To analyze healthcare and prescription drug use among patients taking and those not taking antidepressant drugs in a Swedish community.
Design:
Cross-sectional study.
Setting:
General population of the rural Swedish municipality Tierp of approximately 20 000 inhabitants.
Participants:
All residents of Tierp aged 25 years or older during 1988.
Main Outcome Measures:
Mean number of ambulatory care visits, hospital bed days, and prescriptions per person; proportion of those taking prescription drugs in different pharmacologic classes.
Results:
Patients treated with antidepressant drugs had a significantly (p < 0.05) greater use of ambulatory care, hospital care, and prescription drugs than those who did not take antidepressants in the study population. They also had an increased frequency of use of prescription drugs from virtually all pharmacologic classes. Furthermore, the risk for polypharmacy was high in patients treated with antidepressant medications.
Conclusions:
Those who took antidepressant drugs consumed more health services and prescription drugs than did those not taking an antidepressant. Patients receiving antidepressant treatment may be at serious risk for iatrogenic disease and should be evaluated carefully with respect to concomitant drug use.
Get full access to this article
View all access options for this article.
References
1.
FichterM, WitzkeW, LeiblK, HippiusH.Psychotropic drug use in a representative community sample: the Upper Bavarian study. Acta Psychiatr Scand1989;80:68-77.
2.
MellingerG, BalterM, ManheimerD, CisinJ, ParryH.Psychic distress, life crisis and use of psychotherapeutic medications. Arch Gen Psychiatry1978;35:1045-52.
3.
QuinnK, BakerMJ, EvansB.A population-wide profile of prescription drug use in Saskatchewan, 1989. Can Med Assoc J1992;146:2177-86.
4.
RosholmJU, HallasJ, GramL.Outpatient utilization of antidepressants: a prescription database analysis. J Affect Disord1993;27:21-8.
5.
TurrinaC, Zimmerman-TansellaC, MiccioloR, SicilianiO.A community survey of psychotropic drug consumption in South Verona: prevalence and associated variables. Soc Psychiatry Psychiatr Epidemiol1993;28:40-4.
6.
ApoteksbolagetAB. Svensk läkemedelsstatistik 1988. (Swedish drug statistics 1988). Stockholm: Apoteksbolaget AB, 1989.
7.
BoethiusG.Prescription of drugs 1970–75 in the county of Jämtland, Sweden–-epidemiological and clinical pharmacological aspects. Huddinge, Sweden: Karolinska Institute, Huddinge University Hospital, 1977.
8.
Depression Guideline Panel.Depression in primary care: Vol. 1. Detection and diagnosis. Clinical practice guideline, number 5. Rockville, MD: US Department of Health and Human Services, Public Health Service, Agency for Health Policy and Research, 1993.
9.
MurphyD, SieverL, InselT.Therapeutic responses to tricyclic antidepressants and related drugs in non-affective disorder patient populations. Prog Neuropsychopharmacol Biol Psychiatry1985;9:3-13.
10.
KochH.Utilization of psychotropic drugs in office-based ambulatory care: National Ambulatory Medical Care Survey, 1980 and 1981. Uppsala: National Center for Health Statistics, 1983;(90).
WellsK, StewartA, HaysR.The functioning and well-being of depressed patients. JAMA1989;262:914-9.
13.
WidmerR, CadoretR.Depression in primary care: changes in pattern of patient visits and complaints during a developing depression. J Fam Pract1978;2:292-302.
14.
LacroJ, JesteD.Physical comorbidity and polypharmacy in older psychiatric patients. Biol Psychiatry1994;36:146-52.
15.
von KnorringL.Depressive syndromes in patients with physical disorders. In: Treatment of depression. Workshop. Vol. 1. Uppsala: Läkemedelsverket (Medical Products Agency), 1992:205–15.
16.
KatonW, SullivanM.Depression and chronic medical illness. J Clin Psychiatry1990;51:3-11.
17.
SchwabJ, BialowM, ClemmonsR, MartinP, HolzerC.The Beck Depression Inventory in medical inpatients. Acta Psychiatr Scand1967;43:255-65.
18.
MofficH, PaykelE.Depression in medical inpatients. 1975;126:346-53.
19.
CavanaughS.The prevalence of emotional and cognitive dysfunction in a general medical population: using the MMSE, GHQ and BDI. Gen Hosp Psychiatry1983;5:15-24.
20.
FulopG, StrainJ, VitaJ, LyonsJS, HammerJS. Impact of psychiatric co-morbidity on length of hospital stay for medical/surgical inpatients: a preliminary report. Am J Psychiatry1987;144:878-82.
21.
AnanthJ, JohnsonK.Psychotropic and medical drug interactions. Psychother Psychosom1992;58:178-96.
22.
KatzI, StreimJ, ParmeleeP.Psychiatric-medical comorbidity: implications for health services delivery and for research on depression. Biol Psychiatry1994;36:141-5.
23.
IsacsonD.Heavy use of prescription drugs. Pharmacoepidemiological studies in a Swedish community [PhD thesis]. Uppsala, Sweden: Uppsala University, 1987.
24.
Läkemedelsinformation AB. FASS1988Farmaceutiska specialiteter i Sverige(Pharmaceutical specialities in Sweden). Uppsala: Almqvist & Wiksell, 1988.
25.
HaglundB.Vilka får sjukvård? En statistisk och kartografisk studie av vårdutnyttjandet i Uppsala län (Health care for whom? A statistical and cartographic study of health care utilization in the county of Uppsala [dissertations from the Faculty of Medicine]). Uppsala, Sweden: Uppsala University, 1986.
26.
SAS Institute.SAS procedures guide for personal computers. 6th ed. Cary, NC: SAS Institute, 1987.
27.
KatonW.The epidemiology of depression in medical care. Int J Psychiatry Med1987;17:93-112.
28.
AquiloniusS, GranatM, HartvigP.Utilization of antiparkinson drugs in Norway, Sweden, Denmark and Finland in 1975–1979. Acta Neurol Scand1981;64:47-53.
29.
RendellM, LassekW, RossD, SmithC, KernekS, WilliamsJ,. A pharmaceutical profile of diabetic patients. J Chron Dis1983;36:193-202.
30.
IsacsonD, StålhammarJ.Prescription drug use among diabetics–-a population study. J Chronic Dis1987;40:651-60.
31.
HartzemaA, ChristensenD.Nonmedical factors associated with the prescribing volume among family practitioners in an HMO. Med Care1983;21:990-1000.
32.
SchurmanR, KramerP, MitchellJ.The hidden mental health network. Arch Gen Psychiatry1985;42:89-94.
33.
LeafP, BruceM.Gender differences in the use of mental health related services: a re-examination. J Health Soc Behav1987;28:171 -83.
34.
JohnsonJ, WeissmanMM, KlermanGL. Service utilization and social morbidity associated with depressive symptoms in the community. JAMA1992;267:1478-83.
35.
WidmerR, CadoretR.Depression: the great imitator in family practice. J Fam Pract1983;17:485-505.
36.
MathewR, WeinmanM, MirabiM.Physical symptoms of depression. Br J Psychiatry1981;139:293-6.
37.
KatonW, Roy-ByrneP.Mixed anxiety and depression. J Abnorm Psychol1991;100:337-45.
38.
MalmU.Schizophrenia: secondary depressions and their rational treatment options. In: Treatment of depression. Vol. 1. Uppsala, Sweden: Läkemedelsverket (Medical Products Agency), 1992.
39.
AshtonH.Risks of dependence on benzodiazepine drugs: a major problem of long-term treatment. Br Med J1989;289:103-4.
40.
Socialstyrelsens läkemedelsavdelning.Minska dos och förpackningsstorlek vid förskrivning av benzodiazepiner (Decrease dose and package size when prescribing benzodiazepines). Uppsala, Sweden: Department of Health and Welfare, Division of Drugs; 1989.
41.
DavidsonK, RitsonE.The relationship between alcohol dependence and depression. Alcohol Alcohol1993;28:147-55.
42.
DalackGW, RooseSP. Perspectives on the relationship between cardiovascular disease and affective disorder. J Clin Psychiatry1990;51(suppl 7):4-9.
43.
MagniG.The use of antidepressants in the treatment of chronic pain. A review of the current evidence. Drugs1991;42:730-48.
44.
GerberP, BarrettJ, BarrettJ, OxmanT, ManheimerE, SmithR,. The relationship of presenting physical complaints to depressive symptoms in primary care patients. J Gen Intern Med1992;7:170-3.
45.
CummingsJ.Depression and Parkinson's disease: a review. Am J Psychiatry1992;149:443-54.
46.
WalkerEA, KatonWJ, JemelkaRP, Roy-ByrnePP. Comorbidity of gastrointestinal complaints, depression, and anxiety in the epidemiologic catchment area (ECA) study. Am J Med1992;92(suppl 1A):26S–30s.
ThiessenB, WallaceS, BlackburnJ, WilsonT, BergmanU.Increased prescribing of antidepressants subsequent to β-blocker therapy. Arch Intern Med1990;150:2286-90.
54.
AvornJ, EverittD, WeissS.Increased antidepressant use in patients prescribed β-blockers. JAMA1986;255:357-60.
55.
RobertsonM, TrimbleM, TownsendH.Phenomenology of depression in epilepsy. Epilepsia1987;28:364-72.
56.
GilmanAG, RallT, NiesA, TaylorP, eds. Goodman and Gilman's the pharmacological basis of therapeutics. 8th ed. New York: Pergamon Press, 1990.
57.
MechanicD.Patient behaviour and the organization of medical care. In: TancrediL, ed. Ethics of health care. Washington, DC: Institute of Medicine, National Academy of Sciences, 1974.
58.
ColN, FanaleJ, KronholmP.The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med1990;150:841-5.
59.
ColleyC, LucasL.Polypharmacy: the cure becomes the disease. J Gen Intern Med1993;8:278-83.
