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The prevalence of sleep loss and sleep disorders in young and old adults. AGING BRAIN 2023; 3:100057. [PMID: 36911264 PMCID: PMC9997161 DOI: 10.1016/j.nbas.2022.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/28/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
The ability to sleep declines with age. The National Sleep Foundation, USA has recommended a minimum sleep amount for all ages. Individuals who experience sleep lesser than the recommended amount could be sleep-deprived. Several factors like stress, altered circadian cycle, medical conditions, etc. cause sleep deficiency. Almost 50-60 % of elderly population suffer from sleep disorders such as sleep apnea, restless legs syndrome, REM sleep behavior disorder, etc. Chronic sleep deprivation may further lead to the development of diseases such as Alzheimer's and Parkinson's. This paper reviews the prevalence of sleep disorders and consequences of sleep loss in young and old adults.
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Xu G, Li X, Xu C, Xie G, Liang J. Effect of insomnia in the major depressive disorder. BMC Neurol 2022; 22:341. [PMID: 36088310 PMCID: PMC9463721 DOI: 10.1186/s12883-022-02869-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background People with sleep problems are more likely to have mental disorders. This study aimed to assess the effect of insomnia on the prognosis of patients with major depressive disorder (MDD). Methods We divided the patients into three groups according to the Insomnia Severity Index (ISI) scores. In addition, we compared the results of the Hamilton Depression Scale (HAMD) and Symptom Checklist-90 (SCL-90) scores. We evaluated the effect of insomnia at the 2nd, 4th, and 8th-week follow-up on the prognosis of MDD. Results Fifty-five patients between 19 and 58 years old, with a diagnosis of MDD via the Structured Clinical Interview for the Diagnostic and Statistical Manual-5 (DSM-5). The ISI scores of the moderate and severe group decreased significantly (P < 0.05) in the 2nd week compared to the baseline. The HAMD scores in all groups improved significantly in the 2nd week. Conclusions This study was inspired to assess insomnia as a comorbid disorder for patients with MDD, which may bring poor treatment consequences.
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Borentain S, Williamson D, Turkoz I, Popova V, McCall WV, Mathews M, Wiegand F. Effect of Sleep Disturbance on Efficacy of Esketamine in Treatment-Resistant Depression: Findings from Randomized Controlled Trials. Neuropsychiatr Dis Treat 2021; 17:3459-3470. [PMID: 34880615 PMCID: PMC8646953 DOI: 10.2147/ndt.s339090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the relationship of sleep disturbance to the antidepressant effects of esketamine. MATERIALS AND METHODS Two double-blind, 4-week studies randomized adults with treatment-resistant depression (TRD) to placebo or esketamine nasal spray, each with newly initiated antidepressant. Sleep was assessed using Montgomery-Åsberg Depression Rating Scale (MADRS) item 4. Change in response (≥50% decrease in MADRS total score) and remission (total MADRS score ≤12) at day 28 was examined by presence/absence of baseline sleep disturbance using logistic regression models. Impact on reported sleep disturbance (MADRS item 4 score) was examined using ANCOVA models. RESULTS At baseline, most patients reported disturbed sleep - moderate/severe (65.3%, 369/565), mild (25.3%, 143/565), or none/slightly (9.4%, 53/565) - with similar distribution between treatment groups. A higher proportion of esketamine-treated patients achieved response (OR = 2.05; 95% CI: 1.40-3.02; P < 0.001) and remission (OR = 1.81; 95% CI: 1.23-2.66; P = 0.003) at day 28 compared to antidepressant plus placebo, regardless of presence/severity of sleep disturbance. Consistent with this, sleep (MADRS item 4 score) improved in both groups after the first dose, more so with esketamine by day 8 (between-group difference: P ≤ 0.02 at all time points). Across both treatment groups, 1-point improvement in sleep at day 8 increased the probability of antidepressant response on day 28 by 26% (OR = 1.26, 95% CI: 1.12-1.42; P < 0.001), and remission by 28% (OR = 1.28, 95% CI: 1.14-1.43; P < 0.001). CONCLUSION Antidepressant efficacy of esketamine was demonstrated in patients with TRD, regardless of the presence of sleep disturbance. After 8 days of treatment and thereafter, significantly more esketamine-treated patients reported improvement in sleep versus antidepressant plus placebo.
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Affiliation(s)
- Stephane Borentain
- Department of Global Medical Affairs, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - David Williamson
- CNS Scientific Affairs Liaisons, Janssen Scientific Affairs, LLC, Titusville, NJ, USA.,Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ibrahim Turkoz
- Department of Clinical Statistics, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Vanina Popova
- Department of Neuroscience Clinical Development, Janssen Research & Development, Beerse, Belgium
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Maju Mathews
- Department of Global Medical Affairs, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Frank Wiegand
- Department of Global Medical Affairs, Janssen Research & Development, LLC, Titusville, NJ, USA
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Wu L, Wang XQ, Yang Y, Dong TF, Lei L, Cheng QQ, Li SX. Spatio-temporal dynamics of EEG features during sleep in major depressive disorder after treatment with escitalopram: a pilot study. BMC Psychiatry 2020; 20:124. [PMID: 32171290 PMCID: PMC7071588 DOI: 10.1186/s12888-020-02519-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/26/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous studies have shown escitalopram is related to sleep quality. However, effects of escitalopram on dynamics of electroencephalogram (EEG) features especially during different sleep stages have not been reported. This study may help to reveal pharmacological mechanism underlying escitalopram treatment. METHODS The spatial and temporal responses of patients with major depressive disorder (MDD) to escitalopram treatment were analyzed in this study. Eleven MDD patients and eleven healthy control subjects who completed eight weeks' treatment of escitalopram were included in the final statistics. Six-channel sleep EEG signals were acquired during sleep. Power spectrum and nonlinear dynamics were used to analyze the spatio-temporal dynamics features of the sleep EEG after escitalopram treatment. RESULTS For temporal dynamics: after treatment, there was a significant increase in the relative energy (RE) of δ1 band (0.5 - 2 Hz), accompanied by a significant decrease in the RE of β2 band (20 - 30 Hz). Lempel-Ziv complexity and Co - complexity values were significantly lower. EEG changes at different sleep stages also showed the same regulation as throughout the night sleep. For spatio dynamics: after treatment, the EEG response of the left and right hemisphere showed asymmetry. Regarding band-specific EEG complexity estimations, δ1 and β2 in stage-1 and δ1 in stage-2 sleep stage in frontal cortex is found to be much more sensitive to escitalopram treatment in comparison to central and occipital cortices. CONCLUSIONS The sleep quality of MDD patients improved, EEG response occurred asymmetry in left and right hemispheres due to escitalopram treatment, and frontal cortex is found to be much more sensitive to escitalopram treatment. These findings may contribute to a comprehensive understanding of the pharmacological mechanism of escitalopram in the treatment of depression.
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Affiliation(s)
- Li Wu
- School of automation Hangzhou Dianzi University, HangZhou Economic Development Zone, 1158, 2# Road, BaiYang Street, Hangzhou, 310018 Zhejiang China
| | - Xue-Qin Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Yong Yang
- School of automation Hangzhou Dianzi University, HangZhou Economic Development Zone, 1158, 2# Road, BaiYang Street, Hangzhou, 310018 Zhejiang China
| | - Teng-Fei Dong
- School of automation Hangzhou Dianzi University, HangZhou Economic Development Zone, 1158, 2# Road, BaiYang Street, Hangzhou, 310018 Zhejiang China
| | - Ling Lei
- School of automation Hangzhou Dianzi University, HangZhou Economic Development Zone, 1158, 2# Road, BaiYang Street, Hangzhou, 310018 Zhejiang China
| | - Qi-Qi Cheng
- School of automation Hangzhou Dianzi University, HangZhou Economic Development Zone, 1158, 2# Road, BaiYang Street, Hangzhou, 310018 Zhejiang China
| | - Su-Xia Li
- National Institute on Drug Dependence, Peking University, Beijing, 100191 China
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Dzevlan A, Redzepagic R, Hadzisalihovic M, Curevac A, Masic E, Alisahovic-Gelo E, Merdzanovic E, Hadzimuratovic A. Quality of Life Assessment in Antidepressant Treatment of Patients with Depression and/or Anxiety Disorder. Mater Sociomed 2019; 31:14-18. [PMID: 31213949 PMCID: PMC6511371 DOI: 10.5455/msm.2019.31.14-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: The concept of quality of life (QoL) is becoming an increasingly important criterion in the assessment of treatment outcomes, health outcomes and in the assessment of the benefit-to-load ratio of drugs or therapies that have equivalent mechanisms of action. Aim: The aim of the study was to evaluate the improvement of quality of life, tolerability of therapy and patient compliance in patients with depression and/or anxiety disorder treated with antidepressants. Methods: The study was designed as a clinical, multicenter, prospective, cohort study involving 682 patients of both sexes diagnosed with depression and/or anxiety disorder observed over the 9 months period. The study was conducted from January to December 2017 in six research centers of the PI Health Center of the Canton of Sarajevo. The patients were divided into three groups: depressive, anxious and mixed anxiety-depressive disorder, and the therapy administered was, paroxetine or escitalopram. MOS (Medical Outcomes Study) sleep scale and Q-LES-Q-SF (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form) scale were used for quality of life evaluation. Patients were observed six times over the course of the study. Results: The results of the MOS questionnaire showed that more than 90 percent of patients with depression and/or anxiety disorder who had taken fluoxetine, paroxetine or escitalopram for 36 weeks experienced an improvement in the sleep problem index. Sleep duration was greatly improved in all patients regardless of the antidepressants used. The results of the Q-LES-Q-SF questionnaire showed a significant improvement in quality of life as well as overall pleasure and satisfaction with life due to the use of antidepressants. Conclusion: Therapy with fluoxetine, paroxetine and escitalopram leads to a significant improvement of all recorded parameters, along with the overall quality of life, which makes them very effective in the treatment of depression and/or anxiety disorders.
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Affiliation(s)
- Azra Dzevlan
- Public Institution Health Centre of Sarajevo Canton, Sarajevo
| | | | | | - Amela Curevac
- Public Institution Health Centre of Sarajevo Canton, Sarajevo
| | - Erna Masic
- Public Institution Health Centre of Sarajevo Canton, Sarajevo
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Stein DJ, Khoo JP, Ahokas A, Jarema M, Van Ameringen M, Vavrusova L, Hӧschl C, Bauer M, Bitter I, Mosolov SN, Olivier V, Matharan S, Picarel-Blanchot F, de Bodinat C. 12-week double-blind randomized multicenter study of efficacy and safety of agomelatine (25-50 mg/day) versus escitalopram (10-20 mg/day) in out-patients with severe generalized anxiety disorder. Eur Neuropsychopharmacol 2018; 28:970-979. [PMID: 30135032 DOI: 10.1016/j.euroneuro.2018.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/02/2018] [Accepted: 05/17/2018] [Indexed: 12/18/2022]
Abstract
Treatment of severely symptomatic patients with generalized anxiety disorder (GAD) raises particular concerns for clinicians. This 12-week double-blind study evaluated the efficacy of agomelatine (25-50 mg/day) in the treatment of patients with severe GAD, using escitalopram (10-20 mg) as active comparator. The primary outcome measure was the change from baseline of the total score on the Hamilton Anxiety scale (HAM-A) at week 12. Secondary outcome measures included rate of response to treatment (at least 50% score reduction from baseline) in the HAM-A psychic and somatic anxiety sub-scores, Clinical Global Impression severity and change scores, the Toronto Hospital Alertness Test, the Snaith-Hamilton Pleasure Scale, and the Leeds Sleep Evaluation Questionnaire Scores. Sixty one clinical centers (Australia, Canada, Czech Republic, Finland, Germany, Hungary, Poland, Russia, Slovakia) participated from April 2013 to February 2015. Patient characteristics and demographic data were comparable between treatment groups. Both treatments were associated with a clinically significant decrease in HAM-A total score at week 12; the non-inferiority of agomelatine versus escitalopram was not demonstrated (E(SE) = -0.91(0.69), 95%CI = [-2.26, 0.44], p = 0.195). At week 12, the response rate was 60.9% in the agomelatine group, and 64.8% in the escitalopram group. In both treatment arms, HAM-A psychic and somatic anxiety scores decreased, alertness and sleep parameters improved, and ability to experience pleasure increased. In these secondary outcome measures, there were no significant differences between the treatment groups. Agomelatine was well-tolerated, with a lower incidence of adverse events than escitalopram. Agomelatine and escitalopram are efficacious in treating GAD patients with severe symptoms.
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Affiliation(s)
- Dan J Stein
- University of Cape Town Department of Psychiatry & MRC Unit on Risk and Resilience in Mental Disorders, Groote Schuur Hospital, Anzio Road, Cape Town 7925, South Africa.
| | - Jon-Paul Khoo
- Toowong Specialist Clinic - Level 2, 54 Jephson Street, Toowong, QLD 4066 Australia
| | - Antti Ahokas
- Mehilainen Clinic, Runeberginkatu, 47 A, 00260 Helsinki, Finland
| | - Marek Jarema
- Institute of Psychiatry and Neurology, 3rd Department of Psychiatry, Sobieskiego 9, 02-0957 Warszawa, Poland
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1057 Main St. West, Suite L02, Hamilton, Ontario L8S 1B7, Canada
| | - Livia Vavrusova
- Private Psychiatric Practice - Vavrušová Consulting s.r.o., Záporožská 12, 851 01 Bratislava, Slovakia
| | - Cyril Hӧschl
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czechia
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Germany
| | - Istvan Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa u. 6, H-1083 Budapest Hungary
| | - Sergey N Mosolov
- Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, 3, Poteshnaya street, 107076 Moscow, Russia
| | - Valérie Olivier
- Institut de Recherches Internationales Servier (IRIS), 50 rue Carnot, 92284 Suresnes Cedex, France
| | - Sophie Matharan
- Institut de Recherches Internationales Servier (IRIS), 50 rue Carnot, 92284 Suresnes Cedex, France
| | | | - Christian de Bodinat
- Institut de Recherches Internationales Servier (IRIS), 50 rue Carnot, 92284 Suresnes Cedex, France
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Everitt H, Baldwin DS, Stuart B, Lipinska G, Mayers A, Malizia AL, Manson CCF, Wilson S. Antidepressants for insomnia in adults. Cochrane Database Syst Rev 2018; 5:CD010753. [PMID: 29761479 PMCID: PMC6494576 DOI: 10.1002/14651858.cd010753.pub2] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Insomnia disorder is a subjective condition of unsatisfactory sleep (e.g. sleep onset, maintenance, early waking, impairment of daytime functioning). Insomnia disorder impairs quality of life and is associated with an increased risk of physical and mental health problems including anxiety, depression, drug and alcohol abuse, and increased health service use. hypnotic medications (e.g. benzodiazepines and 'Z' drugs) are licensed for sleep promotion, but can induce tolerance and dependence, although many people remain on long-term treatment. Antidepressant use for insomnia is widespread, but none is licensed for insomnia and the evidence for their efficacy is unclear. This use of unlicensed medications may be driven by concern over longer-term use of hypnotics and the limited availability of psychological treatments. OBJECTIVES To assess the effectiveness, safety and tolerability of antidepressants for insomnia in adults. SEARCH METHODS This review incorporated the results of searches to July 2015 conducted on electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL, 2015, Issue 6), MEDLINE (1950 to 2015), Embase (1980 to 2015) and PsycINFO (1806 to 2015). We updated the searches to December 2017, but these results have not yet been incorporated into the review. SELECTION CRITERIA Randomised controlled trials (RCTs) of adults (aged 18 years or older) with a primary diagnosis of insomnia and all participant types including people with comorbidities. Any antidepressant as monotherapy at any dose whether compared with placebo, other medications for insomnia (e.g. benzodiazepines and 'Z' drugs), a different antidepressant, waiting list control or treatment as usual. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for eligibility and extracted data using a data extraction form. A third review author resolved disagreements on inclusion or data extraction. MAIN RESULTS The search identified 23 RCTs (2806 participants).Selective serotonin reuptake inhibitors (SSRIs) compared with placebo: three studies (135 participants) compared SSRIs with placebo. Combining results was not possible. Two paroxetine studies showed significant improvements in subjective sleep measures at six (60 participants, P = 0.03) and 12 weeks (27 participants, P < 0.001). There was no difference in the fluoxetine study (low quality evidence).There were either no adverse events or they were not reported (very low quality evidence).Tricyclic antidepressants (TCA) compared with placebo: six studies (812 participants) compared TCA with placebo; five used doxepin and one used trimipramine. We found no studies of amitriptyline. Four studies (518 participants) could be pooled, showing a moderate improvement in subjective sleep quality over placebo (standardised mean difference (SMD) -0.39, 95% confidence interval (CI) -0.56 to -0.21) (moderate quality evidence). Moderate quality evidence suggested that TCAs possibly improved sleep efficiency (mean difference (MD) 6.29 percentage points, 95% CI 3.17 to 9.41; 4 studies; 510 participants) and increased sleep time (MD 22.88 minutes, 95% CI 13.17 to 32.59; 4 studies; 510 participants). There may have been little or no impact on sleep latency (MD -4.27 minutes, 95% CI -9.01 to 0.48; 4 studies; 510 participants).There may have been little or no difference in adverse events between TCAs and placebo (risk ratio (RR) 1.02, 95% CI 0.86 to 1.21; 6 studies; 812 participants) (low quality evidence).'Other' antidepressants with placebo: eight studies compared other antidepressants with placebo (one used mianserin and seven used trazodone). Three studies (370 participants) of trazodone could be pooled, indicating a moderate improvement in subjective sleep outcomes over placebo (SMD -0.34, 95% CI -0.66 to -0.02). Two studies of trazodone measured polysomnography and found little or no difference in sleep efficiency (MD 1.38 percentage points, 95% CI -2.87 to 5.63; 169 participants) (low quality evidence).There was low quality evidence from two studies of more adverse effects with trazodone than placebo (i.e. morning grogginess, increased dry mouth and thirst). AUTHORS' CONCLUSIONS We identified relatively few, mostly small studies with short-term follow-up and design limitations. The effects of SSRIs compared with placebo are uncertain with too few studies to draw clear conclusions. There may be a small improvement in sleep quality with short-term use of low-dose doxepin and trazodone compared with placebo. The tolerability and safety of antidepressants for insomnia is uncertain due to limited reporting of adverse events. There was no evidence for amitriptyline (despite common use in clinical practice) or for long-term antidepressant use for insomnia. High-quality trials of antidepressants for insomnia are needed.
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Affiliation(s)
- Hazel Everitt
- University of SouthamptonPrimary Care and Population Sciences, Faculty of MedicineAldermoor Health CentreAldermoor CloseSouthamptonUKSO16 5ST
| | - David S Baldwin
- University of SouthamptonUniversity Department of Psychiatry, Faculty of MedicineSouthamptonUK
| | - Beth Stuart
- University of SouthamptonPrimary Care and Population Sciences, Faculty of MedicineAldermoor Health CentreAldermoor CloseSouthamptonUKSO16 5ST
| | - Gosia Lipinska
- University of Cape TownUCT Sleep Sciences, Department of PsychologyCape TownSouth Africa
| | - Andrew Mayers
- Bournemouth UniversityDepartment of Psychology, Faculty of Science and TechnologyPoole House, Talbot CampusFern BarrowPooleUKBH12 5BB
| | - Andrea L Malizia
- The Burden Centre, Frenchay hospitalDepartment of NeurosurgeryBristolUKBS16 1LE
| | - Christopher CF Manson
- Faculty of Medicine, University of SouthamptonUniversity Department of PsychiatryAcademic Centre, College Keep 4‐12 Terminus TerraceSouthamptonUKSO14 3DT
| | - Sue Wilson
- Imperial College LondonCentre for Neuropsychopharmacology, Division of Brain SciencesBurlington Danes BuildingHammersmith Hospital campusLondonUKW12 0NN
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Wscieklica T, Silva MS, Lemes JA, Melo-Thomas L, Céspedes IC, Viana MB. Deep brain stimulation of the dorsal raphe inhibits avoidance and escape reactions and activates forebrain regions related to the modulation of anxiety/panic. Behav Brain Res 2017; 321:193-200. [DOI: 10.1016/j.bbr.2016.11.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/11/2016] [Accepted: 11/17/2016] [Indexed: 12/24/2022]
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Silva LCA, Viana MB, Andrade JS, Souza MA, Céspedes IC, D'Almeida V. Tryptophan overloading activates brain regions involved with cognition, mood and anxiety. AN ACAD BRAS CIENC 2017; 89:273-283. [PMID: 28225852 DOI: 10.1590/0001-3765201720160177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 12/18/2016] [Indexed: 12/25/2022] Open
Abstract
Tryptophan is the only precursor of serotonin and mediates serotonergic activity in the brain. Previous studies have shown that the administration of tryptophan or tryptophan depletion significantly alters cognition, mood and anxiety. Nevertheless, the neurobiological alterations that follow these changes have not yet been fully investigated. The aim of this study was to verify the effects of a tryptophan-enriched diet on immunoreactivity to Fos-protein in the rat brain. Sixteen male Wistar rats were distributed into two groups that either received standard chow diet or a tryptophan-enriched diet for a period of thirty days. On the morning of the 31st day, animals were euthanized and subsequently analyzed for Fos-immunoreactivity (Fos-ir) in the dorsal and median raphe nuclei and in regions that receive serotonin innervation from these two brain areas. Treatment with a tryptophan-enriched diet increased Fos-ir in the prefrontal cortex, nucleus accumbens, paraventricular hypothalamus, arcuate and ventromedial hypothalamus, dorsolateral and dorsomedial periaqueductal grey and dorsal and median raphe nucleus. These observations suggest that the physiological and behavioral alterations that follow the administration of tryptophan are associated with the activation of brain regions that regulate cognition and mood/anxiety-related responses.
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Affiliation(s)
- Luana C A Silva
- 1Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 3º andar, 04023-062 São Paulo, SP, Brazil
| | - Milena B Viana
- Departamento de Biociências, Universidade Federal de São Paulo, Rua Silva Jardim, 136, 3º andar, 11060-001 Santos, SP, Brazil
| | - José S Andrade
- Departamento de Biociências, Universidade Federal de São Paulo, Rua Silva Jardim, 136, 3º andar, 11060-001 Santos, SP, Brazil
| | - Melyssa A Souza
- Departamento de Biociências, Universidade Federal de São Paulo, Rua Silva Jardim, 136, 3º andar, 11060-001 Santos, SP, Brazil
| | - Isabel C Céspedes
- Departamento de Biociências, Universidade Federal de São Paulo, Rua Silva Jardim, 136, 3º andar, 11060-001 Santos, SP, Brazil
| | - Vânia D'Almeida
- 1Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 3º andar, 04023-062 São Paulo, SP, Brazil
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Pires GN, Bezerra AG, Tufik S, Andersen ML. Effects of acute sleep deprivation on state anxiety levels: a systematic review and meta-analysis. Sleep Med 2016; 24:109-118. [DOI: 10.1016/j.sleep.2016.07.019] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 07/11/2016] [Accepted: 07/20/2016] [Indexed: 11/25/2022]
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[Antidepressant and tolerance: Determinants and management of major side effects]. Encephale 2016; 42:553-561. [PMID: 27423475 DOI: 10.1016/j.encep.2016.05.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/22/2016] [Indexed: 01/19/2023]
Abstract
Antidepressant therapy aims to reach remission of depressive symptoms while reducing the complications and risks of relapse. Even though they have proven their efficacy, it takes several weeks for antidepressants to demonstrate full effectiveness, and adverse effects occur more quickly or (quicker) which can be a source of poor compliance. This latest aspect often leads to dose reduction and/or change of molecule that have the effect of delaying remission. This review attempts to present, from the pharmacological properties of the major classes of antidepressants (monoamine oxidase inhibitor [MAOI], tricyclic antidepressants [TCA], selective serotonin reuptake inhibitor [SSRI] and serotonin and noradrenaline reuptake inhibitor [SNRI]), to the pharmacological mechanisms involved in adverse effects by focusing on sexual dysfunction, nausea/vomiting, and weight changes and sleep disruption. If the activation of dopamine D1/2 or norepinephrine receptors through the autonomic nervous system controls and facilitates sexual desire, increasing serotoninergic transmission through 5-HT1B/2A/2C receptors activation inhibits this process. The pharmacological properties of drugs inducing nausea/vomiting activate opiate receptors μ, increase dopaminergic and serotoninergic transmission activating the dopamine D2 and serotonin 5-HT3 receptors, respectively. Among the causes responsible for weight gain under antidepressant therapy, monoamine neurotransmission still plays an important role. The blockade of serotonin 5-HT2C or histamine H1 receptors is directly responsible for weight gain. Finally, the activation of 5-HT1A/1B/3/7 serotoninergique receptors modulates wakefulness, raid eyes movement or sleep duration. In conclusion, if antidepressant activity of SERT or MAO inhibitors is an indirect consequence of postsynaptic 5-HT, DA, NA receptor activation, it is also responsible for side effects, causes of poor compliance and hence therapeutic failures. Finally, we need to take into account the key role of the nocebo effect in the occurrence of adverse effects. The next generation of antidepressant would aim to have a rapid efficacy in patients unresponsive or resistant to drugs currently available while improving certain effects of tolerance through an optimization of their psychopharmacological properties leading to a reduction of their side effects.
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Yamadera W, Morita M, Sakamoto S, Kuroda A, Itoh H, Nakayama K. Comparison of escitalopram alone and combined with zolpidem in treating major depression and related sleep impairments. Sleep Biol Rhythms 2016. [DOI: 10.1007/s41105-016-0059-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Maneeton N, Maneeton B, Woottiluk P, Likhitsathian S, Suttajit S, Boonyanaruthee V, Srisurapanont M. Quetiapine monotherapy in acute treatment of generalized anxiety disorder: a systematic review and meta-analysis of randomized controlled trials. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:259-76. [PMID: 26834458 PMCID: PMC4716733 DOI: 10.2147/dddt.s89485] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Some studies have indicated the efficacy of quetiapine in the treatment of generalized anxiety disorder (GAD). Objective The purpose of this study was to systematically review the efficacy, acceptability, and tolerability of quetiapine in adult patients with GAD. Methods The SCOPUS, MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched in April 2015. All randomized controlled trials (RCTs) of GAD were considered to be included in this meta-analysis. All RCTs of quetiapine in GAD patients providing endpoint outcomes relevant to severity of anxiety, response rate, remission rate, overall discontinuation rate, or discontinuation rate due to adverse events were included. The version reports from suitable clinical studies were explored, and the important data were extracted. Measurement for efficacy outcomes consisted of the mean-changed scores of the rating scales for anxiety, and response rate. Results A total of 2,248 randomized participants in three RCTs were included. The pooled mean-changed score of the quetiapine-treated group was greater than that of the placebo-treated group and comparable to selective serotonin reuptake inhibitors (SSRIs). Unfortunately, the response and the remission rates in only 50 and 150 mg/day of quetiapine-XR (extended-release) were better than those of the placebo. Their response and remission rates were comparable to SSRIs. The rates of pooled overall discontinuation and discontinuation due to adverse events of quetiapine-XR were greater than placebo. Only the overall discontinuation rate of quetiapine-XR at 50 and 150 mg/day and the discontinuation rate due to adverse events of quetiapine-XR at 50 mg/day were comparable to SSRIs. Conclusion Based on this meta-analysis, quetiapine-XR is efficacious in the treatment of GAD in adult patients. Despite its low acceptability and tolerability, the use of 50–150 mg/day quetiapine-XR for adult GAD patients may be considered as an alternative treatment. Further well-defined studies should be conducted to warrant these outcomes.
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Affiliation(s)
- Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pakapan Woottiluk
- Psychiatric Nursing Division, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | | | - Sirijit Suttajit
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Coplan JD, Aaronson CJ, Panthangi V, Kim Y. Treating comorbid anxiety and depression: Psychosocial and pharmacological approaches. World J Psychiatry 2015; 5:366-378. [PMID: 26740928 PMCID: PMC4694550 DOI: 10.5498/wjp.v5.i4.366] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 12/02/2014] [Accepted: 11/04/2015] [Indexed: 02/05/2023] Open
Abstract
Comorbid anxiety with depression predicts poor outcomes with a higher percentage of treatment resistance than either disorder occurring alone. Overlap of anxiety and depression complicates diagnosis and renders treatment challenging. A vital step in treatment of such comorbidity is careful and comprehensive diagnostic assessment. We attempt to explain various psychosocial and pharmacological approaches for treatment of comorbid anxiety and depression. For the psychosocial component, we focus only on generalized anxiety disorder based on the following theoretical models: (1) “the avoidance model”; (2) “the intolerance of uncertainty model”; (3) “the meta-cognitive model”; (4) “the emotion dysregulation model”; and (5) “the acceptance based model”. For depression, the following theoretical models are explicated: (1) “the cognitive model”; (2) “the behavioral activation model”; and (3) “the interpersonal model”. Integration of these approaches is suggested. The treatment of comorbid anxiety and depression necessitates specific psychopharmacological adjustments as compared to treating either condition alone. Serotonin reuptake inhibitors are considered first-line treatment in uncomplicated depression comorbid with a spectrum of anxiety disorders. Short-acting benzodiazepines (BZDs) are an important “bridging strategy” to address an acute anxiety component. In patients with comorbid substance abuse, avoidance of BZDs is recommended and we advise using an atypical antipsychotic in lieu of BZDs. For mixed anxiety and depression comorbid with bipolar disorder, we recommend augmentation of an antidepressant with either lamotrigine or an atypical agent. Combination and augmentation therapies in the treatment of comorbid conditions vis-à-vis monotherapy may be necessary for positive outcomes. Combination therapy with tricyclic antidepressants, gabapentin and selective serotonin/norepinephrine reuptake inhibitors (e.g., duloxetine) are specifically useful for comorbid chronic pain syndromes. Aripiprazole, quetiapine, risperidone and other novel atypical agents may be effective as augmentations. For treatment-resistant patients, we recommend a “stacking approach” not dissimilar from treatment of hypertension In conclusion, we delineate a comprehensive approach comprising integration of various psychosocial approaches and incremental pharmacological interventions entailing bridging strategies, augmentation therapies and ultimately stacking approaches towards effectively treating comorbid anxiety and depression.
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Kim JM, Stewart R, Bae KY, Kang HJ, Kim SW, Shin IS, Hong YJ, Ahn Y, Jeong MH, Yoon JS. Correlates and Escitalopram Treatment Effects on Sleep Disturbance in Patients with Acute Coronary Syndrome: K-DEPACS and EsDEPACS. Sleep 2015; 38:1105-11. [PMID: 25581916 DOI: 10.5665/sleep.4822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 12/07/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To investigate the correlates of sleep disturbance and to assess escitalopram treatment effects of depression on sleep disturbance in patients with acute coronary syndrome (ACS). DESIGN A cross-sectional study in patients with ACS within 2 w post-ACS, and a 24-w double-blind controlled trial of escitalopram against placebo for patients with ACS who have comorbid depressive disorders. SETTING A university hospital in South Korea. PARTICIPANTS There were 1,152 patients with ACS who were consecutively recruited. Of 446 patients with comorbid depressive disorders, 300 were randomized to the trial. MEASUREMENTS AND RESULTS Sleep disturbance was evaluated by the Leeds Sleep Evaluation Questionnaire. Demographic and clinical characteristics were assessed, including cardiovascular risk factors, current cardiac status, and depressive symptoms. Depressive symptoms were most strongly and consistently associated with sleep disturbance. In addition, older age, female sex, hypertension, and more severe ACS status were associated with certain aspects of sleep disturbance. Escitalopram was significantly superior to placebo for improving sleep disturbance over the 24-w treatment period. These effects were substantially explained by improvement in depressive symptoms. CONCLUSIONS Depression screening is indicated in patients with acute coronary syndrome with sleep disturbance. Successful treatment of depression has beneficial effects on sleep outcomes in these patients. CLINICAL TRIALS INFORMATION ClinicalTrial.gov identifier for the 24-w drug trial, NCT00419471.
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Affiliation(s)
- Jae-Min Kim
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | | | - Kyung-Yeol Bae
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jin-Sang Yoon
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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Sanchez C, Asin KE, Artigas F. Vortioxetine, a novel antidepressant with multimodal activity: Review of preclinical and clinical data. Pharmacol Ther 2015; 145:43-57. [DOI: 10.1016/j.pharmthera.2014.07.001] [Citation(s) in RCA: 315] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 12/21/2022]
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Kotan Z, Bican A, Kotan VO, Bora İ, Yalvac HD, Ozkaya G, Akkaya C. Sleep measurements in women with dysthymic disorder and insomnia. Sleep Biol Rhythms 2014. [DOI: 10.1111/sbr.12092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Zeynep Kotan
- Department of Psychiatry; Abdurrahman Yurtaslan Ankara Onkoloji Training and Research Hospital; Ankara Turkey
| | - Aylin Bican
- Department of Neurology Medicine; Uludag University, Medical Faculty; Bursa Turkey
| | - Vahap Ozan Kotan
- Department of Psychiatry; Ankara Numune Training and Research Hospital; Ankara Turkey
| | - İbrahim Bora
- Department of Neurology Medicine; Uludag University, Medical Faculty; Bursa Turkey
| | - Hayriye Dilek Yalvac
- Department of Psychiatry; Abdurrahman Yurtaslan Ankara Onkoloji Training and Research Hospital; Ankara Turkey
| | - Güven Ozkaya
- Department of Biostatistics; Uludag University, Medical Faculty; Bursa Turkey
| | - Cengiz Akkaya
- Department of Psychiatry; Uludag University, Medical Faculty; Bursa Turkey
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Dorsomedial hypothalamus serotonin 1A receptors mediate a panic-related response in the elevated T-maze. Brain Res Bull 2014; 109:39-45. [DOI: 10.1016/j.brainresbull.2014.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/23/2014] [Accepted: 09/24/2014] [Indexed: 11/22/2022]
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