 3.7 (psychotropic drugs = 1.7; others = 2.0). Thirty-one percent of cases received at least five drugs simultaneously (polypharmacy). Almost one half of all cases received a combination of multiple antidepressant drugs (24.8%, 95% CI 24.1%-25.5%) or a treatment with antidepressant drugs augmented by antipsychotic drugs (21.9%, 95% CI 21.3%-22.6%). The most frequently used antidepressants were selective serotonin reuptake inhibitors, followed by serotonin and norepinephrine reuptake inhibitors and tetracyclic antidepressants. In multivariate analyses, cases with recurrent depressive disorders and cases with severe depression were more likely to receive a combination of multiple antidepressant drugs (Odds ratio recurrent depressive disorder: 1.56, 95% CI 1.41-1.70, severe depression 1.33, 95% CI 1.18-1.48). The risk of any pDDI and PIM in elderly patients increased substantially with each additional drug (Odds Ratio: pDDI 1.32, 95% CI: 1.27-1.38, PIM 1.18, 95% CI: 1.14-1.22) and severity of disease (Odds Ratio per point on CGI-Scale: pDDI 1.29, 95% CI: 1.11-1.46, PIM 1.27, 95% CI: 1.11-1.44), respectively.<h4>Conclusion</h4>This study identified potential sources and determinants of safety risks in pharmacotherapy of depressive disorders and provided additional data which were previously unavailable. Most inpatients with depressive disorders receive multiple psychotropic and non-psychotropic drugs and pDDI and PIM are relatively frequent. Patients with a high number of different drugs must be intensively monitored in the management of their individual drug-related risk-benefit profiles.
format	article
author	Jan Wolff Pamela Reißner Gudrun Hefner Claus Normann Klaus Kaier Harald Binder Christoph Hiemke Sermin Toto Katharina Domschke Michael Marschollek Ansgar Klimke
author_facet	Jan Wolff Pamela Reißner Gudrun Hefner Claus Normann Klaus Kaier Harald Binder Christoph Hiemke Sermin Toto Katharina Domschke Michael Marschollek Ansgar Klimke
author_sort	Jan Wolff
title	Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders.
title_short	Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders.
title_full	Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders.
title_fullStr	Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders.
title_full_unstemmed	Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders.
title_sort	pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/b223070b369c4631a898dc5665c88fd9
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Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders.

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