ADHERENCE AND ASSOCIATED ADVERSE DRUG REACTION WITH ANTIDEPRESSANTS MEDICATION AMONG DEPRESSION PATIENTS IN PSYCHIATRIC HOSPITAL IN POKHARA, NEPAL

  • NIRMAL RAJ MARASINE Department of Pharmaceutical Sciences Program, School of Health and Allied Sciences, Pokhara University, Kaski, Nepal.
  • SABINA SANKHI Department of Pharmaceutical Sciences Program, School of Health and Allied Sciences, Pokhara University, Kaski, Nepal.
  • RAJENDRA LAMICHHANE Department of Public Health, Asian College for Advance Studies, Lalitpur, Nepal.
  • NABIN RAJ MARASINI Department of Public Health, La Grande International College, Kaski, Nepal.
  • NIM BAHADUR DANGI Department of Pharmaceutical Sciences Program, School of Health and Allied Sciences, Pokhara University, Kaski, Nepal.

Abstract

Background: The present study determined the prescription pattern of antidepressants, adverse drug reactions (ADRs), the level of adherence, and factors affecting it.


Methods: This prospective cross-sectional study was conducted with depression patients (n=174; 55.74% female) from August 2019 to November 2019 at a psychiatric hospital of Pokhara, Kaski, Nepal. The Naranjo ADR Probability Scale was employed to assess the ADRs. The rate of medication adherence (MA) was determined using Morisky MA Measurement Scale-Eight. Descriptive statistics (median, interquartile range, frequency, and percentage), bivariate analysis, and Chi-square test were used; p<0.05 was taken as significant in multivariate analysis.


Results: Selective serotonin reuptake inhibitors (SSRIs) were found to be the most commonly prescribed antidepressants (58.04%) followed by serotonin and noradrenaline reuptake inhibitors (SNRIs; 13.79%). More than half of the patients had a low level of adherence (52.29%) and about 74.13% experienced ADR. The most common ADRs were insomnia (17.05%) and anxiety (17.05%). Female were found to be more non-adherent compared to male (odds ratio 1.011; 95% confidence interval; 0.507–1.832). The level of adherence was found to be associated with the probability and severity of ADR.


Conclusion: The majority of patients used SSRIs. ADRs were more prevalent. However, adherence to medications was extremely poor in the hospital, which was attributed to factors such as gender, occupation, education, and ADRs.

Keywords: Depression, Antidepressants, Adverse drug reaction, Adherence

References

1. Mental Health. Available from: https://www.who.int/mental_health/ world-mental-health-day/2017/en.
2. World Health Organization. The World Health Report 2001: Mental Health: New Understanding, New Hope. Geneva: World Health Organization; 2001. Available from: https://www.who.int/whr/2001/ chapter2/en/index4.html.
3. World Health Organization. The Global Burden of Disease: 2004 Update. Geneva: World Health Organization; 2008.
4. Mental Health in Nepal; what do Evidence Say? Available from: https:// www.herd.org.np.
5. Regmi SK, Pokharel A, Ojha SP, Pradhan SN, Chapagain G. Nepal mental health country profile. Int Rev Psychiatry 2004;16:142-9.
6. Armstrong C. APA releases guideline on treatment of patients with major depressive disorder. Am Fam Physician 2011;83:1219-27.
7. Gelenberg AJ, Freeman MP, Markowitz JC, Rosenbaum JF, Thase ME, Trivedi MH, et al. American psychiatric association practice guidelines for the treatment of patients with major depressive disorder. Am J Psychiatry 2010;167:9-118.
8. Qaseem A, Snow V, Denberg TD, Forciea MA, Owens DK. Using second-generation antidepressants to treat depressive disorders: A clinical practice guideline from the American college of physicians Ann Intern Med 2008;149:725-33.
9. Tamburrino MB, Nagel RW, Chahal MK, Lynch DJ. Antidepressant medication adherence: A study of primary care patients. Prim Care Companion J Clin Psychiatry 2009;11:205-11.
10. Abegaz TM, Sori LM, Toleha HN. Self-reported adverse drug reactions, medication adherence, and clinical outcomes among major depressive disorder patients in Ethiopia: A prospective hospital based study. Psychiatry J 2017;2017:5812817.
11. Ho SC, Jacob SA, Tangiisuran B. Barriers and facilitators of adherence to antidepressants among outpatients with major depressive disorder: A qualitative study. PloS One 2017;12:e0179290.
12. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich) 2008;10:348-54.
13. Nahas AR, Sulaiman SA. Prescribing patterns of antidepressants among depressive men in Malaysia: A survey. J Young Pharm 2018;10:98-101.
14. Bauer M, Monz BU, Montejo AL, Quail D, Dantchev N, Demyttenaere K, et al. Prescribing patterns of antidepressants in Europe: Results from the factors influencing depression endpoints research (FINDER) study. Eur Psychiatry 2008;23:66-73.
15. Olfson M, Marcus SC. National patterns in antidepressant medication treatment. Arch Gen Psychiatry 2009;66:848-56.
16. Ferguson JM. SSRI antidepressant medications: Adverse effects and tolerability. Prim Care Companion J Clin Psychiatry 2001;3:22-7.
17. Mishra S, Swain TR, Mohanty M. Adverse drug reaction monitoring of antidepressants in the psychiatry outpatients department of a tertiary care teaching hospital. J Clin Diagn Res 2013;7:1131-4.
18. Mukherjee S, Sen S, Chatterjee SS, Era N, Ghosal M, Tripathi SK. Adverse drug reaction monitoring of antidepressants in the psychiatry out patient department at a tertiary care teaching hospital in India: A cross-sectional observational study. Eur J Psychol Educ Stud 2015;2:14-9.
19. Masand PS, Gupta S. Long-term side effects of newer-generation antidepressants: SSRIS, venlafaxine, nefazodone, bupropion, and mirtazapine. Ann Clin Psychiatry 2002;14:175-82.
20. Al Jumah K, Hassali MA, Al Qhatani D, El Tahir K. Factors associated with adherence to medication among depressed patients from Saudi Arabia: A cross-sectional study. Neuropsychiatr Dis Treat 2014;10:2031-7.
21. Burra TA, Chen E, McIntyre RS, Grace SL, Blackmore ER, Stewart DE. Predictors of self-reported antidepressant adherence. Behav Med 2007;32:127-34.
22. Goethe JW, Woolley SB, Cardoni AA, Woznicki BA, Piez DA. Selective serotonin reuptake inhibitor discontinuation: Side effects and other factors that influence medication adherence. J Clin Psychopharmacol 2007;27:451-8.
23. Demyttenaere K. Compliance during treatment with antidepressants. J Affect Disord 1997;43:27-39.
24. Martin-Vazquez MJ, Garcia-Toro M, Campoamor F, Pareja A, Aguirre I, Salva J, et al. Use and results of antidepressant treatment: Patients’ perception. Curr Drug Ther 2011;6:271-7.
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MARASINE, N. R., S. SANKHI, R. LAMICHHANE, N. R. MARASINI, and N. BAHADUR DANGI. “ADHERENCE AND ASSOCIATED ADVERSE DRUG REACTION WITH ANTIDEPRESSANTS MEDICATION AMONG DEPRESSION PATIENTS IN PSYCHIATRIC HOSPITAL IN POKHARA, NEPAL”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 13, no. 6, Apr. 2020, pp. 127-130 Article Retracted, doi:10.22159/ajpcr.2020.v13i6.37127.
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