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convulsive therapy (ECT) can be prescribed. This treatment is very effective for a greater number of patients. To conclude, when talk therapy is not effective in the treatment of depression, treatment with antidepressants is recommended. 1.2.2 Introduction to the drug methotrexate The population under consideration in this thesis is the population of methotrexate users. Methotrexate (MTX) is a drug used to treat specific types of cancer, and to restrain severe psoriasis and severe rheumatoid arthritis. MTX is an antimetabolite that impedes an enzyme that is vital in the creation of DNA. Its purpose is to slow down the production of tissues which are growing too fast. 19 In addition to common side effects, such as headaches and nausea, sometimes severe side effects occur when using MTX. Among these are allergic reactions, blood in the urine, irregular heartbeat, mental changes, trouble breathing and vision changes. It is strongly recommended not to use MTX if the patient is or is trying to become pregnant, since MTX can cause serious damage to the foetus. 20 With the mentioned side effects and recommendations of treatment in mind, it is clear that MTX is a drug intended to treat serious illnesses. The effectiveness of the drugs has been documented by Yamanaka et al. (2007), who evaluate the efficacy and safety of different MTX dosages using a cross-sectional dataset and a longitudinal dataset with data on Japanese patients diagnosed with rheumatoid arthritis. The cross-sectional analysis is based on 4578 patients observed in 2003 and the longitudinal analysis is based on 1649 patients observed from 2001 until 2005. The data are collected during biannual consultations and consists of the physician’s assessment, an interview with the patient and laboratory data, containing among others a blood count and urine analysis. The evaluation is accomplished by taking advantage of the fact that the patient’s rheumatologist can be identified, and the fact that there is a difference between the dosages prescribed by the rheumatologists. By comparing the outcomes across patients and taking into consideration the different prescribed dosages, the authors find that larger dosages of MTX are related to better effectiveness, but at the same time there is an increase in negative side effects. Through the self-reports it is apparent that these side effects are tolerated by the patients. It should be noted that this study is not a controlled trial since there is no standard way of treating patients with MTX that is applied by all 19 www.drugs.com 20 www.drugs.com 9
heumatologists. But since descriptive statistics show that the patients’ baseline characteristics are similar across the rheumatologists, the differences in outcome are likely to be caused by the differing dosages of MTX. The authors mention that this study is limited since it does not take into account the effect of co medication with other drugs, though RA is seldom treated by MTX alone. This study does not say anything about the patients’ employability, but it shows that MTX is effective in treating RA by restraining the disease activity. 1.2.3 Why it is more likely that patients using MTX develop a depression In the present thesis it is assumed that patients using MTX are more likely to develop a depression than the general population. Different aspects contribute to this assumption. First of all, as already mentioned in section 1.2.1, there is a biological aspect. The disease itself can cause changes in the body that trigger off a depression. Second, there is the psychological angle. Being diagnosed with a chronic disease is a stressful event and gives the patient an element of uncertainty in life. For example in the case of rheumatoid arthritis the course of the disease is very unpredictable and a lot of the damage to the joints occurs in the first years. 21 It is seen that the patient gets into a crisis after the diagnosis, and lives through the different psychological phases of this crisis. The uncertainty can give the patient a lot of psychological strain, which in the worst case can develop into a depression. Most important, regarding whether a patient develops a depression or not, is his or her own ability to cope with the disease and the pain. Also the patient’s immediate surroundings and their support have an influence on the patient’s coping. In the case of rheumatic patients the physical pain and the patient’s psychological condition seem to be interrelated. Often rheumatic patients get depressed and therefore it is important to be aware of the need for psychological treatment early after the diagnosis. The occurrence of anxiety and depression seems to be independent of the degree of severity of the disease. 22 That the risk of developing a depression is indeed higher for patients who are physically ill, is documented by Greener and Guest (2005), who state that between 20 % and 25 % of cancer patients develop a depression. <strong>An</strong>d finally, MTX by itself has the rare side effect of causing depression. Summing up on the mentioned aspects, all in all, MTX users have an increased risk of developing depression compared to the general population 21 Sundhedsstyrelsen (2002) 22 Sundhedsstyrelsen (2002) 10
Page 1 and 2: Estimating the Impact of An
Page 3 and 4: Abstract This thesis aims at analys
Page 5 and 6: 1 Introduction According to the Wor
Page 7 and 8: consisting of lack of data on the d
Page 9 and 10: experience symptoms of depression o
Page 11: (SSRI’s), also called the new ant
Page 15 and 16: H > 0 or a corner solution, H = 0 .
Page 17 and 18: employers more reluctant to hire ne
Page 19 and 20: One of the most cited models when a
Page 21 and 22: One of the factors greatly influenc
Page 23 and 24: Galarraga et al. (2006) have chosen
Page 25 and 26: channel runs through enhanced compl
Page 27 and 28: 3.2 The effect of antidepressants o
Page 29 and 30: of patients receiving appropriate c
Page 31 and 32: Inspired by Galarraga et al. (2006)
Page 33 and 34: are used by other patients groups,
Page 35 and 36: Consequently I am dealing with a se
Page 37 and 38: constructed, and will be explained
Page 39 and 40: As mentioned in chapter 1, one of t
Page 41 and 42: Number of observations 2364 252 211
Page 43 and 44: is perhaps not surprising, since th
Page 45 and 46: Figure 7 The distribution of the us
Page 47 and 48: Figure 9 depicts the defined daily
Page 49 and 50: where φ ( z) is the standard norma
Page 51 and 52: 5.3 The binary response model and p
Page 53 and 54: The log of equation [5.7] gives the
Page 55 and 56: antidepressant use are displayed in
Page 57 and 58: As established in chapter 4, the pa
Page 59 and 60: probit estimation, respectively. Ha
Page 61 and 62: estimation. And ag
Page 63 and 64:
As can be seen from table 7 the ext
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mtx 0.0002 0.0003 0.0001 0.0002 wag
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probit estimation produces more sig
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health. As a consequence, further a
Page 71 and 72:
8 Conclusion The aim of this thesis
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References Agerbo, E., T. Eriksson,
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Zimmerman, F. and W. Katon. 2005. S
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wage2 Dummy=1 if wage income up to
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data medold; set b.lmdb_pct10_2003;
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if Last.aar then output; /*output o
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KEEP AAR ALDER ANC02 ANC36 ANC79 AN
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set b.register; yr=0+aar; DROP aar;
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HIGHER='Middle-range and higher edu
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dayemp4='Between 8 months and 364 d
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data collect; merge test1 (in=a) te
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data test1; set b.finaldata1; proc
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antidep_lastyr=lag(AD_dummy); if (u
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Estimation results Probit yr 2003 -
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Probit estimates Number of obs = 58
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single | -.3439072 .0893125 -3.85 0
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(Assumption: . nested in A) Prob >
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. /*with proxy, generalised residua
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. . /*Panel probit same as Galarrag
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Iteration 7: log pseudolikelihood =
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-----------------------------------
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. . probit emp antidep mtx wageinc
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ho = 0.2 log likelihood = -681.4270
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ab79 | -.2830833 .3452789 -0.82 0.4
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-----------------------------------
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. predict ohat, resid . . probit em
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y99 | -.1676129 .4540083 -0.37 0.71
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ab02*| -.0132912 .01201 -1.11 0.269
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. gen numerator=normdenxb*[ad_dummy
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Iteration 2: log likelihood = -306.
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. . probit emp antidep_last5yrs mtx
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note: 0 failures and 14 successes c
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y = Pr(emp) (predict) = .64904538 -
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Probit yr 2003 - Table 9: . use /ak
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higher | .0160771 .2154333 0.07 0.9
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ieland1*| .2476048 .11071 2.24 0.02
Page 143 and 144:
Random-effects tobit regression Num
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