Risk-benefit balance assessment of SSRI antidepressant use during pregnancy and lactation based on best available evidence

Introduction: Psychiatric disorders are among the leading causes of disability in Western societies. Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed antidepressant drugs during pregnancy and the postpartum period. Over the last decade, conflicting findings regarding the safety of SSRI drugs during pregnancy and lactation have questioned whether such treatments should be used during this period.

Areas covered: We discuss the main criteria that should be considered in the risk/benefit assessment of SSRI treatment in pregnant and/or breastfeeding patients (i.e., risks associated with SSRI use and with untreated depression as well as therapeutic benefits of SSRI and some alternative treatment strategies). For each criterion, available evidence has been synthesized and stratified by methodological quality as well as discussed for clinical impact.

Expert opinion: Currently, it is impossible for most of the evaluated outcomes to distinguish between the effects related to the mother’s underlying disease and those inherent to SSRI treatment. In women suffering from major depression and responding to a pharmacological treatment, introduction or continuation of an SSRI should be encouraged in order to prevent maternal complications and to preserve maternal–infant bonding. The choice of the right drug depends above all on individual patient characteristics such as prior treatment response, diagnoses and comorbid conditions.     

Assessing medication appropriateness in the elderly: a review of available measures

The disproportionate use of medications, combined with age-related pharmacokinetic and pharmacodynamic changes, places older adults at high risk for medication related problems (MRPs). MRPs demonstrate significant morbidity, mortality and economic impact among healthcare systems. The negative outcomes associated with MRPs emphasise the need for more careful and thorough assessments of drug therapy among older adults. In the 1990s a number of methods and instruments were developed to assist in the assessment of medication appropriateness. These tools may be categorised by criteria as: implicit, explicit or one utilising a combination of implicit and explicit criteria. This article reviews these available tools and outlines the advantages and disadvantages of each. In conclusion, those instruments considered to be comprised of both implicit and explicit criteria offer a more thorough assessment of medication appropriateness.     

Tackling the need to teach integrative pharmacology and physiology: problems and ways forward

Despite continued efforts to reduce the numbers of animals used in biomedical research, there are still some research areas in which alternatives cannot be used and animal experimentation is essential. Studies using animals must be carried out by highly trained personnel to ensure experimental success and to minimise pain and distress for the animals. However, recent surveys in the UK have revealed a shortage of skills in techniques involving the use of animals. A survey conducted in 2004 jointly by the British Pharmacological Society and the Physiological Society suggests that only approximately 2% of biomedical graduates in the UK receive training in in vivo experimentation, and that this type of training is likely to be reduced in the future. Evidence from other countries suggests that the problem is widespread. In this article, we discuss the results of the survey by the BPS and the Physiological Society and propose a series of recommendations to address the problem.     

Assessing pharmacological interventions for bone metastases: the need for more patient-centered outcomes

Bone metastases are associated with a broad spectrum of clinical sequelae. Pain, reduced mobility, skeletal complications and treatment-related events reduce quality of life. Numerous randomized controlled trials have evaluated pharmacological interventions to treat bone metastases. The primary outcomes used have evolved over the past 25 years; from improvement in pain to time to first skeletal-related event (SRE). In the current definition, a SRE consists of pathological fracture, spinal cord compression or the need for radiotherapy or surgery to the bone. Currently used outcomes can detect small differences between interventions. However, there are several limitations to SRE-related outcomes. In this article we illustrate the evolution of outcomes used in randomized controlled trials, critically appraising current outcomes used and proposing that more patient-centered outcomes are needed.     

Desire for information about drugs: a survey of the need for information in psychiatric in-patients

Background Promoting therapy adherence requires understanding various psychosocial parameters, including patients need for information. Drug information adapted to patients needs may empower them and increase their confidence in drug therapy. Objectives: To explore psychiatric in-patients information preferences and to test the reliability of a Dutch version of the Intrinsic Desire for Information (IDI) scale in psychiatric institutions in Flanders.Methods Standardised interviews were conducted with psychiatric patients in 11 hospitals. The interview consisted of the IDI-scale and five open questions. Patient demographics collected were sex, age, number of medicines taken, diagnosis, number of admissions during the past year, marital status, education level and occupation.Results 279 patient interviews were completed. A factor analysis on the original 12-item scale yielded 3 factors. An abbreviated scale was derived from the first factor (F1). This 6-item scale measured extent of information desired: (EID) and consisted of six items (Cronbachs = 0,73). A second factor (F2) measured information provider preference (IPP) ( = 0,56) and a third factor (F3) measured inhibited information desire (IID) ( = 0,69). EID was associated with number of medicines taken, duration of hospitalisation and marital status.Conclusion The internal reliability of the EID-factor appears to be reproducible in the specific setting of psychiatric hospitals. It may be useful to help healthcare professionals develop pharmaceutical care towards psychiatric patients. Validation of the scale remains to be completed. Information need in psychiatric in-patients measured by the EID-score was comparable to the need measured in general hospitals during earlier research in England. Targeted information services seem to be desirable to enhance therapy adherence and quality of life in psychiatric patients.