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OBJECTIVE: There are case reports about antidepressants causing arthritis and arthralgia, and the majority of these reports deal with atypical antidepressants, which are serotonin receptor 2A (5-HT(2A))-blocking substances. The aim of this study was to examine a possible association between joint disorders and the use of 5-HT(2A)-blocking atypical antidepressants.

METHODS: We performed a retrospective study using reports of adverse drug reactions (ADRs) of 5-HT(2A)-blocking atypical antidepressant substances concerning joint disorders reported to the Swedish Adverse Drug Reactions Committee and the World Health Organization (WHO) Adverse Reactions Database during the period January 1, 1990 to December 31, 2006. The reports of joint disorders were related to sales figures measured as defined daily doses and to the total number of ADR reports.

RESULTS: In the Swedish material, the 5-HT(2A) antagonists were 45 times more often reported to give joint ADRs when related to sales figures and compared with the selective serotonin reuptake inhibitors (SSRIs; P < 0.001). Joint disorders constituted 6.6% of the total number of reports of possible ADRs for the three 5-HT(2A)-blocking substances mianserin, mirtazapine, and nefazodone compared with 0.5% for the SSRIs (P < 0.001). In the WHO material, the joint disorders constituted 1.3% of all ADRs for the 5-HT(2A)-blocking antidepressants and 0.6% for the SSRIs (P < 0.001).

CONCLUSION: In this study, joint disorders were considerably more frequently reported ADRs of 5-HT(2A)-blocking antidepressants than of other comparable drugs, suggesting a possible association between the use of 5-HT(2A)-blocking antidepressants and joint disorders.

INTRODUCTION: A questionnaire study was conducted among Danish general practitioners (GPs) as part of an international evaluation of the Institute for Rational Pharmacotherapy (IRF). The aim was to investigate GPs' use and opinion of the IRF's activities. MATERIAL AND METHODS: A questionnaire was sent to a random sample of 500 GPs, who were asked about their level of knowledge and frequency of use of IRF's activities, as well as their opinion on the relevance, credibility and independence of the IRF's activities. RESULTS: The response rate was 59%. IRF is generally not the first source of information about new drugs, but is frequently used in the search for information about comparability between drugs and in relation to sudden drug warnings. IRF's Rational Pharmacotherapy bulletin and its GP courses, which nine out of ten GPs knew about, were considered to be highly relevant by 80% and 71%, respectively. All of IRF's activities were considered highly credible. Most GPs felt that the IRF's information increased their confidence in prescribing decisions (84%) and supported them in their role as a GP (88%). CONCLUSION: IRF's activities support the GP's prescribing role through the production of credible, neutral and evidence-based pharmacotherapeutic information that is not available elsewhere. IRF could further refine its dissemination methods, however, in order to reach more GPs and to increase the use of its information.

Introduktion: Som led i en international evaluering af Institut for Rationel Farmakoterapi (IRF) gennemførtes en spørgeskemaundersøgelse blandt alment praktiserende læger for at belyse deres holdninger til og anvendelse af IRFs virkemidler. Materiale og metoder: Et spørgeskema blev sendt til 500 alment praktiserende læger, der var tilfældigt udvalgt af Praktiserende Lægers Organisation. Der blev spurgt til lægernes kendskab til og anvendelse af IRFs aktiviteter samt til opfattelsen af relevans, troværdighed og uafhængighed. Resultater: Svarprocenten var 59. IRF er sjældent den første informationskilde om et nyt lægemiddel, men anvendes hyppigt som informationskilde til sammenligning med andre lægemidler og i forbindelse med pludselige advarsler. Især IRFs Månedsblad og kurser, som kendtes af ni ud af ti læger, vurderedes som i høj grad relevante af hhv. 80% og 71%. Samtlige IRF-aktiviteter vurderedes som meget troværdige. De fleste læger mente, at IRFs information øgede deres sikkerhed i forhold til ordinationer (84%) og støttede dem i deres arbejde (88%). Konklusion: IRFs aktiviteter er en god støtte til de alment praktiserende læger i deres rolle som udskrivere af lægemidler. Lægerne vurderede, at IRF leverer troværdig, uvildig og evidensbaseret information, der ikke er tilgængelig andre steder. IRF kunne dog målrette formidlingen for at nå ud til flere læger og forøge anvendelse af informationen .