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David J, Mousset M, Trombetti K, Sayasouk B, Neilsen C, Suorsa P, Ruben M, Ruben E, Thiessen J, Pychewicz T, Chu P, Huynh TN. Chronic mild stress leads to anxiety-like behavior and decreased p70 S6K1 activity in the hippocampus of male mice. Physiol Behav 2024; 273:114377. [PMID: 37863347 DOI: 10.1016/j.physbeh.2023.114377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/29/2023] [Accepted: 10/15/2023] [Indexed: 10/22/2023]
Abstract
Major affective disorders are highly prevalent, however, current treatments are limited in their effectiveness due to a lack of understanding of underlying molecular mechanisms. Recent studies have shown that reduced activity of p70 S6 kinase 1 (S6K1), a downstream target of the mechanistic target of rapamycin complex 1 (mTORC1), is linked to anxiety-like behavior in both humans and rodents. The purpose of this study was to investigate the relationship between S6K1 and anxiety-like behavior following chronic mild stress (CMS) and drug-induced inhibition of S6K1. Following CMS, anxiety-like behavior was evaluated using an open field (OF) and elevated plus maze (EPM) in adult male C57/Bl6 mice. After behavior analysis, samples of the hippocampus were harvested for quantification of S6K1, S6 ribosomal protein, glycogen synthase kinase-3 β (GSK3β), and beta tubulin via western blot. Our results demonstrate that CMS mice exhibit anxiety-like behavior in the OF and EPM and reduced activity of S6K1 in the hippocampus (HPC). We measured phosphorylation levels of GSK3β and found that GSK3β phosphorylation was also reduced following CMS compared to control mice. Furthermore, pharmacological inhibition of S6K1 with PF-4708671 in male mice was sufficient to produce anxiety-like behavior in the OF and EPM. These results further support the significant role of S6K1 in the pathogenesis of anxiety and affective disorders.
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Affiliation(s)
- Jazmine David
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308 United States of America
| | - Marike Mousset
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308 United States of America
| | - Kirby Trombetti
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308 United States of America
| | - Beverly Sayasouk
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308 United States of America
| | - Calvin Neilsen
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308 United States of America
| | - Parker Suorsa
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308 United States of America
| | - Melissa Ruben
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308 United States of America
| | - Elias Ruben
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308 United States of America
| | - Jacob Thiessen
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308 United States of America
| | - Taylor Pychewicz
- Department of Biomedical Sciences, College of Graduate Studies, Midwestern University, Glendale, AZ 85308, United States of America
| | - Ping Chu
- Department of Biochemistry and Molecular Genetics, College of Graduate Studies, Midwestern University, Glendale, AZ 85308, United States of America
| | - Thu N Huynh
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308 United States of America; Department of Biochemistry and Molecular Genetics, College of Graduate Studies, Midwestern University, Glendale, AZ 85308, United States of America.
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Bhatia V, Dhingra AK, Chopra B, Guarve K. A Review of Clinical Studies Assessing the Therapeutic Efficacy of Escitalopram: A Step Towards Development. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2023; 22:41-50. [PMID: 35232356 DOI: 10.2174/1871527321666220301122807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Major depression is a debilitating, sometimes fatal disorder, deteriorating the quality of life and well-being. Escitalopram showed highly selective and dose-dependent inhibitory activity on human serotonin transport. Selective serotonin reuptake inhibitors (SSRIs) are the first-line drugs to manage major depressive disorder (MDD). OBJECTIVE The objective of this study is to explore the therapeutic potential of escitalopram, a clinically approved drug to manage MDD and panic disorders. METHODS It emphasizes comparative and clinical trial studies with several pharmacological targets reviewed from the data available on PubMed, Science Direct, Clinicaltrails.gov, and from many reputed foundations. RESULTS To highlight the clinical efficacy, safety, recent development, and stable formulation of escitalopram with an increased bioavailability profile. Evidence-based on the available clinical and pharmacoeconomic data, escitalopram represents an effective first-line treatment option for MDD patients. CONCLUSION The present review highlights the placebo-controlled clinical studies and the recent development that can be helpful for further research perspectives.
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Affiliation(s)
- Vishal Bhatia
- Guru Gobind Singh College of Pharmacy, City Center Road, Yamuna Nagar-135001, Haryana, India
| | - Ashwani K Dhingra
- Guru Gobind Singh College of Pharmacy, City Center Road, Yamuna Nagar-135001, Haryana, India
| | - Bhawna Chopra
- Guru Gobind Singh College of Pharmacy, City Center Road, Yamuna Nagar-135001, Haryana, India
| | - Kumar Guarve
- Guru Gobind Singh College of Pharmacy, City Center Road, Yamuna Nagar-135001, Haryana, India
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3
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Wang Z, Li H, Kang Y, Liu Y, Shan L, Wang F. Risks of Digestive System Side-Effects of Selective Serotonin Reuptake Inhibitors in Patients with Depression: A Network Meta-Analysis. Ther Clin Risk Manag 2022; 18:799-812. [PMID: 35992228 PMCID: PMC9386738 DOI: 10.2147/tcrm.s363404] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/29/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose Selective serotonin reuptake inhibitors (SSRIs) are the preferred treatments for depression. The most common adverse drug reactions are symptoms involving the digestive system, leading to low compliance in patients with depression. Therefore, it is important to assess the safety of SSRIs with respect to the digestive system. Several meta-analyses have compared the risks of digestive side effects of SSRIs and other antidepressants. We aimed to compare the risks of various SSRIs (fluoxetine, escitalopram, citalopram, paroxetine, and sertraline) for adverse reactions of the digestive system. Methods Systematic searches returned 30 randomized controlled trials (n = 5004) of five antidepressants and placebos. Results Fluoxetine had the lowest probability of digestive side effects, ranking fifth at 0.548. Sertraline had the highest probability of digestive side effects, with a probability of 0.611. For gastrointestinal tolerability, escitalopram was better than paroxetine (odds ratio [OR] =0.62, 95% confidence interval [CI] 0.43–0.87) and sertraline (OR=0.56, 95% CI 0.32–0.99). Conclusion Fluoxetine exhibited distinct advantages compared to other SSRIs, while sertraline had the greatest likelihood of digestive system side effects. These findings will help doctors understand the relative advantages of various antidepressants.
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Affiliation(s)
- Zhuoyue Wang
- Psychosomatic Medicine Research Division, Inner Mongolia Medical University, Huhhot, People's Republic of China.,Beijing Hui-Long-Guan Hospital, Peking University, Beijing, People's Republic of China
| | - Hui Li
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing, People's Republic of China.,Xinjiang Key Laboratory of Neurological Disorder Research, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Yimin Kang
- Psychosomatic Medicine Research Division, Inner Mongolia Medical University, Huhhot, People's Republic of China
| | - Yanlong Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Ligang Shan
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, People's Republic of China
| | - Fan Wang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, People's Republic of China.,Xinjiang Key Laboratory of Neurological Disorder Research, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
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4
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Liu S, Xiao T, Huang S, Li X, Kong W, Yang Y, Zhang Z, Ni X, Lu H, Zhang M, Shang D, Wen Y. Population pharmacokinetics model for escitalopram in Chinese psychiatric patients: effect of CYP2C19 and age. Front Pharmacol 2022; 13:964758. [PMID: 35924062 PMCID: PMC9340256 DOI: 10.3389/fphar.2022.964758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To establish a population pharmacokinetic model in Chinese psychiatric patients to characterize escitalopram pharmacokinetic profile to identify factors influencing drug exposure, and through simulation to compare the results with the established therapeutic reference range. Methods: Demographic information, dosing regimen, CYP2C19 genotype, concomitant medications, and liver and kidney function indicators were retrospectively collected for inpatients taking escitalopram with therapeutic drug monitoring from 2018 to 2021. Nonlinear mixed-effects modeling was used to model the pharmacokinetic characteristics of escitalopram. Goodness-of-fit plots, bootstrapping, and normalized prediction distribution errors were used to evaluate the model. Simulation for different dosing regimens was based on the final estimations. Results: The study comprised 106 patients and 337 measurements of serum sample. A structural model with one compartment with first-order absorption and elimination described the data adequately. The population-estimated apparent volume of distribution and apparent clearance were 815 and 16.3 L/h, respectively. Age and CYP2C19 phenotype had a significant effect on the apparent clearance (CL/F). CL/F of escitalopram decreased with increased age, and CL/F of poor metabolizer patients was significantly lower than in extensive and immediate metabolizer patients. The final model-based simulation showed that the daily dose of adolescents with poor metabolizer might be as high as 15 mg or 20 mg and referring to the therapeutic range for adults may result in overdose and a high risk of adverse effects in older patients. Conclusion: A population pharmacokinetics model of escitalopram was successfully created for the Chinese population. Depending on the age of the patients, CYP2C19 genotype and serum drug concentrations throughout treatment are required for adequate individualization of dosing regimens. When developing a regimen for older patients, especially those who are poor metabolizers, vigilance is required.
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Affiliation(s)
- Shujing Liu
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Tao Xiao
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Shanqing Huang
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Xiaolin Li
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Wan Kong
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Ye Yang
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Zi Zhang
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Xiaojia Ni
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Haoyang Lu
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Ming Zhang
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Dewei Shang
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
- *Correspondence: Dewei Shang, ; Yuguan Wen,
| | - Yuguan Wen
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
- *Correspondence: Dewei Shang, ; Yuguan Wen,
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Espinola CW, Khoo Y, Parmar R, Demchenko I, Frey BN, Milev RV, Ravindran AV, Parikh SV, Ho K, Rotzinger S, Lou W, Lam RW, Kennedy SH, Bhat V. Pretreatment anxious depression as a predictor of side effect frequency and severity in escitalopram and aripiprazole adjunctive therapy. Brain Behav 2022; 12:e2555. [PMID: 35333448 PMCID: PMC9120722 DOI: 10.1002/brb3.2555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/02/2022] [Accepted: 03/01/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To report side effect frequency and severity in patients with major depressive disorder (MDD) receiving escitalopram and aripiprazole adjunctive therapy and to examine whether pretreatment anxious depression is associated with the number and presence of specific side effects. METHODS 188 of the 211 trial participants provided information on side effects during treatment with escitalopram (10-20 mg) for 8 weeks, and nonresponders received further augmentation on aripiprazole (2-10 mg) adjunctive therapy for another 8 weeks, whereas responders remained on escitalopram. Participants completed the Toronto Side Effects Scale at weeks 2, 4, 10, and 12. Covariate-adjusted negative binomial regression and Wilcoxon tests examined the association between anxious depression (GAD-7 ≥ 10) and number of side effects. Covariate-adjusted logistic regression and chi-square tests explored the association between anxious depression and specific side effects. RESULTS For both therapies, the most frequent side effects were also the most severe. They mostly related to the central nervous system (CNS) (i.e., drowsiness and nervousness). Between baseline and week 2, the number of side effects participants experienced (incidence rate ratio [IRR] = 1.38, p = .010) or had trouble with (IRR = 1.34, p = .026) was significantly higher among those with anxious depression for escitalopram but not adjunctive aripiprazole. Further, odds of experiencing and having trouble with nervousness and agitation were also significantly higher in anxious depression for escitalopram only (p < .05). CONCLUSION Patients on escitalopram and aripiprazole adjunctive therapy may experience and have trouble with CNS side effects. Pretreatment anxious depression may predispose escitalopram recipients with MDD to developing side effects, especially those related to anxiety.
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Affiliation(s)
- Caroline W Espinola
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yuelee Khoo
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Roohie Parmar
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ilya Demchenko
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith Ho
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susan Rotzinger
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Wendy Lou
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital & Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital & Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
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Asghar J, Tabasam M, Althobaiti MM, Adnan Ashour A, Aleid MA, Ibrahim Khalaf O, Aldhyani THH. A Randomized Clinical Trial Comparing Two Treatment Strategies, Evaluating the Meaningfulness of HAM-D Rating Scale in Patients With Major Depressive Disorder. Front Psychiatry 2022; 13:873693. [PMID: 35722557 PMCID: PMC9197773 DOI: 10.3389/fpsyt.2022.873693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/02/2022] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Due to the complexity of symptoms in major depressive disorder (MDD), the majority of depression scales fall short of accurately assessing a patient's progress. When selecting the most appropriate antidepressant treatment in MDD, a multidimensional scale such as the Hamilton Depression Rating scale (HAM-D) may provide clinicians with more information especially when coupled with unidimensional analysis of some key factors such as depressed mood, altered sleep, psychic and somatic anxiety and suicidal ideation etc. METHODS HAM-D measurements were carried out in patients with MDD when treated with two different therapeutic interventions. The prespecified primary efficacy variables for the study were changes in score from baseline to the end of the 12 weeks on HAM-D scale (i.e., ≤ 8 or ≥50% response). The study involved three assessment points (baseline, 6 weeks and 12 weeks). RESULTS Evaluation of both the absolute HAM-D scores and four factors derived from the HAM-D (depressed mood, sleep, psychic and somatic anxiety and suicidal ideation) revealed that the latter showed a greater promise in gauging the anti-depressant responses. CONCLUSION The study confirms the assumption that while both drugs may improve several items on the HAM-D scale, the overall protocol may fall short of addressing the symptoms diversity in MDD and thus the analysis of factor (s) in question might be more relevant and meaningful.
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Affiliation(s)
- Junaid Asghar
- Faculty of Pharmacy, Gomal University, D. I. Khan, Pakistan
| | - Madiha Tabasam
- Faculty of Pharmacy, Gomal University, D. I. Khan, Pakistan
| | | | - Amal Adnan Ashour
- Department of Oral & Maxillofacial Surgery, Taif University, Taif, Saudi Arabia
| | - Mohammed A Aleid
- College of Education, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Osamah Ibrahim Khalaf
- Al-Nahrain Nanorenewable Energy Research Center, Al-Nahrain University, Baghdad, Iraq
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Mandal T, Bairy LK, Sharma PSVN, Valaparla VL. Impact of gender, depression severity and type of depressive episode on efficacy and safety of escitalopram: an observational study on major depressive disorder patients in southern India. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Antidepressant response is a complex trait influenced by clinical, demographic and genetic factors.
Objectives
To explore the influences of baseline depression severity, gender and type of depressive episode on efficacy and safety of escitalopram (10–20 mg/day) in South Indian patients with major depressive disorder (MDD).
Methods
The study was conducted on 18–65-year-old patients (n = 151) suffering from a first or recurrent episode of MDD with a 17-item Hamilton Depression Rating Scale (HDRS-17) score of ≥ 18 at baseline. Efficacy assessments were done using HDRS-17, Montgomery-Asberg Depression Rating Scale (MADRS), and Clinical Global Impression (CGI) at baseline and weeks 4, 8 and 12. Patients were monitored for adverse drug reactions (ADRs). Clinical outcomes were compared among various groups based on gender, type of depressive episode (first or recurrent episode) and baseline HDRS-17 scores (moderate depression—score between 17 and 23; severe depression—score ≥ 24).
Results
Among the 148 subjects who completed the 12-week study, 43.9% and 42.6% achieved response and remission, respectively. The decline in HDRS-17 and MADRS scores from baseline was significant (p value < 0.05) at all follow-up visits and a similar pattern was seen with CGI. Efficacy outcomes were better in the moderate baseline depression group compared with severe depression. There were no associations of efficacy with gender and type of depressive episode. A total of 247 adverse drug reactions (ADR) were reported and 119 (80.41%) subjects experienced at least one ADR during the study period. No serious ADR was reported. Male patients experienced more ADRs compared with females. The safety profile of escitalopram was similar across various groups based on baseline depression severity and type of depressive episode.
Conclusion
The study revealed that escitalopram is efficacious in south Indian MDD patients with a favourable safety profile. The efficacy was influenced by baseline depression severity whereas more ADRs were reported by male patients.
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Saleh R, Majzoub A, Abu El-Hamd M. An update on the treatment of premature ejaculation: A systematic review. Arab J Urol 2021; 19:281-302. [PMID: 34552780 PMCID: PMC8451625 DOI: 10.1080/2090598x.2021.1943273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
To analyse the current therapeutic options for patients with premature ejaculation (PE) and highlight their mechanism(s) of action, effectiveness, advantages and limitations. A literature search was conducted using the PubMed database searching for articles exploring different PE treatment modalities. A Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) approach was used to report the results of the literature search. A total of 149 articles were included in this review. The currently available treatment methods for PE include behavioural therapy, local anaesthetics, tricyclic antidepressants, selective serotonin reuptake inhibitors, and selective phosphodiesterase inhibitors. Most PE treatments are either experimental or used off-label. New treatments are certainly warranted to overcome this exasperating sexual dysfunction.
Abbreviations: AIPE: Arabic Index of Premature Ejaculation; CNS: central nervous system; CYP: cytochrome P450; ED: erectile dysfunction; FDA: United States Food and Drug Administration; H1: histamine receptors; 5-HT: 5-hydroxytryptamine; IELT: The intravaginal ejaculation latency time; IPE: Index of Premature Ejaculation; M1: muscarinic receptors; OCD: obsessive–compulsive disorder; PDE5: phosphodiesterase type 5; PE: premature ejaculation; PEP: Premature Ejaculation Profile; PRO: patient-reported outcome; RCT: randomised controlled trial; SS: Severance Secret (cream); SSRIs: selective serotonin reuptake inhibitors; TCAs: tricyclic antidepressants
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Affiliation(s)
- Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ahmad Majzoub
- Urology Department, Hamad Medical corporation, Doha, Qatar.,Urology Department, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Mohammed Abu El-Hamd
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
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Grigolon RB, Trevizol AP, Gerchman F, Bambokian AD, Magee T, McIntyre RS, Gomes FA, Brietzke E, Mansur RB. Is Obesity A Determinant Of Success With Pharmacological Treatment For Depression? A Systematic Review, Meta-Analysis And Meta-Regression. J Affect Disord 2021; 287:54-68. [PMID: 33773359 DOI: 10.1016/j.jad.2021.03.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The bidirectional association between Major Depressive Disorder (MDD) and obesity suggests that body mass index (BMI) at the baseline could influence remission rates (RR) with pharmacological treatment. We evaluated the influence of baseline BMI on the chances of remission among patients with MDD administered antidepressants. METHODS Based on the guidelines of the PRISMA statement, we conducted a systematic review on PubMed, Cochrane and Embase databases with subsequent meta-analysis and meta-regression. We included only randomized controlled trials evaluating the efficacy of antidepressants of different classes (monotherapy and combined therapies) that evidenced baseline BMI assessment. We created a model to describe the linear relationship between baseline BMI and RR. RESULTS Our systematic review yielded 70 studies with a total of 9,779 patients in the active group and 7,136 patients in the placebo group. In placebo controlled studies, BMI influenced the RR of patients randomized to active treatment. The RR for antidepressants in monotherapy was higher in normal weight to overweight patients rather than obese patients (33% vs 12%, respectively). Also in monotherapy, the RR is higher when the study is conducted on patients with a lower baseline BMI (p=0.029). For combined therapies, the pooled RR was higher in obese patients rather than in normal weight to overweight patients (75% vs 17%, respectively). LIMITATIONS BMI provides no information about body composition and obesity can be related to several potential confounders that potentially influence RR. CONCLUSION The RR with antidepressant therapy seems to be associated with baseline BMI in patients with MDD, although this simple variable was insufficiently explored so far.
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Affiliation(s)
- Ruth Bartelli Grigolon
- Post-Graduation Program in Psychiatry and Medical Psychology, Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alisson P Trevizol
- Temerty Centre for Therapeutic Brain Stimulation and the Mood and Anxiety Ambulatory Services at the Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Fernando Gerchman
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Service of Endocrinology and Metabology, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Taylor Magee
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation (BCDF), Toronto, ON, Canada
| | - Fabiano A Gomes
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada; Inpatient Psychiatric Unit, Kingston General Hospital, Kingston Health Science Centre, Kingston, ON, Canada; Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada; Inpatient Psychiatric Unit, Kingston General Hospital, Kingston Health Science Centre, Kingston, ON, Canada; Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada.
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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Nakagome K, Yokoi Y, Nakagawa A, Tani M, Nishioka G, Yoshimura N, Furukawa TA, Watanabe K, Mimura M, Iwanami A, Abe T. Acceptability of escitalopram versus duloxetine in outpatients with depression who did not respond to initial second-generation antidepressants: A randomized, parallel-group, non-inferiority trial. J Affect Disord 2021; 282:1011-1020. [PMID: 33601673 DOI: 10.1016/j.jad.2020.12.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/30/2020] [Accepted: 12/23/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUNDS Antidepressants are widely used to treat major depressive disorder. First-line treatments with antidepressants are only successful in one-third of patients; however, evidence from randomized controlled trials on second-line treatments is limited. Moreover, recently acceptability is suggested to be a good indicator of overall treatment success. METHODS This is a multi-center two-arm, three-phased randomized controlled trial performed in Japan from December 2013 to March 2017 comparing the acceptability of escitalopram and duloxetine as a second-line drug. Patients, who failed to respond to antidepressants such as sertraline, paroxetine, fluvoxamine, milnacipran or mirtazapine for at least 3 weeks, were randomized to either escitalopram (Group A) or duloxetine (Group B) in Step 1 (8 weeks). In Step 2 (8 weeks), the drug was switched to the other if the first drug failed. The discontinuation rate at the end of Step 1 was the primary endpoint and non-inferiority of escitalopram vs duloxetine was tested. In addition, change in clinical measures from baseline were also assessed at the end of Step 1, 2 and up to 52 weeks. RESULTS At the end of Step 1, Group A (n = 82) was significantly superior to Group B (n = 78) in discontinuation rate (4.9% to 19.2%, P = 0.007). The change in clinical indices from baseline were not different between the groups at either timepoint. LIMITATIONS As the major reason for discontinuation in Group B was the "withdrawal of consent" the concrete reason could not be verified. CONCLUSIONS As a second-line treatment drug, escitalopram was suggested to be non-inferior to duloxetine in acceptability. TRIAL REGISTRATION UMINCTR(UMIN000012367), registered on December 1st, 2013 and last updated on April 4th, 2017.
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Affiliation(s)
- Kazuyuki Nakagome
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan.
| | - Yuma Yokoi
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan
| | - Atsuo Nakagawa
- Keio University Hospital Clinical and Translational Research Center, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masayuki Tani
- Oouchi Hospital, 5-41-1, Nishiarai, Adachi-ku, Tokyo 123-0841, Japan
| | - Gentaro Nishioka
- Nishiyama Hospital, 5-1-1, Imasato Nagaokakyo-shi, Kyoto 617-0814, Japan
| | - Naoki Yoshimura
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan
| | - Toshiaki A Furukawa
- Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Koichiro Watanabe
- Departments of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Akira Iwanami
- Department of Psychiatry, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Takayuki Abe
- Yokohama City University School of Data Science, 22-2, Seto, Kanazawa, Yokohama, Kanagawa 236-0027, Japan
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11
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Cheung CP, Thiyagarajah MT, Abraha HY, Liu CS, Lanctôt KL, Kiss AJ, Saleem M, Juda A, Levitt AJ, Schaffer A, Cheung AH, Sinyor M. The association between placebo arm inclusion and adverse event rates in antidepressant randomized controlled trials: An examination of the Nocebo Effect. J Affect Disord 2021; 280:140-147. [PMID: 33212405 DOI: 10.1016/j.jad.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 07/27/2020] [Accepted: 11/01/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Antidepressant efficacy is influenced by patient expectations and, in randomized controlled trials (RCTs), the probability of receiving a placebo. It is unclear whether tolerability demonstrates a similar pattern. This study aimed to determine whether study design influences adverse event (AE) rates in antidepressant trials for subjects receiving active treatment or placebo. METHODS RCTs comparing one antidepressant to another antidepressant, placebo, or both in major depressive disorder (MDD) (1996-2018) were retrieved from Medline and PsycINFO. Clinicaltrials.gov was searched for unpublished trials. Of 1,997 studies screened, 77 trials were included. Studies were classified as drug-drug, drug-drug-placebo, or drug-placebo based on design and overall number of subjects experiencing any AE was recorded. Subgroup meta-analysis of proportions and meta-regression techniques were used to compare AE rates across study designs in patients receiving active antidepressant treatment and placebo. RESULTS Among the actively treated, AE rates were lower in drug-drug trials (58.5%) compared to drug-drug-placebo (75.7%) and drug-placebo (76.4%) (the model reported coefficients for percent differences between AE rates of different study designs were B=17.0, p<0.001 and B=17.8, p<0.001, respectively). AE rates in patients receiving placebo were not different between study designs. LIMITATIONS The present study is limited by the diverse range of study populations, variability in reporting of AEs, and specific antidepressants employed in the included trials. CONCLUSIONS The inclusion of a placebo arm in the study design was unexpectedly associated with higher rates of AEs among patients receiving active medication in antidepressant trials. This observation has important implications for interpretation of trial tolerability findings.
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Affiliation(s)
- Christian P Cheung
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mathura T Thiyagarajah
- Neuropsychopharmacology Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Haben Y Abraha
- Neuropsychopharmacology Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Celina S Liu
- Neuropsychopharmacology Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Krista L Lanctôt
- Neuropsychopharmacology Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Alex J Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Canada
| | - Mahwesh Saleem
- Neuropsychopharmacology Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Ari Juda
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Amy H Cheung
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.
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12
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Anxious-depressive Pathology in the Structure of Adaptation Disorders (Clinics, Diagnosis, Therapy). Fam Med 2020. [DOI: 10.30841/2307-5112.5-6.2020.224988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective: evaluation of the effectiveness of the drug Giacintia (escitalopram) – coated tablets, 10 mg in the treatment of patients with anxiety and depressive symptoms in the structure of adaptation disorders.
Materials and methods. The study involved 38 patients with adaptive disorders, mixed anxiety-depressive response to ICD-10 (F 43.22). All patients received Giacintia at a dose of 10 mg per day, due to the sufficient therapeutic effect of this dosage. A comprehensive approach was used, which included methods: clinical and psychopathological; psychodiagnostic, based on the scale «Questionnaire of severity of psychopathological symptoms» (Symptom Check List-90-Revised – SCL-90-R), hospital scale of anxiety and depression (HADS) and the scale of social adaptation Sheehan (SDS); methods of mathematical statistics.
Results. Peculiarities of patients’ clinical condition and its dynamics were assessed before treatment (day 1), during therapy (day 14), and after treatment (day 90). As a result of Giacintia therapy, a significant improvement in the mental state of patients was found. When studying the regression of psychopathological symptoms, the positive dynamics of depressive disorders in this category of persons was observed by the end of the second week of therapy, and on the part of anxious – up to 21 days of therapy. Examination of patients at the end of the 90-day course of Giacintia treatment revealed a significant reduction in all previously recorded symptoms of anxiety and depression compared with baseline (p<0.05). On the SCL-90-R scale, on day 14 of therapy, patients showed a significant decrease in obsessive-compulsive symptoms, signs of paranoia (suspicion), hostility (feelings of anger), depressive symptoms, and phobic anxiety. Subsequently, there was a significant decrease in existing psychopathological symptoms and a probable decrease in all scales on day 90 of therapy with the studied antidepressant (t≥2,3477). At the time of the final assessment, the indicator on the scale of depression decreased to 0,52 points, and on the scale of anxiety – to 0,56 points, which indicates a reduction in clinically = pronounced anxiety and depressive symptoms. According to the HADS scale at the initial assessment of clinical and psychopathological manifestations of anxiety and depression, clinically expressed symptoms of anxiety were registered in 71,05 % of individuals (mean score – 15,00±2,39 points), subclinical – in 28,95 % of individuals (mean score – 8,82±0,75 points). At the same time, clinically pronounced symptoms of depression were registered in 81,58 % of individuals (mean score – 15,23±2,33 points), subclinical – in 18,42 % of individuals (mean score – 8,43±0,53 points). A significant decrease in the percentage of clinically pronounced manifestations of depressive symptoms was registered on day 14 of therapy (57,89 % of individuals, p<0,05). At the time of the final HADS assessment, clinically significant symptoms of anxiety and depression were completely reduced in the study group and were represented only by subclinical manifestations in 13,16 % of patients and 11,43 % of patients, respectively.
Conclusions. The results of the study showed high efficacy and good tolerability of the drug Giacintia in the treatment of anxiety and depressive symptoms in the structure of adaptation disorders. Giacintia has not only a balanced pronounced thymoanaleptic effect, but also provides increased professional, social and family activity and improves the quality of life of patients in general. Especially important is the good tolerability of the drug confirmed by the study, the unstable transient nature of adverse events, their insignificant severity, which is a significant advantage in the formation of patients’ commitment to treatment and achieving a deeper and more lasting therapeutic effect. Thus, the use of Giacintia can successfully overcome adaptation disorders and prevent their transformation into chronic conditions.
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13
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Maslej MM, Furukawa TA, Cipriani A, Andrews PW, Mulsant BH. Individual Differences in Response to Antidepressants: A Meta-analysis of Placebo-Controlled Randomized Clinical Trials. JAMA Psychiatry 2020; 77:607-617. [PMID: 32074273 PMCID: PMC7042922 DOI: 10.1001/jamapsychiatry.2019.4815] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Antidepressants are commonly used worldwide to treat major depressive disorder. Symptomatic response to antidepressants can vary depending on differences between individuals; however, this variability may reflect nonspecific or random factors. OBJECTIVES To investigate the assumption of systematic variability in symptomatic response to antidepressants and to assess whether this variability is associated with severity of major depressive disorder, antidepressant class, or year of study publication. DATA SOURCES Data used were from a recent network meta-analysis of acute treatment with licensed antidepressants in adults with major depressive disorder. The following databases were searched from inception to January 8, 2016: the Cochrane Central Register of Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, and PsycINFO. Additional sources were international trial registries, drug approval agency websites, and key scientific journals. STUDY SELECTION Analysis was restricted to double-blind, randomized placebo-controlled trials with available data at the study's end point. DATA EXTRACTION AND SYNTHESIS Baseline and end point means, SDs, number of participants in each group, antidepressant class, and publication year were extracted. The data were analyzed between August 14 and November 18, 2019. MAIN OUTCOMES AND MEASURES With the use of validated methods, coefficients of variation were derived for antidepressants and placebo, and their ratios were calculated to compare outcome variability between antidepressant and placebo. Ratios were entered into a random-effects model, with the expectation that response to antidepressants would be more variable than response to placebo. Analysis was repeated after stratifying by baseline severity of depression, antidepressant class (selective serotonin reuptake inhibitors: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, and vilazodone; serotonin and norepinephrine reuptake inhibitors: desvenlafaxine and venlafaxine; norepinephrine-dopamine reuptake inhibitor: bupropion; noradrenergic agents: amitriptyline and reboxetine; and other antidepressants: agomelatine, mirtazapine, and trazodone), and publication year. RESULTS In the 87 eligible randomized placebo-controlled trials (17 540 unique participants), there was significantly more variability in response to antidepressants than to placebo (coefficients of variation ratio, 1.14; 95% CI, 1.11-1.17; P < .001). Baseline severity of depression did not moderate variability in response to antidepressants. Variability in response to selective serotonin reuptake inhibitors was lower than variability in response to noradrenergic agents (coefficients of variation ratio, 0.88; 95% CI, 0.80-0.97; P = .01), as was the variability in response to other antidepressants compared with noradrenergic agents (coefficients of variation ratio, 0.87; 95% CI, 0.79-0.97; P = .001). Variability also tended to be lower in studies that were published more recently, with coefficients of variation changing by a value of 0.005 (95% CI, 0.002-0.008; P = .003) for every year a study is more recent. CONCLUSIONS AND RELEVANCE Individual differences may be systematically associated with responses to antidepressants in major depressive disorder beyond placebo effects or statistical factors. This study provides empirical support for identifying moderators and personalizing antidepressant treatment.
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Affiliation(s)
- Marta M. Maslej
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Toshiaki A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Yoshida-Konoe, Sakyo, Kyoto, Japan,Department of Clinical Epidemiology, Kyoto University Graduate School of Medicine, Kyoto University School of Public Health, Yoshida-Konoe, Sakyo, Kyoto, Japan
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom,Warneford Hospital, Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom
| | - Paul W. Andrews
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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14
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Meta-analysis of placebo group dropout in adult antidepressant trials. Prog Neuropsychopharmacol Biol Psychiatry 2020; 98:109777. [PMID: 31697973 DOI: 10.1016/j.pnpbp.2019.109777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/28/2019] [Accepted: 10/02/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Minimizing dropouts across antidepressant, placebo-controlled trials remains a major opportunity to improve the efficiency of trials. This meta-analysis investigated placebo dropout rate and its predictors in second generation antidepressant (SGA) for anxiety, depression and obsessive-compulsive disorder (OCD). METHODS A random-effects meta-analysis was performed to examine placebo group dropout rate in SGA trials for depression, anxiety and OCD using Freeman - Tukey transformation. Stratified subgroup analysis by diagnostic indication was performed to examine the dropout rate across disorders. Meta-regression was performed to identify correlates between placebo dropout rate and trial and subject characteristics. RESULTS Meta-analysis included 148 trials with 18,016 participants receiving placebo. Across antidepressant trials the overall placebo dropout rate was 25% (dropout rate ± standard error (SE) = 0.25 ± 0.01, 95% CI: 0.23-0.27, z = 23.95, p < .001) and was similar across disorders (χ2 = 1.09, df = 2, p = .58). The placebo group dropout rate was 26% in depressive disorders, 25% in anxiety disorders and 22% in OCD. Across all diagnostic indications, earlier publication year, placebo lead-in, studies conducted in a single country (instead of internationally), longer trial duration, fewer study sites, more study visits and less baseline illness severity were associated with higher placebo dropout rate. Significant predictors of placebo dropout did not replicate across disorders. CONCLUSION No significant difference was found in placebo dropout rate between internalizing disorders with overall dropout rate for placebo groups in antidepressant trials being around 25%. Placebo dropouts in trials can be minimized by reducing subject burden in trials, enrolling more severely affected subjects and foregoing placebo lead-in periods.
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15
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Aronow WS, Shamliyan TA. Effects of antidepressants on QT interval in people with mental disorders. Arch Med Sci 2020; 16:727-741. [PMID: 32542073 PMCID: PMC7286318 DOI: 10.5114/aoms.2019.86928] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/23/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Drug-induced QT prolongation is associated with higher cardiovascular mortality. MATERIAL AND METHODS We conducted a protocol-based comprehensive review of antidepressant-induced QT prolongation in people with mental disorders. RESULTS Based on findings from 47 published randomized controlled trials (RCTs), 3 unpublished RCTs, 14 observational studies, 662 case reports of torsades de pointes, and 168 cases of QT prolongation, we conclude that all antidepressants should be used only with licensed doses, and that all patients receiving antidepressants require monitoring of QT prolongation and clinical symptoms of cardiac arrhythmias. Large observational studies suggest increased mortality associated with all antidepressants (RR = 1.62, 95% CI: 1.60-1.63, number of adults: 1,716,552), high doses of tricyclic antidepressants (OR = 2.11, 85% CI 1.10-4.22), selective serotonin reuptake inhibitors (OR = 2.78, 95% CI: 1.24-6.24), venlafaxine (OR = 3.73, 95% CI: 1.33-10.45, number of adults: 4,040), and nortriptyline (OR = 4.60, 95% CI: 1.20-18.40, number of adults: 5,298). CONCLUSIONS Evidence regarding the risk of QT prolongation in children is sparse.
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Affiliation(s)
- Wilbert S. Aronow
- Department of Medicine and Cardiology Research, Westchester Medical Center and New York Medical College, New York, USA
| | - Tatyana A. Shamliyan
- Elsevier, Clinical Solutions, Philadelphia, USA
- Corresponding author: Tatyana A. Shamliyan MD, MS, Elsevier Clinical Solutions, 1600 Kennedy Blvd, 19103 Philadelphia, USA, Phone: 2675004863, E-mail:
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16
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Mahajan SS, Tandon VR, Arora M, Mahajan A, Kotwal S. Comparative Efficacy and Safety of Escitalopram versus Desvenlafaxine in Postmenopausal Women with Depression and Anxiety: A Randomized, Open-Label, Comparative Trial. J Midlife Health 2019; 10:141-146. [PMID: 31579188 PMCID: PMC6767953 DOI: 10.4103/jmh.jmh_139_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and Objectives: The aim was to evaluate the comparative efficacy and safety of escitalopram versus desvenlafaxine in postmenopausal women with depression and anxiety in our study cohort. Materials and Methods: A randomized, open-label, intention-to-treat, comparative study was conducted over a period of 1 year. Group 1 (n = 20) patients received tablet escitalopram 10 mg once daily orally which was increased to 20 mg/day when needed at the first follow-up. Group 2 (n = 20) patients received tablet desvenlafaxine 50 mg once daily orally which was increased to 100 mg/day when needed at the first follow-up. Patients were followed at 3 and 6 weeks. Primary endpoints were change in baseline scores (recorded as mean ± standard deviation) of Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A), and safety was also assessed and compared. Results: Forty patients completed the study. Escitalopram was statistically better than desvenlafaxine in reducing depression after 6 weeks of treatment (P < 0.05). Both the drugs were found to be equally effective in treating anxiety. Furthermore, they showed comparable safety and tolerability. Conclusion: Escitalopram appears to be more effective on short-term basis in treating depression, and both the drugs appear equally effective in combating anxiety. Furthermore, they appear to be equally safe and well tolerated in postmenopausal women with depression and anxiety.
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Affiliation(s)
- Sonia Shinde Mahajan
- Department of Pharmacology and Therapeutics, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Vishal R Tandon
- Department of Pharmacology and Therapeutics, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Manu Arora
- Department of Psychiatry, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Annil Mahajan
- Department of General Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Suman Kotwal
- Department of General Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
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17
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Yokoi Y, Nakagawa A, Yoshimura N, Furukawa TA, Mimura M, Iwanami A, Abe T, Nakagome K. Acceptability of escitalopram versus duloxetine in outpatients with depression who did not respond to initial second-generation antidepressants: Study protocol for a randomized, parallel-group, non-inferiority trial. Neuropsychopharmacol Rep 2019; 39:262-272. [PMID: 31531962 PMCID: PMC7292285 DOI: 10.1002/npr2.12078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 11/29/2022] Open
Abstract
Aim The purpose of this study is to compare acceptability of two second generation antidepressants for major depressive disorder patients who have not responded to the first antidepressant for current episode. We will investigate the treatment discontinuation rate and treatment adherence as well as incidence of adverse events in order to evaluate safety. Methods This is a two‐arm, three‐phased randomized controlled trial in which independent assessors will be blinded while treating psychiatrists and patients remain unblinded to treatment allocation. Patients will be randomized to escitalopram or duloxetine in Step 1 (8 weeks), and when entering Step 2 (8 weeks), the drug will be switched to the other if the first one is not effective at the end of Step 1. The acceptability of the allocated drugs, improvements in depression from baseline, adverse events, and attrition rates will be recorded and assessed for up to 52 weeks, including the follow‐up step. Results It is going to be disseminated via our following reports or presentations. Conclusions This study will provide valuable information for clinicians who encounter patients who failed to respond to their first treatment. This is a protocol of randomized controlled trial assessing acceptability of two antidepressants after one antidepressant therapy failed.![]()
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Affiliation(s)
- Yuma Yokoi
- Department of Psychiatry, National Center of Neurology and Psychiatry, National Center Hospital, Tokyo, Japan
| | - Atsuo Nakagawa
- Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
| | - Naoki Yoshimura
- Department of Psychiatry, National Center of Neurology and Psychiatry, National Center Hospital, Tokyo, Japan
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Akira Iwanami
- Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan
| | - Takayuki Abe
- Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
| | - Kazuyuki Nakagome
- National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
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Chen H, Lin Q, Lin T, Lin Y, Lin X, Chen R, Luo L, Lin F, Xiao Y. A controlled study of the efficacy and safety of tandospirone citrate combined with escitalopram in the treatment of vascular depression: A pilot randomized controlled trial at a single-center in China. J Psychiatr Res 2019; 114:133-140. [PMID: 31075722 DOI: 10.1016/j.jpsychires.2019.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/08/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
Vascular depression can respond poorly to antidepressants. This study aimed to explore the efficacy and safety of tandospirone plus escitalopram for treating vascular depression with anxiety. This pilot randomized controlled trial included consecutive inpatients/outpatients with vascular depression/anxiety at the Department of Neurology, Fujian Medical University Union Hospital, China (January 2014 to December 2016). Among 157 patients screened, 100 were randomly divided into the tandospirone + escitalopram (combination therapy) and escitalopram (monotherapy) groups equally, and then followed for 8 weeks. Efficacy was evaluated using the Hamilton Depression (HAMD), Hamilton Anxiety (HAMA), Clinical Global Impression (CGI) and Mini-Mental State examination (MMSE) scales. Adverse events (AEs) were assessed with the Treatment Emergent Symptom Scale (TESS). HAMD and HAMA scores decreased progressively, showing reductions versus baseline at 1, 2, 4 and 8 weeks in both groups (P < 0.001). HAMD and HAMA scores were lower in the tandospirone + escitalopram group than those in the escitalopram group at 1 and 2 weeks (P < 0.001), but not at 4 and 8 weeks. Improvements in CGI scores (severity, improvement and efficacy indexes) were greater in the tandospirone + escitalopram group than that in the escitalopram group at 1 and 2 weeks (P < 0.01), but not at 4 and 8 weeks. The tandospirone + escitalopram group had higher MMSE scores than that in the escitalopram group at 4 and 8 weeks (P < 0.01). All AEs were mild, and the rates were comparable between groups. Augmentation of escitalopram with tandospirone accelerates the onset of anti-depressive and anxiolytic effects and improves cognitive function in patients with vascular depression and anxiety.
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Affiliation(s)
- Hongbin Chen
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China; Institute of Cerebral Vascular Disease of Fujian Province, Fuzhou, PR China; Key Laboratory of Brain Aging and Neurodegenerative Diseases, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, PR China
| | - Qianwen Lin
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China; Institute of Cerebral Vascular Disease of Fujian Province, Fuzhou, PR China; Key Laboratory of Brain Aging and Neurodegenerative Diseases, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, PR China
| | - Ting Lin
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China; Institute of Cerebral Vascular Disease of Fujian Province, Fuzhou, PR China; Key Laboratory of Brain Aging and Neurodegenerative Diseases, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, PR China
| | - Yongsen Lin
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China; Institute of Cerebral Vascular Disease of Fujian Province, Fuzhou, PR China; Key Laboratory of Brain Aging and Neurodegenerative Diseases, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, PR China
| | - Xiaohui Lin
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China; Institute of Cerebral Vascular Disease of Fujian Province, Fuzhou, PR China; Key Laboratory of Brain Aging and Neurodegenerative Diseases, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, PR China
| | - Ronghua Chen
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China; Institute of Cerebral Vascular Disease of Fujian Province, Fuzhou, PR China; Key Laboratory of Brain Aging and Neurodegenerative Diseases, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, PR China
| | - Ling Luo
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China; Institute of Cerebral Vascular Disease of Fujian Province, Fuzhou, PR China; Key Laboratory of Brain Aging and Neurodegenerative Diseases, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, PR China
| | - Feifei Lin
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China; Institute of Cerebral Vascular Disease of Fujian Province, Fuzhou, PR China; Key Laboratory of Brain Aging and Neurodegenerative Diseases, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, PR China
| | - Yingchun Xiao
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China; Institute of Cerebral Vascular Disease of Fujian Province, Fuzhou, PR China; Key Laboratory of Brain Aging and Neurodegenerative Diseases, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, PR China.
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Liu L, Fu M, Pei S, Zhou L, Shang J. R-Fluoxetine Increases Melanin Synthesis Through a 5-HT1A/2A Receptor and p38 MAPK Signaling Pathways. Int J Mol Sci 2018; 20:ijms20010080. [PMID: 30585252 PMCID: PMC6337216 DOI: 10.3390/ijms20010080] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 12/02/2022] Open
Abstract
Fluoxetine, a member of the class of selective serotonin reuptake inhibitors, is a racemic mixture and has an anxiolytic effect in rodents. Previously, we have shown that fluoxetine can up-regulate melanin synthesis in B16F10 melanoma cells and normal human melanocytes (NMHM). However, the role of r-fluoxetine and s-fluoxetine, in the regulation of melanin synthesis, is still unknown. Here, we show how r-fluoxetine plays a critical role in fluoxetine enhancing melanogenesis, both in vivo and vitro, by up-regulating tyrosinase (TYR) and the microphthalmia-associated transcription factor (MITF) expression, whereas, s-fluoxetine does not show any effect in the vivo and vitro systems. In addition, we found that r-fluoxetine induced melanin synthesis through the serotonin1A receptor (5-HT1A) and serotonin 2A receptor (5-HT2A). Furthermore, r-fluoxetine increased the phosphorylation of p38 mitogen-activated protein kinase (p38 MAPK), without affecting the phosphorylation of extracellularly responsive kinase (ERK1/2) and c-Jun N-terminal kinase (JNK). These data suggest that r-fluoxetine may be used as a drug for skin hypopigmentation disorders.
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Affiliation(s)
- Li Liu
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China.
- Jiangsu Key Laboratory of TCM Evaluation and Translational Research, China Pharmaceutical University, Nanjing 210009, China.
| | - Mengsi Fu
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China.
- Jiangsu Key Laboratory of TCM Evaluation and Translational Research, China Pharmaceutical University, Nanjing 210009, China.
| | - Siran Pei
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China.
- Jiangsu Key Laboratory of TCM Evaluation and Translational Research, China Pharmaceutical University, Nanjing 210009, China.
| | - Liangliang Zhou
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China.
- Jiangsu Key Laboratory of TCM Evaluation and Translational Research, China Pharmaceutical University, Nanjing 210009, China.
| | - Jing Shang
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China.
- Jiangsu Key Laboratory of TCM Evaluation and Translational Research, China Pharmaceutical University, Nanjing 210009, China.
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Telang S, Walton C, Olten B, Bloch MH. Meta-analysis: Second generation antidepressants and headache. J Affect Disord 2018; 236:60-68. [PMID: 29715610 DOI: 10.1016/j.jad.2018.04.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/22/2018] [Accepted: 04/04/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND To assess the risk of headache associated with commonly prescribed antidepressant medications and to examine the impact of medication class, pharmacodynamics and dosage on risk of headache. METHODS We searched PubMed to identify all randomized, double-blind, placebo-controlled trials examining the efficacy of second generation antidepressant medications in the treatment of adults with depression, anxiety or obsessive-compulsive disorders. We used a fixed-effect meta-analysis to examine the pooled risk ratio of headache reported as a side-effect in adults treated with second generation antidepressants compared to placebo. We used stratified subgroup analysis and meta-regression to examine the effects of medication type, class, dosage, indication, and receptor affinity profile on the measured risk of headache. RESULTS SSRIs were associated with a significantly increased risk of headache (RR = 1.06, 95%CI = 1.00-1.13, z = 2.0, p = 0.045) when compared to placebo. There was no significant difference (test for subgroup differences χ2 = 2.2, df = 1, p = 0.14) in the risk of headache between SSRIs and SNRIs (RR = 0.97, 95%CI = 0.88-1.06, p = 0.63). There was no significant difference in the relative risk of headache with second generation antidepressants based on diagnostic indication, pharmacological properties and dosage of medications. The only antidepressants that were found to be significantly associated with increased risk of headache compared to placebo were bupropion (RR = 1.22, 95%CI = 1.06-1.41, z = 2.73, p = 0.006) and escitalopram (RR = 1.18, 95%CI = 1.01-1.37, z = 2.11, p = 0.04). LIMITATIONS The small number of studies that examined side effects within fixed-dose trials may have limited the power to examine the association between medication dosing and risk of headache. Additionally, reporting bias could potentially occur non-randomly across agents and therefore effect meta-analysis results. CONCLUSIONS Headaches reported after the initiation of second generation antidepressant medications are more likely to be coincidental than a treatment-emergent side effect of these medications.
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Affiliation(s)
| | - Celeste Walton
- Undergraduate student at Sewanee, The University of the South, Sewanee, Tennessee, USA; Summer intern at the Yale Child Study Center, New Haven, CT, USA
| | - Baris Olten
- The Yale Child Study Center, New Haven, CT, USA
| | - Michael H Bloch
- The Yale Child Study Center and the Department of Psychiatry of Yale University, New Haven, CT, USA.
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Si T, Wang G, Yang F, Fang Y, Fang M, Li J, Dong J, Shen X, Zhuo J, Rui Q, Wang J, Cuili H. Efficacy and safety of escitalopram in treatment of severe depression in Chinese population. Metab Brain Dis 2017; 32:891-901. [PMID: 28299626 DOI: 10.1007/s11011-017-9992-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 03/08/2017] [Indexed: 11/25/2022]
Abstract
Severe depression accounts for one-third of depressed patients. Increasing severity of depression usually hinders patients from achieving remission. This study evaluated the efficacy and safety of escitalopram in acute-phase treatment of severe major depressive disorder (MDD). A total of 225 participants with severe MDD (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria), with a current depressive episode and Montgomery-Asberg Depression Rating Scale (MADRS) score of ≥30 were enrolled. Participants received flexible dose escitalopram (10-20 mg/d) treatment for 8 weeks. Symptoms status was assessed by MADRS, Hamilton Depression Rating Scale (HAM-D-17), and Hamilton Anxiety Rating Scale (HAM-A). Quality of life was assessed by Short Form-12 (SF-12) and safety by adverse events, laboratory investigations, vital signs and physical findings. The remission (MADRS total score ≤ 10) rate in the intent-to-treat set (n = 207) was 72.9% at week 8. Significant improvement in symptoms compared to baseline, as evaluated by MADRS, HAMD-17 and HAMA scores at baseline, week 1, week 2, week 4, and week 8 (p < 0.0001 for all), was noted. Mean (SD) reduction from baseline in MADRS total score was 26.6 (11.38). Improvements in SF-12 score were significant (p = 0.000) and positively related to symptom improvement and negatively related to treatment-emergent adverse events (TEAEs). TEAEs were reported in 28.38% of participants. Most common TEAEs (>4%) were somnolence (9.0%), nausea (7.7%), hyperhidrosis (4.5%), dry mouth and dizziness (4.1% each). No serious TEAEs were reported. Escitalopram was effective and well-tolerated for acute-phase treatment of severe depression in Chinese population.
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Affiliation(s)
- Tianmei Si
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital/ Institute of Mental Health) and the Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Gang Wang
- Beijing Anding Hospital of Capital University of Medical Sciences, Beijing, China
| | - Fude Yang
- Beijing Huilongguan Hospital, Beijing, China
| | - Yiru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Jijun Li
- Nanjing Brain Hospital, Jiangsu, China
| | - Jicheng Dong
- Qingdao Mental Health Center, Qingdao, Shandong, China
| | | | - Jianmin Zhuo
- Xi'an Janssen Pharmaceutical Ltd, Beijing, China
| | - Qing Rui
- Xi'an Janssen Pharmaceutical Ltd, Beijing, China
| | - Jinan Wang
- Xi'an Janssen Pharmaceutical Ltd, Beijing, China
| | - Hu Cuili
- Xi'an Janssen Pharmaceutical Ltd, Beijing, China.
- Therapeutic Area Physician, Medical Department, China R&D and Scientific Affairs, Xi'an Janssen Pharmaceutical Ltd., 19F, Tower 3, China Central Place, No. 77 Jian Guo Road, Chao Yang District, Beijing, 100025, China.
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Jakobsen JC, Katakam KK, Schou A, Hellmuth SG, Stallknecht SE, Leth-Møller K, Iversen M, Banke MB, Petersen IJ, Klingenberg SL, Krogh J, Ebert SE, Timm A, Lindschou J, Gluud C. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. BMC Psychiatry 2017; 17:58. [PMID: 28178949 PMCID: PMC5299662 DOI: 10.1186/s12888-016-1173-2] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 12/20/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The evidence on selective serotonin reuptake inhibitors (SSRIs) for major depressive disorder is unclear. METHODS Our objective was to conduct a systematic review assessing the effects of SSRIs versus placebo, 'active' placebo, or no intervention in adult participants with major depressive disorder. We searched for eligible randomised clinical trials in The Cochrane Library's CENTRAL, PubMed, EMBASE, PsycLIT, PsycINFO, Science Citation Index Expanded, clinical trial registers of Europe and USA, websites of pharmaceutical companies, the U.S. Food and Drug Administration (FDA), and the European Medicines Agency until January 2016. All data were extracted by at least two independent investigators. We used Cochrane systematic review methodology, Trial Sequential Analysis, and calculation of Bayes factor. An eight-step procedure was followed to assess if thresholds for statistical and clinical significance were crossed. Primary outcomes were reduction of depressive symptoms, remission, and adverse events. Secondary outcomes were suicides, suicide attempts, suicide ideation, and quality of life. RESULTS A total of 131 randomised placebo-controlled trials enrolling a total of 27,422 participants were included. None of the trials used 'active' placebo or no intervention as control intervention. All trials had high risk of bias. SSRIs significantly reduced the Hamilton Depression Rating Scale (HDRS) at end of treatment (mean difference -1.94 HDRS points; 95% CI -2.50 to -1.37; P < 0.00001; 49 trials; Trial Sequential Analysis-adjusted CI -2.70 to -1.18); Bayes factor below predefined threshold (2.01*10-23). The effect estimate, however, was below our predefined threshold for clinical significance of 3 HDRS points. SSRIs significantly decreased the risk of no remission (RR 0.88; 95% CI 0.84 to 0.91; P < 0.00001; 34 trials; Trial Sequential Analysis adjusted CI 0.83 to 0.92); Bayes factor (1426.81) did not confirm the effect). SSRIs significantly increased the risks of serious adverse events (OR 1.37; 95% CI 1.08 to 1.75; P = 0.009; 44 trials; Trial Sequential Analysis-adjusted CI 1.03 to 1.89). This corresponds to 31/1000 SSRI participants will experience a serious adverse event compared with 22/1000 control participants. SSRIs also significantly increased the number of non-serious adverse events. There were almost no data on suicidal behaviour, quality of life, and long-term effects. CONCLUSIONS SSRIs might have statistically significant effects on depressive symptoms, but all trials were at high risk of bias and the clinical significance seems questionable. SSRIs significantly increase the risk of both serious and non-serious adverse events. The potential small beneficial effects seem to be outweighed by harmful effects. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013004420.
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Affiliation(s)
- Janus Christian Jakobsen
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812 Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, DK 2100 Copenhagen, Denmark
- Department of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | - Kiran Kumar Katakam
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812 Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, DK 2100 Copenhagen, Denmark
| | - Anne Schou
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812 Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, DK 2100 Copenhagen, Denmark
| | - Signe Gade Hellmuth
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812 Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, DK 2100 Copenhagen, Denmark
| | - Sandra Elkjær Stallknecht
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812 Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, DK 2100 Copenhagen, Denmark
| | - Katja Leth-Møller
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812 Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, DK 2100 Copenhagen, Denmark
| | - Maria Iversen
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812 Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, DK 2100 Copenhagen, Denmark
| | - Marianne Bjørnø Banke
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812 Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, DK 2100 Copenhagen, Denmark
| | - Iggiannguaq Juhl Petersen
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812 Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, DK 2100 Copenhagen, Denmark
| | - Sarah Louise Klingenberg
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812 Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, DK 2100 Copenhagen, Denmark
| | - Jesper Krogh
- Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sebastian Elgaard Ebert
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812 Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, DK 2100 Copenhagen, Denmark
| | - Anne Timm
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812 Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, DK 2100 Copenhagen, Denmark
| | - Jane Lindschou
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812 Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, DK 2100 Copenhagen, Denmark
| | - Christian Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812 Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, DK 2100 Copenhagen, Denmark
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An H, Choi B, Park KW, Kim DH, Yang DW, Hong CH, Kim SY, Han SH. The Effect of Escitalopram on Mood and Cognition in Depressive Alzheimer’s Disease Subjects. J Alzheimers Dis 2016; 55:727-735. [DOI: 10.3233/jad-160225] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hoyoung An
- National Institute of Dementia, Seongnam, South Korea
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Booyeol Choi
- Department of Psychiatry, University of Ulsan College of Medicine Asan Medical Center, Seoul, South Korea
| | - Kun-woo Park
- Department of Neurology, Korea University, School of Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Do-Hoon Kim
- Department of Psychiatry, Hallym University, College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, South Korea
| | - Dong-Won Yang
- Department of Neurology, The Catholic University of Korea, College of Medicine, Seoul St. Mary’s Hospital, Seoul, South Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Seong Yoon Kim
- Department of Psychiatry, University of Ulsan College of Medicine Asan Medical Center, Seoul, South Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk University College of Medicine, Konkuk University Medical Center, Seoul, South Korea
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Yazıcı AE, Erdem P, Erdem A, Yazıcı K, Acar ŞT, Başterzi AD, Taşdelen B. Depresyonu Olan Son Dönem Böbrek Yetmezliği Hastalarında Essitalopramın Etkinliği ve Tolerabilitesi: Bir Açık Plasebo Kontrollü Çalışma. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20120215011558] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Pervin Erdem
- Mersin Üniversitesi Tıp Fakültesi Psikiyatri AD, Mersin-Türkiye
| | | | - Kemal Yazıcı
- Mersin Üniversitesi Tıp Fakültesi Psikiyatri AD, Mersin-Türkiye
| | - Şenel Tot Acar
- Mersin Üniversitesi Tıp Fakültesi Psikiyatri AD, Mersin-Türkiye
| | | | - Bahar Taşdelen
- Mersin Üniversitesi Tıp Fakültesi Biyoistatistik AD, Mersin-Türkiye
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Vortioxetine for major depressive disorder: An indirect comparison with duloxetine, escitalopram, levomilnacipran, sertraline, venlafaxine, and vilazodone, using number needed to treat, number needed to harm, and likelihood to be helped or harmed. J Affect Disord 2016; 196:225-33. [PMID: 26938965 DOI: 10.1016/j.jad.2016.02.042] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 12/26/2015] [Accepted: 02/13/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vortioxetine is approved for the treatment of major depressive disorder and differs from other antidepressants in terms of its pharmacodynamic profile. Given the limited number of head-to-head studies comparing vortioxetine with other antidepressants, indirect comparisons using effect sizes observed in other trials can be helpful to discern potential differences in clinical outcomes. METHODS Data sources were the clinical trial reports for the pivotal short-term double-blind trials for vortioxetine and from publicly available sources for the pivotal short-term double-blind trials for two commonly used generic serotonin specific reuptake inhibitor antidepressants (sertraline, escitalopram), two commonly used generic serotonin-norepinephrine reuptake inhibitor antidepressants (venlafaxine, duloxetine), and two recently introduced branded antidepressants (vilazodone, levomilnacipran). Response was the efficacy outcome of interest, defined as a≥50% reduction from baseline on the Montgomery-Asberg Depression Rating Scale or Hamilton Depression Rating Scale. The tolerability outcome of interest was discontinuation because of an adverse event. Number needed to treat (NNT) and number needed to harm (NNH) for these outcomes vs. placebo were calculated, as well as likelihood to be helped or harmed (LHH) to contrast efficacy vs. tolerability. RESULTS The analysis included 8 studies for duloxetine, 3 studies for escitalopram, 5 studies for levomilnacipran, 1 study for sertraline, 4 studies for venlafaxine, 2 studies for vilazodone, and 11 studies for vortioxetine. NNTs for response vs. placebo were 6 (95% CI 5-8), 7 (5-11), 10 (8-16), 6 (4-13), 6 (5-9), 8 (6-16), and 9 (7-11), respectively. NNHs for discontinuation because of an adverse event vs. placebo were 25 (17-51), 31 (19-92), 19 (14-27), 7 (5-12), 8 (7-11), 27 (15-104), and 43 (28-91), respectively. LHH values contrasting response vs. discontinuation because of an adverse event were 4.3, 4.6, 1.8, 1.2, 1.4, 3.3, and 5.1 respectively. LIMITATIONS Subjects were all participants in carefully designed and executed clinical trials and may not necessarily reflect patients in clinical settings who may have complex psychiatric and non-psychiatric comorbidities. The measured outcomes come from different studies and thus comparisons are indirect. CONCLUSIONS Vortioxetine demonstrates similar efficacy to that observed for duloxetine, escitalopram, levomilnacipran, sertraline, venlafaxine, and vilazodone, however overall tolerability as measured by discontinuation because of an adverse event differs. Vortioxetine is 5.1 times more likely to be associated with response than discontinuation because of an adverse event when compared to placebo.
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Jakubovski E, Varigonda AL, Freemantle N, Taylor MJ, Bloch MH. Systematic Review and Meta-Analysis: Dose-Response Relationship of Selective Serotonin Reuptake Inhibitors in Major Depressive Disorder. Am J Psychiatry 2016; 173:174-83. [PMID: 26552940 PMCID: PMC4975858 DOI: 10.1176/appi.ajp.2015.15030331] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Previous studies suggested that the treatment response to selective serotonin reuptake inhibitors (SSRIs) in major depressive disorder follows a flat response curve within the therapeutic dose range. The present study was designed to clarify the relationship between dosage and treatment response in major depressive disorder. METHOD The authors searched PubMed for randomized placebo-controlled trials examining the efficacy of SSRIs for treating adults with major depressive disorder. Trials were also required to assess improvement in depression severity at multiple time points. Additional data were collected on treatment response and all-cause and side effect-related discontinuation. All medication doses were transformed into imipramine-equivalent doses. The longitudinal data were analyzed with a mixed-regression model. Endpoint and tolerability analyses were analyzed using meta-regression and stratified subgroup analysis by predefined SSRI dose categories in order to assess the effect of SSRI dosing on the efficacy and tolerability of SSRIs for major depressive disorder. RESULTS Forty studies involving 10,039 participants were included. Longitudinal modeling (dose-by-time interaction=0.0007, 95% CI=0.0001-0.0013) and endpoint analysis (meta-regression: β=0.00053, 95% CI=0.00018-0.00088, z=2.98) demonstrated a small but statistically significant positive association between SSRI dose and efficacy. Higher doses of SSRIs were associated with an increased likelihood of dropouts due to side effects (meta-regression: β=0.00207, 95% CI=0.00071-0.00342, z=2.98) and decreased likelihood of all-cause dropout (meta-regression: β=-0.00093, 95% CI=-0.00165 to -0.00021, z=-2.54). CONCLUSIONS Higher doses of SSRIs appear slightly more effective in major depressive disorder. This benefit appears to plateau at around 250 mg of imipramine equivalents (50 mg of fluoxetine). The slightly increased benefits of SSRIs at higher doses are somewhat offset by decreased tolerability at high doses.
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Affiliation(s)
- Ewgeni Jakubovski
- From the Yale Child Study Center, New Haven, Conn.; the University of Vermont College of Medicine, Burlington, Vt.; Child Study Center and Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Primary Care and Population Health, University College London; and the Department of Psychosis Studies, King's College London
| | - Anjali L Varigonda
- From the Yale Child Study Center, New Haven, Conn.; the University of Vermont College of Medicine, Burlington, Vt.; Child Study Center and Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Primary Care and Population Health, University College London; and the Department of Psychosis Studies, King's College London
| | - Nicholas Freemantle
- From the Yale Child Study Center, New Haven, Conn.; the University of Vermont College of Medicine, Burlington, Vt.; Child Study Center and Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Primary Care and Population Health, University College London; and the Department of Psychosis Studies, King's College London
| | - Matthew J Taylor
- From the Yale Child Study Center, New Haven, Conn.; the University of Vermont College of Medicine, Burlington, Vt.; Child Study Center and Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Primary Care and Population Health, University College London; and the Department of Psychosis Studies, King's College London
| | - Michael H Bloch
- From the Yale Child Study Center, New Haven, Conn.; the University of Vermont College of Medicine, Burlington, Vt.; Child Study Center and Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Primary Care and Population Health, University College London; and the Department of Psychosis Studies, King's College London
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Arroll B, Chin WY, Martis W, Goodyear-Smith F, Mount V, Kingsford D, Humm S, Blashki G, MacGillivray S. Antidepressants for treatment of depression in primary care: a systematic review and meta-analysis. J Prim Health Care 2016. [DOI: 10.1071/hc16008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTION
Evidence for the effectiveness of drug treatment for depression in primary care settings remains limited, with little information on newer antidepressant classes.
AIM
To update an earlier Cochrane review on the effectiveness of antidepressants in primary care to include newer antidepressant classes, and to examine the efficacy of individual agents.
METHODS
Selection criteria included antidepressant studies with a randomly assigned placebo group where half or more subjects were recruited from primary care. The Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) group searched multiple databases to identify eligible studies. Data extraction was performed independently by two reviewers. Data were analysed using Revman version 5.3.5.
RESULTS
In total, 17 papers and 22 comparisons were included for analysis. Significant benefits in terms of response were found for tricyclic antidepressants (TCA) with a relative risk (RR) = 1.23 (95% CI, 1.01–1.48), and serotonin selective reuptake inhibitors (SSRI) with a RR = 1.33 (95% CI, 1.20–1.48). Mianserin was effective for continuous outcomes. Numbers needed to treat (NNT) for TCA = 8.5; SSRI = 6.5; and venlafaxine = 6. Most studies were industry-funded and of a brief duration (≤ 8 weeks). There was evidence of publication bias. There were no studies comparing newer antidepressants against placebo.
CONCLUSION
Antidepressants such as TCA, SSRI, SNRI (serotonin–norepinephrine reuptake inhibitor) and NaSSA (noradrenergic and specific serotonergic antidepressant) classes appear to be effective in primary care when compared with placebo. However, in view of the potential for publication bias and that only four studies were not funded by industry, caution is needed when considering their use in primary care.
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Franco R, Petrovic M. Suggesting a Way to Understand the Actual Potential of Anti-Alzheimer's Disease Drugs That Show Promise in Transgenic Mouse Models. Front Neurol 2015; 6:206. [PMID: 26500603 PMCID: PMC4594007 DOI: 10.3389/fneur.2015.00206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/08/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rafael Franco
- Departament de Bioquímica i Biologia Molecular, Facultat de Biologia, Universitat de Barcelona , Barcelona , Spain ; Centro de Investigación Biomédica en Red: Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III , Madrid , Spain
| | - Milos Petrovic
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire , Preston , UK
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Jacobsen PL, Mahableshwarkar AR, Chen Y, Chrones L, Clayton AH. Effect of Vortioxetine vs. Escitalopram on Sexual Functioning in Adults with Well-Treated Major Depressive Disorder Experiencing SSRI-Induced Sexual Dysfunction. J Sex Med 2015; 12:2036-48. [PMID: 26331383 DOI: 10.1111/jsm.12980] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Sexual dysfunction is common with serotonergic antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), and does not resolve in most patients. Vortioxetine, an antidepressant with a multimodal mechanism of action, has shown low rates of sexual dysfunction in previous major depressive disorder (MDD) trials. AIM This study compared the effects of vortioxetine and escitalopram on sexual functioning in adults with well-treated MDD experiencing treatment-emergent sexual dysfunction (TESD). METHODS Participants treated with, and responding to, citalopram, paroxetine, or sertraline were randomized to switch to either vortioxetine (10/20 mg; n = 225) or escitalopram (10/20 mg; n = 222) for 8 weeks. Sexual function was assessed using the Changes in Sexual Functioning Questionnaire Short Form (CSFQ-14), and antidepressant efficacy was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS), Clinical Global Impressions (CGI) scale, and Profile of Mood States brief form (POMS-brief). Safety and tolerability were also assessed. MAIN OUTCOME MEASURES The primary endpoint was change from baseline in the CSFQ-14 total score after 8 weeks of treatment. The MADRS, CGI, and POMS-brief were used to assess antidepressant efficacy. Safety was assessed via adverse events, vital signs, electrocardiograms, laboratory values, weight, and physical examination findings. RESULTS Vortioxetine showed significantly greater improvements in CSFQ-14 total score (8.8 ± 0.64, mean ± standard error) vs. escitalopram (6.6 ± 0.64; P = 0.013). Benefits vs. escitalopram were significant on four of five dimensions and all three phases of sexual functioning assessed by the CSFQ-14 (P < 0.05). Antidepressant efficacy continued in both groups, with similar, but slight, improvements in MADRS and CGI scores. Vortioxetine and escitalopram had similar clinical efficacy profiles in this study, with safety profiles similar to previous trials. Nausea (n = 9, 4.0%) was the most common treatment-emergent adverse event leading to discontinuation of vortioxetine. CONCLUSION Switching antidepressant therapy to vortioxetine may be beneficial for patients experiencing sexual dysfunction during antidepressant therapy with SSRIs.
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Affiliation(s)
| | | | - Yinzhong Chen
- Takeda Development Center Americas, Deerfield, IL, USA
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Song GM, Tian X, Shuai T, Yi LJ, Zeng Z, Liu S, Zhou JG, Wang Y. Treatment of Adults With Treatment-Resistant Depression: Electroconvulsive Therapy Plus Antidepressant or Electroconvulsive Therapy Alone? Evidence From an Indirect Comparison Meta-Analysis. Medicine (Baltimore) 2015; 94:e1052. [PMID: 26131818 PMCID: PMC4504538 DOI: 10.1097/md.0000000000001052] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Electroconvulsive therapy (ECT) and antidepressant are the effective treatment alternatives for patients with treatment-resistant depression (TRD); however, the effects and safety of the ECT plus antidepressant relative to ECT alone remain controversial. We decide to assess the potential of ECT plus antidepressant compared with ECT alone by undertaking an indirect comparison meta-analysis.Databases from PubMed, ISI Web of Science, CENTRAL, Clinicaltrials.gov, EMBASE, CBM (China Biomediccal Literatures Database), and CNKI (China National Knowledge Infrastructure) were searched for relevant studies through November 21, 2014. Literature was screened, data were extracted and methodological quality of the eligible trial was assessed by 2 independent reviewers accordingly. Then, head-to-head and indirect comparison meta-analyses were carried out.A total of 17 studies which including 13 studies regarding ECT plus antidepressant versus antidepressant alone and 4 studies concerning ECT versus antidepressant alone containing a total of 1098 patients were incorporated into this meta-analysis. The head-to-head comparison suggested that response rate can be improved in the ECT plus antidepressant (RR, 1.82; 95% CI, 1.55-2.14) and ECT alone group (RR, 2.24, 95% CI, 1.51-3.33) compared with antidepressant alone, respectively; adverse complications including memory deterioration and somatization were not significantly increased except incidence of memory deterioration in ECT plus antidepressant in the 4th weeks after treatment (RR, 0.09, 95% CI, 0.02-0.49). Indirect comparison meta-analysis showed that no significant differences were detected in response rate and memory deterioration between ECT plus antidepressant and ECT alone. However, ECT plus antidepressant increased the incidence of memory deterioration relative to ECT alone.With present evidence, the regime of ECT plus antidepressant should not be preferentially recommended to treat the patients with TRD relative to ECT alone.
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Affiliation(s)
- Guo-Min Song
- From Department of Nursing, Tianjin Hospital, Tianjin, Peoples' Republic of China (G-MS); Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, Peoples' Republic of China (XT, TS, L-JY, ZZ); School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, Peoples' Republic of China (XT, TS, L-JY, ZZ, YW); School of Nursing, Peking Union Medical College, Beijing, Peoples' Republic of China (SL); and Department of Oncology, Affiliated Hospital of Zunyi Medical College, Zunyi, Peoples' Republic of China (J-GP)
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Maity N, Ghosal MK, Gupta A, Sil A, Chakraborty S, Chatterjee S. Clinical effectiveness and safety of escitalopram and desvenlafaxine in patients of depression with anxiety: a randomized, open-label controlled trial. Indian J Pharmacol 2015; 46:433-7. [PMID: 25097285 PMCID: PMC4118540 DOI: 10.4103/0253-7613.135959] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 04/28/2014] [Accepted: 06/19/2014] [Indexed: 11/30/2022] Open
Abstract
Aim: Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI) are effective in treating anxiety disorders associated with major depressive disorder (MDD). This randomized, controlled, parallel-group, open-label, phase 4 trial (CTRI/2012/08/002895) was undertaken to compare the effectiveness and safety of desvenlafaxine versus escitalopram, a standard antidepressant. Materials and Methods: Effectiveness was assessed using the Hamilton Depression Rating Scale (HAM-D17) and Hamilton Anxiety Rating Scale (HAM-A). Response to treatment was assessed by ≥50% decrease of baseline scores (responder rate). Safety and tolerability was evaluated by changes in routine laboratory parameters, vital signs, and adverse events reported by the subject and/or observed by the clinician. Results: Responder rates for both HAM-A and HAM-D scores at 8 weeks were better in the escitalopram group compared to the desvenlafaxine group (HAM-A 76.92% vs. 71.05%; HAM-D 79.48% vs 73.68%) but the differences were not statistically significant (P = 0.59 and P = 0.61). Within group changes of both scores, from baseline to subsequent visits in both treatment arms were statistically significant (P < 0.01). Conclusion: The effectiveness of desvenlafaxine was comparable to escitalopram, but escitalopram was better tolerated.
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Affiliation(s)
- Nabakumar Maity
- Department of Pharmacology, Institute of Postgraduate Education and Research, Kolkata, West Bengal, India
| | - Malay Kumar Ghosal
- Department of Psychiatry, Institute of Psychiatry, Kolkata, West Bengal, India
| | - Anupam Gupta
- Department of Pharmacology, North Bengal Medical College, Siliguri, Darjeeling, West Bengal, India
| | - Amrita Sil
- Department of Pharmacology, Institute of Postgraduate Education and Research, Kolkata, West Bengal, India
| | - Sushmita Chakraborty
- Departrment of Pharmacology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Suparna Chatterjee
- Department of Pharmacology, Institute of Postgraduate Education and Research, Kolkata, West Bengal, India
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Jeong JH, Bahk WM, Woo YS, Lee KU, Kim DH, Kim MD, Kim W, Yang JC, Lee KH. Efficacy and safety of generic escitalopram (Lexacure(®)) in patients with major depressive disorder: a 6-week multicenter, randomized, rater-blinded, escitalopram-comparative, non-inferiority study. Neuropsychiatr Dis Treat 2015; 11:2557-64. [PMID: 26504387 PMCID: PMC4605251 DOI: 10.2147/ndt.s90796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The primary aim of this non-inferiority study was to investigate the clinical effectiveness and safety of generic escitalopram (Lexacure(®)) versus branded escitalopram (Lexapro(®)) for patients with major depressive disorder (MDD). METHODS The present study included 158 patients, who were randomized (1:1) to receive a flexible dose of generic escitalopram (n=78) or branded escitalopram (n=80) over a 6-week single-blind treatment period. The clinical benefits in the two groups were evaluated using the Montgomery-Åsberg Depression Rating Scale (MADRS), the 17-item Hamilton Depression Rating Scale (HDRS), the Clinical Global Impressions-Severity scale (CGI-S), and the Clinical Global Impressions-Improvement scale (CGI-I) at baseline, week 1, week 2, week 4, and week 6. The frequency of adverse events (AEs) was also assessed to determine safety at each follow-up visit. RESULTS During the 6-week study period, 30 patients (38.5%) from the generic escitalopram group and 28 patients (30.0%) from the branded escitalopram group dropped out of the study (P=0.727). The MADRS, HDRS, CGI-S, and CGI-I scores significantly decreased in both groups, and there were no significant differences between the groups. At week 6, 28 patients (57.1%) in the generic escitalopram group and 35 patients (67.3%) in the branded escitalopram group had responded to treatment (as indicated by a ≥50% decrease from the baseline MADRS score; P=0.126), and the remission rates (MADRS score: ≤10) were 42.9% (n=21) in generic escitalopram group and 53.8% (n=28) in the branded escitalopram group (P=0.135). The most frequently reported AEs were nausea (17.9%), sleepiness/somnolence (7.7%), weight gain (3.8%), and dry mouth (2.6%) in the generic escitalopram group and nausea (20.0%), sleepiness/somnolence (3.8%), weight gain (2.5%), and dry mouth (2.5%) in the branded escitalopram group. CONCLUSION The present non-inferiority study demonstrated that generic escitalopram is a safe and an effective initial treatment for patients with MDD and may also be considered as an additional therapeutic option for this population.
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Affiliation(s)
- Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyung-Uk Lee
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Do Hoon Kim
- Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, South Korea
| | - Moon-Doo Kim
- Department of Psychiatry, Jeju National University Hospital, Jeju, South Korea
| | - Won Kim
- Department of Psychiatry, Stress Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, South Korea
| | - Jong-Chul Yang
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, South Korea
| | - Kwang Heun Lee
- Department of Psychiatry, College of Medicine, Dongguk University, Gyeongju, South Korea
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Llorca PM, Lançon C, Brignone M, Rive B, Salah S, Ereshefsky L, Francois C. Relative efficacy and tolerability of vortioxetine versus selected antidepressants by indirect comparisons of similar clinical studies. Curr Med Res Opin 2014; 30:2589-606. [PMID: 25249164 DOI: 10.1185/03007995.2014.969566] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Vortioxetine is an antidepressant with multimodal activity which has shown efficacy in major depressive disorder (MDD) patients in six of ten short-term, randomized, placebo-controlled trials (completed end 2012). METHODS We performed meta-regression analyses to indirectly compare vortioxetine to seven marketed antidepressants with different mechanisms of action. To ensure study comparability, only experimental drug and placebo arms from placebo-controlled registration studies were included in primary analyses. The main outcomes were efficacy (standardized mean difference in change from baseline to 2 months on primary endpoint [MADRS/HAM-D]), and tolerability (withdrawal rate due to adverse events). RESULTS For efficacy, estimates of treatment effect (negative estimates favor vortioxetine) for vortioxetine versus comparators were: agomelatine, -0.16 (p = 0.11); desvenlafaxine, 0.03 (p = 0.80); duloxetine, 0.09 (p = 0.42); escitalopram, -0.05 (p = 0.70); sertraline, -0.04 (p = 0.83); venlafaxine IR/XR, 0.12 (p = 0.33); and vilazodone, -0.25 (p = 0.11). For tolerability, all but one combination was numerically in favor of vortioxetine (odds ratio < 1), although not all differences were statistically significant: agomelatine, 1.77 (p = 0.03); desvenlafaxine, 0.58 (p = 0.04); duloxetine, 0.75 (p = 0.26); escitalopram, 0.67 (p = 0.28); sertraline, 0.30 (p = 0.01); venlafaxine, 0.47 (p = 0.01); and vilazodone, 0.64 (p = 0.18). Sensitivity analyses did not significantly alter antidepressant effect estimates or relative ranking. CONCLUSION These meta-regression data show that vortioxetine offers a comparable or favorable combination of efficacy (measured by MADRS/HAM-D) and tolerability (measured by withdrawal rate due to adverse events) versus other antidepressants in registration studies in MDD. Alternative methods like mixed-treatment comparison and inclusion of all randomized studies and active reference arms may provide complementary information to this analysis (more evidence but also more heterogeneity). Key messages: Indirect comparisons based on registration studies allow a useful comparison between a recently approved antidepressant and an approved drug. Vortioxetine offers a comparable or favorable combination of efficacy (measured by MADRS/HAM-D assessments) and tolerability (measured by withdrawal rate due to adverse events) versus other antidepressants in registration studies in MDD.
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Reichenpfader U, Gartlehner G, Morgan LC, Greenblatt A, Nussbaumer B, Hansen RA, Van Noord M, Lux L, Gaynes BN. Sexual dysfunction associated with second-generation antidepressants in patients with major depressive disorder: results from a systematic review with network meta-analysis. Drug Saf 2014; 37:19-31. [PMID: 24338044 DOI: 10.1007/s40264-013-0129-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sexual dysfunction (SD) is prevalent in patients with major depressive disorder (MDD) and is also associated with second-generation antidepressants (SGADs) that are commonly used to treat the condition. Evidence indicates under-reporting of SD in efficacy studies. SD associated with antidepressant treatment is a serious side effect that may lead to early termination of treatment and worsening of quality of life. OBJECTIVES Our objective was to systematically assess the harms of SD associated with SGADs in adult patients with MDD by drug type. METHODS We retrieved English-language abstracts from PubMed, EMBASE, the Cochrane Library, PsycINFO, and International Pharmaceutical Abstracts from 1980 to October 2012 as well as from reference lists of pertinent review articles and grey literature searches. Two independent reviewers identified randomized controlled trials (RCTs) of at least 6 weeks' duration and observational studies with at least 1,000 participants. STUDY SELECTION Reviewers abstracted data on study design, conduct, participants, interventions, outcomes and method of SD ascertainment, and rated risk of bias. A senior reviewer checked and confirmed extracted data and risk-of-bias ratings. ANALYSES Random effects network meta-analysis using Bayesian methods for data from head-to-head trials and placebo-controlled comparisons; descriptive analyses calculating weighted mean rates from individual trials and observational studies. RESULTS/SYNTHESIS Data from 63 studies of low and moderate risk of bias (58 RCTs, five observational studies) with more than 26,000 patients treated with SGADs were included. Based on network meta-analyses of 66 pairwise comparisons from 37 RCTs, most comparisons showed a similar risk of SD among included SGADs. However, credible intervals were wide and included differences that would be considered clinically relevant. We observed three main patterns: bupropion had a statistically significantly lower risk of SD than some other SGADs, and both escitalopram and paroxetine showed a statistically significantly higher risk of SD than some other SGADs. We found reporting of harms related to SD inconsistent and insufficient in some trials. LIMITATIONS Most trials were conducted in highly selected populations. Search was restricted to English-language only. CONCLUSION AND IMPLICATIONS Because of the indirect nature of the comparisons, the often wide credible intervals, and the high variation in magnitude of outcome, we rated the overall strength of evidence with respect to our findings as low. The current degree of evidence does not allow a precise estimate of comparative risk of SD associated with a specific antidepressant. In the absence of such evidence, clinicians need to be aware of SD as a common adverse event and should discuss patients' preferences before initiating antidepressant therapy.
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Affiliation(s)
- Ursula Reichenpfader
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Dr.-Karl-Dorrek-Str. 30, 3500, Krems, Austria,
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Escitalopram treatment of depression in human immunodeficiency virus/acquired immunodeficiency syndrome: a randomized, double-blind, placebo-controlled study. J Nerv Ment Dis 2014; 202:133-7. [PMID: 24469525 DOI: 10.1097/nmd.0000000000000082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Depression can be a chronic and impairing illness in people with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome. Large randomized studies of newer selective serotonin reuptake inhibitors such as escitalopram in the treatment of depression in HIV, examining comparative treatment efficacy and safety, have yet to be done in HIV-positive patients. This was a fixed-dose, placebo-controlled, randomized, double-blind study to investigate the efficacy of escitalopram in HIV-seropositive subjects with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, major depressive disorder. One hundred two participants were randomly assigned to either 10 mg of escitalopram or placebo for 6 weeks. An analysis of covariance of the completers found that there was no advantage for escitalopram over placebo on the Montgomery-Asberg Depression Rating Scale (p = 0.93). Sixty-two percent responded to escitalopram and 59% responded to placebo on the Clinical Global Impression Scale. Given the relatively high placebo response, future trials in this area need to be selective in participant recruitment and to be adequately powered.
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The cardiovascular safety profile of escitalopram. Eur Neuropsychopharmacol 2013; 23:1391-400. [PMID: 23928296 DOI: 10.1016/j.euroneuro.2013.05.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 05/17/2013] [Accepted: 05/28/2013] [Indexed: 11/20/2022]
Abstract
The cardiovascular effects of escitalopram were examined in a large group of participants in double-blind, randomized, placebo-controlled studies. Escitalopram (n=3298) was administered at doses between 5 and 20mg/day. Patients were treated in acute (8-12 weeks) and long-term (24 weeks) studies. Assessment of cardiovascular safety included heart rate, blood pressure (BP), treatment-emergent adverse events (TEAEs) and electrocardiograms (ECGs). In the short-term, there was a small, but statistically significant 2 beats per minute decrease in heart rate with escitalopram compared with placebo. The difference compared to placebo in systolic or diastolic BP was not clinically or statistically significant. Valid ECG assessments at both baseline and last assessment were available for 2407 escitalopram patients and 1952 placebo patients. Escitalopram-placebo differences in mean changes in ECG values were not clinically meaningful. The mean difference to placebo in the corrected QT [Fridericia's (QTcF)] interval was 3.5 ms (all escitalopram doses); 1.3 ms (escitalopram 10mg) and 1.7 ms (escitalopram 20mg) (p=0.2836 for 10 versus 20 mg). One out of 2407 escitalopram patients had a QTcF interval >500 ms and a change from baseline >60 ms. The incidence and types of cardiac-associated adverse events were similar between patients treated for 8-12 weeks with placebo (2.2%) or escitalopram (1.9%) and for 24 weeks with placebo (2.7%) or escitalopram (2.3%). Analyses of data from long-term studies and studies of the elderly showed similar results. In conclusion, these data demonstrate that escitalopram, like other SSRIs, has a statistically significant effect on heart rate and no clinically meaningful effect on ECG values, BP, with a placebo-level incidence of cardiac-associated adverse events.
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Karlsson L, Carlsson B, Hiemke C, Ahlner J, Bengtsson F, Schmitt U, Kugelberg FC. Altered brain concentrations of citalopram and escitalopram in P-glycoprotein deficient mice after acute and chronic treatment. Eur Neuropsychopharmacol 2013; 23:1636-44. [PMID: 23428338 DOI: 10.1016/j.euroneuro.2013.01.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 01/13/2013] [Accepted: 01/15/2013] [Indexed: 12/26/2022]
Abstract
According to both in vitro and in vivo data P-glycoprotein (P-gp) may restrict the uptake of several antidepressants into the brain, thus contributing to the poor success rate of current antidepressant therapies. The therapeutic activity of citalopram resides in the S-enantiomer, whereas the R-enantiomer is practically devoid of serotonin reuptake potency. To date, no in vivo data are available that address whether the enantiomers of citalopram and its metabolites are substrates of P-gp. P-gp knockout (abcb1ab (-/-)) and wild-type (abcb1ab (+/+)) mice underwent acute (single-dose) and chronic (two daily doses for 10 days) treatment with citalopram (10mg/kg) or escitalopram (5mg/kg) Serum and brain samples were collected 1-6h after the first or last i.p. injection for subsequent drug analysis by an enantioselective HPLC method. In brain, 3-fold higher concentrations of S- and R-citalopram, and its metabolites, were found in abcb1ab (-/-) mice than in abcb1ab (+/+) mice after both acute and chronic citalopram treatments. After escitalopram treatment, the S-citalopram brain concentration was 3-5 times higher in the knockout mice than in controls. The results provide novel evidence that the enantiomers of citalopram are substrates of P-gp. Possible clinical and toxicological implications of this finding need to be further elucidated.
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Affiliation(s)
- Louise Karlsson
- Department of Medical and Health Sciences, Division of Drug Research, Clinical Pharmacology, Linköping University, Linköping, Sweden
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Gehlawat P, Gupta R, Rajput R, Gahlan D, Gehlawat VK. Diabetes with comorbid depression: role of SSRI in better glycemic control. Asian J Psychiatr 2013; 6:364-8. [PMID: 24011681 DOI: 10.1016/j.ajp.2013.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 02/23/2013] [Accepted: 03/30/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The presence of depression in patients with diabetes mellitus is reported to be associated with poor glycemic control and an increased risk of diabetic complications. Treatment of depression with selective serotonin reuptake inhibitors (SSRIs) may improve glycemic control and may be beneficial for patients with comorbid depression and diabetes. AIMS AND OBJECTIVE To study the effect of Escitalopram (SSRI) in patients with diabetes mellitus with comorbid depression and the relationship of treatment response for depression and glycemic control. RESEARCH DESIGN AND METHODS 40 patients received open-label Escitalopram therapy for up to 12 weeks. Clinical outcome measures included Hamilton Depression rating scale (HAM-D) assessment at 3, 6, and 12 weeks. In addition, fasting and post-prandial plasma glucose level, weight and waist circumference, glycosylated hemoglobin level (HbA1C), lipid profile, renal function test and fundus examination were done before and during Escitalopram therapy. RESULTS A significant decline in mean HAM-D scores was observed 3 weeks onwards till the end of the study during Escitalopram therapy. There was a corresponding decline in mean fasting and post-prandial plasma glucose level at 6 and 12 weeks respectively and glycosylated hemoglobin level at 12 weeks was observed. CONCLUSION Escitalopram is effective in treating depression in patients with diabetes mellitus, and has beneficial effects on glycemic control.
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Affiliation(s)
- Pratibha Gehlawat
- Department of Psychiatry, Pt.B.D.Sharma PGIMS, Rohtak, Haryana, India.
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Kátai Z, Adori C, Kitka T, Vas S, Kalmár L, Kostyalik D, Tóthfalusi L, Palkovits M, Bagdy G. Acute escitalopram treatment inhibits REM sleep rebound and activation of MCH-expressing neurons in the lateral hypothalamus after long term selective REM sleep deprivation. Psychopharmacology (Berl) 2013; 228:439-49. [PMID: 23515582 DOI: 10.1007/s00213-013-3046-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 02/25/2013] [Indexed: 01/28/2023]
Abstract
RATIONALE Selective rapid eye movement sleep (REMS) deprivation using the platform-on-water ("flower pot") method causes sleep rebound with increased REMS, decreased REMS latency, and activation of the melanin-concentrating hormone (MCH) expressing neurons in the hypothalamus. MCH is implicated in the pathomechanism of depression regarding its influence on mood, feeding behavior, and REMS. OBJECTIVES We investigated the effects of the most selective serotonin reuptake inhibitor escitalopram on sleep rebound following REMS deprivation and, in parallel, on the activation of MCH-containing neurons. METHODS Escitalopram or vehicle (10 mg/kg, intraperitoneally) was administered to REMS-deprived (72 h) or home cage male Wistar rats. During the 3-h-long "rebound sleep", electroencephalography was recorded, followed by an MCH/Fos double immunohistochemistry. RESULTS During REMS rebound, the time spent in REMS and the number of MCH/Fos double-labeled neurons in the lateral hypothalamus increased markedly, and REMS latency showed a significant decrease. All these effects of REMS deprivation were significantly attenuated by escitalopram treatment. Besides the REMS-suppressing effects, escitalopram caused an increase in amount of and decrease in latency of slow wave sleep during the rebound. CONCLUSIONS These results show that despite the high REMS pressure caused by REMS deprivation procedure, escitalopram has the ability to suppress REMS rebound, as well as to diminish the activation of MCH-containing neurons, in parallel. Escitalopram caused a shift from REMS to slow wave sleep during the rebound. Furthermore, these data point to the potential connection between the serotonergic system and MCH in sleep regulation, which can be relevant in depression and in other mood disorders.
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Affiliation(s)
- Zita Kátai
- Department of Pharmacodynamics, Semmelweis University, 1089 Nagyvárad tér 4., Budapest, Hungary
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Rutherford BR, Cooper TM, Persaud A, Brown PJ, Sneed JR, Roose SP. Less is more in antidepressant clinical trials: a meta-analysis of the effect of visit frequency on treatment response and dropout. J Clin Psychiatry 2013; 74:703-15. [PMID: 23945448 PMCID: PMC3898620 DOI: 10.4088/jcp.12r08267] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 01/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We investigated how the number of follow-up visits affects response rates and dropout among patients in antidepressant trials for major depressive disorder (MDD). DATA SOURCES MEDLINE, PsycINFO, and PubMed were searched to identify trials contrasting antidepressants to placebo or active comparator in adults with depression. The index terms depression-drug therapy, depressive disorder-drug therapy, and antidepressant agents, in addition to the classes and individual generic names of all antidepressants, were combined using the "or" operator. Results were limited to (1) English-language articles, (2) publication year 1985 or later, (3) age group ≥ 18 years, and (4) publication types including clinical trials, controlled clinical trials, meta-analysis, multicenter study, randomized controlled trial, or review. STUDY SELECTION Included articles reported trials of approved antidepressant medications for MDD in outpatients aged 18-65 years, were 6-12 weeks in duration, and had response rates specified using a standardized measure. Trials were excluded for enrolling inpatients, pregnant women, psychotic subjects, or those with treatment-resistant depression. These criteria allowed 9,189 articles identified in the literature review to be narrowed to 111 reports. DATA EXTRACTION Demographic characteristics, the number of study visits planned in each treatment cell, duration of active treatment, attrition rates, and response rates to medication and placebo were entered into a database. RESULTS In a multilevel meta-analysis, active medication versus placebo (OR = 1.96, P < .001), active comparator versus placebo-controlled study design (OR = 1.82, P < .001), and longer versus shorter duration (OR = 1.87, P < .001) were associated with significantly increased odds of treatment response. After controlling for these variables, the number of study visits did not significantly influence response rates (OR = 0.97, P = .877). The odds of dropout were significantly decreased for active comparator versus placebo-controlled trials (OR = 0.67, P = .002) and longer versus shorter duration trials (OR = 0.54, P = .035), while increasing numbers of study visits significantly increased the odds of participant dropout (OR = 2.77, P < .001). CONCLUSIONS Visit schedules that are much more frequent than are commonly practiced in the community treatment of depression may increase the expense of clinical trials and make them less generalizable to standard clinical treatment.
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Affiliation(s)
- Bret R Rutherford
- New York State Psychiatric Institute, 1051 Riverside Dr, Box 98, New York, NY 10032, USA.
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Lam RW, Annemans L. Efficacy, effectiveness and efficiency of escitalopram in the treatment of major depressive and anxiety disorders. Expert Rev Pharmacoecon Outcomes Res 2012; 7:559-76. [PMID: 20528319 DOI: 10.1586/14737167.7.6.559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In addition to the large personal challenge that depression and anxiety present, these disorders are associated with a substantial burden of disability and lost productivity, and are responsible for considerable strain on healthcare resources and on society. Escitalopram is recommended as first-line therapy for the treatment of major depressive disorder and severe depression, and is indicated in anxiety disorders. Compared with other antidepressants, escitalopram has equal or superior efficacy, as proven in clinical trial settings, equal or superior real-life effectiveness, established in both clinical and observational studies, and a better tolerability profile. While drug acquisition costs are higher for escitalopram than for generic drugs such as fluoxetine and citalopram, numerous prospective and modeled economic analyses show that associated direct and indirect costs of treatment are lower with escitalopram than with citalopram, fluoxetine, sertraline and venlafaxine. Thus, escitalopram appears to be more economically efficient than many antidepressants currently available. Escitalopram has a prominent role in the treatment of major depressive disorder and anxiety disorders, and may also prove to be important in the treatment of mixed depressive anxiety disorder.
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Affiliation(s)
- Raymond W Lam
- Professor of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.
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Classical and novel approaches to the preclinical testing of anxiolytics: A critical evaluation. Neurosci Biobehav Rev 2012; 37:2318-30. [PMID: 22981935 DOI: 10.1016/j.neubiorev.2012.09.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 08/21/2012] [Accepted: 09/05/2012] [Indexed: 01/11/2023]
Abstract
Over 80% of current anxiety studies employ one of the tests that were developed earlier than, or concurrently with the elevated plus-maze, i.e. before 1985. Considering 1985 as a historical reference point, we briefly review here 115 new tests and models of anxiety, the development of which was likely prompted by the poor predictive validity of classical tests as shown here by the comparison of preclinical and clinical findings with putative novel anxiolytics. The new approaches comprise major innovations to classical tests, the pre-test application of manipulations that mimic etiological factors of anxiety disorders, and entirely new approaches including anxiety disorder-specific tests. Thus, intensive test development over the last 27 years created a large pool of novel approaches. However, these are infrequently used and as such, their impact on anxiolytic drug development remains low. We suggest here that test/model development should step over the intensive phase when several new methods are proposed each year and should start selecting and establishing the methodologies that would successfully replace or complement classical tests. We propose here a novel strategy for improving the validity of anxiety testing that includes the retrospective analysis of the predictive validity of new procedures (as opposed to classical pharmacological validation), and a call for concerted international efforts at both the conceptual and practical levels. Similar endeavors proved recently successful with other psychiatric disorders.
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Pae CU, Masand PS, Peindl K, Mannelli P, Han C, Marks DM, Patkar AA. An open-label, rater-blinded, flexible-dose, 8-week trial of escitalopram in patients with major depressive disorder with atypical features. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2012; 10:205-10. [PMID: 18615172 DOI: 10.4088/pcc.v10n0305] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Accepted: 11/05/2007] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Although selective serotonin reuptake inhibitors (SSRIs) have become the standard of care for the treatment of major depressive disorder (MDD), limited data exist to support their use in MDD with atypical features. The current study investigates the efficacy of the SSRI escitalopram in an 8-week, open-label, flexible-dose, rater-blinded trial. METHOD Seventeen DSM-IV MDD subjects aged from 18 through 65 years completed screening procedures, provided informed consent, and went through a minimum 2-week washout from preexisting antide-pressants except fluoxetine (a minimum 4-week wash-out). They subsequently received escitalopram (10-20 mg/day) for 8 weeks. The primary efficacy measure was a change in score from baseline to end of treatment on the Structured Interview Guide for the Hamilton Rating Scale for Depression-Seasonal Affective Disorder version (SIGH-SAD), which includes a set of items for atypical symptoms. Secondary efficacy measures were defined as changes from baseline to end of treatment in scores on the SIGH-SAD atypical symptoms subscale (consisting of 8 items specific to atypical features), Beck Depression Inventory-II, Beck Anxiety Inventory, Sheehan Disability Scale, and Epworth Sleepiness Questionnaire. The study was conducted from October 2005 to November 2006. RESULTS The mean age was 43.9 years, and 70.6% of subjects were women. The dropout rate was 11.8% (N = 2/17). The mean dose of escitalopram was 18.3 mg/day. The total SIGH-SAD score (mean ± SD) reduced by 53.8% from baseline (33.3 ± 8.2) to end of treatment (15.4 ± 9.4) (t = 4.24, p < .001). The atypical symptoms subscale score reduced by 44.5% from baseline (11.0 ± 4.3) to end of treatment (6.1 ± 2.8) (t = 5.26, p = .001). Ten subjects (62.5%) were classified as responders at end of treatment as defined by ≥ 50% reduction in SIGH-SAD total score. Overall, escitalopram was well tolerated. CONCLUSIONS Our preliminary study indicates that escitalopram may be beneficial in the treatment of MDD with atypical features. Adequately powered, randomized, double-blind, placebo-controlled trials are necessary to determine the efficacy of escitalopram in this disorder. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00610506.
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Affiliation(s)
- Chi-Un Pae
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C, USA
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Papakostas GI, Fan H, Tedeschini E. Severe and anxious depression: combining definitions of clinical sub-types to identify patients differentially responsive to selective serotonin reuptake inhibitors. Eur Neuropsychopharmacol 2012; 22:347-55. [PMID: 22099607 DOI: 10.1016/j.euroneuro.2011.09.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 09/15/2011] [Accepted: 09/17/2011] [Indexed: 11/25/2022]
Abstract
Patients with severe major depressive disorder are more likely than those with mild/moderate depression to experience the relative benefits of antidepressant therapy versus placebo. Several studies have, unexpectedly, failed to show a similar antidepressant-placebo discrepancy between patients with versus without anxious depression, although patients with anxious depression are more likely to meet criteria for severe depression than those without. The aim of this study was to confirm the absence of treatment moderating effects for anxious depression in a general clinical trial population, and to examine for the presence of treatment moderating effects in severe depression. Patient-level outcome data from all randomized, double-blind, placebo-controlled trials involving the use of the selective serotonin reuptake inhibitor escitalopram for adults with major depressive disorder sponsored by H. Lundbeck A/S or Forest Laboratories were pooled. Studies focusing on patients with a specific axis-I or -III co-morbidity were excluded. Data from five trials were pooled. Anxious depression was not found to serve as a treatment moderator for selective serotonin reuptake inhibitor therapy versus placebo. However, when patients with severe depression were analyzed separately, anxious depression significantly influenced the relative degree of symptom reduction with selective serotonin reuptake inhibitors versus placebo (p=0.0094). In fact, the numbers needed to treat for remission for these two sub-types were the largest and smallest reported to date from analyses of large datasets of antidepressants (22 for severe anxious versus 4 for severe non-anxious depression). Subdividing patients with severe major depressive disorder into those with versus without anxious depression results in the characterization of sub-types that are particularly "responsive" (severe non-anxious) and "unresponsive" (severe anxious) to selective serotonin reuptake inhibitor therapy (relative to placebo). These findings are preliminary, of yet undetermined clinical relevance, and warrant replication and further exploration.
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Affiliation(s)
- George I Papakostas
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Park HY, Lee BJ, Kim JH, Bae JN, Hahm BJ. Rapid improvement of depression and quality of life with escitalopram treatment in outpatients with breast cancer: a 12-week, open-label prospective trial. Prog Neuropsychopharmacol Biol Psychiatry 2012; 36:318-23. [PMID: 22142651 DOI: 10.1016/j.pnpbp.2011.11.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 11/21/2011] [Accepted: 11/21/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Among patients with cancer, the management of depression is very important to improve quality of life as well as distress. Because the efficacy of escitalopram, a potent serotonin reuptake inhibitor, has not been well evaluated in cancer patients, we investigated its effects on depression and quality of life in outpatients with breast cancer. METHODS A 12-week, open-label, prospective study with escitalopram (5-20mg/day) was performed in 79 breast cancer outpatients with depression. The primary outcome was measured using the Hamilton Depression Rating Scale (HAMD), which was administered at baseline, 1, 2, 4, 8, and 12 weeks after treatment. The Functional Assessment of Cancer Therapy-Breast (FACT-B), MD Anderson Symptoms Inventory (MDASI), Clinical Global Impression-Severity of Illness (CGI-S), and Distress Thermometer (DT) were also used to measure improvement in symptoms, distress, and quality of life. RESULTS Compared to baseline, HAMD, DT, and CGI-S scores were significantly decreased at week 1 and onwards, and FACT-B and MDSAI were improved at week 2 and onwards. At the end point (week 12), all FACT-B subscales including the physical, emotional, social/family, functional well-being, and the breast cancer subscales were improved. Improvement in distress and quality of life was associated with a reduction in depressive symptoms. Of all participants, 45.1% met the response criterion (at least a 50% decrease in HAMD total score), and 30.6% met the remission criterion (HAMD total score ≤ 7) at week 12. CONCLUSIONS In the present study, escitalopram improved quality of life and reduced depression in breast cancer patients. Symptoms rapidly improved within 1 week, influencing quality of life. Escitalopram may be an effective treatment of depressive symptoms in breast cancer patients.
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Affiliation(s)
- Hye Yoon Park
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
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Randomized, placebo-controlled trials of antidepressants for acute major depression: thirty-year meta-analytic review. Neuropsychopharmacology 2012; 37:851-64. [PMID: 22169941 PMCID: PMC3280655 DOI: 10.1038/npp.2011.306] [Citation(s) in RCA: 170] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Antidepressant-placebo response-differences (RDs) in controlled trials have been declining, potentially confounding comparisons among older and newer drugs. For clinically employed antidepressants, we carried out a meta-analytic review of placebo-controlled trials in acute, unipolar, major depressive episodes reported over the past three decades to compare efficacy (drug-placebo RDs) of individual antidepressants and classes, and to consider factors associated with year-of-reporting by bivariate and multivariate regression modeling. Observed drug-placebo differences were moderate and generally similar among specific drugs, but larger among older antidepressants, notably tricyclics, than most newer agents. This outcome parallels selective increases in placebo-associated responses as trial-size has increased in recent years. Study findings generally support moderate efficacy of clinically employed antidepressants for acute major depression, but underscore limitations of meta-analyses of controlled trials for ranking drugs by efficacy. We suggest that efficiency and drug-placebo differences may be improved with fewer sites and subjects, and better quality-control of diagnostic and clinical assessments.
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Kirino E. Escitalopram for the management of major depressive disorder: a review of its efficacy, safety, and patient acceptability. Patient Prefer Adherence 2012; 6:853-61. [PMID: 23271894 PMCID: PMC3526882 DOI: 10.2147/ppa.s22495] [Citation(s) in RCA: 45] [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] [Indexed: 01/20/2023] Open
Abstract
Escitalopram (escitalopram oxalate; Cipralex(®), Lexapro(®)) is a selective serotonin reuptake inhibitor (SSRI) used for the treatment of major depressive disorder (MDD) and anxiety disorder. This drug exerts a highly selective, potent, and dose-dependent inhibitory effect on the human serotonin transport. By inhibiting the reuptake of serotonin into presynaptic nerve endings, this drug enhances the activity of serotonin in the central nervous system. Escitalopram also has allosteric activity. Moreover, the possibility of interacting with other drugs is considered low. This review covers randomized, controlled studies that enrolled adult patients with MDD to evaluate the efficacy of escitalopram based on the Montgomery-Asberg Depression Rating Scale and the Hamilton Depression Rating Scale. The results showed that escitalopram was superior to placebo, and nearly equal or superior to other SSRIs (eg, citalopram, paroxetine, fluoxetine, sertraline) and serotonin-noradrenaline reuptake inhibitors (eg, duloxetine, sustained-release venlafaxine). In addition, with long-term administration, escitalopram has shown a preventive effect on MDD relapse and recurrence. Escitalopram also showed favorable tolerability, and associated adverse events were generally mild and temporary. Discontinuation symptoms were milder with escitalopram than with paroxetine. In view of the patient acceptability of escitalopram, based on both a meta-analysis and a pooled analysis, this drug was more favorable than other new antidepressants. The findings indicate that escitalopram achieved high continuity in antidepressant drug therapy.
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Affiliation(s)
- Eiji Kirino
- Department of Psychiatry, Juntendo University Shizuoka Hospital, Shizuoka, Japan
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
- Correspondence: Eiji Kirino, Juntendo University Shizuoka Hospital, 1129 Nagaoka Izunokunishi Shizuoka 4102211 Japan, Tel +81 55 948 3111, Fax +81 55 948 5088, Email
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de Knegt RJ, Bezemer G, Van Gool AR, Drenth JPH, Hansen BE, Droogleever Fortuyn HA, Weegink CJ, Hengeveld MW, Janssen HLA. Randomised clinical trial: escitalopram for the prevention of psychiatric adverse events during treatment with peginterferon-alfa-2a and ribavirin for chronic hepatitis C. Aliment Pharmacol Ther 2011; 34:1306-17. [PMID: 21999489 DOI: 10.1111/j.1365-2036.2011.04867.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Treatment of hepatitis C with peginterferon and ribavirin is associated with psychiatric side-effects, frequently necessitating dose reduction or therapy cessation. AIM To assess the efficacy of prophylactic escitalopram to prevent psychiatric side-effects during peginterferon and ribavirin treatment in a randomised, double-blind, placebo-controlled trial. METHODS Seventy-nine hepatitis C patients were treated with peginterferon and ribavirin. Patients received escitalopram (n = 40, 10 mg) or placebo (n = 39), which was initiated together with peginterferon and ribavirin. Primary outcomes were an increase of two points or more on the items reported sadness, inner tension and impaired concentration of the Montgomery-Asberg Depression Rating Scale, and hostile feelings of the Brief Anxiety Scale. Secondary outcome was the development of depression diagnosed by the Mini-International Neuropsychiatric Interview. Measurements were performed at baseline, week 4, 12 and 24 during anti-viral treatment, and 24 weeks thereafter. RESULTS The incidence of psychiatric side-effects was significantly lower in patients treated with escitalopram compared with placebo for all primary and secondary outcomes, except for impaired concentration: reported sadness 27.5 vs. 48.7% (P = 0.052), inner tension 17.5 vs. 38.5% (P = 0.038), impaired concentration 55.0 vs. 66.7% (P = 0.288) and hostile feelings 22.5 vs. 43.6% (P = 0.046) (escitalopram vs. placebo, Chi-squared test). The sum scores of all four endpoints showed an overall beneficial effect of escitalopram (P = 0.009, Mann-Whitney U-test). Depression occurred in 12.5% of the patients in the escitalopram-group vs. 35.9% in the placebo-group (P = 0.015, Chi-squared test). CONCLUSIONS Prophylactic treatment with escitalopram is effective in the prevention of psychiatric side-effects during interferon-based treatment of hepatitis C.
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Affiliation(s)
- R J de Knegt
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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