News briefs: Depression causes medical costs to soar; drug updates
News briefs
Depression causes medical costs to soar
A new study sharply highlights the need for adequate behavioral health benefits. Patients with treatment-resistant depression cost the health care system thousands each year for both depression-related and general medical costs, according to the study presented at the recent American Psychiatric Association meeting in New Orleans. Researchers analyzed medical and prescription claims data from the 1995-1998 MEDSTAT MarketScan Database to evaluate health care use and costs of patients with treatment-resistant depression.
Patients with treatment-resistant depression were categorized into two groups: low-to- moderate treatment resistance and severe treatment resistance. Patients in the first group had been treated with at least three antidepressants. Patients in the severe group had been treated with at least two antidepressants and hospitalized for depression. A comparison group of patients diagnosed with, and successfully treated for, depression without evidence of treatment resistance also was evaluated.
Researchers found that treatment-resistant depression is associated with higher inpatient, outpatient, and total health care costs. Specifically, the average total annual health care cost for patients with low-to-moderate treatment-resistant depression was $9,991 vs. $41,475 for those with severe treatment-resistant depression. Further, treatment-resistant patients were at least twice as likely to be hospitalized and had 15% more outpatient visits than non-treatment-resistant depression patients.
Novel drug surpasses SSRIs
A novel antidepressant that exhibits dual reuptake inhibition promises to surpass the popular selective serotonin reuptake inhibitors (SSRIs) for the treatment of major depression. Results of a study presented at the recent American Psychiatric Association meeting in New Orleans found that venlafaxine achieved significant remission of major depressive disorder after eight weeks of therapy.
Researchers analyzed data from more than 2,000 patients with moderate-to-severe major depressive disorder from eight randomized double-blind studies. Patients in these studies were randomized to receive venlafaxine, an SSRI, or placebo for eight weeks. Findings include:
- 43% of patients receiving a low dose of venlafaxine (75 mg) achieved significant remission at eight weeks.
- 45% of patients receiving a higher dose of venlafaxine (76 mg to 150 mg) achieved significant remission at eight weeks.
- 35% of patients receiving an SSRI achieved significant remission at eight weeks.
- 25% of patients receiving placebo experienced significant remission at eight weeks.
Venlafaxine works simultaneously on both serotonin and norepinephrine, two neurotransmitters implicated in depression and anxiety.
Drug prevents eating disorder relapse
Fluoxetine hydrochloride, a selective serotonin reuptake inhibitor used to treat depression, also helps people with anorexia nervosa maintain healthy body weight, according to a study released by researchers at the University of Pittsburgh (PA). The study is the first to suggest that an antidepressant may be useful in helping recovering anorexics sustain normal body weight after hospitalization.
Researchers followed 35 anorexia outpatients who had recovered a significant amount of their body weight for 12 months following hospital discharge. Fluoxetine was prescribed for 16 patients while the remainder took placebo. Among the patients on fluoxetine, 10 of 16 did not relapse and maintained a healthy body weight. Only three of the 19 patients on placebo were successful in maintaining a healthy body weight.
"Until now," notes lead investigator Walter H. Kaye, MD, professor of psychiatry at the University of Pittsburgh School of Medicine, "there have been no effective drug treatments for anorexia."
However, Kaye cautions that for fluoxetine to be effective, patients must first reach a healthy body weight. "If they are malnourished," he explains, "their serotonin system may be unresponsive to medication. Serotonin comes from tryptophan, an amino acid which can only be obtained in the diet," he notes. "Often, the only way to help patients return to a healthy body weight is through structured inpatient treatment. Once patients have a healthy body weight, medication that helps them maintain it outside the hospital and prevent relapse may ultimately save lives."
Antipsychotic provides long-lasting relief
A long-lasting, injectable formulation of the antipsychotic risperidone provides consistent, reliable symptom relief for schizophrenia and eliminates the need to take daily medication, according to a study presented at a recent psychiatric research meeting in Whistler, British Columbia, Canada.
"When taken as directed, many oral medications used to treat patients with schizophrenia work well," notes John Kane, MD, professor of psychiatry, neurology, and neuroscience at Albert Einstein College of Medicine in New York City. "However, a number of studies that followed patients with schizophrenia for three months to two years show that more than 40% of the individuals are unable to take their medication as prescribed — frequently leading to a return to their symptoms and renewed suffering. One significant factor is the difficulty patients have in complying with a regimen that requires pills to be taken once a day or more over an extended period of time."
This formulation, which has yet to be approved by the U.S. Food and Drug Administration in Rockville, MD, encapsulates risperidone in tiny microspheres made of a biodegradable polymer. The microspheres are injected into the muscle, where they gradually degrade to provide consistent blood levels of the drug.
In a three-month, randomized, double-blind, placebo-controlled study of 400 patients with schizophrenia, all patients were given oral risperidone in gradually increasing doses to a maximum of 4 mg per day over a one-week period. Treatment with oral risperidone continued for another three weeks after the injections began, to provide a smooth transition between formulations. Participants were divided into four groups:
- 25 mg risperidone microsphere group;
- 50 mg risperidone microsphere group;
- 75 mg risperidone group;
- placebo group.
Patients in all groups received an injection every two weeks. All patients were monitored for signs of relapse. At the first sign of deterioration, patients were taken out of the study and treated. In all, 30% of patients in the placebo group withdrew due to insufficient treatment response compared to 22% for the 25 mg risperidone group, 16% for the 50 mg risperidone group, and 14% for the 75 mg risperidone group.
Patients in all three risperidone microsphere groups experienced greater symptom relief than patients in the placebo group.
Drug helps heart patients survive longer
Researchers at St. Michael’s Hospital at the University of Toronto recently completed the first trial to compare the effectiveness of the two most common drugs for treatment of cardiac arrest. Results indicate that amiodarone outperforms the more commonly used lidocaine, say the study’s authors. And that has major implications for the recommended standard of treatment for cardiac arrest by paramedics and hospitals across the United States and Canada, they note.
More than 250,000 Americans suffer out-of-hospital cardiac arrest each year, according to the American Heart Association in Dallas. Fewer than 10% of these cases survive. The vast majority of cardiac arrests are caused by ventricular fibrillation (VF). Patients with VF die within five to seven minutes unless they receive cardiopulmonary resuscitation (CPR) and an electrical shock, or defibrillation, as early as possible. If defibrillation does not work immediately, the next step is administration of an anti-arrhythmic drug, followed by additional defibrillations.
Better than lidocaine
Prior to the Canadian study, the most commonly used anti-arrhythmic drugs had never been compared to determine which is most effective. Traditionally, lidocaine has been the drug used for cardiac arrest. However, last year, the American Heart Association Advanced Life Support guidelines recommended a promising drug called amiodarone as an alternative to lidocaine.
The Canadian study, ALIVE (Amiodarone vs. Lidocaine In Pre-hospital Ventricular fibrillation Evaluation), followed 348 randomized patients who had suffered cardiac arrest and who had one of the two drugs administered in a blinded fashion by Toronto Emergency Medical System paramedics. The study found that 50% more patients treated with amiodarone survived to be admitted to the hospital than patients treated with lidocaine.
"Although there have been major advancements in treating out-of-hospital cardiac arrest," notes Paul Dorian, MD, staff cardiologist and director of the Arrhythmia Service at St. Michael’s Hospital and professor at the University of Toronto, "the overall survival rate has been relatively low. We knew we might be able to improve those odds by determining the most-effective possible drug option. The results from ALIVE mean that we can now tell ambulance personnel and emergency room departments that amiodarone appears to be the most-effective drug, based on the evidence we have to date."
The ALIVE trial paves the way for further investigations to determine the longer-term survival of cardiac arrest patients, say the study’s authors. This study followed patients up to the point of hospital admission, but a much larger trial is needed to verify whether more patients receiving amiodarone go on to survive to discharge from the hospital, they note.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.