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Dev V, Dixon SN, Fleet JL, Gandhi S, Gomes T, Harel Z, Jain AK, Shariff SZ, Tawadrous D, Weir MA, Garg AX. Higher anti-depressant dose and major adverse outcomes in moderate chronic kidney disease: a retrospective population-based study. BMC Nephrol 2014; 15:79. [PMID: 24884589 PMCID: PMC4024017 DOI: 10.1186/1471-2369-15-79] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/01/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many older patients have chronic kidney disease (CKD), and a lower dose of anti-depressants paroxetine, mirtazapine and venlafaxine is recommended in patients with CKD to prevent drug accumulation from reduced elimination. Using information available in large population-based healthcare administrative databases, we conducted this study to determine if ignoring the recommendation and prescribing a higher versus lower dose of anti-depressants associates with a higher risk of adverse events. METHODS We conducted a population-based cohort study to describe the 30-day risk of delirium in older adults who initiated a higher vs. lower dose of these three anti-depressants in routine care. We defined delirium using the best proxy available in our data sources - hospitalization with an urgent head computed tomography (CT) scan. We determined if CKD status modified the association between anti-depressant dose and outcome, and examined the secondary outcome of 30 day all-cause mortality. We used multivariable logistic regression analyses to estimate adjusted odds ratios (relative risk (RR)) and 95% confidence intervals. RESULTS We identified adults (mean age 75) in Ontario who started a new study anti-depressant at a higher dose (n=36,651; 31%) or lower dose (n=81,160; 69%). Initiating a higher vs. lower dose was not associated with an increased risk of hospitalization with head CT (1.09% vs. 1.27% (adjusted RR 0.90; 95% CI, 0.80 to 1.02), but was associated with a lower risk of all-cause mortality (0.76% vs. 0.97% RR 0.82; 95% CI, 0.71 to 0.95). Neither of these relative risks were modified by the presence of CKD (p=0.16, 0.68, respectively). CONCLUSIONS We did not observe an increase in two adverse outcomes when study anti-depressants were initiated at a higher dose in elderly patients with moderate CKD. Contrary to our hypothesis, the 30-day risk of mortality was lower when a higher versus lower dose of anti-depressant was initiated in these patients, a finding which requires corroboration and further study.
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Affiliation(s)
- Varun Dev
- Schulich School of Medicine, Western University, London, Canada
| | - Stephanie N Dixon
- Schulich School of Medicine, Western University, London, Canada
- Division of Nephrology, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Jamie L Fleet
- Division of Nephrology, Western University, London, Ontario, Canada
| | - Sonja Gandhi
- Schulich School of Medicine, Western University, London, Canada
- Division of Nephrology, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Tara Gomes
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Ziv Harel
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Arsh K Jain
- Schulich School of Medicine, Western University, London, Canada
- Division of Nephrology, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Salimah Z Shariff
- Schulich School of Medicine, Western University, London, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Davy Tawadrous
- Schulich School of Medicine, Western University, London, Canada
- Division of Nephrology, Western University, London, Ontario, Canada
| | - Matthew A Weir
- Schulich School of Medicine, Western University, London, Canada
- Division of Nephrology, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Amit X Garg
- Schulich School of Medicine, Western University, London, Canada
- Division of Nephrology, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- London Kidney Clinical Research Unit, Room ELL-101, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A 4G5, Canada
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Haberzettl R, Bert B, Fink H, Fox MA. Animal models of the serotonin syndrome: a systematic review. Behav Brain Res 2013; 256:328-45. [PMID: 24004848 DOI: 10.1016/j.bbr.2013.08.045] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 08/26/2013] [Accepted: 08/28/2013] [Indexed: 11/16/2022]
Abstract
The serotonin syndrome (SS) is a potentially life-threatening disorder in humans which is induced by ingestion of an overdose or by combination of two or more serotonin (5-HT)-enhancing drugs. In animals, acute administration of direct and indirect 5-HT agonists also leads to a set of behavioral and autonomic responses. In the current review, we provide an overview of the existing versions of the animal model of the SS. With a focus on studies in rats and mice, we analyze the frequency of behavioral and autonomic responses following administration of 5-HT-enhancing drugs and direct 5-HT agonists administered alone or in combination, and we briefly discuss the receptor mediation of these responses. Considering species differences, we identify a distinct set of behavioral and autonomic responses that are consistently observed following administration of direct and indirect 5-HT agonists. Finally, we discuss the importance of a standardized assessment of SS responses in rodents and the utility of animal models of the SS in translational studies, and provide suggestions for future research.
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Affiliation(s)
- Robert Haberzettl
- Institute of Pharmacology and Toxicology, School of Veterinary Medicine, Freie Universität Berlin, Koserstrasse 20, 14195 Berlin, Germany
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