MESUT SANCAR, Emine DÜZGÜN, BETÜL OKUYAN, BETÜL OKUYAN, Mecit ÇALIŞKAN, Kadir COŞKUN, FİKRET VEHBİ İZZETTİN

Antidepresan Kullanan Majör Depresyon Hastalarında Yan Etkilerin ve Hasta Uyuncunun Değerlendirilmesi

Bu çalışmanın amacı, antidepresan kullanan majör depresyon hastalarında yan etkilerin ve hasta uyuncunun değerlendirilmesidir. Çalışma Şubat-Mayıs 2013 tarihleri arasında bir psikiyatri polikliniğinde yürütülmüştür. yan etkilerin tespiti için “toronto yan Etki Ölçeği”, tedaviye uyuncun belirlenmesi için ise “Morisky green levine uyunç Ölçeği” kullanılmıştır. Çalışma 56 majör depresyon tanısı alan hasta ile (yaş ortalaması: 40,82 ± 14,28; erkek/kadın: 13/43) tamamlanmıştır. Hastalar depresyon tedavisi için essitalopram (% 46,4), sertralin (% 26,8), venlafaksin (% 10,7), sitalopram (% 8,9) ve paroksetin (%7,1) kullanmaktaydı. Hastaların en yaygın bildirdiği yan etkilerin sersemlik/gündüz uykuya eğilim (% 57,1), ağız kuruluğu (% 46,4), uykuda artış (% 46,4), iştah artması (% 37,5) ve halsizlik veya yorgunluk (% 30,4) olduğu tespit edilmiştir. Hastaların yaşadıkları bu yan etkiler şiddet derecesine göre değerlendirildiğinde ilk sıraları sersemlik/ gündüz uykuya eğilim (% 25,0), uykuda artış (% 19,6) ve libido azalması (% 14,3) yan etkilerinin aldığı gözlenmiştir. Çalışmaya katılan hastaların sadece % 26,8’inin ilaçlarına uyunç oranlarının yüksek olduğu saptanmıştır. antidepresan kullanan hastalarda görülen yan etki sıklığının ve şiddetinin yüksek olduğu ve ayrıca hastaların ilaç uyunç oranlarının düşük olduğu sonucuna varılmıştır. Bu hastaların poliklinikten aldıkları rutin hizmetin yanısıra eczacılar tarafından yan etkiler ve uyunç konusunda eğitilmeleri ve izlenmeleri, ilaç kaynaklı olası sorunların önüne geçilmesine katkı sağlayacaktır.

Determination of side effects and medication adherence in major depression patients utilized antidepressants

The aim of the study is to determine side effects, and medication adherence in patients who were diagnosed with major depression utilized antidepressants. This study was conducted in outpatient psychiatry clinic between February 2013 and May 2013. ‘toronto Side Effects Scale’ and 4-item Morisky-greenlevine Medication adherence Scale were evaluated. Fifty-six major depression patients (mean of age: 40.82 ± 14.28 years old; male/female: 13/43) were included in this study. Patients were treated with escitalopram (46.4%), sertraline (26.8%), venlafaxine (10.7%), citalopram (8.9%) and paroxetine (7.1%). The most common side effects that patients reported were drowsiness/ daytime somnolence (57.1%), dry mouth (46.4%) and increased sleep (46.4%), increased appetite (37.5%) and malaise or fatigue (30.4%). The most severity side effects that patients experienced were drowsiness/ daytime somnolence (25%), increased sleep (19.6%) and decreased libido (14.3%). Only fifteen (26.8%) patients were found high adherent to their medication. It was concluded that although the frequency and severity of side effects have been found high, the percentage of patients’ medication adherence has been obtained low. Patient education and monitoring regarding side effects and medication adherence providing by pharmacists would be contributed to prevent possible drug induced problems in these patients besides the routine services they are taken from outpatient clinic.

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Canales Pl, Dorson Pg, Crismon Ml. Outcomes assessment of clinical pharmacy services in psychiatric inpatient setting. am J Health Syst Pharm 2001; 58:1309-16.
aljumah K, Hassali Ma. Impact of pharmacist intervention on adherence and mesurable patient outcomes among depressed patients: a randomised controlled study. BMC Psychiatry 2015; 15:219-27
al-Jumah Ka, Qureshi na. Impact of pharmacist interventions on patients’ adherence to antidepressants and patient-reported outcomes: a systematic review. Patient Prefer adher 2012; 6:87-100
Murata a, Kanbayashi t, Shimizu t, Miura M. risk factors for drug nonadherence in antidepressant-treated patients and implications of pharmacist adherence instructions for adherence improvement. Patient Prefer adherence 2012; 6: 863-9.
rubio-Valera M, Serrano-Blnaco a, Magdalena-Belio J, Fernandez a, garcia-Campayo J, Pujol MM, Del Hoyo yl. Effectiveness of pharmacist care in the improvement of adherence to antidepressants: a systematic review and metaanalysis. ann Pharmacother 2011; 45:39-48
al-Saffar n, abdulkareem a, abdulhakeem a, Salah aQ, Heba M. Depressed patients’ preferences for education about medications by pharmacists in Kuwait. Patient Educ Couns 2008; 72: 94-101
Cappocia Kl, Boudreau DM, Blough DK, Ellsworth aJ, Clark Dr, Stevens ng, Katon WJ, Sullıvan SD. am J Health Syst Pharm 2004; 61: 364-72.
Bungay KM, adler Da, rogers WH, McCoy C, Kaszuba M, Supran S, Pei y, Cynn DJ, Wilson IB. Description of a clinical pharmacist intervention administered to primary care patients with depression. gen Hosp Psychiatry 2004; 26: 210-8.
adler Da, Bungay KM, Wilson IB, Pei y, Supran S, Peckham E,Cynn DJ, rogers WH. The impact of a pharmacist intervention on 6 month outcomes in depressed primary care patients. gen Hosp Psychiatry 2004; 26: 199-209.
Sawada n, uchida H, Suzuki t, Watanabe K, Kikuchi t, Handa t, Kashima H. Persistence and compliance to antidepressant treatment in patients with depression: a chart review. BMC Psychiatry 2009; 9:38-47.
Kostev K, rex J, Eith t, Heilmaier C. Which adverse effects influence the dropout rate in selective serotonin reuptake inhibitor (SSrI) treatment? results for 50,824 patients. ger Med Sci 2014; 12:15
ashton a, Jamerson B, Wagoner C. antidepressant related adverse effects impacting treatment compliance: results of a patient survey. Curr Ther res Clin Exp 2005; 66:96-106.
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.
Dewan MJ, anand VS. Evaluating the tolerability of the newer antidepressants. J nerv Ment Dis 1999; 187:96-101.
Marques laM, galduroz JCF, noto ar. Pharmaceutical care to patients treated with antidepressants. rev Calid asist 2012; 27:55-64.
Morisky DE, green lW, levine DM. Concurrent and Predictive Validity of a Self-reported Measure of Medication adherence and long-term Predictive Validity of Blood Pressure Control. Med Care 1986; 24: 67–74.
yılmaz S. Psikiyatri hastalarında ilaç yan etkileri ve ilaç uyumu. i.Ü. Sağlık Bilimleri Enstitüsü, yüksek lisans tezi, istanbul, (Danışman: Doç. Dr. Sevim Buzlu). 2004.
Vanderkooy JD, Kennedy SH, Bagby rM. antidepressant side effects in depression patients in a naturalistic setting: a study of bupropion, moclobemide, paroxetine, sertraline, and venlafaxine. Can J Psychiatry 2002; 47: 174-80
gabrial a, Violato C. Knowledge of and attitudes towards depression and adherence to treatment: The antidepressant adherence scale (aaS). J affect Disorders 2010; 126:388-94.
Hunot VM, Horne r, leese Mn, Churchill rC. a cohort study of adherence to antidepressants in primary care: The influence of antidepressant concerns and treatment preferences. Prim Care Companion J Clin Psychiatry 2007; 9:91-9.
Vergouwen aCM, Bakker a, Katon WJ, Verheij tJM, Koerselman F. improving adherence to antidepressants: a systematic review of interventions. J Clin Psychiatry 2003; 64: 1415-20.
Serretti a, Drago a, Spina E. Pharmacogenomics of depression. In: Pharmacogenomics in Psychiatry. Eds:Schwab M, Kaschka WP, Spina E. adv Biol Psychiatry, Basel, Karger. 2010, pp. 58-74.
Weızman S, gonda X, Dome P, Faludı g. Pharmacogenetics of antidepressive drugs: a way towards personalized treatment of majör depressive disorder. neuropsychopharmacol Hung, 2012; 14:87-101