Utilizing Consumer Health Posts for Pharmacovigilance: Identifying Underlying Factors Associated with Patients’ Attitudes Towards Antidepressants

Non-adherence to antidepressants is a major obstacle to antidepressants therapeutic benefits, resulting in increased risk of relapse, emergency visits, and significant burden on individuals and the healthcare system. Several studies showed that non-adherence is weakly associated with personal and clinical variables, but strongly associated with patients’ beliefs and attitudes towards medications. The traditional methods for identifying the key dimensions of patients’ attitudes towards antidepressants are associated with some methodological limitations, such as concern about confidentiality of personal information. In this study, attempts have been made to address the limitations by utilizing patients’ self report experiences in online healthcare forums to identify underlying factors affecting patients attitudes towards antidepressants. The data source of the study was a healthcare forum called “askapatients.com”. 892 patients’ reviews were randomly collected from the forum for the four most commonly prescribed antidepressants including Sertraline (Zoloft) and Escitalopram (Lexapro) from SSRI class, and Venlafaxine (Effexor) and duloxetine (Cymbalta) from SNRI class. Methodology of this study is composed of two main phases: I) generating structured data from unstructured patients’ drug reviews and testing hypotheses concerning attitude, II) identification and normalization of Adverse Drug Reactions (ADRs), Withdrawal Symptoms (WDs) and Drug Indications (DIs) from the posts, and mapping them to both The UMLS and SNOMED CT concepts. Phase II also includes testing the association between ADRs and attitude. The result of the first phase of this study showed that “experience of adverse drug reactions”, “perceived distress received from ADRs”, “lack of knowledge about medication’s mechanism”, “withdrawal experience”, “duration of usage”, and “drug effectiveness” are strongly associated with patients attitudes. However, demographic variables including “age” and “gender” are not associated with attitude. Analysis of the data in second phase of the study showed that from 6,534 identified entities, 73% are ADRs, 12% are WDs, and 15 % are drug indications. In addition, psychological and cognitive expressions have higher variability than physiological expressions. All three types of entities were mapped to 811 UMLS and SNOMED CT concepts. Testing the association between ADRs and attitude showed that from twenty-one physiological ADRs specified in the ASEC questionnaire, “dry mouth”, “increased appetite”, “disorientation”, “yawning”, “weight gain”, and “problem with sexual dysfunction” are associated with attitude. A set of psychological and cognitive ADRs, such as “emotional indifference” and “memory problem were also tested that showed significance association between these types of ADRs and attitude. The findings of this study have important implications for designing clinical interventions aiming to improve patients\u27 adherence towards antidepressants. In addition, the dataset generated in this study has significant implications for improving performance of text-mining algorithms aiming to identify health related information from consumer health posts. Moreover, the dataset can be used for generating and testing hypotheses related to ADRs associated with psychiatric mediations, and identifying factors associated with discontinuation of antidepressants. The dataset and guidelines of this study are available at https://sites.google.com/view/pharmacovigilanceinpsychiatry/hom

The Information Practices of People Living with Depression: Constructing Credibility and Authority

Depressive episodes and chronic depression often provide the impetus for both online and offline everyday life information-seeking and sharing and the seeking of support. While allopathic medication, psychiatric, and other biomedical services are the standard treatments for depression, people often use complementary and alternative medicine (CAM) to supplement or supplant biomedical treatments. Depression is a nebulous disorder with varying causes, illness trajectories, and a wide variety of potentially effective treatments. Often, treating and managing depression forms a project for life (Wikgren, 2001) where the need for information is continuous. In the present study, I have used a constructionist, discourse analytic approach as outlined by Potter (1996) and Wooffitt (1992) to analyze the messages posted to three online newsgroups devoted to depression, CAM, and the practices of biomedicine and to analyze the transcripts from 10 semi-structured interviews with participants who self-identified as currently having depression or who have suffered from depression in the past. I have sought to understand how people justify using, or not using, CAM to treat depression. Specifically, I have investigated how people with depression use information in discourse to justify healthcare decisions and to create credible and authoritative accounts; how people with depression conceptualize CAM therapies, mainstream medicine, and depression and how these conceptualizations are represented in the discursive constructions of individuals as competent information-seekers and users; and I have investigated the information practices (e.g., everyday life information-seeking, sharing, and use) of people living with depression. My findings show that while expert, biomedical information sources and knowledge are most often drawn upon and referred to by newsgroup posters and interviewees to warrant claims, people used a variety of discursive strategies and regular speech patterns to create credible and authoritative accounts, to portray themselves as competent information-seekers and users, to support their claims for either using or foregoing a certain treatment, and to counter the authoritative knowledge of biomedicine. In addition, my findings emphasize the importance of orienting information discussed in Savolainen’s (1995) everyday life information-seeking (ELIS) model. For many people with depression, information was used to maintain a sense of coherence (related to “mastery of life” within the ELIS model) and to create meaning in addition to solving practical problems. My findings suggest that an additional information-seeking principle to those outlined by Harris and Dewdney (1994) deserves further research attention: people seek information that is congruent with their worldview and values

Testing the Efficacy of a Brief Psychoeducational Video On Improving Mental Health Literacy

Mental health literacy (MHL) is defined as knowledge and beliefs about mental health disorders which aid in recognition, management, or prevention (Jorm et al., 1997). The concept of MHL is essential in helping individuals understand and recognize symptoms of mental health disorders. In addition, MHL encompasses components related to stigma and attitudes that serve to facilitate or inhibit help seeking behaviors. Although the public has benefited greatly from initiatives aimed at improving knowledge about physical disease, similar initiatives aimed at improving MHL have been comparatively neglected. Many members of the public have difficulty recognizing specific types of psychological distress (Jorm, 2000). Yet, limited interventions aimed at improving MHL have been evaluated and assessed. Enhancement of MHL can lead to a greater likelihood of treatment engagement and successful outcome. The purpose of this study is to introduce the concept of MHL to a wider audience and identifying possible brief psychoeducational interventions that can improve the public’s knowledge about mental health. It was hypothesized that a brief psychoeducational video about depression would be an effective strategy that increases MHL as it relates to knowledge about depression, stigma towards depression, and attitudes towards seeking professional psychological help. Participants were randomly assigned to watch either a video about depression or a video about nutrition. After viewing their respective videos, participants in both conditions were asked to complete scales that measured their depression literacy, stigma towards depression, and attitudes towards seeking professional psychological help. Participants demonstrated similar levels of depression literacy, stigma towards depression, and attitudes towards seeking professional psychological help, regardless of their assigned condition. However, this study found that individuals who have had previous mental health treatment tended to have more positive attitudes towards seeking professional psychological care. This finding suggests the possibility that a healthy interaction with a mental health professional can enhance attitudes towards mental health and increase the likelihood of future treatment engagement

From mental health industry to humane care : suggestions for an alternative systemic approach to distress

The article proposes a rough outline of an alternative systemic approach to mental health issues and of a more humane mental health care system. It suggests focusing on understanding mental distress as stemming from problems in living, using medications as agents facilitating psychotherapy, or as a last resort and short-term help, according to the principles of harm reduction. It argues that understanding drugs as psychoactive substances and studying the subjective effects they produce could lead to better utilization of medications and improvements in terms of conceptualizing and assessing treatment effects. Qualitative research could be particularly useful in that regard. It also advocates a radical departure from current diagnostic systems and proposes a synthesis of already existing alternatives to be used for both research and clinical purposes. Accordingly, a general idea for an alternative mental health care system, based on a combination of Open Dialogue Approach, Soteria houses, individual and group psychotherapy, cautious prescribing, services helping with drug discontinuation, peer-led services and social support is presented. The proposition could be seen as a first step towards developing a systemic alternative that could replace the currently dominating approach instead of focusing on implementing partial solutions that can be co-opted by the current one

Phenomenology of SSRI induced low sexual desire in women treated for depression

Healthy sexual functioning is a topic often not discussed in the mental health field (Arcos, 2004). Women are diagnosed with depression at twice the rate of men and are more frequently prescribed Selective Serotonin Reuptake Inhibitors (SSRI’s) than their male counter parts (Bigos et al, 2009; Fabre and Smith, 2012). SSRI’s have been well documented to cause sexual side effects such as loss of desire for sexual activity. While the incidence of sexual side effects is well documented, the effect it has upon women’s lives and how it impacts women has not been actively researched. This research focuses on gaining a better understanding of the phenomenon by asking the question: What is the lived experience of women who are diagnosed with depression, treated with SSRI medications, and living with the sexual side effect of low or absent desire? Semi-structured interviews were conducted with three women via telephone interviews and analyzed using interpretative phenomenological analysis for superordinate and subordinate themes. Four superordinate themes were identified through this analysis: Making a Choice – Duality of being mentally well or sexually well, Engaging in Sexual Acts – The sexual experience, Why Don’t You Love Me? – Impact of and upon spouse, and Is This Normal? – Talking to others and making comparisons. These themes were further broken down into fifteen subordinate themes. Findings substantiate that women’s sexuality is multifactorial, complex, and sexual side effects from SSRIs are further impacted by relationship dynamics, societal/cultural roles, and communication styles within the relationship. Research and clinical implications of these findings support addressing sexual side effects of SSRI medications from an individual perspective to a couple perspective. Addressing the additional factors impacting women’s sexual functioning and satisfaction may assist to mitigate the sexual side effects of SSRI medications.Includes bibliographical references (pages 134-144)."In partial fulfillment of the requirements for the degree of Master of Psychiatric Nursing.

AMBIGUITY, TEMPORALITY, AND AGENCY IN ONLINE HEALTH COMMUNITIES FOR DYSTHYMIA

Within the heterogeneous amalgam that constitutes “depression” exists dysthymia—a chronic, mild subtype that is rarely the sole focus of public discussion or academic research on the subject of depression. If depression in general is an experientially and linguistically ambiguous phenomenon, as is often claimed, then dysthymia can be considered especially ambiguous given that its chronic, low-grade symptoms are difficult to distinguish from one’s habitual self. Informed by Kenneth Burke’s views on the rhetorical productivity of ambiguity, this dissertation provides a rhetorical account of dysthymia’s ambiguity. It traces a rhetorical history of the conditions that led to dysthymia’s construction as a strategically ambiguous diagnostic entity in the DSM-III, as well as the conditions that led to dysthymia’s replacement with “Persistent Depressive Disorder” in the DSM-5. In addition to providing historical context, this dissertation rhetorically analyzes interactions in online health communities for dysthymia, identifying the ways in which dysthymia’s ambiguity functions as a rhetorical resource. Despite conventional wisdom suggesting that recent biopsychiatric explanations of depression have fully displaced previous psychoanalytic explanations, Chapter 2 of this dissertation observes that explanatory aspects of both paradigms blend together in dysthymia online health communities, which provides a useful strategy for negotiating matters of agency. Focusing on temporality, Chapter 3 argues that the temporal perspectives present in online accounts of dysthymia are marked by temporal expansion rather than the temporal contraction often seen in accounts of chronic physical illness. In contrast to temporal contraction, which is thought to often bolster an individual’s felt sense of agency in the present, this chapter argues that temporal expansion may tend to attenuate one’s felt sense of agency in the present. Chapter 4 explores online health community members’ widespread dissatisfaction with the label of dysthymia, most of which centers upon the disorder’s designation as “mild.” This chapter describes the rhetorical conundrum occasioned by being diagnosed with a “mild” or “high-functioning” mood disorder, and identifies the strategies used to challenge the aptness of “mild” as a descriptor for the subjective experience of dysthymia

Patients’ Accounts of Non-Acceptance and Non-Adherence to Drug Treatment in Depression A Scoping Review and Narrative Synthesis of Research Findings on Patients’ Views on Antidepressants

Major depressive disorder (MDD) is a disabling condition with a high frequency of recurrence and non-recovery, resulting in serious morbidity and mortality (Kessler & Bromet, 2013; Stotland, 2012; Alonso et al., 2013). Depressive patients are said to report persistent symptoms and long-term disability despite high primary care utilization and medicines, and this notion is challenging the efficacy of existing models of care (Stirling et al., 2001; Ambresin et al., 2015). Despite increased numbers of issued prescriptions, the prevalence of depression remains static (Ambresin et al. 2015; Baxter et al., 2014; Wittchen et al., 2011), or demonstrates progressive course (Mojtabai et al. 2016; Hidaka, 2012). This striking polarity of findings opens space for further research. Former studies designed to promote medications for the treatment of depression generated rather discouraging findings (Aikens et al., 2008; Kutcher et al. 2002; Brook et al. 2005; Pampallona et al., 2004; Katon et al., 2001). It seems imperative to undertake a careful analysis of reasons, for which the low effectiveness of treatment may result from its low utilization. A better understanding of individual views on antidepressants may help improve adherence as well as patient-centeredness in depression care and suggest innovative, more effective intervention strategies. Purpose of the study: This review summarises patients’ accounts of experiences with drug therapy in depressive disorder. Perceptions of mood-stabilizing drugs have been explored with the aim to unravel negative treatment decisions. Individual and common beliefs that lead to refusal of antidepresant treatment as well as challenges experienced during initially accepted and initiated treatment have been identified and explained. Methods: With the help of Arksey and O’Malley’s scoping review methodology as a guide, several databases were searched: MEDLINE through PubMed, Scopus, PsycNET and Google Scholar. In addition, bibliographies and references of relevant studies were searched online. As a result, 41 qualitative research papers remained the core of this work. Design triangulation was used to examine the consistency and reliability of qualitative data with 71 quantitative and mixed-methods studies. Concepts emerging from summarized findings are presented in a thematic analysis. The research was conducted in a manner that will allow this review to be replicable. Findings: Utilization of antidepressants continues to raise concerns. Existing scholarly evidence concerning attitudes and people’s behavior in relation to mood-stabilizing drugs uncovered a rich spectrum of ethical, racial, cultural and emotional underpinnings of medical treatment. There were accounts of patients who both accepted and refused drug treatment in the process of acceptance or denial of their depressive condition. Pattern of ignorant or dismissive behaviors observed in health care professionals was the cause of major frustration. Conclusions: depressive patients either fully refuse the medicines or they do not adhere to recommended treatment. The analysed studies provide evidence that adherence to antidepressants is a complex health behavior that is mediated by multiple factors based on patients’ cultural, religious and ethical beliefs. The most serious reasons for non-compliance are adverse side effects and frustration experienced due to lack of efficacy of drug treatment and absence of permanent cure after prolonged use of medications. A major concern is the quick diagnostic procedure based on patient’s self-report and the ease of prescribing antidepressants viewed by patients as unnecessary and harmful. Complains about lack of continuous medical support indicate an urgent need of revision of existing mental-health services and regulations

Digital Healthcare and Expertise

This open access book explores how expertise about bipolar disorder is performed on American and French digital platforms by combining insights from STS, medical sociology and media studies. It addresses topical questions, including: How do different stakeholders engage with online technologies to perform expertise about bipolar disorder? How does the use of the internet for processes of knowledge evaluation and production allow for people diagnosed with bipolar disorder to reposition themselves in relation to medical professionals? How do cultural markers shape the online performance of expertise about bipolar disorder? And what individualizing or collectivity-generating effects does the internet have in relation to the performance of expertise? The book constitutes a critical and nuanced intervention into dominant discourses which approach the internet either as a quick technological fix or as a postmodern version of Pandora’s box, sowing distrust among people and threatening unified conceptualizations and organized forms of knowledge

Doctors, Death, and Drug Money : A Quantitative Analysis of Direct-to-Physician Pharmaceutical Marketing and Mortality

This thesis examines direct-to-physician pharmaceutical marketing in the United States of America. In 2013, about 78 opioid prescriptions were being written for every 100 people, and 17,000 people in the United States died from an opioid overdose. This study asks, what is the relationship, if any, between contemporary direct-to-physician pharmaceutical marketing practices and opioid mortality in the United States? Contained within an expansive piece of U.S. federal legislation, the Patient Protection and Affordable Care Act of 2010 is a provision which mandates pharmaceutical manufacturers to report marketing payments made to physicians, hospitals, and other relevant healthcare providers. By connecting marketing payments to mortality data at several geospatial levels, the study finds that there is a plausible relationship between the direct-to-physician pharmaceutical marketing and mortality