Television is a medium through which dominant cultural ideologies about health and illness circulate. Direct-to-consumer (DTC) drug advertisements, such as those for antidepressants, communicate a distinct image of illness and intervention, and have the potential to shape how we understand these experiences. Though there has been much debate on whether such advertising should be permitted, as well as explorations of their impact, there is an absence of qualitative research on how the public interacts with and makes meaning of these ads. The purpose of this study was to explore the ways in which the public interacts with the messages related to depression and its treatment in DTC antidepressant ads shown on television. Six semi-structured focus groups of 1-2 hours, with 4-6 female participants per group were conducted. Within each group, 2-3 DTC antidepressant ads were viewed, followed by a discussion after each viewing. Focusing on the function of language, discourse analysis was the methodology chosen to explore how the women took up and negotiated the messages within the ads. I show how the women problematized the presentation of depression and its treatment within the ads, often positioning the ads as falling short due to various oversimplifications of depression and treatment. More specifically, they evidenced a reclaiming of normal and depression, as well as a caution in engaging with and staking claims to these categories. This research provides a more in-depth understanding as to how these ads can impact women, who are over-represented in those who are prescribed antidepressants, and how women can take on and challenge the messages in these ads.

The main study purposes were to determine: whether antidepressant (AD) use increases the risk of type 2 diabetes mellitus; and whether results differ when using different methodological designs: retrospective cohort design and nested case-control design. A retrospective Texas Medicaid database analysis of new AD (exposed cohort) and benzodiazepine (unexposed cohort [BZ]) users from January 1, 2002 to December 31, 2009 was conducted. Patients aged 18-64 years without diabetes at cohort entry were included. The primary outcome was incident diabetes and the main independent variable was AD vs. BZ use. Covariates included age, gender, race/ethnicity, medication adherence, persistence, number of concomitant diabetogenic medications, Chronic Disease Score, treatment duration, year of cohort entry, and use of both AD and BZ at index. Regression analyses (adjusted) were used to address the study purposes. Of the study cohort (N=44,715), 35,552 (79.5%) were AD users and 9,163 (20.5%) were BZ users. Patients were followed for an average of 2.3±1.9 years (Median=1.8 years), were on average 38.6±14.2 years old, and 69.3% were female. Using the retrospective cohort design, AD use was associated with a 48.9% increase (logistic regression) and 60.0% increase (Cox regression) in the risk of diabetes compared to BZ use (logistic regression analysis: RR[subscript adj]. =1.489; 95% CI: 1.331-1.667; Cox regression analysis: HR[subscript adj]. =1.600; 95% CI: 1.437 - 1.783). Using a nested case-control design within the entire study cohort, AD use was associated with a 54.1% increase in the risk of diabetes compared to BZ use (OR[subscript adj]. =1.541; 95% CI: 1.368 - 1.735). Using a nested case-control design within the exposed cohort, current AD use was associated with a two-fold higher risk of diabetes compared to former AD use (OR[subscript adj]. =1.995; 95% CI: 1.759 - 2.264). Among antidepressant classes, TCAs, SSRIs, SNRIs, and Other ADs were associated with a higher diabetes risk compared with BZs. The results from the present study suggest that AD use is associated with an increased risk of diabetes. Clinicians may need to take this into account when choosing treatment for depression in patients at high risk of diabetes. / text

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Mental health disorders such as depression and insomnia are prevalent in the community; the use of antidepressants and benzodiazepines is therefore common. However if these medications are not prescribed and used appropriately issues relating to safety and/or efficacy can occur. There is also some concern about the misuse of benzodiazepines by the injecting drug user (IDU) community. The overall aim of this PhD was to perform international utilization comparison studies and analyze national prescribing data to understand and describe factors influencing the use of prescription medicines, in particular antidepressants and benzodiazepines, and to develop some ideas and initiatives to improve future use. Comparisons in the prescribing of benzodiazepines and antidepressants between Nova Scotia, Canada and Australia were undertaken. Dispensing data for all publicly subsidized benzodiazepines and related compounds and antidepressant classes of medications and utilization was compared from 2000-2003, using the World Health Organisation ATC/ DDD system. Australian dispensing data were also used to examine changes in the utilization of antidepressants and benzodiazepines between different age groups within Australia from 2003-2006. Dispensing data and numerical data derived from reports from Australia’s Illicit Drug Reporting System (IDRS) were used to estimate benzodiazepine use by those who inject heroin, in areas with high proportion of persons who inject heroin in Sydney, Melbourne and Brisbane. To determine a strategy aimed at improving the use of benzodiazepines, the literature was searched and the latest interventions, solely focusing on increasing appropriate prescribing and reducing long term use of benzodiazepines worldwide were retrieved and analyzed. The comparison studies showed the use of benzodiazepines increased at a steady but comparable rate in both Australia and Nova Scotia, although overall use was much higher in Nova Scotia than Australia (123 and 48 DDD/1000 beneficiaries/day, respectively). However, the use of antidepressants in Nova Scotia increased at a higher rate than Australia. The variations between the two jurisdictions may be due to the more limited range of benzodiazepines available in Australia, or perhaps different initiatives to control. The differences may also be due to increased exposure to marketing, promotion, education or different prescribing practices in Nova Scotia compared to Australia. From 2003 to 2006, the use of antidepressants increased with age, with those over 65 years having the greatest use (86.9 and 97.7DDD/1000 population/day, respectively). Differences were also seen in the antidepressant most utilized, with the elderly using more tricyclic antidepressants than those who were younger. The utilization of benzodiazepines decreased from 2003-2006 in the same population (66.6 and 61 DDD/1000 concession beneficiaries/day, respectively). However, those over 85 had the highest use of benzodiazepines and used more long acting benzodiazepines than those aged 35-44. This demonstrates that the elderly still account for most use per capita of benzodiazepines. Some of this use may be inappropriate (e.g. use of long-acting benzodiazepines) and hence may provide a useful target for future educational intervention. The elderly also account for the largest per capita use of antidepressants. In areas with a high proportion of heroin IDU, the utilization of benzodiazepines by the estimated IDU population decreased (4064048DDDs in 2000 to 2613100 DDDs in 2006) however the overall use of benzodiazepines in Australia continued to increase from 2000-2006. This demonstrates that the increase in benzodiazepine utilization during this period was not primarily driven by use among IDU. The review identified three main target audiences at which interventions for improving the use of benzodiazepines were aimed at. These were consumers, General Practitioners or long term care facilities. Education, audit and feedback and alerts were the 3 major intervention approaches taken in the studies. The review concluded that studies which used a multi-factorial approach had the largest and most sustained reductions in benzodiazepines use. It appears that support groups for patients, non-voluntary recruitment of GPs, and oral delivery of alerts or feedback may all improve the outcomes of interventions. Using the review findings, an intervention targeting consumers and health professionals was conducted in a rural and urban area of Australia, using informative emails, bookmarks and website over a 6 month period. The intervention showed a significant decrease in the long term use of benzodiazepines within nursing homes located in the intervention geographical areas compared to the control areas. In conclusion the utilization studies revealed the current trends in utilization of antidepressants and benzodiazepines for Australia and led to the development of an intervention, based on factors that were found to influence prescribing of benzodiazepines. The intervention aimed at various target audiences did produce a small improvement in the prescribing of benzodiazepines.

Thesis (Ph. D.)--University of Washington, 2005. / Vita. Includes bibliographical references (leaves 70-88).

Orientador: Telma Gonçalves Carneiro Spera de Andrade / Banca: Camila Marroni Roncon / Banca: Miriam Mendonça Morato de Andrade / Resumo: Fármacos antidepressivos como os inibidores seletivos de recaptação de serotonina (ISRSs; exemplos: fluoxetina e escitalopram) são drogas de primeira escolha no tratamento dos Transtornos de Ansiedade Generalizada (TAG) e do Transtorno do Pânico (TP). No entanto, apesar de eficazes na terapêutica, esses fármacos apresentam limitações no seu uso, tais como: os efeitos desejados ocorrem somente após administração crônica, em torno de 3 a 4 semanas após o início do tratamento; a proporção relativamente alta de pacientes que não respondem à medicação e o frequente aumento nos níveis de ansiedade desse pacientes no início do tratamento, levando à descontinuidade do uso destas drogas. Nesse sentido, há grande interesse na busca de novas estratégias de tratamento, identificando outros sistemas de neurotransmissão que possam estar relacionados à etiologia e, consequentemente, ao tratamento desses transtornos de ansiedade. Estudos prévios apontaram o envolvimento de opioides endógenos na modulação da ansiedade. Mais especificamente em relação ao TP, já se constatou que mecanismos opioides favorecem a atividade inibitória da serotonina em neurônios da Substância Cinzenta Periaquedutal Dorsal (SCPD) que modulam a fuga/pânico, possivelmente por meio da formação de heterodímeros entre receptores 5-HT1A e μ-opioide. Com base em tais aspectos, o presente estudo teve por objetivo investigar o efeito da Buprenorfina, um agonista parcial de receptores µ-opioide e antagonista de receptores κ-op... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Antidepressant drugs such as the selective serotonin reuptake inhibitors (SSRI; examples: fluoxetine and escitalopram) are first choice drugs for treating Generalized Anxiety Disorders (GAD) and Panic Disorder (PD). However, in spite of being therapeutically effective, such drugs present use limitations, such as: the desired effects occur only after chronic administration, within 3 to 4 weeks after the beginning of treatment; a relatively high proportion of patients who do not respond to the drug and the frequent increase of anxiety levels of such patients at the beginning of the treatment, leading to discontinuity in the use of such drugs. Along these lines, there is a great interest in the search of new treatment strategies, identifying other neurotransmission systems which may be related to the etiology and, consequently, to the treatment of such anxiety disorders. Previous studies pointed to the involvement of endogenous opioids in anxiety modulation. More specifically in relation to PD, one has found out that opioid mechanisms favor the inhibitory activity of serotonin in periaqueductal grey matter (dPAG) neurons which modulate escape/panic, probably by means of the formation of heterodimers between 5-HT1A and μ-opioide receptors. Based on such features, this study was carried out aiming at investigating buprenorfine effects, a partial μ-opioide receptor agonist and κ- opioidereceptor antagonist, on the manifestation of defensive behaviors related to GA... (Complete abstract click electronic access below) / Mestre

Neste trabalho enfocaremos o consumo de antidepressivos, buscando questionar a posição mais comumente aceita para explicar o alto consumo dessas substâncias, que geralmente responsabiliza os ardilosos estratagemas das indústrias farmacêuticas ou a hegemonia da psiquiatria biológica na medicina. Acreditamos que as respostas devem ser buscadas em análises mais profundas, e não simplesmente na demonização desse ou daquele ator social considerado isolada,e,tem, pois admitimos que no consumo se constrói parte da racionalidade integrativa e comunicativa de uma sociedade, logo, pensar o consumo implica em um enfoque dos sujeitos enquanto consumidores, indivíduos e cidadãos. Partindo desses considerações, analisaremos o consumo de antidepressivos pela ótica dos usuários através da análise do conteúdo de um site de relacionamentos muito popular na internet brasileira, conhecido como Orkut. / In this work we will focus on the use of antidepressants, seeking to question the position most commonly accepted to explain the high consumption of these substances, which usually blames "cunning ploys" of the pharmaceutical industry or the hegemony of biological psychiatry in medicine. We believe that the answers are to be found in deeper analysis, and not simply on the demonization of this or that social actor considered isolated, and has since admitted that "in the consumption builds part of integrative and communicative rationality of a society" thus think consumption implies a focus subjects as consumers, individuals and citizens. Based on these considerations, we analyze the consumption of antidepressants by the viewpoint of the user by analyzing the content of a site very popular relationships in the Brazilian Internet, known as Orkut.

Made available in DSpace on 2014-10-09T12:34:24Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:09:44Z (GMT). No. of bitstreams: 0 / Dissertação (Mestrado) / IPEN/D / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Neste trabalho enfocaremos o consumo de antidepressivos, buscando questionar a posição mais comumente aceita para explicar o alto consumo dessas substâncias, que geralmente responsabiliza os ardilosos estratagemas das indústrias farmacêuticas ou a hegemonia da psiquiatria biológica na medicina. Acreditamos que as respostas devem ser buscadas em análises mais profundas, e não simplesmente na demonização desse ou daquele ator social considerado isolada,e,tem, pois admitimos que no consumo se constrói parte da racionalidade integrativa e comunicativa de uma sociedade, logo, pensar o consumo implica em um enfoque dos sujeitos enquanto consumidores, indivíduos e cidadãos. Partindo desses considerações, analisaremos o consumo de antidepressivos pela ótica dos usuários através da análise do conteúdo de um site de relacionamentos muito popular na internet brasileira, conhecido como Orkut. / In this work we will focus on the use of antidepressants, seeking to question the position most commonly accepted to explain the high consumption of these substances, which usually blames "cunning ploys" of the pharmaceutical industry or the hegemony of biological psychiatry in medicine. We believe that the answers are to be found in deeper analysis, and not simply on the demonization of this or that social actor considered isolated, and has since admitted that "in the consumption builds part of integrative and communicative rationality of a society" thus think consumption implies a focus subjects as consumers, individuals and citizens. Based on these considerations, we analyze the consumption of antidepressants by the viewpoint of the user by analyzing the content of a site very popular relationships in the Brazilian Internet, known as Orkut.

Made available in DSpace on 2014-10-09T12:34:24Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:09:44Z (GMT). No. of bitstreams: 0 / O uso acentuado de fármacos e de produtos de higiene e cuidados pessoais por grande parcela da população e a conseqüente e contínua entrada dos mesmos no ambiente gera uma necessidade cada vez maior de se investigar a presença, o comportamento e os efeitos causados à biota aquática, bem como novas formas de tratamento para efluentes contendo tais substâncias. O cloridrato de fluoxetina é um princípio ativo utilizado em tratamentos de distúrbios depressivos e de ansiedade. Enquanto o surfactante dodecilsulfato de sódio está presente em diversos produtos de limpeza e de cuidados pessoais. O presente estudo teve como enfoque avaliar a toxicidade aguda do cloridrato de fluoxetina, dodecil sulfato de sódio bem como a mistura de ambos frente aos organismos aquáticos Hyalella azteca, Daphnia similis e Vibrio ficheri. A redução da toxicidade do cloridrato de fluoxetina e da mistura após tratamento com radiação ionizante, proveniente de acelerador industrial de elétrons, também foi objeto de estudo. Para Daphnia similis os valores médios de CE5048h encontrados para o fármaco, o surfactante e a mistura não irradiados foram de 14,4 %, 9,62% e 13,8%, respectivamente. Após irradiação das substâncias, a dose de 5 kGy se mostrou a mais efetiva, resultando em valores médios de CE5048h de 84,60% e >90 %, para o fármaco e para a mistura respectivamente. Para Hyalella azteca foram realizados ensaios de toxicidade aguda para coluna d\'água com duração de 96 horas, cujas médias dos valores de CE5096h encontradas para o fármaco, o surfactante e a mistura não irradiados foram de 5,63 %, 19,29 %, 6,27 %, respectivamente. Para o fármaco e mistura irradiados com a dose de 5 kGy, foram de 69,57% e 77,7 %, respectivamente. Para Vibrio ficheri os ensaios de toxicidade aguda para o fármaco não tratado e para o fármaco irradiado com 5 kGy geraram valores de CE5015min de 6,9 % e 32,88 %, respectivamente. Tais resultados evidenciaram a redução da toxicidade das subtâncias - teste após irradiação. / Dissertação (Mestrado) / IPEN/D / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP