Medication Non-adherence in Depression: A Systematic Review and Metanalysis.

OBJECTIVE: Medication non-adherence is frequently reported in patients with major depressive disorder (MDD). The objective of this review is to consolidate data on the prevalence of non-adherence to antidepressant in MDD. METHODS: A systematic review with meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and the protocol was registered in PROSPERO under the number CRD42021199987. Studies assessing medication adherence in MDD were searched in PubMed/Medline, Embase, CINAHL (The Cumulative Index to Nursing and Allied Health Literature) and PsycINFO. The data extraction was performed by two independents authors. Meta-analysis used random effects model and performed a subgroup analysis. RESULTS: From the articles retrieved, eleven studies were considered eligible for the final analysis. Most of them assessed non-adherence by self-report scales, followed by Pharmacy Dispensation Records, Monitoring Events Medication System (MEMS) and blood tests. The pooled proportion of non-adherence was 42% (95% IC 30%-54%), but heterogeneity was very large (I2=99%). CONCLUSION: Data from the selected studies suggests that a high number of individuals with MDD do not adequately take their medication as prescribed. The high heterogenicity of measures used for the assessment of adherence may have impacted the great variability of the results. The results suggest it is necessary that health care professionals should address this issue in order to achieve a better treatment outcome in major depression.

Prevalence of sexual dysfunction in depressive and persistent depressive disorders: a systematic review and meta-analysis.

The aim of this study was to estimate the prevalence of sexual dysfunction in depressive disorders in individuals not in pharmacological treatment. For this purpose, we performed a systematic review and meta-analysis using the PRISMA guidelines, and the review was registered in PROSPERO (registration number CRD42020179709). Studies that evaluated sexual function and dysfunction in major depressive disorder (MDD) and persistent depressive disorder (PDD) were identified through searches in PubMed/Medline, Web of Science, PsychINFO, Scopus, and Scielo. Twelve cross-sectional studies were eligible. In women with MDD, the pooled prevalence rates of sexual impairment were: 47.22% (95% CI: 34.86-59.58) for arousal; 65.30% (95% CI: 45.86-84.73) for desire; 36.98% (95% CI: 28.42-45.54) for lubrication; 34.17% (95% CI: 17.87-50.46) for orgasm; and 33.91% (95% CI: 17.48-50.34) for sexual satisfaction. In men, the sexual impairment prevalence rates were: 26.45% (95% CI: 12.26-40.63) for arousal; 40.32% (95% CI: 22.19-58.46) for desire; 32.07% (95% CI: 26.14-37.99) for erection; 35.27% (95% CI: 5.13-65.41) for orgasm; and 23.05% (95% CI: 13.60-32.51) for sexual satisfaction. Overall sexual dysfunction was found in 82.75% of women (95% CI: 74.71-90.78) and 63.26% of men (95% CI: 52.83-73.69). Our results show that various sexual functions are impaired in MDD, making imperative the systematic evaluation of these alterations by clinicians. Future studies should be conducted, especially in PDD, to elucidate the role of these disorders in sexual function.

Impairment of Sexual Desire in Treatment-Resistant Depression: Prevalence and Correlates.

Objective: To assess sexual desire in patients with treatment-resistant depression (TRD).Methods: Baseline data were analyzed from an ongoing cohort study at an outpatient clinic specializing in TRD treatment in Brazil. The cohort comprised consecutive patients with the diagnosis of TRD who sought treatment at this center between November 2015 and January 2021. The Hamilton Depression Rating Scale (HDRS) genital symptoms item (item 14) was used as a proxy to assess sexual desire.Results: Sixty-five participants with TRD were included. There was sexual desire impairment in 67.7% of patients. Men (87.5%) were more affected than women (61.2%), and this difference was statistically significant (P = .05). Depression severity was associated with greater complaints of this aspect of sexual function (P < .01).Conclusions: Participants with TRD had a high prevalence of sexual desire impairment, which was associated with greater depressive symptom severity and male sex. The findings suggest that health care professionals should systematically assess sexual desire in patients with TRD in daily clinical practice. Further longitudinal studies are needed in larger samples using specific instruments for assessing sexual dysfunction and comparing TRD and non-TRD populations.

Effectiveness of Pharmacologic Interventions in the Management of Weight Gain in Patients With Severe Mental Illness: A Systematic Review and Meta-Analysis.

OBJECTIVE: To collate and analyze randomized controlled trials (RCTs) that evaluated pharmacologic interventions to reduce weight gain in patients with severe mental illness (SMI). DATA SOURCES: Searches were conducted in PubMed, Web of Science, and PsycINFO databases from inception through May 9, 2019, using the terms ("severe mental disease" OR "severe mental illness" OR "severe mental disorder" OR schizophre* OR bipolar OR antipsychotic*) AND (weight) AND (pharmacologic* OR treatment). There was no language restriction, and the electronic search was complemented by a manual search for additional articles in reference lists and previous reviews. STUDY SELECTION: Fifty-two studies investigating different pharmacologic weight loss interventions in SMI were retrieved. Only RCTs assessing pharmacologic interventions to manage weight gain in adult subjects with SMI and reporting change in body weight as a primary outcome were included. DATA EXTRACTION: Two reviewers independently extracted data about the name and dose of the pharmacologic agent used to manage weight gain, trial duration, agent used for index disease, psychiatric diagnostics, and the mean change in body weight over the course of the trial. A meta-analysis was performed using a random effects model to pool mean body weight change over the course of the trial. RESULTS: The most-studied agent was metformin (14 studies), followed by topiramate (6 studies), nizatidine (4 studies), and sibutramine (3 studies). Other agents were investigated in 1 or 2 isolated studies. A meta-analytical procedure showed a significant pooled mean difference of -3.27 kg (95% CI, -4.49 to -2.06) for metformin compared with placebo and -5.33 kg (95% CI, -7.20 to -3.46) favoring topiramate. CONCLUSIONS: Metformin and topiramate were the most-studied agents for weight control in SMI and were considered efficacious and safe in promoting weight reduction compared to placebo in this population. More studies are required with larger sample sizes and in line with the recommendations from research from the obesity and metabolic field to better define guidelines for use of pharmacologic interventions to reduce weight gain in patients with SMI.

Susceptibility of Rhipicephalus (Boophilus) microplus to fluazuron (2.5mg/kg) and a combination of novaluron (2.0mg/kg)+eprinomectin (0.36mg/kg) in field studies in Brazil.

The present study aimed to determine the susceptibility of 32 R. (B.) microplus populations from Southeast, Midwest and South regions of Brazil, to fluazuron (2.5mg/kg), administered topically (pour-on). Additionally, five populations (Southeast and Midwest regions) of the southern cattle tick were evaluated using in vivo field studies, regarding their susceptibility to a new combination of novaluron (2.0mg/kg)+eprinomectin (0.36mg/kg), administered subcutaneously, compared with two positive controls (fluazuron 2.5mg/kg and eprinomectin 0.5mg/kg), both administered topically (pour-on). Selected bovines were allocated to treatment groups on day 0, and block formation was based on arithmetic means of female ticks (4.5-8.0mm long) counted on three consecutive days (-3, -2 and -1). To evaluate therapeutic and residual efficacies of these formulations, tick counts (females ranging from 4.5 to 8.0mm long) were performed on days 3, 7 and 14 post-treatment, continuing on a weekly basis until the end of each experiment. Results obtained throughout this study, utilizing field efficacy trials, allowed us to conclude that four R. (B.) microplus populations (including two in the Southeast and two in the Midwest regions) could be diagnosed as resistant, or with low susceptibility, to fluazuron (2.5mg/kg). Such fact was detected in farms where owners applied products containing this active component on cattle for at least five years, with treatment intervals of 30-55days during the rainy season. Nonetheless, in vitro studies should be performed in order to reinforce in vivo results obtained on the present study. Regarding efficacy indexes obtained by the association of eprinomectin and the novel molecule novaluron against R. (B.) microplus, none of the trials managed to obtain efficacies superior to 48%. Such results, allied to data obtained by different researchers and previously published in literature, reinforce the perception that maybe these formulations containing novaluron, in the administered dosages and treatment routes, may not be effective tools for controlling R. (B.) microplus. However, future studies must be conducted in order to support such hypothesis. Additionally, all five R. (B.) microplus populations were diagnosed as resistant, or with low susceptibility, to eprinomectin (0.5mg/kg) as well. Even though fluazuron, administered topically (pour on), is still an excellent active principle to be used against R. (B.) microplus, resistance management strategies should be quickly implemented in order to keep selection pressure in Brazil at a minimum level for this compound.

Spatial distribution and risk factors for Toxoplasma gondii seropositivity in cattle slaughtered for human consumption in Rondônia, North region, Brazil.

The present study aimed to evaluate Toxoplasma gondii seroprevalence in cattle slaughtered for human consumption from rural properties in the state of Rondônia, North region, Brazil; the seroprevalence was determined using indirect immunofluorescence assays (IFATs). Additionally, spatial distribution and risk factors associated with toxoplasmosis were also analyzed. Of the 1000 cattle serum samples examined, 53 (5.3%) were determined to be seropositive for T. gondii with antibody titers (IgG) ≥64. In regard to results of the studied risk factors (presence of cats, cats with free access to cattle, breeding system, animal's gender, consumption of raw milk by humans on the property and cattle abortion in the last 12 months) and the odds ratio (OR) of each of these factors influencing cattle to acquire toxoplasmosis, only animals raised on a feeder/stocker/backgrounder system presented a higher probability of being seropositive for T. gondii (OR≥1, P=0.04) than cattle raised only in a feeder/stocker system. There was no association between the occurrence of reproductive problems and T. gondii seropositivity. Based on results obtained in the Brazilian state of Rondônia, it could be concluded that the presence of cats and their contact with cattle on each property, cattle breeding purpose and cattle abortion in the last 12 months were not considered risk factors for T. gondii infection in cattle. Considering that the presence of T. gondii was detected in animals slaughtered in the state of Rondônia, consuming raw or undercooked meat from seropositive cattle should be considered a route of transmission of T. gondii to humans. However, the prevalence of toxoplasmosis diagnosed in cattle from this state (5.30%) is lower than the prevalence of toxoplasmosis observed in South, Southeast and Center-West regions of Brazil, which may vary between 48.5% and 71.0%. The low prevalence of toxoplasmosis in cattle is highlighted in Rondônia, which is the sixth largest state for cattle slaughtering in Brazil and is responsible for producing 20% of all cattle meat exported by Brazil.