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Antidepressant Use and Risk of Myocardial Infarction: A Longitudinal Investigation of Sex-Specific Associations in the HUNT Study. Psychosom Med 2023; 85:26-33. [PMID: 36201782 DOI: 10.1097/psy.0000000000001144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Antidepressants are thought to affect the risk of cardiovascular disease, although the nature of the association is unclear. Men and women have unique cardiovascular risk factors, and sex differences in depression as well as the efficacy of antidepressants are important to consider. We examined whether antidepressant use was associated with risk of having a myocardial infarction (MI) and whether this association was sex-specific. METHODS Data from The Trøndelag Health Study were used, gathered from a population in Norway ( N = 31,765), collected from 1995 to 2008. These data were combined with the Norwegian Cause of Death Registry and the Norwegian Prescription Database. We performed logistic regression models to examine the association of antidepressant use on risk of having a fatal or nonfatal MI, adjusting for depression, anxiety, diabetes, systolic blood pressure, cholesterol, waist-hip ratio, smoking, age, and sex. Results are presented as odds ratios (ORs) and 95% confidence intervals in parentheses. RESULTS The results indicated that antidepressant use was associated with a reduced risk of having MI at a later date (OR = 0.49 [0.38-0.64]). Although this association was somewhat stronger for women (OR = 0.46 [0.31-0.68]) compared with men (OR = 0.53 [0.37-0.75]), analysis did not identify a sex-specific association of antidepressant use on MI. Follow-up analyses on different subtypes of antidepressants showed that both selective serotonin reuptake inhibitor and tricyclic antidepressant were associated with a reduced risk of MI. CONCLUSIONS In this population study, the use of antidepressants was associated with a reduced risk of MI. This association was stronger for women, although we detected no interaction between sex and antidepressant use in terms of reduced risk of MI. Although limitations apply regarding causality, especially concerning a dose-response relationship, the results suggest that antidepressant use might reduce the risk of MI among both men and women.
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Blom T, Meinsma R, Rutgers M, Buitenhuis C, Dekken-Van den Burg M, van Kuilenburg ABP, Tytgat GAM. Selective serotonin reuptake inhibitors (SSRIs) prevent meta-iodobenzylguanidine (MIBG) uptake in platelets without affecting neuroblastoma tumor uptake. EJNMMI Res 2020; 10:78. [PMID: 32642907 PMCID: PMC7343696 DOI: 10.1186/s13550-020-00662-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/25/2020] [Indexed: 12/21/2022] Open
Abstract
Background The therapeutic use of [131I]meta-iodobenzylguanidine ([131I]MIBG) is often accompanied by hematological toxicity, mainly consisting of persistent and severe thrombocytopenia. While MIBG accumulates in neuroblastoma cells via selective uptake by the norepinephrine transporter (NET), the serotonin transporter (SERT) is responsible for cellular uptake of MIBG in platelets. In this study, we have investigated whether pharmacological intervention with selective serotonin reuptake inhibitors (SSRIs) may prevent radiotoxic MIBG uptake in platelets without affecting neuroblastoma tumor uptake. Methods To determine the transport kinetics of SERT for [125I]MIBG, HEK293 cells were transfected with SERT and uptake assays were conducted. Next, a panel of seven SSRIs was tested in vitro for their inhibitory potency on the uptake of [125I]MIBG in isolated human platelets and in cultured neuroblastoma cells. We investigated in vivo the efficacy of the four best performing SSRIs on the accumulation of [125I]MIBG in nude mice bearing subcutaneous neuroblastoma xenografts. In ex vivo experiments, the diluted plasma of mice treated with SSRIs was added to isolated human platelets to assess the effect on [125I]MIBG uptake. Results SERT performed as a low-affinity transporter of [125I]MIBG in comparison with NET (Km = 9.7 μM and 0.49 μM, respectively). Paroxetine was the most potent uptake inhibitor of both serotonin (IC50 = 0.6 nM) and MIBG (IC50 = 0.2 nM) in platelets. Citalopram was the most selective SERT inhibitor of [125I]MIBG uptake, with high SERT affinity in platelets (IC50 = 7.8 nM) and low NET affinity in neuroblastoma cells (IC50 = 11.940 nM). The in vivo tested SSRIs (citalopram, fluvoxamine, sertraline, and paroxetine) had no effect on [125I]MIBG uptake levels in neuroblastoma xenografts. In contrast, treatment with desipramine, a NET selective inhibitor, resulted in profoundly decreased xenograft [125I]MIBG levels (p < 0.0001). In ex vivo [125I]MIBG uptake experiments, 100- and 34-fold diluted murine plasma of mice treated with citalopram added to isolated human platelets led to a decrease in MIBG uptake of 54–76%, respectively. Conclusion Our study demonstrates for the first time that SSRIs selectively inhibit MIBG uptake in platelets without affecting MIBG accumulation in an in vivo neuroblastoma model. The concomitant application of citalopram during [131I]MIBG therapy seems a promising strategy to prevent thrombocytopenia in neuroblastoma patients.
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Affiliation(s)
- Thomas Blom
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Gastroenterology & Metabolism, Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Rutger Meinsma
- Gastroenterology & Metabolism, Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Marja Rutgers
- Department of Experimental Therapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Corine Buitenhuis
- Department of Experimental Therapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marieke Dekken-Van den Burg
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - André B P van Kuilenburg
- Gastroenterology & Metabolism, Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Zachwieja E, Butler AJ, Grau LC, Summers S, Massel D, Orozco F, Hernandez VH. The association of mental health disease with perioperative outcomes following femoral neck fractures. J Clin Orthop Trauma 2019; 10:S77-S83. [PMID: 31695264 PMCID: PMC6823790 DOI: 10.1016/j.jcot.2019.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/20/2018] [Accepted: 01/02/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Mental illness in the United States is a growing problem, leading to significant implications for those effected as well as direct and indirect costs to the health care system. The association between psychiatric comorbidity and increased risk of perioperative adverse events has previously been described following elective orthopedic surgery, however, there is a paucity of literature evaluating the correlation between mental health disease and outcomes in patients in an orthopedic trauma setting. METHODS Utilizing data from the US National Hospital Discharge Survey, all patients undergoing surgery for femoral neck fracture were identified between the years 1990 and 2007. The association of depression, anxiety, dementia and schizophrenia on surgical outcomes were then analyzed using univariate regression analysis. RESULTS A cohort of 2,432,931 patients was identified. All psychiatric comorbidities were associated with a lower rate of routine discharge home following surgery (p < 0.001). Schizophrenia was associated with increased odds of any adverse event (p < 0.001), acute post-operative mechanical complications (p < 0.001) and increased length of stay (p < 0.001). DISCUSSION Patients undergoing surgery for femoral neck fracture with comorbid psychiatric illness are at increased risk for non-routine discharge. Schizophrenia is independently associated with an increased risk for post-operative complications. An awareness of these risks should optimize preoperative multidisciplinary patient care planning so as to maximize patient outcome and minimize resource utilization.
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Affiliation(s)
- Erik Zachwieja
- University of Miami, Department of Orthopedic Surgery, 1400 NW 12th Ave, Miami, FL, 33136, USA
| | - Alexander J. Butler
- University of Miami, Department of Orthopedic Surgery, 1400 NW 12th Ave, Miami, FL, 33136, USA,Corresponding author.
| | - Luis C. Grau
- University of Miami, Department of Orthopedic Surgery, 1400 NW 12th Ave, Miami, FL, 33136, USA
| | - Spencer Summers
- University of Miami, Department of Orthopedic Surgery, 1400 NW 12th Ave, Miami, FL, 33136, USA
| | - Dustin Massel
- University of Miami, Department of Orthopedic Surgery, 1400 NW 12th Ave, Miami, FL, 33136, USA
| | - Fabio Orozco
- Rothman Orthopaedic Institute, 925 Chestnut St, Philadelphia, PA, 19107, USA
| | - Victor H. Hernandez
- University of Miami, Department of Orthopedic Surgery, 1400 NW 12th Ave, Miami, FL, 33136, USA
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Kim SY, Kim SW, Shin IS, Oh IJ, Park CK, Kim YC, Kim JM. Collaborative Care to Relieve Psychological Distress in Patients with Medically Inoperable Lung Cancer: Design and Rationale for a Clinical Trial. Psychiatry Investig 2019; 16:547-553. [PMID: 31352737 PMCID: PMC6664219 DOI: 10.30773/pi.2019.03.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/09/2019] [Indexed: 11/27/2022] Open
Abstract
Psychological distress is common in lung cancer patients with a poor prognosis. The present study aims to investigate the efficacy of collaborative care for patients with newly diagnosed inoperable lung cancer in South Korea. The study is a three-arm parallel-groups nonrandomized clinical trial with an active arm that includes distressed patients who receive collaborative care, one comparison arm that includes distressed patients who receive enhanced usual care, and another comparison arm that includes non-distressed patients. In total, 267 consecutive patients newly diagnosed with medically inoperative lung cancer will be recruited. The primary outcomes are the changes in Hospital Anxiety and Depression Scale-depression and the Distress Thermometer at 12 and 32 weeks after enrollment. Sub-analyses of patients in the active arm of the study will include a comparison of the efficacy of a combination of oral antidepressant (escitalopram) treatment and collaborative care versus that of collaborative care alone.
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Affiliation(s)
- Seon-Young Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Mental Health Clinic, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.,Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Cheol-Kyu Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.,Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Young-Chul Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.,Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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Tseng YL, Braun A, Chang JPC, Chiang ML, Tseng CY, Chen W. Micromolar concentrations of citalopram or escitalopram inhibit glycoprotein VI-mediated and integrin αIIbβ3-mediated signaling in human platelets. Toxicol Appl Pharmacol 2018; 364:106-113. [PMID: 30592962 DOI: 10.1016/j.taap.2018.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/21/2018] [Accepted: 12/24/2018] [Indexed: 01/05/2023]
Abstract
Collagen and convulxin induce platelet aggregation through glycoprotein VI (GPVI)-FcRγ-Syk signaling pathway. In addition, fibrinogen induces platelet activation through integrin αIIbβ3-FcγRIIa-Syk signaling pathway. We previously reported that high concentrations of selective serotonin reuptake inhibitors (SSRI) reduce platelet aggregation induced by collagen. We further investigated the effects of SSRI on GPVI- and αIIbβ3-mediated signaling pathway. Citalopram and escitalopram, two relatively pure SSRI, were used in this study. Both citalopram and escitalopram concentration-dependently inhibited convulxin-induced platelet aggregation, serotonin (5-HT) release and the activation of αIIbβ3. 5-HT concentration in washed platelets was unchanged after short-term treatment with citalopram. The additional 5-HT failed to fully rescue the inhibitory effect of citalopram on convulxin-induced aggregation. Convulxin-induced phosphorylation of Syk, LAT, and Akt was inhibited by citalopram and escitalopram. Citalopram inhibited the interaction between FcRγ and Syk, whereas the phosphorylation of FcRγ in response to convulxin remained unaltered. Further, citalopram inhibited the increase of the interaction between serotonin transporter and Syk induced by convulxin. In the presence of Mn2+, escitalopram inhibited the formation of lamellipodia on immobilized fibrinogen. Escitalopram did not influence the binding of fibrinogen to platelets. It inhibited the phosphorylation of Syk and PAK triggered by the adhesion on fibrinogen. Our data demonstrate that micromolar concentrations of citalopram and escitalopram inhibit GPVI- and αIIbβ3-mediated platelet functions. The mechanism of the inhibitory effect of citalopram or escitalopram is not the influence on the activation of GPVI or the interaction between fibrinogen and αIIbβ3, but the interaction between Syk and its upstream molecules.
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Affiliation(s)
- Yu-Lun Tseng
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
| | - Attila Braun
- Institute of Experimental Biomedicine, University Hospital of Würzburg, Würzburg, Germany
| | - Jane Pei-Chen Chang
- Department of Psychiatry, University Hospital and School of Medicine, China Medical University, Taichung, Taiwan
| | - Meng-Ling Chiang
- Department of Oral Pathology and Oral Diagnosis, Department of Pediatric Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chi-Yu Tseng
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wenchun Chen
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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Maslej MM, Bolker BM, Russell MJ, Eaton K, Durisko Z, Hollon SD, Swanson GM, Thomson JA, Mulsant BH, Andrews PW. The Mortality and Myocardial Effects of Antidepressants Are Moderated by Preexisting Cardiovascular Disease: A Meta-Analysis. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 86:268-282. [PMID: 28903117 DOI: 10.1159/000477940] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/30/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Antidepressants (ADs) are commonly prescribed medications, but their long-term health effects are debated. ADs disrupt multiple adaptive processes regulated by evolutionarily ancient biochemicals, potentially increasing mortality. However, many ADs also have anticlotting properties that can be efficacious in treating cardiovascular disease. We conducted a meta-analysis assessing the effects of ADs on all-cause mortality and cardiovascular events in general-population and cardiovascular-patient samples. METHODS Two reviewers independently assessed articles from PubMed, EMBASE, and Google Scholar for AD-related mortality controlling for depression and other comorbidities. From these articles, we extracted information about cardiovascular events, cardiovascular risk status, and AD class. We conducted mixed-effect meta-analyses testing sample type and AD class as moderators of all-cause mortality and new cardiovascular events. RESULTS Seventeen studies met our search criteria. Sample type consistently moderated health risks. In general-population samples, AD use increased the risks of mortality (HR = 1.33, 95% CI: 1.14-1.55) and new cardiovascular events (HR = 1.14, 95% CI: 1.08-1.21). In cardiovascular patients, AD use did not significantly affect risks. AD class also moderated mortality, but the serotonin reuptake inhibitors were not significantly different from tricyclic ADs (TCAs) (HR = 1.10, 95% CI: 0.93-1.31, p = 0.27). Only "other ADs" were differentiable from TCAs (HR = 1.35, 95% CI: 1.08-1.69). Mortality risk estimates increased when we analyzed the subset of studies controlling for premedication depression, suggesting the absence of confounding by indication. CONCLUSIONS The results support the hypothesis that ADs are harmful in the general population but less harmful in cardiovascular patients.
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Affiliation(s)
- Marta M Maslej
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON, Canada
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7
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Roweth HG, Yan R, Bedwani NH, Chauhan A, Fowler N, Watson AH, Malcor JD, Sage SO, Jarvis GE. Citalopram inhibits platelet function independently of SERT-mediated 5-HT transport. Sci Rep 2018; 8:3494. [PMID: 29472624 PMCID: PMC5823918 DOI: 10.1038/s41598-018-21348-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/01/2018] [Indexed: 11/09/2022] Open
Abstract
Citalopram prevents serotonin (5-HT) uptake into platelets by blocking the serotonin reuptake transporter (SERT). Although some clinical data suggest that selective serotonin reuptake inhibitors (SSRIs) may affect haemostasis and thrombosis, these poorly-characterised effects are not well understood mechanistically and useful in vitro data is limited. We sought to determine whether the inhibitory effects of citalopram on platelets are mediated via its pharmacological inhibition of 5-HT transport. We quantified the inhibitory potency of (RS)-, (R)- and (S)-citalopram on platelet function. If SERT blockade is the primary mechanism for citalopram-mediated platelet inhibition, these potencies should show quantitative congruence with inhibition of 5-HT uptake. Our data show that citalopram inhibits platelet aggregation, adhesion and thromboxane production with no difference in potency between (R)- and (S)-isomers. By contrast, citalopram had a eudysmic ratio of approximately 17 (S > R) for SERT blockade. Furthermore, nanomolar concentrations of citalopram inhibited 5-HT uptake into platelets but had no effect on other platelet functions, which were inhibited by micromolar concentrations. Our data indicate that citalopram-induced inhibition of platelets in vitro is not mediated by blockade of 5-HT transport. This raises a new question for future investigation: by what mechanism(s) does citalopram inhibit platelets?
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Affiliation(s)
- Harvey G Roweth
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, U.K
| | - Ruoling Yan
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, U.K
| | - Nader H Bedwani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, U.K
| | - Alisha Chauhan
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, U.K
| | - Nicole Fowler
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, U.K
| | - Alice H Watson
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, U.K
| | | | - Stewart O Sage
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, U.K
| | - Gavin E Jarvis
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, U.K..
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8
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Dietrich-Muszalska A, Wachowicz B. Platelet haemostatic function in psychiatric disorders: Effects of antidepressants and antipsychotic drugs. World J Biol Psychiatry 2017; 18:564-574. [PMID: 27112326 DOI: 10.3109/15622975.2016.1155748] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives Platelets, the smallest anucleated blood cells, play an essential role in the first step of complex haemostatic process. This review presents the haemostatic function of blood platelets related to their activation in psychiatric disorders (schizophrenia, depression), the role of antipsychotic and antidepressant medication, and introduces the mechanisms by which activated platelets may be involved in the pathophysiology of these disorders. Methods Platelets are interesting and easily accessible blood cells to study biochemical pathways related to schizophrenia and other psychiatric disorders, and their complex activation process might be useful as a diagnostic peripheral marker for studying psychiatric disorders and haemostatic complications. Results The excessive activation of platelets observed in patients with depression and schizophrenia is involved in cardiovascular diseases, stroke and increased risk of thrombotic complications that may be major causes of morbidity and mortality of patients. The use of antidepressants or antipsychotic drugs in depression and schizophrenia treatment is often associated with haematological side effects such as bleeding, venous thromboembolism and impaired platelet function. Conclusions Understanding the role of platelet activation in psychiatric disorders such as schizophrenia or depression and medication may improve therapies in the future.
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Affiliation(s)
- Anna Dietrich-Muszalska
- a Department of Biological Psychiatry of the Chair of Experimental and Clinical Physiology , Medical University of Lodz , Lodz , Poland
| | - Barbara Wachowicz
- b Department of General Biochemistry , University of Lodz , Lodz , Poland
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9
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Biffi A, Scotti L, Corrao G. Use of antidepressants and the risk of cardiovascular and cerebrovascular disease: a meta-analysis of observational studies. Eur J Clin Pharmacol 2017; 73:487-497. [DOI: 10.1007/s00228-016-2187-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/19/2016] [Indexed: 01/11/2023]
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10
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Samuel NG, Seifert CF. Risk of Bleeding in Patients on Full-Dose Enoxaparin With Venous Thromboembolism and Selective Serotonin Reuptake Inhibitors. Ann Pharmacother 2016; 51:226-231. [PMID: 27834194 DOI: 10.1177/1060028016677309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are very commonly prescribed agents that are also potent antiplatelet agents. OBJECTIVE This study was designed compare the rate of major bleeding events between patients who were treated with low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) on SSRIs and those not on chronic SSRI therapy. METHODS This was a retrospective cohort study of 575 patients with a primary or secondary diagnosis of an acute VTE initiated on full-dose enoxaparin with or without an SSRI between October 1, 2009, and October 1, 2014, in a 443-bed, single tertiary care referral county teaching hospital. RESULTS No significant difference was found in the incidence of major bleeding in the SSRI versus non-SSRI group (19.6% vs 17.0%, P = 0.548). Ad hoc analysis demonstrated an elevated risk of major bleeding in patients on escitalopram compared with those on any of the other SSRIs (46.2% vs 15.2%, P = 0.018). Multivariate analysis demonstrated that escitalopram use-OR (95% CI) = 18.85 (1.84-193.6)-was associated with increased major bleeding, and acid suppressive therapy-0.24 (0.07-0.90); P = 0.014-was associated with decreased major bleeding in patients reporting alcohol use. CONCLUSION No difference was found in the incidence of major bleeding in patients on LMWH and SSRIs versus those on LMWH but not on SSRIs. However, ad hoc findings showed a significantly higher rate of major bleeding events in patients who received escitalopram and alcohol among patients on full-dose enoxaparin for VTE. These findings merit further exploration.
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Affiliation(s)
- Nephy G Samuel
- 1 Texas A&M University Health Science Center, College Station, TX, USA.,2 Texas Tech University Health Sciences Center, Lubbock, TX, USA
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11
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The Influence of Psychiatric Comorbidity on Inpatient Outcomes following Distal Humerus Fractures. ACTA ACUST UNITED AC 2016. [DOI: 10.1155/2016/4913808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. The influence of psychiatric comorbidity on outcomes following inpatient management of upper extremity fractures is poorly understood. Methods. The National Hospital Discharge Survey was queried to identify patients admitted to US hospitals with distal humerus fractures between 1990 and 2007. Patients were subdivided into 5 groups: depression, anxiety, schizophrenia, dementia, and no psychiatric comorbidity. Multivariable logistic regression analysis identified independent risk factors for adverse events, requirement of blood transfusion, and discharge to another inpatient facility. Results. A cohort representative of 526,185 patients was identified as having a distal humerus fracture. Depression, anxiety, and dementia were independently associated with higher odds of in-hospital adverse events (P<0.001). Depression was associated with higher odds of inpatient blood transfusion (P<0.001). Depression, schizophrenia, and dementia were associated with higher odds of nonroutine discharge to another inpatient facility (P<0.001). Patients with a diagnosis of schizophrenia had a mean of 12 (P<0.001) more days of care than patients with no psychiatric comorbidity. Discussion. Patients with comorbid psychiatric illness who are admitted to hospitals with distal humerus fractures are at increased risk of inpatient adverse events and posthospitalization care.
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Do A, Noohi S, Elie D, Mahdanian AA, Yu C, Segal M, Looper KJ, Rej S. Health Canada Warning on Citalopram and Escitalopram--Its Effects on Prescribing in Consultation-Liaison Psychiatry. PSYCHOSOMATICS 2015; 57:57-63. [PMID: 26633294 DOI: 10.1016/j.psym.2015.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 09/09/2015] [Accepted: 09/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Reports have suggested that citalopram and escitalopram may prolong the QTc interval, leading Health Canada to issue a warning to limit their dosages in 2012. Little is known about the effects of this warning and similar ones (e.g., by the Food and Drug Administration) on antidepressant prescribing in inpatients with acute medical illness, who are theoretically at high risk of QTc prolongation. The main objective of our study is to examine the effect of the Health Canada warning on citalopram/escitalopram prescribing patterns in the consultation-liaison (C-L) psychiatry setting. METHODS We performed a retrospective cohort study including 275 randomly selected inpatients with medical illness assessed by the psychiatric C-L team of a large Canadian academic hospital between 2008 and 2014. We grouped patients based on whether they were assessed by the C-L team before or after the citalopram Health Canada warning. Our primary outcome was change in citalopram/escitalopram prescribing patterns. RESULTS We found that of patients seen before the Health Canada warning, a significantly higher number were prescribed citalopram/escitalopram (44.1% vs. 22.3%, χ(2) = 14.835, p < 0.001), even after controlling for confounders. However, the percentage of patients using a citalopram/escitalopram dose exceeding those recommended by the Health Canada warning was similar in both groups (8.9% vs. 12.1%, χ(2) = 0.233, p = 0.63). CONCLUSIONS Overall, C-L psychiatrists were less likely to prescribe citalopram/escitalopram following the Health Canada warning, which did not translate into safer dosing. Clinicians should not avoid prescribing citalopram/escitalopram appropriately in medically vulnerable inpatients when benefits outweigh disadvantages.
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Affiliation(s)
- André Do
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada
| | - Saeid Noohi
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada
| | - Dominique Elie
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada
| | - Artin A Mahdanian
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada
| | - Ching Yu
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada
| | - Marilyn Segal
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada
| | - Karl J Looper
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada
| | - Soham Rej
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
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13
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The influence of psychiatric comorbidity on perioperative outcomes following primary total hip and knee arthroplasty; a 17-year analysis of the National Hospital Discharge Survey database. J Arthroplasty 2015; 30:165-70. [PMID: 25267536 DOI: 10.1016/j.arth.2014.08.034] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 08/26/2014] [Accepted: 08/30/2014] [Indexed: 02/01/2023] Open
Abstract
Studies conflict regarding the impact of psychiatric illnesses including depression, anxiety, dementia and schizophrenia on perioperative outcomes following total hip (THA) and knee arthroplasty (TKA). Psychiatric comorbidity incidence, in-hospital adverse events, discharge disposition, and mortality were assessed for THA or TKA patients between 1990 and 2007 using the US National Hospital Discharge Survey. A cohort representative of 8,379,490 patients was identified and analyzed using multivariable regression analysis. Diagnoses of depression, dementia and schizophrenia were associated with increased odds of adverse events (P<0.001). Schizophrenia and depression were associated with higher odds of perioperative blood transfusion (P<0.001). All psychiatric comorbidities were associated with higher odds of non-routine discharge (P<0.001). Diagnosis of dementia was associated with higher in-hospital mortality (P<0.001).
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Hantsoo L, Czarkowski KA, Child J, Howes C, Epperson CN. Selective serotonin reuptake inhibitors and endothelial function in women. J Womens Health (Larchmt) 2014; 23:613-8. [PMID: 24886268 DOI: 10.1089/jwh.2013.4623] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Among women worldwide, major depression (MDD) and heart disease rank first and second, respectively, in burden of disease. Although selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed, possible inhibition of nitric oxide (NO) function has caused concerns about their effects on protective vascular mechanisms. Our study aimed to determine the effect of SSRIs on flow-mediated vascular dilatation (FMD), platelet aggregation, and platelet NO production among women. METHODS Women (n=28) without known cardiovascular disease were recruited prior to undergoing SSRI treatment for MDD, postpartum depression (PPD), or premenstrual dysphoric disorder (PMDD). Symptoms were quantified using the Hamilton Depression/Anxiety and Beck Depression scales. FMD, platelet aggregation, and platelet NO production were measured before and after 1 month of SSRI (sertraline, fluoxetine, or paroxetine) therapy. RESULTS Depression and anxiety symptoms decreased significantly with SSRI treatment (ps <0.01). FMD and platelet aggregation did not differ between pre- and posttreatment, although FMD rose to the normal range (≥ 8%) in two of three women with abnormal FMD prior to SSRI treatment. We observed a 21% decrease (p=0.024) in platelet NO production. CONCLUSIONS SSRI treatment had little effect on FMD or platelet aggregation. The health impact of decreased NO production is unclear, particularly in this relatively young group of women without cardiovascular disease, but should be considered in future studies focusing on SSRI safety in patients with cardiovascular disease.
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Affiliation(s)
- Liisa Hantsoo
- 1 Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania
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Kim JM, Bae KY, Kang HJ, Kim SW, Shin IS, Hong YJ, Kim JH, Shin HY, Ahn Y, Kim JK, Jeong MH, Yoon JS. Design and Methodology for the Korean Observational and Escitalopram Treatment Studies of Depression in Acute Coronary Syndrome: K-DEPACS and EsDEPACS. Psychiatry Investig 2014; 11:89-94. [PMID: 24605129 PMCID: PMC3942557 DOI: 10.4306/pi.2014.11.1.89] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/01/2013] [Accepted: 04/02/2013] [Indexed: 11/19/2022] Open
Abstract
Depression is common after acute coronary syndrome (ACS), adversely affecting cardiac course and prognosis. There have been only a few evidence-based treatment options for depression in ACS. Accordingly, we planned the Korean Depression in ACS (K-DEPACS) study, which investigated depressive disorders in patients with ACS using a naturalistic prospective design, and the Escitalopram for DEPACS (EsDEPACS) trial, which assessed the efficacy and safety of escitalopram for treating major or minor depression in patients with ACS. Participants in the K-DEPACS study were consecutively recruited from patients with ACS who were recently hospitalized at Chonnam National University Hospital, Gwangju, South Korea. Diagnoses were confirmed by coronary angiography from 2005. Data on depressive and cardiovascular characteristics were obtained at 2 weeks, 3 months, 12 months, and every 6 months thereafter following the index ACS admission. The K-DEPACS participants who met the DSM-IV criteria for major or minor depressive disorder were randomly assigned to groups in the 24-week, double-blind, placebo-controlled EsDEPACS trial beginning in 2007. The outcome of treatments for depressive and other psychiatric symptoms, issues related to safety, including general adversity, and cardiovascular factors were assessed. The K-DEPACS study can significantly contribute to research on the complex relationships between depression and ACS. The results of the EsDEPACS trial provide an additional treatment option for clinicians treating these patients.
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Affiliation(s)
- Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Kyung-Yeol Bae
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department 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
| | - Ju-Han Kim
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Young Shin
- Department of Biomedical Science, Chonnam National University Medical School, and Clinical Trial Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - YoungKeun Ahn
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jong-Keun Kim
- Department of Pharmacology, Chonnam National University Medical School, and Division of Clinical Pharmacology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Myung-Ho Jeong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jin-Sang Yoon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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Anwar MJ, Pillai KK, Samad A, Vohora D. Effect of escitalopram on cardiomyopathy-induced anxiety in mice. Hum Exp Toxicol 2013; 32:632-9. [PMID: 23696557 DOI: 10.1177/0960327112462728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The present study was aimed to evaluate the effect of escitalopram on anxiety following doxorubicin (DOX)-induced cardiomyopathy, a rodent model for heart failure (HF), in mice. The study was carried out in Swiss albino mice. DOX was used at a dose of 10 mg/kg intravenously. Escitalopram was administered at the doses of 10 and 20 mg/kg orally for 7 days pre- and 7 days post-DOX. Anxiety was measured on day 8 and on day 14 using elevated plus maze and Vogel's conflict test. On day 14, serum lactate dehydrogenase (LDH) was estimated. The mice were then killed and their hearts were dissected out for the estimation of malondialdehyde (MDA) and for the transmission electron microscopic (TEM) studies. Our results showed that the DOX administration induced cardiomyopathy in mice. This was evidenced by the increased levels of serum LDH and tissue MDA and was also confirmed by TEM. Escitalopram (20 mg/kg) not only reversed the anxiety-like effects induced by DOX but also DOX-induced increase in LDH and MDA as well as the morphological alterations induced by DOX in TEM studies. Escitalopram, thus, appears to be a good candidate for alleviating anxiety in patients with HF.
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Affiliation(s)
- M J Anwar
- Department of Pharmacology, Faculty of Pharmacy, Jamia Hamdard, Hamdard University, New Delhi, India
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Assessment of platelet indices in patients with neurodegenerative diseases: mean platelet volume was increased in patients with Parkinson's disease. Curr Gerontol Geriatr Res 2013; 2013:986254. [PMID: 24382959 PMCID: PMC3870626 DOI: 10.1155/2013/986254] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/10/2013] [Accepted: 11/11/2013] [Indexed: 12/02/2022] Open
Abstract
Platelets induce chronic inflammation which is a key step in atherosclerosis and may be involved in the progression of neurodegenerative diseases (NDD). We aimed to measure the mean platelet volume (MPV) and platelet count (PLC) in NDD patients. The present study was designed to investigate the platelet function by measuring MPV and PLC in NDD. A total of 182 outpatients with Alzheimer's (AD) or Parkinson's diseases (PD) were included. The control group consisted of 104 healthy subjects. Platelet count was similar between groups. MPV values of PD patients were higher than those of AD patients and controls (P < 0.001). MPV correlated negatively with Heohn and Yahr scale (HYS) score (P < 0.001). Increased MPV in patients with PD may point to a platelet dysfunction. High-grade inflammation presents with low levels of MPV as seen in PD patients with high HYS scores.
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Demographics and Perioperative Outcome in Patients with Depression and Anxiety Undergoing Total Joint Arthroplasty: A Population-Based Study. PSYCHOSOMATICS 2013. [DOI: 10.1016/j.psym.2012.08.009] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Andrews PW, Thomson JA, Amstadter A, Neale MC. Primum non nocere: an evolutionary analysis of whether antidepressants do more harm than good. Front Psychol 2012; 3:117. [PMID: 22536191 PMCID: PMC3334530 DOI: 10.3389/fpsyg.2012.00117] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 03/30/2012] [Indexed: 12/28/2022] Open
Abstract
Antidepressant medications are the first-line treatment for people meeting current diagnostic criteria for major depressive disorder. Most antidepressants are designed to perturb the mechanisms that regulate the neurotransmitter serotonin - an evolutionarily ancient biochemical found in plants, animals, and fungi. Many adaptive processes evolved to be regulated by serotonin, including emotion, development, neuronal growth and death, platelet activation and the clotting process, attention, electrolyte balance, and reproduction. It is a principle of evolutionary medicine that the disruption of evolved adaptations will degrade biological functioning. Because serotonin regulates many adaptive processes, antidepressants could have many adverse health effects. For instance, while antidepressants are modestly effective in reducing depressive symptoms, they increase the brain's susceptibility to future episodes after they have been discontinued. Contrary to a widely held belief in psychiatry, studies that purport to show that antidepressants promote neurogenesis are flawed because they all use a method that cannot, by itself, distinguish between neurogenesis and neuronal death. In fact, antidepressants cause neuronal damage and mature neurons to revert to an immature state, both of which may explain why antidepressants also cause neurons to undergo apoptosis (programmed death). Antidepressants can also cause developmental problems, they have adverse effects on sexual and romantic life, and they increase the risk of hyponatremia (low sodium in the blood plasma), bleeding, stroke, and death in the elderly. Our review supports the conclusion that antidepressants generally do more harm than good by disrupting a number of adaptive processes regulated by serotonin. However, there may be specific conditions for which their use is warranted (e.g., cancer, recovery from stroke). We conclude that altered informed consent practices and greater caution in the prescription of antidepressants are warranted.
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Affiliation(s)
- Paul W. Andrews
- Department of Psychology, Neuroscience and Behaviour, McMaster UniversityHamilton, ON, Canada
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth UniversityRichmond, VA, USA
| | - J. Anderson Thomson
- Counseling and Psychological Services, Student Health, University of VirginiaCharlottesville, VA, USA
- Institute of Law, Psychiatry and Public Policy, University of VirginiaCharlottesville, VA, USA
| | - Ananda Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth UniversityRichmond, VA, USA
| | - Michael C. Neale
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth UniversityRichmond, VA, USA
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Canan F, Ataoglu A. The effect of escitalopram on platelet activity. Thromb Res 2011; 127:57. [DOI: 10.1016/j.thromres.2010.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 07/20/2010] [Accepted: 07/20/2010] [Indexed: 10/19/2022]
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