Psychotropic medication use in former ICU patients with mental health problems: A prospective observational follow-up study.

PURPOSE: To describe the extent to which patients with mental health problems after admission to an Intensive Care Unit (ICU) initiate and use psychotropic medication. METHODS: All adult patients who stayed in the ICU of the University Medical Center Utrecht for 48 h or more between 2013 and 2017, alive after 1 year and not admitted to the ICU with brain injury, were eligible. Questionnaires were used to identify mental health problems, depression, anxiety and posttraumatic stress disorder (PTSD) and psychotropic medication use. RESULTS: Of the 1328 former ICU patients, 24.3% (n = 323) had developed any of the mental health problems. Of this group, 29.7% (n = 96) used psychotropic medication one year after discharge versus the 10.6% (n = 107) of patients without these problems (OR 3.17, 95% CI 2.29-4.38). They were further 4.33 (95% CI 2.62-7.16) times more likely to initiate psychotropic medication (18.7% vs 4.8%) after ICU admission. Similar patterns were observed for individual groups of psychotropics: antidepressants, antipsychotics and benzodiazepines. DISCUSSION: Former ICU patients with mental health problems were almost four times more likely to use psychotropic medication than former ICU patients without these problems. Future research should investigate whether mental health problems are properly diagnosed and treated in former ICU patients.

Discontinuation Rates of Antidepressant Use by Dutch Soldiers.

INTRODUCTION: Soldiers have a higher risk for developing psychiatric disorders that require treatment; often with antidepressants. However, antidepressants as well as the psychiatric disorder, may influence military readiness in several ways. In the general population, early discontinuation of antidepressant treatment is often seen. It is yet unknown whether this occurs to a similar extent in soldiers. The objective of this study was to evaluate discontinuation of antidepressant use by Dutch soldiers in the first 12 months after start and determinants thereof. MATERIALS AND METHODS: Data were obtained from the military pharmacy. All Dutch soldiers who started using an antidepressant between 2000 and 2014 were included. Kaplan-Meier curves were constructed to estimate the discontinuation rate over time and the influence of each determinant on discontinuation rate was estimated using Cox regression. RESULTS: About 25.9% of de 2479 starters had discontinued their antidepressant use after 1 month; after 3 and 6 months this number increased to 52.7% and 70.3%, respectively. Early discontinuation was higher in soldiers who received their first prescription from a neurologist or rehabilitation specialist (HR 1.85, 95% CI 1.55-2.21, HR 2.66 95% CI 1.97-3.58) compared to soldiers with a first prescription from a general practitioner. In addition, early discontinuation was lower in soldiers who were prescribed serotonin reuptake inhibitors and other antidepressants (HR 0.57, 95% CI 0.51-0.60, HR 0.63, 95% CI 0.55-0.73) and in soldiers between 40 and 50 years of age (HR 0.79, 95% CI 0.70-0.89). CONCLUSION: More than half of the soldiers discontinued their prescribed antidepressant within 3 months and after 6 months, only 30% were still on antidepressants.

Prevalence of Psychotropic Medication Use Among Dutch Military Personnel Between 2003 and 2012 and Its Comparison to the Dutch General Population.

BACKGROUND: The armed forces work under high pressure and in stressful environments and it is well known that being in the military is a risk factor for psychiatric problems. However, it remains unknown how prevalent psychotropic medication use is in military personnel. OBJECTIVE: To assess prevalence of psychotropic medication use in Dutch military personnel and compare to the Dutch general population. METHODS: Data were obtained from the military pharmacy. From 2003 to 2012, the year-prevalence of psychotropic medication use was calculated from the number of distributed psychotropic medications and the number of Dutch military personnel. For the year 2011, the year-prevalence of psychotropic medication use in the military was compared to that of the Dutch general population. RESULTS: The year-prevalence of psychotropic medication use increased by 55%, from 1.64% in 2003 to 2.54% in 2012 in Dutch military personnel. An increase is seen in the number of users of psychotropic medication. Also the use of antidepressants and attention deficit hyperactivity disorder medication increased. CONCLUSION: Over the last decade, there has been a 1.5-fold increase in psychotropic medication dispensed to Dutch military personnel. However, Dutch military personnel were significantly less likely to use psychotropic medications compared to the Dutch general population.

A psychoneuroimmunological review on cytokines involved in antidepressant treatment response.

OBJECTIVES: The literature exploring the role that cytokine functioning plays in the pathogenesis and treatment of depressive illness is reviewed. The review focuses on the influence of antidepressants on cytokines, and on how treatment response might be affected by genetic variants of cytokines. METHOD: The authors systematically reviewed the scientific literature on the subject over the last 20 years, searching PubMed, PsychInfo, and Cochrane databases. RESULTS: Antidepressants modulate cytokine functioning, and these mechanisms appear to directly influence treatment outcome in depression. Antidepressants appear to normalize serum levels of major inflammatory cytokines, including interleukin (IL)-1beta, IL-6, tumor necrosis factor alpha (TNF-alpha), and interferon gamma (IFN-gamma). Antidepressants are postulated to modulate cytokine functioning through their effects on intracellular cyclic adenosyl monophosphate (cAMP), serotonin metabolism, the hypothalamo-pituitary-adrenocortical (HPA) axis or through a direct action on neurogenesis. Preliminary research shows that cytokine genotypes and functioning may be able to help predict antidepressant treatment response. CONCLUSIONS: Current literature demonstrates an association between antidepressant action and cytokine functioning in major depression. Improved understanding of the specific pharmacologic and pharmacogenetic mechanisms is needed. Such knowledge may serve to enhance our understanding of depression, leading to promising new directions in the pathology, nosology, and treatment of depression.

The interleukin 1 beta (IL1B) gene is associated with failure to achieve remission and impaired emotion processing in major depression.

BACKGROUND: Accumulating evidence suggests the involvement of inflammatory processes and cytokines in particular in the pathophysiology of major depression (MDD) and resistance to antidepressant treatment. Furthermore, amygdala and anterior cingulate cortex (ACC) responsiveness to emotional stimuli has been suggested as a predictor of treatment response. This study investigated the association between genetic variants of the interleukin 1 beta (IL1B) gene and amygdala and ACC responsiveness to emotional stimuli and response to antidepressant treatment. METHODS: In this analysis, 256 Caucasian patients with MDD (145 women, 111 men) were genotyped for variants rs16944, rs1143643, and rs1143634 in the IL1B gene (2q14). Response to antidepressant treatment over 6 weeks was defined as remission (< or = 7 on the Hamilton Rating Scale for Depression-21-question) and response (>50% decrease on Hamilton Rating Scale for Depression-21-question). Brain activity under visual presentation of emotional faces was assessed in a subsample of 32 depressed patients by means of functional magnetic resonance imaging at 3 T. RESULTS: Pharmacogenetic analyses show significant associations of the GG genotypes of single nucleotide polymorphisms (SNPs) rs16944 (odds ratio = 1.74; 95% confidence interval 1.2-4.3) and rs1143643 (odds ratio = 3.1; 95% confidence interval 1.3-7.8) (compared with the AA genotype) with nonremission after 6 weeks. The imaging analyses show that the number of G-alleles in both SNPs (rs16944 and rs1143643) was associated with reduced responsiveness of the amygdala and ACC to emotional stimulation. CONCLUSIONS: The present study suggests a negative effect of the IL1B gene on pharmacological response and amygdala and ACC function involving the same genotypes of two SNPs (rs16944, rs116343), which taken together increase the risk of nonremission over 6 weeks of antidepressant treatment in MDD.