Improving prescribing practices in primary care: pharmacological treatment of depression in patients with excess weight
Notice bibliographique
Résumé
Background. Pharmacological treatment of depression needs individualized approaches, with consideration of patients’ characteristics amongst other factors. One of the most important factors associated with the differential response to antidepressants (AD) is a patient’s body weight. Presently, there are no guidelines to individualize the prescribing of AD for patients with excess weight. Moreover, it is not clear whether prescribing of AD with obesogenic (weight-increasing) adverse effects is associated with increased health risks in this population.Objectives. The objectives of this thesis are 1) to synthesize the evidence, by groups and types of AD, on the role of excess body weight in response to AD treatment in people with depression; 2a) to describe, in Canadian primary care, the prevalence and patterns of AD prescribing to patients with depression and obesity; 2b) to quantify the differences in prescribing AD with weight-modulating and cardiovascular adverse effects for patients in different weight groups; 3) to estimate the difference in the association between prescribing of obesogenic AD and health care utilization (hospitalizations) in patients with and without excess weight.Methods. For objective 1, a comprehensive scoping review was conducted. For objective 2a, a cohort of adult patients with depression was extracted from the national Canadian Primary Care Sentinel Surveillance Network (CPCSSN) Electronic Medical Records database for 2011-2016. The association between AD prescribing and weight category was evaluated cross-sectionally. For objective 2b, the CPCSSN cohort was restricted to the incident users of AD. Associations between obesity and prescribing of AD known for their weight-modulating and cardiovascular adverse effects were examined in logistic and mixed effects regression models. For objective 3, the population-based cohort, “The Care Trajectories - Enriched Data” (TorSaDE), was used. Cox regression analysis and cosine similarity metrics were utilized to examine the role of excess weight in the association between exposure to obesogenic AD and all-cause hospitalizations. Results. In the scoping review, the evidence on the differential response of people with excess weight to individual AD was synthesized. The analysis for objective 2 showed that, compared with normal weight patients, patients with obesity were more likely to receive an AD prescription (adjusted Odds Ratio [aOR]=1.17; 95% Confidence Interval [CI]: 1.12-1.22). Prescribing patterns of AD with weight-modulating and cardiovascular effects were different between patients with obesity and normal weight. The adjusted hazard ratio for all-cause hospitalizations was higher in the patients jointly exposed to excess weight and obesogenic AD, compared with patients with only one of these exposures (objective 3). Conclusion. The data synthesized in the scoping review helped clarifying best practices for antidepressant prescribing for patients with obesity. Prescribing high number of different AD, including AD with obesogenic and cardiovascular side effects, to patients with obesity is concerning, as well as the trend for the increased risk for hospitalizations in patients with the joint exposure to excess weight and obesogenic AD. The risks and benefits of treatment of the excess weight patients with individual obesogenic AD need to be further studied using a large longitudinal cohort of patients with depression and repeated BMI measures
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,026 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,004 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».