Search PubMed⌕ Search

Biomedical subjects

U Bergman

Publications and source records attributed to U Bergman.

At least 55 records · Page 3Linked to original sources
PubMed1997

Modern oral contraceptives and cardiovascular disease.

We reviewed evidence that bears on the cardiovascular safety of combined oral contraceptives containing second- and third-generation progestogens and < 50 micrograms of estrogen. Recent epidemiologic studies indicate that current use of these formulations is associated with a smaller increase in the incidence of venous thromboembolism than earlier formulations. In some studies the increase for third-generation formulations containing desogestrel or gestodene was about 1.5 to 2 times that for second-generation formulations, but there is evidence that differences between users in underlying risk and likelihood of being diagnosed contributed to this result. Recent studies of myocardial infarction suggest a smaller increase in risk associated with modern formulations than with earlier ones; one study suggests a threefold increase for second-generation formulations and no increase for third-generation formulations, but the finding requires confirmation. Recent studies of stroke indicate little or no increase in risk for modern formulations among women without risk factors. We conclude that modern combined oral contraceptives are safer than earlier formulations with respect to cardiovascular disease, which occurs rarely in young women.

Cardiovascular Diseases↗
PubMed1997

The utilization of antidepressants--a key issue in the prevention of suicide: an analysis of 5281 suicides in Sweden during the period 1992-1994.

Antidepressants detected by the National Department of Forensic Chemistry in 5281 suicides in Sweden during the period 1992-1994 were related to data on usage expressed in person-years of exposure. Antidepressants were detected in 874 subjects (16.5%). In relation to their use, fluvoxamine, citalopram, moclobemide, mianserin and trimipramine were found more often than the reference drug, amitriptyline (i.e. over-risks). Toxic concentrations of antidepressants were detected in 232 subjects (4.4%). Most people committing suicide were not taking antidepressants immediately before their death, even though 40-85% may have been depressed. Undertreatment and therapeutic failure are the main problems with antidepressants, not the risk of using antidepressants in overdose. Comparisons of new antidepressants should focus on efficacy in relation to reference tricyclics. The huge increase in the use of antidepressants in Sweden since 1990-1991 has been paralleled by a significant decrease in suicide rates.

Amitriptyline↗
PubMed1996

Epidemiological data suggest antidepressants reduce suicide risk among depressives.

In spite of the availability of antidepressant medication for several decades, it has not been shown that such medication lowers the risk for suicide in depressed patients. This report explores this apparent paradox by means of pharmacoepidemiological methods. Data on the prevalence of depression in the population and among suicides as well as data on the prevalence of antidepressant medication in depressed suicides were obtained from a review of the literature. Data on the prevalence of antidepressant medication in the population in 1990-1991 were obtained from the statistics of the Swedish National Corporation of Pharmacies. It was found that only one in five depressed individuals with major depression were treated with antidepressants in Sweden. The calculated risk for suicide among depressed patients who were treated with antidepressants was 141 per 100,000 person years and, among the untreated, 259 per 100,000 person years (i.e., 1.8 times higher among the untreated). This supports the hypothesis that antidepressant medication decreases the risk for suicide in depressed patients. The reason this has not been obvious in the general suicide statistics seems to be that so few depressed people are treated with antidepressants. Effective suicide prevention strategies should include intensive efforts to recognize and treat more depressed people.

Antidepressive Agents↗
PubMed1996

The use of antidepressants and therapeutic drug monitoring by general practitioners and psychiatrists: findings from a questionnaire survey in two Swedish areas.

We wished to assess general practitioners' and psychiatrists' sensitivity and specificity in the diagnosis of depression, rationale for drug of choice, average and range of prescribed daily doses of antidepressants, and use of therapeutic drug monitoring (TDM). A questionnaire survey was given to 264 psychiatrists and general practitioners (GPs) in one urban area of Stockholm and the rural county of Jamtland, Sweden. The response rate was 86% (n = 228). The survey was validated against independent studies of actual prescription rates. One of eight physicians presented with a hypothetical case history of major depression appeared unwilling to use antidepressants. Two-thirds of the GPs and one-fourth of the psychiatrists usually prescribed doses that were too low. Many doctors never prescribed doses higher than 150 mg/day of common tricyclic antidepressants, although many patients clearly need higher doses. The choice of drug was based mostly on the therapeutic tradition and seldom on considerations of scientific evidence. The few physicians who utilized TDM (plasma concentrations) for dosing prescribed a more flexible dosage schedule and higher average doses as well as higher maximal doses. Interestingly, there were no significant differences in dosing between GPs and psychiatrists in this group, while striking differences were found in the whole study group, with GPs prescribing much smaller doses. Regular use of TDM as a means for individualizing the dose regimen of antidepressants should be encouraged, as well as continuous education of general practitioners in the diagnosis and treatment of depression.

Antidepressive Agents↗
PubMed1995

Prescribing patterns for elderly community-dwelling heavy medicinal drug users in Manitoba, Canada and Jämtland, Sweden.

Patterns of drugs prescribed for elderly community-dwelling heavy medicinal drug users were determined from random samples of data bases and compared between Manitoba, Canada and Jämtland, Sweden for the year 1981. Qualitatively, there was 80% concordance between the 20 most frequently prescribed drugs in Manitoba and in Jämtland. Gender differences were rare, but there were notable quantitative differences for prescription of specific drugs between the two jurisdictions. Drugs to treat cardiovascular diseases were prominent in both groups with thiazides, triamterene and alpha-methyldopa more frequently prescribed for Manitoba patients, and furosemide, potassium supplements and digoxin more frequently prescribed for patients from Jämtland. The frequent prescribing of codeine in combination analgesics in Manitoba and phenothiazines in Jämtland appears to represent geographically disparate approaches to the use of these drugs. Overall, the concordance of prescribed drugs for elderly heavy medicinal drug users from these two jurisdictions appears to outweigh the differences. These results indicate that data from studies of heavy medicinal drug users, at least in the industrialized world, may be more widely applicable than to the geographical location from where they were obtained.

Aged↗
PubMed1995

Self-poisonings with antidepressants and other psychotropics in an urban area of Sweden.

As part of a WHO project on parasuicide, the medications used for self-poisoning in the Stockholm area were studied. The prescribing rates of the medications were estimated from an independent survey of prescriptions. Anxiolytics, hypnotics, and analgesics were the drugs most commonly used for parasuicide. Related to prescribing rates, antipsychotics and anxiolytics represented an increased risk for parasuicide compared to the average for psychotropics. Analgesics, on the other hand, showed a lower risk for parasuicide. The low number of self-poisonings with antidepressants may reflect that suicidal individuals are seldom prescribed antidepressants and/or that antidepressants actually prevent suicidal acts. As we have shown earlier for completed suicides, underprescribing and therapeutic failure seem to be greater problems with antidepressants than their use for self-poisoning.

Adolescent↗
PubMed1994

Choice of antidepressants: questionnaire survey of psychiatrists and general practitioners in two areas of Sweden.

OBJECTIVE: To identify factors that affect physicians' choice of specific antidepressant drugs in order to evaluate the validity of epidemiological studies of the risks (particularly suicide) and benefits of different compounds. DESIGN: Questionnaire survey of 264 psychiatrists and general practitioners in an urban area and a rural area of Sweden with validation of data by independent prescription surveys. SETTING: Urban area of greater Stockholm and rural county of Jämtland, Sweden. SUBJECTS: 228 physicians (86%) who answered the questionnaire. MAIN OUTCOME MEASURES: The drugs used as first line drugs of choice, as drugs of choice in particularly severe depression, and as drugs of choice for disorders other than depression. RESULTS: Amitriptyline was the most common first line drug of choice among both psychiatrists and general practitioners. The patterns of choice of antidepressants in the two areas accorded with prescribing patterns in two independent prescription surveys. Amitriptyline was chosen even more frequently for severe depression and depression with severe insomnia. Clomipramine was chosen comparatively more often for depression with severe anxiety. Low toxicity compounds (mainly lofepramine, mianserin, and moclobemide) were more often the drug of choice in depression associated with overt risk of suicide. Amitriptyline and clomipramine were used extensively for disorders other than depression (40% and 54% of prescriptions, compared with 13-19% for some other major antidepressants). CONCLUSION: Patient groups treated with different antidepressant compounds may not be comparable with respect to diagnoses and severity of disease. In particular, lofepramine, mianserin, and moclobemide, and possibly amitriptyline, seem to be chosen more often for patients prone to suicide.

Antidepressive Agents↗