Medical Costs and Utilization in Patients With Depression Treated With Adjunctive Atypical Antipsychotic Therapy.

Medical costs and utilization in patients with depression treated with adjunctive atypical antipsychotic therapy.

Filed under: Depression Treatment

Clinicoecon Outcomes Res. 2013; 5: 49-57
Nadkarni A, Kalsekar I, You M, Forbes R, Hebden T

To compare total medical costs and utilization over a 12-month period in commercially insured patients receiving FDA-approved adjunctive atypical antipsychotics (aripiprazole, olanzapine, or quetiapine) for depression.A retrospective claims analysis was conducted from 2005-2010 using the PharMetrics database. Subjects were adult commercial health-plan members with depression, identified using International Classification of Diseases codes and followed for 12 months after augmentation with an atypical antipsychotic. Outcomes included total medical costs, hospitalization, and ER visits. Generalized linear models and logistic regression were used to compare the total medical costs and the odds of hospitalization and ER visits between the treatment groups after adjusting for baseline demographic and clinical characteristics.A total of 9675 patients with depression were included in the analysis, of which 68.4% were female, with a mean age of 45.2 (±12.0) years. Adjusted 12-month total medical costs were higher for olanzapine ($ 14,275) and quetiapine ($ 12,998) compared to aripiprazole ($ 9,801; P < 0.05 for all comparisons with aripiprazole). When divided into inpatient and outpatient costs, olanzapine and quetiapine had significantly higher adjusted inpatient costs compared to aripiprazole ($ 6,124 and $ 4,538 vs $ 2,976, respectively; P < 0.05 for all comparisons with aripiprazole). Similar results were seen for adjusted outpatient costs. Adjusted odds of hospitalization for olanzapine (odds ratio [OR] = 1.73; 95% CI confidence interval [CI] = 1.42-2.10) and quetiapine (OR = 1.40; 95% CI = 1.21-1.60) were significantly higher than aripiprazole at 12 months. The adjusted odds of an ER visit for olanzapine (OR = 1.40; 95% CI = 1.18-1.65) and quetiapine (OR = 1.62; 95% CI = 1.44-1.81) were also significantly higher compared to aripiprazole at 12 months.In commercially insured major depressive disorder patients, olanzapine and quetiapine were associated with higher total medical costs, the difference being primarily attributable to higher inpatient costs. Additionally, olanzapine and quetiapine were associated with significantly higher odds of hospitalization and ER visits compared to aripiprazole. HubMed – depression


A critical review of the recent literature and selected therapy guidelines since 2006 on the use of lamotrigine in bipolar disorder.

Filed under: Depression Treatment

Neuropsychiatr Dis Treat. 2013; 9: 101-11
Tränkner A, Sander C, Schönknecht P

The anticonvulsant drug lamotrigine (LTG), a sodium channel blocker and inhibitor of glutamate release, has been found to have antidepressant effects in the treatment of bipolar disorder. It is recommended by certain therapy guidelines as a first-line agent for acute and maintenance therapy in bipolar depression, but there have been only some promising results of placebo-controlled trials on its acute antidepressant effects, and the recommendation in therapy guidelines has been reconsidered. On the contrary, positive results for maintenance therapy could be confirmed, and LTG is still a well-tolerated option, especially in patients with predominant depressive episodes. Antimanic effects are not shown in the literature, and its use is not advised in any guidelines that were examined. In conclusion, the findings of the present review article on treatment guidelines for bipolar disorder question the role of LTG in acute depressive states, and critically discusses its use, particularly in acute depressive states.
HubMed – depression


Nurse home visits with or without alert buttons versus usual care in the frail elderly: a randomized controlled trial.

Filed under: Depression Treatment

Clin Interv Aging. 2013; 8: 85-95
Favela J, Castro LA, Franco-Marina F, Sánchez-García S, Juárez-Cedillo T, Bermudez CE, Mora-Altamirano J, Rodriguez MD, García-Peña C

To assess whether an intervention based on nurse home visits including alert buttons (NV+AB) is effective in reducing frailty compared to nurse home visits alone (NV-only) and usual care (control group) for older adults.Unblinded, randomized, controlled trial.Insured population covered by the Mexican Social Security Institute living in the city of Ensenada, Baja California, Mexico.Patients were aged over 60 years with a frailty index score higher than 0.14.After screening and informed consent, participants were allocated randomly to the control, NV+AB, or NV-only groups.The primary outcome was the frailty score 9 months later. Quality of life, depression, comorbidities, health status, and health service utilization were also considered.The framing sample included 819 patients. Of those, 591 were not located because they did not have a landline/telephone (341 patients), they had died (107), they were ill (50), or they were not currently living in the city (28). A screening interview was applied to 228 participants, and 57 had a score ?0.14, 171 had ?0.14, and 16 refused to complete the baseline questionnaire. A home visit was scheduled for 155 patients. However, 22 did not complete the baseline questionnaire. The final 133 subjects were randomized into the NV+AB (n = 45), NV-only (n = 44), and control (n = 44) groups. There were no statistically significant differences in the baseline characteristics of the groups. The mean age overall was 76.3 years (standard deviation 4.7) and 45% were men. At the baseline, 61.65% were classified as frail. At end of follow-up the adjusted prevalence of frailty in NV+AB group was 23.3% versus 58.3% in the control group.An intervention based on NV+AB seems to have a positive effect on frailty scores.
HubMed – depression


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