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Antidepressant dosage taken by patients with bipolar disorder: factors associated with irregularity.

Bauer R, Glenn T, Alda M, Sagduyu K, Marsh W, Grof P, Munoz R, Murray G, Ritter P, Lewitzka U, Severus E, Whybrow PC, Bauer M - Int J Bipolar Disord (2013)

Bottom Line: Factors significantly associated with irregularity were as follows: total number of psychotropic medications (p = 0.005), pill burden (p = 0.005), and depression (p = 0.015).Neither the percent of days missing doses nor the drug holidays were associated with any demographic or clinical factors.Medication regimen complexity and depressed mood are associated with increased irregularity.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry and Psychotherapy, Medical Faculty, Technische Universität Dresden, Fetscherstr 74, Dresden, 01307 Germany.

ABSTRACT

Background: This study analyzed regularity in the daily dosage of antidepressants taken by patients with bipolar disorder and identified the factors associated with irregularity.

Methods: Daily self-reported medication dosage taken and mood ratings were available from 144 patients who received treatment as usual. All 144 patients took the same antidepressant for at least 100 days. One hundred eleven of these patients were also taking a mood stabilizer. Approximate entropy (ApEn) was used to measure serial regularity in daily dosage. Regularity is the tendency that values within a time series remain the same on incremental comparisons. Drug holidays (missing three or more consecutive days) were also determined. Generalized estimating equations (GEE) were used to estimate if any demographic or clinical variables were associated with regularity.

Results: Although the mean percent of days missing doses was only 18.6%, there was a wide range of regularity in the daily antidepressant dosage. Drug holidays were common, occurring in 41% of the analyses. Factors significantly associated with irregularity were as follows: total number of psychotropic medications (p = 0.005), pill burden (p = 0.005), and depression (p = 0.015). Neither the percent of days missing doses nor the drug holidays were associated with any demographic or clinical factors. For patients taking both antidepressants and mood stabilizers, there was no significant difference in regularity in daily dosage between these drugs.

Discussion: There can be considerable irregularity in daily dosage despite a low percent of days missing doses. Medication regimen complexity and depressed mood are associated with increased irregularity. Daily regularity in drug dosage may be more dependent on the individual than on the specific drug. Research on the clinical impact of irregularity in daily dosage of antidepressants is needed.

No MeSH data available.


Related in: MedlinePlus

Irregularity in antidepressant usage (high ApEn). (A) Bupropion usage. ApEn(1,0.2 × SD,100) = 0.456, 17% missing days, 0 holidays. (B) Bupropion usage. ApEn(1,0.2 × SD,100) = 0.443, 20% missing days, 4 holidays. (C) Escitalopram usage. ApEn(1,0.2 × SD,100) = 0.541, 24% missing days, 0 holidays. (D) Escitalopram usage. ApEn(1,0.2 × SD,100) = 0.453, 7% missing days, 0 holidays.
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Fig1: Irregularity in antidepressant usage (high ApEn). (A) Bupropion usage. ApEn(1,0.2 × SD,100) = 0.456, 17% missing days, 0 holidays. (B) Bupropion usage. ApEn(1,0.2 × SD,100) = 0.443, 20% missing days, 4 holidays. (C) Escitalopram usage. ApEn(1,0.2 × SD,100) = 0.541, 24% missing days, 0 holidays. (D) Escitalopram usage. ApEn(1,0.2 × SD,100) = 0.453, 7% missing days, 0 holidays.

Mentions: There was at least 1 day of missing data in 136 (66%) of the 207 analysis periods. One or more drug holidays, defined as missing three or more consecutive days (Urquhart 1997), was present in 85 (41.1%) of the analysis periods. See Table 3. Of the 85 analysis periods, with at least one drug holiday, more than one drug holiday was present in 38 (44.7%). There was no significant association between drug holidays and any demographic or clinical values. Figure 1 provides examples of patients with irregular antidepressant dosage despite a low percent of days missing doses, related to the missing days and drug holidays.Table 3


Antidepressant dosage taken by patients with bipolar disorder: factors associated with irregularity.

Bauer R, Glenn T, Alda M, Sagduyu K, Marsh W, Grof P, Munoz R, Murray G, Ritter P, Lewitzka U, Severus E, Whybrow PC, Bauer M - Int J Bipolar Disord (2013)

Irregularity in antidepressant usage (high ApEn). (A) Bupropion usage. ApEn(1,0.2 × SD,100) = 0.456, 17% missing days, 0 holidays. (B) Bupropion usage. ApEn(1,0.2 × SD,100) = 0.443, 20% missing days, 4 holidays. (C) Escitalopram usage. ApEn(1,0.2 × SD,100) = 0.541, 24% missing days, 0 holidays. (D) Escitalopram usage. ApEn(1,0.2 × SD,100) = 0.453, 7% missing days, 0 holidays.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4215816&req=5

Fig1: Irregularity in antidepressant usage (high ApEn). (A) Bupropion usage. ApEn(1,0.2 × SD,100) = 0.456, 17% missing days, 0 holidays. (B) Bupropion usage. ApEn(1,0.2 × SD,100) = 0.443, 20% missing days, 4 holidays. (C) Escitalopram usage. ApEn(1,0.2 × SD,100) = 0.541, 24% missing days, 0 holidays. (D) Escitalopram usage. ApEn(1,0.2 × SD,100) = 0.453, 7% missing days, 0 holidays.
Mentions: There was at least 1 day of missing data in 136 (66%) of the 207 analysis periods. One or more drug holidays, defined as missing three or more consecutive days (Urquhart 1997), was present in 85 (41.1%) of the analysis periods. See Table 3. Of the 85 analysis periods, with at least one drug holiday, more than one drug holiday was present in 38 (44.7%). There was no significant association between drug holidays and any demographic or clinical values. Figure 1 provides examples of patients with irregular antidepressant dosage despite a low percent of days missing doses, related to the missing days and drug holidays.Table 3

Bottom Line: Factors significantly associated with irregularity were as follows: total number of psychotropic medications (p = 0.005), pill burden (p = 0.005), and depression (p = 0.015).Neither the percent of days missing doses nor the drug holidays were associated with any demographic or clinical factors.Medication regimen complexity and depressed mood are associated with increased irregularity.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry and Psychotherapy, Medical Faculty, Technische Universität Dresden, Fetscherstr 74, Dresden, 01307 Germany.

ABSTRACT

Background: This study analyzed regularity in the daily dosage of antidepressants taken by patients with bipolar disorder and identified the factors associated with irregularity.

Methods: Daily self-reported medication dosage taken and mood ratings were available from 144 patients who received treatment as usual. All 144 patients took the same antidepressant for at least 100 days. One hundred eleven of these patients were also taking a mood stabilizer. Approximate entropy (ApEn) was used to measure serial regularity in daily dosage. Regularity is the tendency that values within a time series remain the same on incremental comparisons. Drug holidays (missing three or more consecutive days) were also determined. Generalized estimating equations (GEE) were used to estimate if any demographic or clinical variables were associated with regularity.

Results: Although the mean percent of days missing doses was only 18.6%, there was a wide range of regularity in the daily antidepressant dosage. Drug holidays were common, occurring in 41% of the analyses. Factors significantly associated with irregularity were as follows: total number of psychotropic medications (p = 0.005), pill burden (p = 0.005), and depression (p = 0.015). Neither the percent of days missing doses nor the drug holidays were associated with any demographic or clinical factors. For patients taking both antidepressants and mood stabilizers, there was no significant difference in regularity in daily dosage between these drugs.

Discussion: There can be considerable irregularity in daily dosage despite a low percent of days missing doses. Medication regimen complexity and depressed mood are associated with increased irregularity. Daily regularity in drug dosage may be more dependent on the individual than on the specific drug. Research on the clinical impact of irregularity in daily dosage of antidepressants is needed.

No MeSH data available.


Related in: MedlinePlus