What is the impact of antidepressant side effects on medication adherence among adult patients diagnosed with depressive disorder: A systematic review.

BACKGROUND: Medication adherence is a prerequisite to achieving beneficial treatment outcomes. In major depressive disorder, many patients fail to complete medication regimens, raising concern for poor treatment outcomes. It is usual to experience adverse drug reactions (ADRs) while taking antidepressants, and relative discomfort is reported by patients. AIMS: The present review focuses on the presence of antidepressant-related side effects and the subsequent relationship with medication non-adherence. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Following the preliminary research, the research question and eligibility criteria were created based on the PICO framework. All articles retrieved from the selected databases were exported to Covidence, a Systematic Review managing software tool. Two reviewers assessed the papers to identify the risk of bias using the Joanna Briggs Institute critical appraisal tool for cross-sectional studies. Seven studies with a low-moderate risk of bias fulfilled the eligibility criteria and were conducted from 2013 to 2020 in Europe, Africa and Asia. RESULTS: The results demonstrated high levels of suboptimal adherence ranging from 46% to 83% amongst the studied population. A variety of side effects were reported by a significant number of participants predominantly with moderate severity. A correlation between the presence of ADRs and suboptimal rates of adherence to antidepressants was found. Somnolence and headaches among other unspecified ADRs were found to increase the dropout rates for selective serotonin reuptake inhibitors. CONCLUSIONS: The present study elucidates the need for effective interventions to facilitate antidepressant adherence and enhance doctor-patient communication, benefiting both the individuals and the healthcare system and leading to better clinical outcomes and reduction of relapse-related costs.

Vertebral artery injuries.

Vertebral artery injuries are identified more frequently now than in the past for both penetrating and blunt trauma. This is as a result of increased suspicion and awareness, liberal use of color flow Doppler, CT angiography, and traditional four-vessel angiography. The vast majority of patients who are not exsanguinating at the time of presentation can be managed nonoperatively or by angiographic embolization. Operative management should be reserved only for patients with severe active bleeding or when interventional radiology fails. The surgical exposure is complex and demands excellent knowledge of the local anatomy.

Cadmium and lead pollution from secondary metal refinery operations.

A study was made of cadmium and lead levels around a small secondary metal recovery factory as part of an environmental monitoring programme in a London borough. Lead levels were essentially typical for an urban environment whereas the levels of cadmium-in-air and in household dust gave rise to very considerable concern. Some of the problems associated with assessing the potential hazard and the steps taken to control the emission are considered. It is suggested that clearly-defined standards and procedures are necessary in order to deal efficiently with similar cases as they are discovered.

The rodent ultrasound production mechanism.

Rodents produce two types of sounds, audible and ultrasonic, that differ markedly in physical structure. Studies of sound production in light gases show that whereas the audible cries appear to be produced, as in the case of most other mammals, by vibrating structures in the larynx, the ultrasonic cries are produced by a different mechanism, probably a whistle. 'Bird-call' whistles are shown to have all the properties of rodent ultrasonic cries and to mimic them in almost every detail. Thus it is concluded that rodents have two distinct sound production mechanisms, one for audible cries and one for ultrasonic cries.