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P.2.128 Pharmacological management of depression in spain: a survey of psychiatrists and primary care physicians opinions
P2 Affective disorders and antidepressants
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Treatment of premenstrual disorder in primary assistance: preliminary results
J.M. Santos 1 *, J.V. Cobo 1 , I. Marfinez 2, A. Moya 2, J.M. Carmona 2, E. Gfilvez2. ]Corporaci6 Sanitdria Pare
Tauli, Deparment of Mental Health, Sabadell, Spain; 2ABS Castellar del Vallds, Primaty Assistance, Spain Objectives: 1. Describe the preliminary results of efficacy and safety of the treatment with sertraline of the Late-luteal Phase Disforic Disorder in Primary Assistance. 2. Determine the clinical characteristics of the patients. M e t h o d s : Design: Prospective, randomized, not blinded. Subjects: Women 18 55 years treated by Family Doctors at ABS Castellar del Valles (Barcelona, Spain) during the period between June 2003 and December 2004, who presented criteria for Late-luteal Phase Disforic Disorder DSM-IV in a Two months prospective analysis. Population of reference: 22,500 half-urban inhabitants. Exclusion criteria: medical or psychiatric illnesses. Other medical or psychoactive treatments. Daily treatment with sertraline during 12 months. Stratified aleatorization in Two groups: 50 or 150 mg/d Variables: Clinical, personality (Millon-II Test, spanish version) and outcome. Clinical Global Impression Severity (CGI-S) at the base line, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, and 14th month, and Clinical Global Impression Improvement scale (CGI-I) at 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, and 14th month (patients and doctors). Specific scales of Premenstrual Symptoms at 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, and 14th month. Results: Clinical emergence of cases: 31 patients. Incidence: 9.18 cases/10,000 inhabitants/year. Age: medium 40±7.1 (26 49). Married status: 87% married. Initial CGI-S: 5.07±0.76 (range 3 6). High rates of drop-outs: 51.6%. No significative differences between age or CGI-S between the drop-outs and the treatment group. High correlations between CGI-I of patient and CGI-I of doctors. High rates of response and remision. No significative secondary effects: abdominal disconfort in one case and reduced libido in two cases C o n c l u s i o n s : The preliminary results of the daily treatment with sertraline of the Late-luteal Phase Disforic Disorder DSMIV in Primary Assistance are positive. We detected high rates of response and remision and no significative secondary effects. On the other hand, we detected high rates of drop-outs.
References [1] Freeman et al. 1999, Differential Response to Antidepressants in Women With Premenstrual Syndrome/Premenstrual Dysphoric Disorder: A Randomized Controlled Trial. Archives of General PsychiatL2¢ 56 (10): 939939. [2] Jermain et al. 1999, Luteal Phase Sertraline Treatment for Premenstrual Dysphoric Disorder. Arch Fam Med 8:328 332.
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Pharmacological management of depression in Spain: a survey of psychiatrists and primary care physicians opinions
G. Rubio 1 *, B. Marfin-Agueda 2, F. Ldpez-Mufioza 2, J.A. Guerra 3, C. Alamo 2. ]Services Mental Health, Psychiatry,
Madrid, Spain; 2Faculty of Medicine, University of Alcala, Pharmacology, Spain; 3Faculty of Medicine, University of Alcala, Psychiatty, Spain Objective: Depression constitutes the more prevalent psychiatric disorder in our society. Epidemiological evidences suggest that its
$447
incidence is growing up. From a therapeutical perspective, there have been considerable changes in the available pharmacological tools for the depression treatment, mainly from the clinical introduction of selective serotonin reuptake inhibitors (SSRI) at the end of the 80 decade and later with other antidepressant agents, such as venlafaxine, mirtazapine or reboxetine. The objective of the present study is to evaluate the current situation in the pharmacotherapy of depression in Spain, from the Psychiatrist and the Primary Care Physician view points. M e t h o d : 339 interviews were carried out with two groups of physician (238 Primary Care and 101 Psychiatrists) in different Spanish cities. The distribution, application and questionnaires collection were made throughout 2002. Results: Almost both GPs and psychiatrists establish a pharmacological treatment for all their depressive patients. More than 70% of the Psychiatrists are using other therapeutic tools (psychotherapy, advice) also, while only about 50% of the GPs are using them (p < 0.001). Both groups of physicians coincide in the major utilization of SSRI, as first election drugs (93% of both groups), but differ regarding the use of antidepressant drugs. The most used pharmacological agents by the psychiatrists are the SSRI (98.3%), followed by venlafaxine (84.4%), anxiolytics (68.4%), mirtazapine (58.9%) and reboxetine (55.8%). Only 49.5% of the psychiatrist would use tricyclic antidepressants (TCAs). In the case of GPs, the most used pharmacological groups are SSRI (98.3%) and anxiolytics (73.4%). A 38% is using venlafaxine and a 35% TCAs. Under 10% of GPs are using mirtazapine, reboxetine and other antidepressant groups. Regarding efficacy perception of the different antidepressant agents by the physicians, the GPs are considering the SSRI as the most effective group. In the second efficacy place are the TCAs and the SNRI (venlafaxine). However, for the psychiatrist the TCAs would be the most effective, followed by the SNRI and the SSRI. The most frequent adverse effects described for both groups of physicians are those of gastrointestinal type, sexual dysfunction and those related with the CNS, being the psychiatrist who are mentioning a higher percentage of adverse effects. The pharmacological treatment compliance is considered "good-very good" by most of the 80% of both groups of physicians. The main reasons for withdrawal are clearly different depending on the type of physician, being the long lasting treatment the most frequent reason in Primary Care (66.8%) and the adverse effects in psychiatry (79.8%). About 40 50% of physicians are considering that other important reason for withdrawal is that the patients are "thinking that they no longer need the drug". C o n c l u s i o n : Commonly, the most used antidepressants by psychiatrist are SSRI and venlafaxine, having also incorporated to their therapeutic tools new marketed agents, such as IRNS, NaSSA and IRNA. In the case of GPs, the most common antidepressants used were SSRI, therefore being these antidepressants the election drugs for both groups. The therapeutical compliance is higher with pharmacological treatments than with no pharmaceutical agents, according to the opinion of both groups of physicians.
•
Treatment of premenstrual disorder in primary assistance: preliminary results
J.M. Santos 1 *, J.V. Cobo 1 , I. Marfinez 2, A. Moya 2, J.M. Carmona 2, E. Gfilvez2. ]Corporaci6 Sanitdria Pare
Tauli, Deparment of Mental Health, Sabadell, Spain; 2ABS Castellar del Vallds, Primaty Assistance, Spain Objectives: 1. Describe the preliminary results of efficacy and safety of the treatment with sertraline of the Late-luteal Phase Disforic Disorder in Primary Assistance. 2. Determine the clinical characteristics of the patients. M e t h o d s : Design: Prospective, randomized, not blinded. Subjects: Women 18 55 years treated by Family Doctors at ABS Castellar del Valles (Barcelona, Spain) during the period between June 2003 and December 2004, who presented criteria for Late-luteal Phase Disforic Disorder DSM-IV in a Two months prospective analysis. Population of reference: 22,500 half-urban inhabitants. Exclusion criteria: medical or psychiatric illnesses. Other medical or psychoactive treatments. Daily treatment with sertraline during 12 months. Stratified aleatorization in Two groups: 50 or 150 mg/d Variables: Clinical, personality (Millon-II Test, spanish version) and outcome. Clinical Global Impression Severity (CGI-S) at the base line, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, and 14th month, and Clinical Global Impression Improvement scale (CGI-I) at 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, and 14th month (patients and doctors). Specific scales of Premenstrual Symptoms at 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, and 14th month. Results: Clinical emergence of cases: 31 patients. Incidence: 9.18 cases/10,000 inhabitants/year. Age: medium 40±7.1 (26 49). Married status: 87% married. Initial CGI-S: 5.07±0.76 (range 3 6). High rates of drop-outs: 51.6%. No significative differences between age or CGI-S between the drop-outs and the treatment group. High correlations between CGI-I of patient and CGI-I of doctors. High rates of response and remision. No significative secondary effects: abdominal disconfort in one case and reduced libido in two cases C o n c l u s i o n s : The preliminary results of the daily treatment with sertraline of the Late-luteal Phase Disforic Disorder DSMIV in Primary Assistance are positive. We detected high rates of response and remision and no significative secondary effects. On the other hand, we detected high rates of drop-outs.
References [1] Freeman et al. 1999, Differential Response to Antidepressants in Women With Premenstrual Syndrome/Premenstrual Dysphoric Disorder: A Randomized Controlled Trial. Archives of General PsychiatL2¢ 56 (10): 939939. [2] Jermain et al. 1999, Luteal Phase Sertraline Treatment for Premenstrual Dysphoric Disorder. Arch Fam Med 8:328 332.
•
Pharmacological management of depression in Spain: a survey of psychiatrists and primary care physicians opinions
G. Rubio 1 *, B. Marfin-Agueda 2, F. Ldpez-Mufioza 2, J.A. Guerra 3, C. Alamo 2. ]Services Mental Health, Psychiatry,
Madrid, Spain; 2Faculty of Medicine, University of Alcala, Pharmacology, Spain; 3Faculty of Medicine, University of Alcala, Psychiatty, Spain Objective: Depression constitutes the more prevalent psychiatric disorder in our society. Epidemiological evidences suggest that its
$447
incidence is growing up. From a therapeutical perspective, there have been considerable changes in the available pharmacological tools for the depression treatment, mainly from the clinical introduction of selective serotonin reuptake inhibitors (SSRI) at the end of the 80 decade and later with other antidepressant agents, such as venlafaxine, mirtazapine or reboxetine. The objective of the present study is to evaluate the current situation in the pharmacotherapy of depression in Spain, from the Psychiatrist and the Primary Care Physician view points. M e t h o d : 339 interviews were carried out with two groups of physician (238 Primary Care and 101 Psychiatrists) in different Spanish cities. The distribution, application and questionnaires collection were made throughout 2002. Results: Almost both GPs and psychiatrists establish a pharmacological treatment for all their depressive patients. More than 70% of the Psychiatrists are using other therapeutic tools (psychotherapy, advice) also, while only about 50% of the GPs are using them (p < 0.001). Both groups of physicians coincide in the major utilization of SSRI, as first election drugs (93% of both groups), but differ regarding the use of antidepressant drugs. The most used pharmacological agents by the psychiatrists are the SSRI (98.3%), followed by venlafaxine (84.4%), anxiolytics (68.4%), mirtazapine (58.9%) and reboxetine (55.8%). Only 49.5% of the psychiatrist would use tricyclic antidepressants (TCAs). In the case of GPs, the most used pharmacological groups are SSRI (98.3%) and anxiolytics (73.4%). A 38% is using venlafaxine and a 35% TCAs. Under 10% of GPs are using mirtazapine, reboxetine and other antidepressant groups. Regarding efficacy perception of the different antidepressant agents by the physicians, the GPs are considering the SSRI as the most effective group. In the second efficacy place are the TCAs and the SNRI (venlafaxine). However, for the psychiatrist the TCAs would be the most effective, followed by the SNRI and the SSRI. The most frequent adverse effects described for both groups of physicians are those of gastrointestinal type, sexual dysfunction and those related with the CNS, being the psychiatrist who are mentioning a higher percentage of adverse effects. The pharmacological treatment compliance is considered "good-very good" by most of the 80% of both groups of physicians. The main reasons for withdrawal are clearly different depending on the type of physician, being the long lasting treatment the most frequent reason in Primary Care (66.8%) and the adverse effects in psychiatry (79.8%). About 40 50% of physicians are considering that other important reason for withdrawal is that the patients are "thinking that they no longer need the drug". C o n c l u s i o n : Commonly, the most used antidepressants by psychiatrist are SSRI and venlafaxine, having also incorporated to their therapeutic tools new marketed agents, such as IRNS, NaSSA and IRNA. In the case of GPs, the most common antidepressants used were SSRI, therefore being these antidepressants the election drugs for both groups. The therapeutical compliance is higher with pharmacological treatments than with no pharmaceutical agents, according to the opinion of both groups of physicians.