Transcript Use of Psychotropic Medications in Patients Before and

Thomas J Dingle, MD, Jay S Pepose, MD, PhD, Susan K Feigenbaum,
PhD, Mujtaba A Qazi, MD
* None of the investigators have any financial interests related to this presentation
Purpose
• The percentage of US adults with a diagnosable mental disorder may be
as high as 20%.1
• The prevalence of psychotropic drug use in the general, noninstitutionalized United States population is between 8.1% and 11.1%.2,3
• Depression and mood disorders have been associated with a poor
psychosocial outcome for various surgical procedures,4-7 including refractive
surgery.8
• On April 25, 2008 the FDA Ophthalmic Devices Advisory Panel meeting
heard both expert opinion and family and patient testimony on post-LASIK
depression and suicide.
• The are over 700,000 refractive surgery procedures performed each year in
the USA, and this population includes patients with psychiatric disorders.
Purpose
• To assess the prevalence of psychotropic medication use in various patient
populations at one institution (Pepose Vision Institute)
• To compare the prevalence of psychotropic medication use in the prerefractive surgery population compared to:
a) the general US population over age 18
b) the contact lens population over age 18
c) the LASIK retreatment population
• To compare the prevalence of psychotropic medication use prior to primary
refractive surgery and prior to retreatment
• To assess the odds ratio of psychotropic medication use associated with age
and gender in the refractive surgery and contact lens groups, and to compare
these odds ratios to the general population
Methods
Retrospective chart review of patients in one high volume, refractive
practice (Pepose Vision Institute)
The charts were selected randomly from previous office visits from
2002 to 2008.
The data collected was analyzed using Linear Prob, Probit, Logit
qualitative choice estimation models
Results
Three Study Populations
Primary
Refractive
Surgery
Retreatment
Contact Lens
Users
Number
N=120
N=120
N=115
Mean age (SD)
and Range
40.5±10.8 (20-60)
44.9±13.1 (18-70)
43.9±9.3 (20-63)
% Male
52.1
33.0
39.0
Mean Spherical
Equivalent and
range
-3.5±2.8
(-10.4 to +2.75D)
-2.79±3.9
(-14.24 to +7.25D)
-4.14±2.46
(-11.25 to +5.0D)
Absolute
Spherical
Equivalent
3.84±2.39D
*MRx prior to primary
surgery
3.86±2.84D
4.64±2.46
Psychotropic Drug Use
Drug
Indications
Primary
Refractive Surg.
Retreatment
Contact Lens
Users
Nortryptyline
TCAntidepressant
1
0
0
Buspirone
General anxiety
disorder
1
0
0
Duloxetine
SNRI; Antidepressant
0
0 (+1 added between
treatment)
1
Venlafaxine
SNRI; Depression, GAD,
panic disorder
5
4
2
Doxapine
TCA
0
1
0
Amitryptyline
TCA
1
2
2
Escitalopram
SSRI, Depression, GAD
2
1 (+1 added between
treatment)
2
Paroxetine
SSRI; depression, OCD,
panic disorder
0
0
3
Fluoxetine
SSRI; depression, OCD,
panic disorder
3
3
0
Trazadone
TCA
3
1 (+1 added between
treatment)
0
Diazepam
Anti-anxiety
1
1
0
Buproprion
Anti-depressant, ADD
3
1 (+1 added between
treatment)
3
Alprazolam
Anti-anxiety, Panic
Disorder
1
0
1
Psychotropic Drug Use
(one or more medications)
Primary
refractive
surgery
Retreatment
Contact Lens
Users
General
Population
(NHANES 19992002)
N=120
N=120
N=115
N=12,060
13.9%
11.1%
15% prior to
primary surgery
16.7%
15.8% prior to
retreatment
Psychotropic Drug Use by Gender
Men
Women
Primary
Refractive
Surgery
Retreatme
nt
n=63
% Drug
Use in
NHANES
Contact
Lens User
% Drug Use in
3 Study
Groups
n=48
n=38
n=149
n=396
8.0%
6.3%
10.5%
8.1%*
8.0%
n=57
n=72
n=77
n=206
n=687
26.3%
20.8%
15.6%
20.4%*†
13.9%†
* Psychotropic drug use was higher in female compared to male subjects (p=0.001)
†
Psychotropic drug use in females was higher in study subjects compared to the general population (p=0.001)
Results
Variables affecting CTL fitting versus refractive surgery
 Psychotropic drug use and age (with and without gender as an
independent variable) were not significant predictors of the probability of
refractive surgery versus contact lens use.
 Male gender was a significant predictor of the probability of refractive
surgery (p=0.02).
 Higher spherical equivalent was a significant predictor of the probability
of contact lens fitting (p=0.02)
Results
Variables affecting the probability of retreatment
 Psychotropic drug use did not increase the probability of retreatment
 Adding a psychotropic medication after primary treatment did not
increase the probability of retreatment
 Older age (p=0.003) increased the probability of retreatment
 Men were 14% less likely than women, on average, to have retreatment
surgery (p=0.04)
 Higher pre-LASIK spherical equivalents increased the likelihood of
retreatment; p=0.06 (Logit p=0.05)
 The probability of adding a psychotropic medication after initial
refractive surgery and prior to retreatment was not correlated with the
pre-retreament spherical equivalent or the time from initial surgery to
retreatment
Conclusions
 In aggregate, choosing keratorefractive surgery does not appear to pre-select for
patients taking psychotropic medications.
 Use of anti-depressant/anti-anxiety medications is more common in women than
men and has similar prevalence in patients electing to undergo refractive laser
surgery or contact lens fitting.
 The incidence of psychotropic drug use in both contact lens and LASIK patients
was significantly higher than that reported in the general US adult population. This
could reflect regional, socioeconomic, other demographic differences, or changes in
national drug use since 2002.
 There were few changes in psychotropic drug use in patients between primary
LASIK and retreatment, and no changes in the other 2 groups.
 The length of time between primary LASIK and retreatment did not increase the
likelihood of adding psychotropic drugs.
Conclusions
 Further studies are indicated to assess any effect of
preoperative depression, anxiety or mood disorder on a
patient’s perceived outcome of LASIK surgery and the
surgical experience.
 Some anti-depressant medications can cause dry eye
and mydriasis, which may independently decrease
patient satisfaction post-LASIK surgery.9 These potential
drug side effects should be screened for and
aggressively managed.
.
References
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