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Taylor D, Poulou S, Clark I. The cardiovascular safety of tricyclic antidepressants in overdose and in clinical use. Ther Adv Psychopharmacol 2024; 14:20451253241243297. [PMID: 38827015 PMCID: PMC11141239 DOI: 10.1177/20451253241243297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/07/2024] [Indexed: 06/04/2024] Open
Abstract
Tricyclic antidepressants (TCAs) remain widely prescribed for depression and many other conditions. There may be important differences between individual TCA in regard to their overdose toxicity and their cardiac toxicity in clinical use. We conducted a systematic review to compare the toxicity of individual TCA in overdose and the risk of serious adverse cardiac events occurring with therapeutic doses. We used the fatal toxicity index (FTI) and case fatality ratio as markers of fatality in overdose, and hazard ratios or odds ratios for the risk of cardiovascular adverse events during normal clinical use. In all, 30 reports of mortality in overdose and 14 observational studies assessing the risk of cardiovascular adverse events in clinical use were included. FTI values were of the same order of magnitude (101-102) for all TCAs except lofepramine. Desipramine appears to be somewhat more likely than other TCAs to lead to death in overdose. Amitriptyline, clomipramine, dothiepin/dosulepin, doxepin, trimipramine and imipramine showed broadly similar toxicity and were usually reported to be less toxic than desipramine. Data on nortriptyline were contradictory. Lofepramine had the lowest risk of death in overdose. The rank order of overdose toxicity was broadly consistent between different FTI definitions and between markers used. With respect to the risk of cardiovascular events at clinically relevant exposure, amitriptyline, nortriptyline and lofepramine were associated with a greater risk of in-use cardiotoxicity. All measures of overdose toxicity were subject to external influences and confounding. The continued use of TCAs in depression and other conditions should be minimized when considering their undoubted toxicity in overdose and possible toxicity in normal clinical use.
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Affiliation(s)
- David Taylor
- Pharmacy Department, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
- Institute of Pharmaceutical Sciences, King’s College London, London, UK
| | - Sofia Poulou
- Institute of Pharmaceutical Sciences, King’s College London, London, UK
| | - Ivana Clark
- Institute of Pharmaceutical Sciences, King’s College London, London, UK
- Pharmacy Department, Maudsley Hospital, London, UK
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2
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Smolderen KG, Samaan Z, Decker C, Collins T, Lazar RM, Itoga NK, Mena-Hurtado C. Association Between Mental Health Burden, Clinical Presentation, and Outcomes in Individuals With Symptomatic Peripheral Artery Disease: A Scientific Statement From the American Heart Association. Circulation 2023; 148:1511-1528. [PMID: 37781785 DOI: 10.1161/cir.0000000000001178] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Along with the rising burden of peripheral artery disease (PAD), mental health concerns are increasingly being recognized as a comorbidity to address in the chronic disease management of symptomatic PAD. Apart from a high prevalence of comorbid mental health conditions, the role of pain and changing health behaviors and the broader impacts of illness and adaptation to living with PAD require specialized behavioral health expertise. This scientific statement builds a case that this expertise should be integrated within the multidisciplinary PAD team. Furthermore, areas such as cognitive dysfunction and palliative care are highlighted as needing psychological interventions. Although much of the evidence of the efficacy of psychological and psychotropic interventions has been extrapolated from other cardiovascular populations, evidence for the role of psychological interventions for behavior change, for example, uptake of exercise regimens, is increasingly being accrued within PAD. Areas for behavioral health needs and interactions with PAD treatment are discussed, including the use of opioids, depression management, anxiety and stress reduction interventions, the use of benzodiazepines and antidepressants, smoking cessation, rehabilitation trajectories after amputation, and the role of cognitive decline for PAD treatment and outcomes. A case summary highlights the stigma around mental health and vascular disease and the fragmentation of care. This scientific statement provides remarks for building a road map for integrated behavioral PAD care and potential solutions to overcome these barriers. Instrumental to reaching these changes are interprofessional advocacy efforts and initiatives that help break down the stigma around mental health and promote evidence-based collaborative, nonhierarchical, and multidisciplinary PAD care.
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3
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OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1124-1141. [DOI: 10.1093/eurjpc/zwac006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/25/2021] [Accepted: 01/04/2022] [Indexed: 11/12/2022]
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4
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Chen CM, Ding H, Mabry KM, Ko MC. Enhanced antidepressant-like effects of a delta opioid receptor agonist, SNC80, in rats under inflammatory pain. Pharmacol Biochem Behav 2022; 214:173341. [DOI: 10.1016/j.pbb.2022.173341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
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5
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Joshi S, Tepper SJ, Lucas S, Rasmussen S, Nelson R. A narrative review of the importance of pharmacokinetics and drug-drug interactions of preventive therapies in migraine management. Headache 2021; 61:838-853. [PMID: 34214182 PMCID: PMC8361687 DOI: 10.1111/head.14135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/28/2022]
Abstract
Objective To review the pharmacokinetics of major classes of migraine preventives and the clinical implications of drug–drug interactions (DDIs) with the use of these therapies in migraine management. Background Preventive treatments for migraine are recommended for a large proportion of patients with frequent migraine attacks. These patients often exhibit a number of comorbidities, which may lead to the introduction of multiple concomitant therapies. Potential DDIs must be considered when using polytherapy to avoid increased risk of adverse events (AEs) or inadequate treatment of comorbid conditions. Methods A literature search was performed to identify pharmacokinetic properties and potential DDIs of beta‐blockers, antiepileptic drugs, antidepressants, calcium channel blockers, gepants, and monoclonal antibody therapies targeting the calcitonin gene‐related peptide pathway with medications that may be used for comorbid conditions. Results Most DDIs occur through alterations in cytochrome P450 isoenzyme activity and may be complicated by genetic polymorphism for metabolic enzymes. Additionally, drug metabolism may be altered by grapefruit juice ingestion and smoking. The use of migraine preventive therapies may exacerbate symptoms of comorbid conditions or increase the risk of AEs associated with comorbid conditions as a result of DDIs. Conclusions DDIs are important to consider in patients with migraine who use multiple medications. The development of migraine‐specific evidence‐based preventive treatments allows for tailored clinical management that reduces the risk of DDIs and associated AEs in patients with comorbidities.
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Affiliation(s)
- Shivang Joshi
- Neurology/Headache Medicine, DENT Neurologic Institute, Amherst, NY, USA
| | - Stewart J Tepper
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Sylvia Lucas
- Department of Neurology, University of Washington Medical Centers, Seattle, WA, USA
| | | | - Rob Nelson
- Global Medical, Amgen Inc., Thousand Oaks, CA, USA.,US Medical Affairs, Amgen Inc., Thousand Oaks, CA, USA
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6
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Taylor RW, Marwood L, Oprea E, DeAngel V, Mather S, Valentini B, Zahn R, Young AH, Cleare AJ. Pharmacological Augmentation in Unipolar Depression: A Guide to the Guidelines. Int J Neuropsychopharmacol 2020; 23:587-625. [PMID: 32402075 PMCID: PMC7710919 DOI: 10.1093/ijnp/pyaa033] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/27/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pharmacological augmentation is a recommended strategy for patients with treatment-resistant depression. A range of guidelines provide advice on treatment selection, prescription, monitoring and discontinuation, but variation in the content and quality of guidelines may limit the provision of objective, evidence-based care. This is of importance given the side effect burden and poorer long-term outcomes associated with polypharmacy and treatment-resistant depression. This review provides a definitive overview of pharmacological augmentation recommendations by assessing the quality of guidelines for depression and comparing the recommendations made. METHODS A systematic literature search identified current treatment guidelines for depression published in English. Guidelines were quality assessed using the Appraisal of Guidelines for Research and Evaluation II tool. Data relating to the prescription of pharmacological augmenters were extracted from those developed with sufficient rigor, and the included recommendations compared. RESULTS Total of 1696 records were identified, 19 guidelines were assessed for quality, and 10 were included. Guidelines differed in their quality, the stage at which augmentation was recommended, the agents included, and the evidence base cited. Lithium and atypical antipsychotics were recommended by all 10, though the specific advice was not consistent. Of the 15 augmenters identified, no others were universally recommended. CONCLUSIONS This review provides a comprehensive overview of current pharmacological augmentation recommendations for major depression and will support clinicians in selecting appropriate treatment guidance. Although some variation can be accounted for by date of guideline publication, and limited evidence from clinical trials, there is a clear need for greater consistency across guidelines to ensure patients receive consistent evidence-based care.
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Affiliation(s)
- Rachael W Taylor
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Lindsey Marwood
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
| | - Emanuella Oprea
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Valeria DeAngel
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sarah Mather
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Beatrice Valentini
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- Department of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Roland Zahn
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Allan H Young
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anthony J Cleare
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom
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Wang SM, Han C, Bahk WM, Lee SJ, Patkar AA, Masand PS, Pae CU. Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review. Chonnam Med J 2018; 54:101-112. [PMID: 29854675 PMCID: PMC5972123 DOI: 10.4068/cmj.2018.54.2.101] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 01/19/2023] Open
Abstract
Randomized trials have shown that selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have better safety profiles than classical tricyclic antidepressants (TCAs). However, an increasing number of studies, including meta-analyses, naturalistic studies, and longer-term studies suggested that SSRIs and SNRIs are no less safe than TCAs. We focused on comparing the common side effects of TCAs with those of newer generation antidepressants including SSRIs, SNRIs, mirtazapine, and bupropion. The main purpose was to investigate safety profile differences among drug classes rather than the individual antidepressants, so studies containing comparison data on drug groups were prioritized. In terms of safety after overdose, the common belief on newer generation antidepressants having fewer side effects than TCAs appears to be true. TCAs were also associated with higher drop-out rates, lower tolerability, and higher cardiac side-effects. However, evidence regarding side effects including dry mouth, gastrointestinal side effects, hepatotoxicity, seizure, and weight has been inconsistent, some studies demonstrated the superiority of SSRIs and SNRIs over TCAs, while others found the opposite. Some other side effects such as sexual dysfunction, bleeding, and hyponatremia were more prominent with either SSRIs or SNRIs.
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Affiliation(s)
- Sheng-Min Wang
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea.,International Health Care Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Changsu Han
- Department of Psychiatry, Korea University, College of Medicine, Seoul, Korea
| | - Won-Myoung Bahk
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Soo-Jung Lee
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ashwin A Patkar
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Chi-Un Pae
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.,Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
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8
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Stoyek MR, Jonz MG, Smith FM, Croll RP. Distribution and chronotropic effects of serotonin in the zebrafish heart. Auton Neurosci 2017; 206:43-50. [DOI: 10.1016/j.autneu.2017.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 05/03/2017] [Accepted: 07/17/2017] [Indexed: 01/23/2023]
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9
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Herbet M, Gawrońska-Grzywacz M, Izdebska M, Piątkowska-Chmiel I. Effect of the interaction between atorvastatin and selective serotonin reuptake inhibitors on the blood redox equilibrium. Exp Ther Med 2016; 12:3440-3444. [PMID: 27882176 DOI: 10.3892/etm.2016.3794] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/27/2016] [Indexed: 01/03/2023] Open
Abstract
Cardiovascular disease and depression often occur simultaneously in the same patient. Long-term polypharmacotherapy can lead to drug-induced oxidative stress. Data concerning the effects of concomitant treatment with atorvastatin and selective serotonin reuptake inhibitors (SSRIs) are lacking. The aim of the present study was to examine oxidative stress parameters in the blood of rats after 28 days treatment with atorvastatin combined with fluoxetine or paroxetine. The study was carried out on male Wistar rats weighing 200-250 g. Aqueous solutions of atorvastatin (10 mg/kg), fluoxetine (10 mg/kg) and paroxetine (10 mg/kg) were injected once a day for 28 days, separately or concomitantly. The activity of glutathione peroxidase (GPX) was determined in the whole blood, whereas the activity of glutathione reductase (GR) and the total antioxidant status (TAS) were determined in the serum. The results demonstrated that concomitant administration of atorvastatin with fluoxetine caused an increase in the GPX activity and the TAS. Atorvastatin administered to rats with paroxetine increased the activities of GPX and GR. In the groups of rats receiving atorvastatin or SSRIs separately, no statistically significant changes in the investigated parameters were observed. The changes that were detected may indicate an increase in endogenous antioxidant levels during the concomitant application of atorvastatin with SSRIs and thus a drug-drug interaction having an effect on the blood redox equilibrium.
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Affiliation(s)
- Mariola Herbet
- Chair and Department of Toxicology, Medical University of Lublin, 20-093 Lublin, Poland
| | | | - Magdalena Izdebska
- Chair and Department of Toxicology, Medical University of Lublin, 20-093 Lublin, Poland
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10
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Depression in heart failure: Intricate relationship, pathophysiology and most updated evidence of interventions from recent clinical studies. Int J Cardiol 2016; 224:170-177. [PMID: 27657469 DOI: 10.1016/j.ijcard.2016.09.063] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/07/2016] [Accepted: 09/15/2016] [Indexed: 12/18/2022]
Abstract
Heart failure (HF) is a burgeoning chronic health condition affecting more than 20million people worldwide. Patients with HF have a significant (17.1%) 30-day readmission rate, which invites substantial penalty in payment to hospitals from Centers for Medicare and Medicaid Services, as per the newly introduced Hospital Readmissions Reduction Program. Depression is one of the important risk factors for readmission in HF patients. It has a significant prevalence in patients with HF and contributes to the overall poor quality of life in them. Several behavioral (smoking, obesity, lack of exercise and medication noncompliance) and pathophysiological factors (hypercortisolism, elevated inflammatory biomarkers, fibrinogen, and atherosclerosis) have been found responsible for the adverse outcome in patients with HF and concomitant depression. Hippocampal volume loss noted in patients with acute HF exacerbations may contribute to the development of depressive symptoms in them. Screening for depression in HF patients continues to be challenging due to a considerable overlap in symptoms. Published trials on the use of antidepressants and cognitive behavioral therapy (CBT) have shown variable outcomes. Newer modalities like internet-based CBT have been tried in small studies, with promising results. A recent meta-analysis observed the beneficial role of aerobic exercise training in patients with HFrEF. Future long-term prospective studies may contribute to the formulation of a detailed screening and management guideline for patients with HF and depression. Our review is aimed to summarize the intricate relationship between depression and heart failure, with respect to their epidemiology, pathophysiological aspects, and optimal management approach.
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11
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Evaluation of nefazodone-induced cardiotoxicity in human induced pluripotent stem cell-derived cardiomyocytes. Toxicol Appl Pharmacol 2016; 296:42-53. [DOI: 10.1016/j.taap.2016.01.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 01/12/2016] [Accepted: 01/21/2016] [Indexed: 01/10/2023]
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12
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Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R, Singh AB. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2015; 49:1087-206. [PMID: 26643054 DOI: 10.1177/0004867415617657] [Citation(s) in RCA: 511] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. METHODS Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSIONS The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh. INTERNATIONAL EXPERT ADVISORS Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng, Professor John O'Brien, Professor Harold Sackeim, Professor Jan Scott, Dr Nobuhiro Sugiyama, Professor Eduard Vieta, Professor Lakshmi Yatham. AUSTRALIAN AND NEW ZEALAND EXPERT ADVISORS Professor Marie-Paule Austin, Professor Michael Berk, Dr Yulisha Byrow, Professor Helen Christensen, Dr Nick De Felice, A/Professor Seetal Dodd, A/Professor Megan Galbally, Dr Josh Geffen, Professor Philip Hazell, A/Professor David Horgan, A/Professor Felice Jacka, Professor Gordon Johnson, Professor Anthony Jorm, Dr Jon-Paul Khoo, Professor Jayashri Kulkarni, Dr Cameron Lacey, Dr Noeline Latt, Professor Florence Levy, A/Professor Andrew Lewis, Professor Colleen Loo, Dr Thomas Mayze, Dr Linton Meagher, Professor Philip Mitchell, Professor Daniel O'Connor, Dr Nick O'Connor, Dr Tim Outhred, Dr Mark Rowe, Dr Narelle Shadbolt, Dr Martien Snellen, Professor John Tiller, Dr Bill Watkins, Dr Raymond Wu.
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Affiliation(s)
- Gin S Malhi
- Discipline of Psychiatry, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Darryl Bassett
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia School of Medicine, University of Notre Dame, Perth, WA, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, VIC, Australia
| | - Kristina Fritz
- CADE Clinic, Discipline of Psychiatry, Sydney Medical School - Northern, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Bill Lyndon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia Mood Disorders Unit, Northside Clinic, Greenwich, NSW, Australia ECT Services Northside Group Hospitals, Greenwich, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Greg Murray
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Richard Porter
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Ajeet B Singh
- School of Medicine, Deakin University, Geelong, VIC, Australia
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Lee S, Lee HA, Kim SJ, Kim KS. Cellular mechanisms for trazodone-induced cardiotoxicity. Hum Exp Toxicol 2015; 35:501-10. [DOI: 10.1177/0960327115595683] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The second-generation selective 5-HT2 receptor antagonists and reuptake inhibitors (SARIs) class antidepressants are known to have fewer cardiovascular side effects than the older ones. However, several case reports showed that trazodone, one of the second-generation SARIs, induces QT prolongation, cardiac arrhythmia, and ventricular tachycardia. Although these clinical cases suggested trazodone-induced cardiotoxicity, the toxicological actions of trazodone on cardiac action potentials (APs) beyond the human ether-a-go-go related gene (hERG) remain unclear. To elucidate the cellular mechanism for the adverse cardiac effects of trazodone, we investigated its effects on cardiac APs and ion channels using whole-cell patch clamp techniques in human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and transiently transfected human embryonic kidney cells (HEK293) with cardiac ion channel complementary DNA. Trazodone dose-dependently decreased the maximum upstroke velocity ( Vmax) and prolonged the AP duration, inducing early after depolarizations at 3 and 10 μM that triggered ventricular arrhythmias in hiPSC-CMs. Trazodone also inhibited all of the major ion channels ( IKr, IKs, INa, and ICa), with an especially high inhibitory potency on hERG. These data indicate that the prolonged AP duration and decreased Vmax due to trazodone are mainly the result of hERG and sodium ion inhibition, and its inhibitory effects on cardiac ion channels can be exhibited in hiPSC-CMs.
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Affiliation(s)
- S Lee
- Next-Generation Pharmaceutical Research Center, Korea Institute of Toxicology, Korea Research Institute of Chemical Technology, Yuseong-gu, Daejeon, Korea
| | - H-A Lee
- Next-Generation Pharmaceutical Research Center, Korea Institute of Toxicology, Korea Research Institute of Chemical Technology, Yuseong-gu, Daejeon, Korea
- Department of Physiology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - SJ Kim
- Department of Physiology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - K-S Kim
- Next-Generation Pharmaceutical Research Center, Korea Institute of Toxicology, Korea Research Institute of Chemical Technology, Yuseong-gu, Daejeon, Korea
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14
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Agorastos A, Kellner M, Stiedl O, Muhtz C, Wiedemann K, Demiralay C. Blunted autonomic reactivity to pharmacological panic challenge under long-term escitalopram treatment in healthy men. Int J Neuropsychopharmacol 2014; 18:pyu053. [PMID: 25522396 PMCID: PMC4376541 DOI: 10.1093/ijnp/pyu053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Central serotonergic pathways influence brain areas involved in vagal cardiovascular regulation and, thereby, influence sympathetic efferent activity. Selective serotonin reuptake inhibitors (SSRIs) affect multiple serotonergic pathways, including central autonomic pathways. However, only a few studies have assessed SSRI-mediated effects on autonomic reactivity in healthy individuals using heart rate variability (HRV). METHODS The present study assessed the influence of long-term treatment with escitalopram (ESC) on autonomic reactivity to an intravenous application of 50 µg cholecystokinin tetrapeptide (CCK-4) in 30 healthy young men using a double-blind, placebo (PLA)-controlled, randomized, within-subject cross-over design. Main outcome measures were time- and frequency-domain HRV parameters, assessed at both baseline and immediately after CCK-4 application. RESULTS Results showed substantial effects for the treatment × CCK-4 challenge interaction with respect to heart rate (p < 0.001; pη(2) = 0.499), SDNN (p < 0.001; pη(2) = 576), RMSSD (p = 0.015; pη(2) = 194), NN50% (p = 0.008; pη(2) = 0.224), and LF% (p = 0.014; pη(2) = 0.196), and moderate effects with respect HF% (p = 0.099; pη(2) = 0.094), with PLA subjects showing a higher increase in HR and SDNN and a higher decrease in RMSSD, NN50, LF and HF than subjects in the ESC condition. Thus, ESC treatment significantly blunted the autonomic reactivity to CCK-4. Secondary analysis indicated no effect of the 5-HTTLPR polymorphism on CCK-4-induced autonomic response. CONCLUSIONS Our results support findings suggesting an effect of SSRI treatment on autonomic regulation and provide evidence that ESC treatment is associated with blunted autonomic reactivity in healthy men.
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Affiliation(s)
- Agorastos Agorastos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz).
| | - Michael Kellner
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Oliver Stiedl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Christoph Muhtz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
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Mago R, Tripathi N, Andrade C. Cardiovascular adverse effects of newer antidepressants. Expert Rev Neurother 2014; 14:539-51. [DOI: 10.1586/14737175.2014.908709] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dhillon S. Duloxetine: a review of its use in the management of major depressive disorder in older adults. Drugs Aging 2014; 30:59-79. [PMID: 23239363 DOI: 10.1007/s40266-012-0040-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Duloxetine (Cymbalta(®)) is a selective serotonin norepinephrine reuptake inhibitor indicated for the treatment of major depressive disorder (MDD). This article reviews the therapeutic efficacy and tolerability of duloxetine in older adults with MDD and summarizes its pharmacological properties. Treatment with duloxetine significantly improved several measures of cognition, depression, anxiety, pain and health-related quality-of-life (HR-QOL) in older adults with MDD in two 8-week, double-blind, placebo-controlled trials. However, no significant improvements in measures of depression were observed at week 12 (primary endpoint) of a 24-week, double-blind trial, although symptoms of depression did improve significantly at earlier timepoints. Benefit of treatment was also observed during continued therapy in the 24-week study (i.e. after the 12-week primary endpoint) and in an open-label, 52-week study, with improvements being observed in some measures of depression, pain and HR-QOL. Duloxetine was generally well tolerated in these studies, with nausea, dizziness and adverse events reflecting noradrenergic activity (e.g. dry mouth, constipation) being the most common treatment-emergent adverse events during treatment for up to 52 weeks. Duloxetine therapy had little effect on cardiovascular parameters and bodyweight. Although further well designed and long-term studies in this patient population are required to confirm the efficacy of duloxetine and to compare it with that of other antidepressants, current evidence suggests that treatment with duloxetine may be beneficial in older adults with MDD.
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Affiliation(s)
- Sohita Dhillon
- Adis, 41 Centorian Drive, Mairangi Bay, Private Bag 65901, North Shore, Auckland, New Zealand.
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Rose'meyer R. A review of the serotonin transporter and prenatal cortisol in the development of autism spectrum disorders. Mol Autism 2013; 4:37. [PMID: 24103554 PMCID: PMC3852299 DOI: 10.1186/2040-2392-4-37] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 09/13/2013] [Indexed: 01/28/2023] Open
Abstract
The diagnosis of autism spectrum disorder (ASD) during early childhood has a profound effect not only on young children but on their families. Aside from the physical and behavioural issues that need to be dealt with, there are significant emotional and financial costs associated with living with someone diagnosed with ASD. Understanding how autism occurs will assist in preparing families to deal with ASD, if not preventing or lessening its occurrence. Serotonin plays a vital role in the development of the brain during the prenatal and postnatal periods, yet very little is known about the serotonergic systems that affect children with ASD. This review seeks to provide an understanding of the biochemistry and physiological actions of serotonin and its termination of action through the serotonin reuptake transporter (SERT). Epidemiological studies investigating prenatal conditions that can increase the risk of ASD describe a number of factors which elevate plasma cortisol levels causing such symptoms during pregnancy such as hypertension, gestational diabetes and depression. Because cortisol plays an important role in driving dysregulation of serotonergic signalling through elevating SERT production in the developing brain, it is also necessary to investigate the physiological functions of cortisol, its action during gestation and metabolic syndromes.
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Affiliation(s)
- Roselyn Rose'meyer
- School of Medical Sciences, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland 4222, Australia.
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18
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Influence of combined treatment with mianserin and simvastatin on selected biochemical serum parameters of liver and kidney function in rats. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2013. [DOI: 10.12923/j.2084-980x/26.3/a.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The aim of the present study was to assess the impact of combined 14-day treatment with mianserin (10 mg/kg) and simvastatin (1 or 10 mg/kg) on selected biochemical liver and kidney parameters in rats (AST and ALT activities and the concentrations of AFP, total protein, urea, creatinine and ß2-M). The results showed the increase in both transaminases activities, creatinine concentration and the decrease of AFP, total protein and ß2-M concentrations. The results indicate that 14-day combined administration of mianserin with simvastatin negatively affects the liver functioning. The observed changes in kidney biochemical parameters may suggest a risk of renal dysfunction during long-term combined treatment with these drugs.
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Rustad JK, Stern TA, Hebert KA, Musselman DL. Diagnosis and treatment of depression in patients with congestive heart failure: a review of the literature. Prim Care Companion CNS Disord 2013; 15:13r01511. [PMID: 24392265 DOI: 10.4088/pcc.13r01511] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/12/2013] [Indexed: 01/02/2023] Open
Abstract
CONTEXT Major depressive disorder (MDD) can be challenging to diagnose in patients with congestive heart failure, who often suffer from fatigue, insomnia, weight changes, and other neurovegetative symptoms that overlap with those of depression. Pathophysiologic mechanisms (eg, inflammation, autonomic nervous system dysfunction, cardiac arrhythmias, and altered platelet function) connect depression and congestive heart failure. OBJECTIVE We sought to review the prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure. DATA SOURCES A search of all English-language articles between January 2003 and January 2013 was conducted using the search terms congestive heart failure and depression. STUDY SELECTION We found 1,498 article abstracts and 19 articles (meta-analyses, systematic reviews, and original research articles) that were selected for inclusion, as they contained information about our focus on diagnosis, treatment, and pathophysiology of depression associated with congestive heart failure. The search was augmented with manual review of reference lists of articles from the initial search. Articles selected for review were determined by author consensus. DATA EXTRACTION The prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure were reviewed. Particular attention was paid to the safety, efficacy, and tolerability of antidepressant medications commonly used to treat depression and how their side-effect profiles impact the pathophysiology of congestive heart failure. Drug-drug interactions between antidepressant medications and medications used to treat congestive heart failure were examined. RESULTS MDD is highly prevalent in patients with congestive heart failure. Moreover, the prevalence and severity of depression correlate with the degree of cardiac dysfunction and development of congestive heart failure. Depression increases the risk of congestive heart failure, particularly in those patients with coronary artery disease , and is associated with a poorer quality of life, increased use of health care resources, more frequent adverse clinical events and hospitalizations, and twice the risk of mortality. CONCLUSIONS At present, limited empirical data exist with regard to treatment of depression in the increasingly large population of patients with congestive heart failure. Evidence reveals that both psychotherapeutic treatment (eg, cognitive-behavioral therapy) and pharmacologic treatment (eg, use of the selective serotonin reuptake inhibitor sertraline) are safe and effective in reducing depression severity in patients with cardiovascular disease. Collaborative care programs featuring interventions that work to improve adherence to medical and psychiatric treatments improve both cardiovascular disease and depression outcomes. Depression rating scales such as the 9-item Patient Health Questionnaire should be used to monitor therapeutic efficacy.
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Affiliation(s)
- James K Rustad
- Department of Psychiatry and Behavioral Medicine, Morsani College of Medicine, University of South Florida, Tampa, and Department of Psychiatry, University of Central Florida College of Medicine, Orlando (Dr Rustad); Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston (Dr Stern); Departments of Medicine (Ms Hebert) and Psychiatry (Dr Musselman), University of Miami/Miller School of Medicine, Miami, Florida
| | - Theodore A Stern
- Department of Psychiatry and Behavioral Medicine, Morsani College of Medicine, University of South Florida, Tampa, and Department of Psychiatry, University of Central Florida College of Medicine, Orlando (Dr Rustad); Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston (Dr Stern); Departments of Medicine (Ms Hebert) and Psychiatry (Dr Musselman), University of Miami/Miller School of Medicine, Miami, Florida
| | - Kathy A Hebert
- Department of Psychiatry and Behavioral Medicine, Morsani College of Medicine, University of South Florida, Tampa, and Department of Psychiatry, University of Central Florida College of Medicine, Orlando (Dr Rustad); Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston (Dr Stern); Departments of Medicine (Ms Hebert) and Psychiatry (Dr Musselman), University of Miami/Miller School of Medicine, Miami, Florida
| | - Dominique L Musselman
- Department of Psychiatry and Behavioral Medicine, Morsani College of Medicine, University of South Florida, Tampa, and Department of Psychiatry, University of Central Florida College of Medicine, Orlando (Dr Rustad); Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston (Dr Stern); Departments of Medicine (Ms Hebert) and Psychiatry (Dr Musselman), University of Miami/Miller School of Medicine, Miami, Florida
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20
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Abstract
BACKGROUND Cardiovascular events are inconclusively associated with duloxetine use in clinical trials and spontaneous reports. This analysis of cardiovascular events in relation to duloxetine use within a large health insurance database provides further data on the association. METHODS This cohort study was conducted within a population with commercial health insurance. Adults with depression who initiated duloxetine were matched to separate cohorts of initiators of venlafaxine, selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants (TCAs), along with untreated patients with depression, and enrollees without depression. The cohorts were followed for cardiovascular events (acute myocardial infarction, sudden death, hypertensive crisis, arrhythmia, and coronary revascularization), which were identified through health insurance claims and confirmed upon review of underlying medical records. Proportional hazards and Poisson regression models were used for comparisons. RESULTS There were approximately 64,000 person-years of follow-up among all cohorts (including 17,386 person-years among 21,457 duloxetine initiators), yielding 279 cardiovascular events. Relative to duloxetine initiators, those without depression had lower rates of combined events (incidence rate ratio [IRR], 0.51; 95% confidence interval [CI], 0.32-0.81) and coronary revascularizations (IRR, 0.51; 95% CI 0.29-0.89). The IR of each of the cardiovascular outcomes did not differ across the other cohorts, even accounting for time since last duloxetine dispensing. CONCLUSION The incidence of cardiovascular events did not differ among duloxetine initiators relative to other antidepressant comparators or those with untreated depression but was higher than those without depression, suggesting that depression itself (or associated morbidities) may affect the risk of cardiovascular events.
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21
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Efficacy and tolerability of the novel triple reuptake inhibitor amitifadine in the treatment of patients with major depressive disorder: a randomized, double-blind, placebo-controlled trial. J Psychiatr Res 2012; 46:64-71. [PMID: 21925682 DOI: 10.1016/j.jpsychires.2011.09.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 09/01/2011] [Accepted: 09/01/2011] [Indexed: 12/28/2022]
Abstract
Amitifadine (EB-1010, formerly DOV 21,947) is a serotonin-preferring triple reuptake inhibitor with a relative potency to inhibit serotonin, norepinephrine, and dopamine uptake of ∼1:2:8, respectively. This 6-week, multicenter, randomized, double-blind, parallel, placebo-controlled study evaluated the efficacy and tolerability of amitifadine in 63 patients with major depressive disorder. Eligible patients (17-item Hamilton Depression Rating Scale [HAMD-17] ≥ 22 at baseline) were randomized to amitifadine 25 mg twice daily (BID) for 2 weeks, then 50 mg BID for 4 weeks or placebo. Mean baseline scores in the modified intent-to-treat population (n = 56) were 31.4 for the Montgomery-Åsberg Depression Rating Scale (MADRS), 29.6 for the HAMD-17, and 25.4 for the Derogatis Interview for Sexual Functioning - Self Report (DISF-SR). At the end of the 6-week double-blind treatment, estimated least squares mean change from baseline (mixed-model repeated measures [MMRM]) in MADRS total score was statistically significantly superior for amitifadine compared to placebo (18.2 vs. 22.0; p = 0.028), with an overall statistical effect size of -0.601 (Cohen's d). Amitifadine also was statistically significantly superior to placebo (p = 0.03) for the Clinical Global Impression of Change - Improvement. An anhedonia factor score grouping of MADRS Items 1 (apparent sadness), 2 (reported sadness), 6 (concentration difficulties), 7 (lassitude), and 8 (inability to feel) demonstrated a statistically significant difference in favor of amitifadine compared to placebo (p = 0.049). No differences were observed between treatments in DISF-SR scores. Amitifadine was well-tolerated. Two patients on each treatment discontinued the study early due to adverse events; however, no serious adverse events were reported. This initial clinical trial in patients with severe major depression demonstrated significant antidepressant activity with amitifadine, including attenuating symptoms of anhedonia, and a tolerability profile that was comparable to placebo. The efficacy and tolerability of amitifadine for major depressive disorder are being investigated in additional clinical trials.
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22
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Wozniak G, Toska A, Saridi M, Mouzas O. Serotonin reuptake inhibitor antidepressants (SSRIs) against atherosclerosis. Med Sci Monit 2011; 17:RA205-14. [PMID: 21873959 PMCID: PMC3560505 DOI: 10.12659/msm.881924] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are a class of drug widely used for treatment of mood disorders, including depression and cardiovascular disease. A search for related articles in the PubMed database was attempted. It covered studies, reports, reviews and editorials of the last 5 years. Pro-inflammatory cytokines, such as TNF-α, IL-1 and IL-6, stimulate central serotonin (5-HT) neurotransmission and are over-expressed in depression, which has been linked with hypothalamic-pituitary-adrenal axis (HPA) hyperactivity. They have also been implicated in the pathogenesis and progression of other stress-induced disorders, like myocardial infarction (MI) and coronary heart disease (CHD), as they seem to modulate cardiovascular function by a variety of mechanisms. Biological mechanisms like these may explain the link between depression and CHD. There are a variety of environmental factors as well as genetic factors that might influence the pharmacogenetics of antidepressant drugs. New generation selective serotonin reuptake inhibitor antidepressants (SSRIs) causing a reduced cardiovascular morbidity and mortality may be related to serotonin platelet abnormalities in depressed patients that are effectively treated by SSRIs. SSRIs such as fluoxetine, paroxetine, sertraline and citalopram are not only considered to be free from the cardiotoxicity of their predecessors but also to function as safe and efficacious agents against depression, platelet activation, atherosclerosis and development and prognosis of coronary heart disease. However, there is a need for more studies in order to establish the exact biochemical mechanisms that are responsible for these diseases and the immunoregulatory effects of chronic use of SSRI medications.
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Affiliation(s)
- Greta Wozniak
- Medical School, University of Thessaly, Larissa, Greece.
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23
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Bacon SL, Lavoie KL, Arsenault A, Dupuis J, Pilote L, Laurin C, Gordon J, Gautrin D, Vadeboncoeur A. The research on endothelial function in women and men at risk for cardiovascular disease (REWARD) study: methodology. BMC Cardiovasc Disord 2011; 11:50. [PMID: 21831309 PMCID: PMC3170269 DOI: 10.1186/1471-2261-11-50] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 08/10/2011] [Indexed: 11/10/2022] Open
Abstract
Background Endothelial function has been shown to be a highly sensitive marker for the overall cardiovascular risk of an individual. Furthermore, there is evidence of important sex differences in endothelial function that may underlie the differential presentation of cardiovascular disease (CVD) in women relative to men. As such, measuring endothelial function may have sex-specific prognostic value for the prediction of CVD events, thus improving risk stratification for the overall prediction of CVD in both men and women. The primary objective of this study is to assess the clinical utility of the forearm hyperaemic reactivity (FHR) test (a proxy measure of endothelial function) for the prediction of CVD events in men vs. women using a novel, noninvasive nuclear medicine -based approach. It is hypothesised that: 1) endothelial dysfunction will be a significant predictor of 5-year CVD events independent of baseline stress test results, clinical, demographic, and psychological variables in both men and women; and 2) endothelial dysfunction will be a better predictor of 5-year CVD events in women compared to men. Methods/Design A total of 1972 patients (812 men and 1160 women) undergoing a dipyridamole stress testing were recruited. Medical history, CVD risk factors, health behaviours, psychological status, and gender identity were assessed via structured interview or self-report questionnaires at baseline. In addition, FHR was assessed, as well as levels of sex hormones via blood draw. Patients will be followed for 5 years to assess major CVD events (cardiac mortality, non-fatal MI, revascularization procedures, and cerebrovascular events). Discussion This is the first study to determine the extent and nature of any sex differences in the ability of endothelial function to predict CVD events. We believe the results of this study will provide data that will better inform the choice of diagnostic tests in men and women and bring the quality of risk stratification in women on par with that of men.
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Affiliation(s)
- Simon L Bacon
- Montreal Behavioural Medicine Centre, Montreal, Canada.
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Hamaguchi Y, Tatematsu Y, Furukawa K, Matsubara T, Nakayama S. Imipramine inhibition of TRPM-like plasmalemmal Mg2+ transport in vascular smooth muscle cells. J Cell Mol Med 2011; 15:593-601. [PMID: 20132412 PMCID: PMC3922381 DOI: 10.1111/j.1582-4934.2010.01024.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Depression is associated with vascular disease, such as myocardial infarction and stroke. Pharmacological treatments may contribute to this association. On the other hand, Mg2+ deficiency is also known to be a risk factor for the same category of diseases. In the present study, we examined the effect of imipramine on Mg2+ homeostasis in vascular smooth muscle, especially via melastatin-type transient receptor potential (TRPM)-like Mg2+-permeable channels. The intracellular free Mg2+ concentration ([Mg2+]i) was measured using 31P-nuclear magnetic resonance (NMR) in porcine carotid arteries that express both TRPM6 and TRPM7, the latter being predominant. pHi and intracellular phosphorus compounds were simultaneously monitored. To rule out Na+-dependent Mg2+ transport, and to facilitate the activity of Mg2+-permeable channels, experiments were carried out in the absence of Na+ and Ca2+. Changing the extracellular Mg2+ concentration to 0 and 6 mM significantly decreased and increased [Mg2+]i, respectively, in a time-dependent manner. Imipramine statistically significantly attenuated both of the bi-directional [Mg2+]i changes under the Na+- and Ca2+-free conditions. This inhibitory effect was comparable in influx, and much more potent in efflux to that of 2-aminoethoxydiphenyl borate, a well-known blocker of TRPM7, a channel that plays a major role in cellular Mg2+ homeostasis. Neither [ATP]i nor pHi correlated with changes in [Mg2+]i. The results indicate that imipramine suppresses Mg2+-permeable channels presumably through a direct effect on the channel domain. This inhibitory effect appears to contribute, at least partially, to the link between antidepressants and the risk of vascular diseases.
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Affiliation(s)
- Yukihisa Hamaguchi
- Department of Cell Physiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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25
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Mutch WAC, Fransoo RR, Campbell BI, Chateau DG, Sirski M, Warrian RK. Dementia and depression with ischemic heart disease: a population-based longitudinal study comparing interventional approaches to medical management. PLoS One 2011; 6:e17457. [PMID: 21387018 PMCID: PMC3046165 DOI: 10.1371/journal.pone.0017457] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 02/04/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We compared the proportion of ischemic heart disease (IHD) patients newly diagnosed with dementia and depression across three treatment groups: percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical management alone (IHD-medical). METHODS AND FINDINGS De-identified, individual-level administrative records of health service use for the population of Manitoba, Canada (approximately 1.1 million) were examined. From April 1, 1993 to March 31, 1998, patients were identified with a diagnosis of IHD (ICD-9-CM codes). Index events of CABG or PCI were identified from April 1, 1998 to March 31, 2003. Outcomes were depression or dementia after the index event. Patients were followed forward to March 31, 2006 or until censored. Proportional hazards regression analysis was undertaken. Independent variables examined were age, sex, diabetes, hypertension and income quintile, medical management alone for IHD, or intervention by PCI or CABG. Age, sex, diabetes, and presence of hypertension were all strongly associated with the diagnosis of depression and dementia. There was no association with income quintile. Dementia was less frequent with PCI compared to medical management; (HR = 0.65; p = 0.017). CABG did not provide the same protective effect compared to medical management (HR = 0.90; p = 0.372). New diagnosis depression was more frequent with interventional approaches: PCI (n = 626; hazard ratio = 1.25; p = 0.028) and CABG (n = 1124, HR = 1.32; p = 0.0001) than non-interventional patients (n = 34,508). Subsequent CABG was nearly 16-fold higher (p<0.0001) and subsequent PCI was 22-fold higher (p<0.0001) for PCI-managed than CABG-managed patients. CONCLUSIONS Patients managed with PCI had the lowest likelihood of dementia-only 65% of the risk for medical management alone. Both interventional approaches were associated with a higher risk of new diagnosed depression compared to medical management. Long-term myocardial revascularization was superior with CABG. These findings suggest that PCI may confer a long-term protective effect from dementia. The mechanism(s) of dementia protection requires elucidation.
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Affiliation(s)
- W Alan C Mutch
- Department of Anesthesia and Peri-operative Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
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26
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Antiplatelet effects of antidepressant treatment: A randomized comparison between escitalopram and nortriptyline. Thromb Res 2010; 126:e83-7. [DOI: 10.1016/j.thromres.2010.04.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 04/07/2010] [Accepted: 04/29/2010] [Indexed: 01/23/2023]
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Parashar S, Vaccarino V. Depression and CHD risk: how should we intervene? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2010; 9:272-7. [PMID: 17761112 DOI: 10.1007/s11936-007-0022-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Depression is common in the community and is a risk factor for the development of coronary heart disease (CHD). In patients with CHD, the prevalence of major depression is nearly 20% and the prevalence of minor depressive disorder is approximately 27%. When present in patients with existing CHD, depression is independently associated with worse outcome, including higher morbidity and mortality, and worse health status. Observational studies suggest that use of antidepressant medications in patients with CHD is associated with decreased risk of cardiovascular events. However, only one randomized controlled trial, the ENRICHD (Enhancing Recovery in Coronary Heart Disease) study, was designed to evaluate whether treatment of depression in patients with CHD can improve cardiac prognosis. Although the study showed that cognitive behavior therapy was better than usual care in improving depression, there was no improvement in all-cause mortality or recurrent cardiac events. There have been no clinical trials specifically designed to evaluate whether pharmacologic treatment of depression improves cardiovascular outcomes in patients with CHD. Thus, there is a clear need for additional trials testing interventions to improve cardiac prognosis based on treatment of depression. In the meantime, depression remains an important illness in its own right and deserves treatment. Safe and effective treatments of depression in patients with CHD include cognitive behavior therapy and selective serotonin reuptake inhibitors.
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Affiliation(s)
- Susmita Parashar
- Department of Medicine, Emory University, 49 Jesse Hill Jr. Drive, Atlanta, GA 30345, USA.
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28
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Ehrenthal JC, Herrmann-Lingen C, Fey M, Schauenburg H. Altered cardiovascular adaptability in depressed patients without heart disease. World J Biol Psychiatry 2010; 11:586-93. [PMID: 20218928 DOI: 10.3109/15622970903397714] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Despite its clinical importance and relevance for health care policy, the pathways between depression and stress regulation remain poorly understood. The objective of our study was to compare cardiovascular and autonomic responses to brief psychosocial stress in a group of severely depressed subjects without heart disease and a non-depressed control-group. METHODS We recorded cardiovascular and autonomic reactions to two different stress tasks including anger recall and mental arithmetic in a sample of 25 severely depressed and 25 non-depressed subjects. Aggregated data were compared with repeated-measures MANOVA. We used contrasts to evaluate different response patterns concerning cardiovascular and autonomic reactivity vs. recovery. RESULTS Depressed subjects showed overall reduced high-frequency heart rate variability and an altered cardiovascular adaptability concerning heart rate, blood pressure, cardiac output, and, on a trend level, peripheral resistance. With few exceptions, we found no differences between reactivity vs. recovery response patterns. CONCLUSIONS Our results provide further evidence for altered cardiovascular reactivity and impaired cardiac autonomic functioning in depression. Further research is needed on psychophysiological response to either more disease-oriented or more personality-oriented stressors.
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Affiliation(s)
- Johannes C Ehrenthal
- Clinic for Psychosomatic and General Clinical Medicine, University of Heidelberg, Thibautstrasse 2, Heidelberg, Germany.
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Marano G, Harnic D, Lotrionte M, Biondi-Zoccai G, Abbate A, Romagnoli E, Mazza M. Depression and the cardiovascular system: increasing evidence of a link and therapeutic implications. Expert Rev Cardiovasc Ther 2009; 7:1123-47. [PMID: 19764865 DOI: 10.1586/erc.09.78] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This review explores the epidemiological evidence for the relationship between depression and cardiovascular disease from a mechanistic standpoint. It is important to examine the biological, behavioral and social mechanisms to improve outcomes for depressed cardiac patients. A number of plausible biobehavioral mechanisms linking depression and cardiovascular disease have been identified. Tricyclic antidepressants have various effects on the cardiovascular system, while selective serotonin reuptake inhibitors are not associated with adverse cardiac effects and should, therefore, be the preferred choice for the treatment of most patients with comorbid depression and cardiovascular disease.
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Affiliation(s)
- Giuseppe Marano
- Department of Neuroscience, Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy
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Pousti A, Bakhtiarian A, Najafi R, Deemyad T, Brumand K, Hosseini MJ. Effect of sertraline on ouabain-induced arrhythmia in isolated guinea-pig atria. Depress Anxiety 2009; 26:E106-10. [PMID: 19242981 DOI: 10.1002/da.20407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The effect of sertraline a selective serotonin reuptake inhibitor antidepressant was studied on ouabain-induced toxicity (arrhythmia) in spontaneously beating isolated guinea-pig atria. METHODS The guinea-pig atrium was dissected out and suspended in modified Krebs solution under physiological conditions. Drugs were added into solutions. The changes in rate and force of contractions were measured using a physiograph. RESULTS Sertraline (2-16 microg/mL) caused a dose-dependent decrease in the rate of contractions (17-46%) and in the contractile force (26-48%). Ouabain alone (1.2 microg/mL) produced arrhythmia at 7.8 min and asystole at 22 min. Pre- administration of the atria with sertraline (8 microg/mL) significantly increased the time required to produce arrhythmia by ouabain to 20.5 min, prolonged the beating of atria to more than 64.5 min and delayed the occurrence of asystolia. The pattern of contractile force induced by sertraline + ouabain was more regular than that produced by ouabain alone. CONCLUSIONS These findings indicate that sertraline produces direct cardiac action, probably due to the inhibition of cardiac Na(+) and Ca(2+) channels. Our results suggest that sertraline may reduce the membrane conduction through inhibition of ionic channels which decrease ouabain-induced arrhythmia.
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Affiliation(s)
- Abbas Pousti
- Department of Pharmacology, Medical School, Tehran University of Medical Sciences, Tehran, Iran.
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Dekker RL, Peden AR, Lennie TA, Schooler MP, Moser DK. Living with depressive symptoms: patients with heart failure. Am J Crit Care 2009; 18:310-8. [PMID: 19556409 DOI: 10.4037/ajcc2009672] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients with heart failure often experience depressive symptoms that affect health-related quality of life, morbidity, and mortality. Researchers have not described the experience of patients with heart failure living with depressive symptoms. Understanding this experience will help in developing interventions to decrease depressive symptoms. OBJECTIVE To describe the experience of patients with heart failure living with depressive symptoms. METHODS This study was conducted by using a qualitative descriptive design. The sample consisted of 10 outpatients (50% female, mean age 63 [SD, 13] years, 70% New York Heart Association class III or IV) with heart failure who were able to describe depressive symptoms. Data were collected via taped, individual, 30- to 60-minute interviews. ATLAS ti (version 5) was used for content analysis. RESULTS Participants described emotional and somatic symptoms of depression. Negative thinking was present in all participants and reinforced their depressed mood. The participants experienced multiple stressors that worsened depressive symptoms. The overarching strategy for managing depressive symptoms was "taking my mind off of it." Patients managed depressive symptoms by engaging in activities such as exercise and reading, and by using positive thinking, spirituality, and social support. CONCLUSIONS Patients with heart failure experience symptoms of depression that are similar to those experienced by the general population. Clinicians should assess patients with heart failure for stressors that worsen depressive symptoms. Strategies that researchers and clinicians can use to reduce depressive symptoms in patients with heart failure include engaging patients in activities, positive thinking, and spirituality. Helping patients find enhanced social support may also be important.
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Affiliation(s)
- Rebecca L. Dekker
- Rebecca L. Dekker is a doctoral candidate, Ann R. Peden is a professor, Terry A. Lennie is an associate professor and associate dean for doctoral studies, Mary P. Schooler is a psychiatric nurse practitioner, and Debra K. Moser is a professor and Linda C. Gill Chair in the College of Nursing at the University of Kentucky in Lexington
| | - Ann R. Peden
- Rebecca L. Dekker is a doctoral candidate, Ann R. Peden is a professor, Terry A. Lennie is an associate professor and associate dean for doctoral studies, Mary P. Schooler is a psychiatric nurse practitioner, and Debra K. Moser is a professor and Linda C. Gill Chair in the College of Nursing at the University of Kentucky in Lexington
| | - Terry A. Lennie
- Rebecca L. Dekker is a doctoral candidate, Ann R. Peden is a professor, Terry A. Lennie is an associate professor and associate dean for doctoral studies, Mary P. Schooler is a psychiatric nurse practitioner, and Debra K. Moser is a professor and Linda C. Gill Chair in the College of Nursing at the University of Kentucky in Lexington
| | - Mary P. Schooler
- Rebecca L. Dekker is a doctoral candidate, Ann R. Peden is a professor, Terry A. Lennie is an associate professor and associate dean for doctoral studies, Mary P. Schooler is a psychiatric nurse practitioner, and Debra K. Moser is a professor and Linda C. Gill Chair in the College of Nursing at the University of Kentucky in Lexington
| | - Debra K. Moser
- Rebecca L. Dekker is a doctoral candidate, Ann R. Peden is a professor, Terry A. Lennie is an associate professor and associate dean for doctoral studies, Mary P. Schooler is a psychiatric nurse practitioner, and Debra K. Moser is a professor and Linda C. Gill Chair in the College of Nursing at the University of Kentucky in Lexington
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Sowden GL, Huffman JC. The impact of mental illness on cardiac outcomes: A review for the cardiologist. Int J Cardiol 2009; 132:30-7. [DOI: 10.1016/j.ijcard.2008.10.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 10/01/2008] [Indexed: 11/28/2022]
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Smolderen KGE, Aquarius AE, de Vries J, Smith ORF, Hamming JF, Denollet J. Depressive symptoms in peripheral arterial disease: a follow-up study on prevalence, stability, and risk factors. J Affect Disord 2008; 110:27-35. [PMID: 18237784 DOI: 10.1016/j.jad.2007.12.238] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 12/20/2007] [Accepted: 12/20/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Depressive symptoms are associated with poor prognosis in coronary artery disease, but there is a paucity of research on these symptoms in peripheral arterial disease (PAD). We examined the clinical correlates and 18-month course of depressive symptoms in PAD patients. METHODS 166 patients with symptomatic lower-extremity PAD (39% women; M age=64.9 +/- 10 years) completed the 10-item Center for Epidemiological Studies Depression scale. A score > or =4 indicates clinically relevant depressive symptoms. Depressive symptoms were re-assessed at 6, 12, and 18 months follow-up. Ankle-brachial index (ABI) and treadmill walking distance were used to assess PAD severity. RESULTS At baseline, depressive symptoms (CES-D > or =4) were present in 16% of the patients. Depressed patients performed worse regarding pain free (p=0.003) and maximum (p=0.005) walking distance. After adjusting for age, sex, education, ABI, psychotropic medication use, cardiovascular risk factors, and comorbidity, depressive symptoms remained stable in initially depressed patients. Using mixed modelling, three subgroups were identified in the total sample. The majority of PAD patients did not have depressive symptoms (58%), but there were two groups who persistently experienced either subclinical (27%) or clinically manifest (15%) depressive symptoms. LIMITATIONS Only baseline data of ABI and treadmill walking performance were available. CONCLUSIONS Depressive symptomatology was present in a substantial number of PAD patients, tended to be stable, and was associated with reduced walking distance. These apparently evident results are overlooked thus far in this patient group and deserve further attention in research and clinical care.
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Affiliation(s)
- Kim G E Smolderen
- CoRPS, Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands.
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Carneiro AMD, Cook EH, Murphy DL, Blakely RD. Interactions between integrin alphaIIbbeta3 and the serotonin transporter regulate serotonin transport and platelet aggregation in mice and humans. J Clin Invest 2008; 118:1544-52. [PMID: 18317590 DOI: 10.1172/jci33374] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 01/09/2008] [Indexed: 01/08/2023] Open
Abstract
The essential contribution of the antidepressant-sensitive serotonin (5-HT) transporter SERT (which is encoded by the SLC6A4 gene) to platelet 5-HT stores suggests an important role of this transporter in platelet function. Here, using SERT-deficient mice, we have established a role for constitutive SERT expression in efficient ADP- and thrombin-triggered platelet aggregation. Additionally, using pharmacological blockers of SERT and the vesicular monoamine transporter (VMAT), we have identified a role for ongoing 5-HT release and SERT activity in efficient human platelet aggregation. We have also demonstrated that fibrinogen, an activator of integrin alphaIIbbeta3, enhances SERT activity in human platelets and that integrin alphaIIbbeta3 interacts directly with the C terminus of SERT. Consistent with these findings, knockout mice lacking integrin beta3 displayed diminished platelet SERT activity. Conversely, HEK293 cells engineered to express human SERT and an activated form of integrin beta3 exhibited enhanced SERT function that coincided with elevated SERT surface expression. Our results support an unsuspected role of alphaIIbbeta3/SERT associations as well as alphaIIbbeta3 activation in control of SERT activity in vivo that may have broad implications for hyperserotonemia, cardiovascular disorders, and autism.
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Affiliation(s)
- Ana Marin D Carneiro
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548, USA
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Somberg TC, Arora RR. Depression and heart disease: therapeutic implications. Cardiology 2008; 111:75-81. [PMID: 18376116 DOI: 10.1159/000119692] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 10/07/2007] [Indexed: 11/19/2022]
Abstract
The consequences of depression and coronary artery disease (CAD) were reviewed in the literature. The comorbidity of depression and CAD results in an increased cardiovascular mortality. We reviewed possible explanations for this increased morbidity, which include: toxicity of tricyclic antidepressants that can cause cardiac arrhythmias, abnormalities in platelet function leading to increased platelet aggregation due to abnormalities in serotonin in the platelet (an abnormality that possibly causes depression in the central nervous system), diffuse atherosclerosis causing central nervous system abnormalities including depression (vascular depression), as well as the possibility that depressed patients are less compliant with their medications and physician-directed health recommendations. Recent reports of selective serotonin reuptake inhibitors (SSRIs) causing a reduced cardiovascular mortality may be related to serotonin platelet abnormalities in depressed patients that are effectively treated by SSRIs (SADHART and ENRICHD trial). It is possible that these trials reveal a mechanism of depression that also effects platelet function and can be improved with SSRI therapy, suggesting a preferential therapeutic pathway for the treatment of depressed patients with CAD.
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Treating body dysmorphic disorder with medication: evidence, misconceptions, and a suggested approach. Body Image 2008; 5:13-27. [PMID: 18325859 PMCID: PMC2705931 DOI: 10.1016/j.bodyim.2007.12.003] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 12/28/2007] [Accepted: 12/28/2007] [Indexed: 11/23/2022]
Abstract
Body dysmorphic disorder (BDD) is a relatively common and often disabling disorder with high morbidity and mortality. Both psychotropic medication and cognitive behavioral therapy (CBT) are considered first-line treatments for BDD, and medication treatment is often essential for more severely ill and suicidal patients. In this practical overview of the pharmacotherapy of BDD, we briefly describe BDD's clinical features, associated morbidity, and how to recognize and diagnose BDD. We describe the importance of forming a therapeutic alliance with the patient, the need for psychoeducation, and other essential groundwork for successful treatment of BDD. We review available pharmacotherapy research, with a focus on serotonin-reuptake inhibitors (SSRIs, or SRIs), which are currently considered the medication of choice for BDD. Many patients have substantial improvement in core BDD symptoms, psychosocial functioning, quality of life, suicidality, and other aspects of BDD when treated with appropriate pharmacotherapy that targets BDD symptoms. We also discuss practical issues such as dosing, length of treatment, and potential side effects associated with the use of SRIs. In addition, we discuss pharmacotherapy approaches that can be tried if SRI treatment alone is not adequately helpful. Finally, some misconceptions about pharmacotherapy, gaps in knowledge about BDD's treatment, and the need for additional research are discussed.
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Nuyen J, Spreeuwenberg PM, Van Dijk L, den Bos GAMV, Groenewegen PP, Schellevis FG. The influence of specific chronic somatic conditions on the care for co-morbid depression in general practice. Psychol Med 2008; 38:265-277. [PMID: 17825119 DOI: 10.1017/s0033291707001298] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Limited information exists on the relationship between specific chronic somatic conditions and care for co-morbid depression in primary care settings. Therefore, the present prospective, general practice-based study examined this relationship. METHOD Longitudinal data on morbidity, prescribing and referrals concerning 991 patients newly diagnosed with depression by their general practitioner (GP) were analysed. The influence of a broad range of 13 specific chronic somatic conditions on the initiation of any depression care, as well as the prescription of continuous antidepressant therapy for 180 days, was examined. Multilevel logistic regression analysis was used to control for history of depression, psychiatric co-morbidity, sociodemographics and interpractice variation. RESULTS Multilevel analysis showed that patients with pre-existing ischaemic heart disease (72.1%) or cardiac arrhythmia (59.3%) were significantly less likely to have any depression care being initiated by their GP than patients without chronic somatic morbidity (88.0%). No other specific condition had a significant influence on GP initiation of any care for depression. Among the patients being prescribed antidepressant treatment by their GP, none of the conditions was significantly associated with being prescribed continuous treatment for 180 days. CONCLUSIONS Our study indicates that patients with ischaemic heart disease or cardiac arrhythmia have a lower likelihood of GP initiation of any care for depression after being newly diagnosed with depression by their GP. This finding points to the importance of developing interventions aimed at supporting GPs in the adequate management of co-morbid depression in heart disease patients to reduce the negative effects of this co-morbidity.
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Affiliation(s)
- J Nuyen
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
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Abstract
Panic disorder (PD) is a disabling condition which appears in late adolescence or early adulthood and affects more frequently women than men. PD is frequently characterized by recurrences and sometimes by a chronic course and, therefore, most patients require long-term treatments to achieve remission, to prevent relapse and to reduce the risks associated with comorbidity. Pharmacotherapy is one of the most effective treatments of PD. In this paper, the pharmacological management of PD is reviewed. Many questions about this effective treatment need to be answered by the clinician and discussed with the patients to improve her/his collaboration to the treatment plan: which is the drug of choice; when does the drug become active; which is the effective dose; how to manage the side effects; how to manage nonresponse; and how long does the treatment last. Moreover, the clinical use of medication in women during pregnancy and breastfeeding or in children and adolescents was reviewed and its risk-benefit balance discussed.
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Affiliation(s)
- Carlo Marchesi
- Psychiatric Section, Department of Neuroscience, University of Parma Parma, Italy.
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Kapfhammer HP. Depressive und Angststörungen bei somatischen Krankheiten. PSYCHIATRIE UND PSYCHOTHERAPIE 2008. [PMCID: PMC7122024 DOI: 10.1007/978-3-540-33129-2_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Depressiv-ängstliche Störungen sind bei den unterschiedlichen somatischen Erkrankungen häufig. Sie sind nicht nur als Reaktion auf die Situation der Erkrankung zu verstehen, sondern in ein komplexes Bedingungsgefüge eingebettet. Sie sind besonders häufig bei Erkrankungen, die das Zentralnervensystem oder endokrine Regulationssysteme direkt betreffen. Es besteht ein enger Zusammenhang zur Chronizität, Schwere und Prognose der Erkrankung. Eigenständige Effekte von diversen pharmakologischen Substanzgruppen sind wahrscheinlich.
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Nelson JC, Holden K, Roose S, Salzman C, Hollander SB, Betzel JV. Are there predictors of outcome in depressed elderly nursing home residents during treatment with mirtazapine orally disintegrating tablets? Int J Geriatr Psychiatry 2007; 22:999-1003. [PMID: 17447229 DOI: 10.1002/gps.1779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Treatment studies of depression in residential care are limited. Reports of predictors of response are rare. In the largest nursing home prospective antidepressant trial reported, we examined predictors of response. METHODS This was a 12-week open-label study of mirtazapine orally disintegrating tablets performed in 30 US nursing homes. Subjects were men and women aged >or=70, with a Mini Mental State Exam (MMSE) score >or=10, who had a depressive disorder that required antidepressant treatment. Mirtazapine was started at 15 mg at bedtime, and adjusted to 15-45 mg/day. A 16-item Hamilton Depression Rating Scale was used to assess depression at baseline, weeks 2, 4, 8, and 12 or early termination. RESULTS One hundred and twenty-four patients received at least one dose of study drug and of these, 119 had at least one post-drug assessment. Mean age was 82.9 years and 72% were female. Response rates at 12 weeks were 47% on the HAMD and 54% on the CGI. Age, sex, MMSE score, medical burden, history of prior depression, and baseline HAMD severity were not significantly associated with HAMD response (>or=50% improvement) and in most cases correlations were trivial, <0.1. Advanced age, medical burden, and cognitive impairment did not predict adverse events. CONCLUSIONS In this sample of depressed nursing home residents treated with mirtazapine orally disintegrating tablets, advanced age, medical illness, and cognitive impairment did not predict response. The findings suggest that these variables need not be viewed as obstacles to treatment.
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Affiliation(s)
- J Craig Nelson
- University California San Francisco, San Francisco, CA, USA.
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Havik OE, Sivertsen B, Relbo A, Hellesvik M, Grov I, Geiran O, Andreassen AK, Simonsen S, Gullestad L. Depressive Symptoms and All-Cause Mortality After Heart Transplantation. Transplantation 2007; 84:97-103. [PMID: 17627244 DOI: 10.1097/01.tp.0000268816.90672.a0] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Several studies indicate that heart transplantation (HTx) is associated with depression and reduced quality of life. However, the impact of depression on the prognosis for HTx-patients has not yet been sufficiently established. The aim of the present study was to prospectively investigate the influence of depression on mortality in patients with HTx, adjusting for other known risk factors. METHODS In a prospective, cross-sectional study with minimum 5-year follow-up, symptoms of depression were assessed in 147 HTx-patients using the Beck Depression Inventory (BDI). RESULTS Mild to severe depressive symptoms (BDI > or =10) were observed in 36 patients (24.5%). Depressive symptoms on inclusion increased the risk of mortality during the follow-up period. The risk remained significant after adjusting for several somatic and lifestyle risk factors, and the adjusted relative risk associated with depression (risk ratio: 2.32; 95% CI: 1.13-4.79; P=0.02) was comparable to the adjusted relative risk associated with time since HTx. CONCLUSIONS Symptoms of depression predict mortality independently of somatic and lifestyle risk factors in HTx patients, and this group of patients should be screened for depressive symptoms.
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Affiliation(s)
- Odd E Havik
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.
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Stafford L, Berk M, Reddy P, Jackson HJ. Comorbid depression and health-related quality of life in patients with coronary artery disease. J Psychosom Res 2007; 62:401-10. [PMID: 17383491 DOI: 10.1016/j.jpsychores.2006.12.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This article reviews recent studies relating to the impact of depression and its treatment on the health-related quality of life (HRQOL) of patients with coronary artery disease (CAD). METHODS Articles for the primary review were identified via MEDLINE and PsycINFO (1995-2006). RESULTS Evidence suggests that depression has an aversive impact on the HRQOL of patients with stable CAD as well as on patients hospitalized for acute myocardial infarction and coronary artery bypass graft surgery. Unfortunately, there are few depression treatment studies in patients with CAD that make use of standardized HRQOL measures, but the limited evidence suggests that successful treatment has positive implications for HRQOL in these patients. The mechanisms through which depression impacts on HRQOL require further study but are likely to be behavioral. CONCLUSIONS Depressive symptoms significantly undermine HRQOL in patients with CAD despite successful medical and surgical management. Although successful treatment of depression has not been shown to reduce mortality rates in patients with CAD, further study may find that the HRQOL benefits of such treatment are equally valuable.
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Affiliation(s)
- Lesley Stafford
- Department of Psychology, School of Behavioural Science, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
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Artinian NT, Washington OGM, Flack JM, Hockman EM, Jen KLC. Depression, stress, and blood pressure in urban African-American women. ACTA ACUST UNITED AC 2006; 21:68-75. [PMID: 16760688 DOI: 10.1111/j.0889-7204.2006.04787.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
African-American women have disturbingly high rates of hypertension, exceeding those of African-American men and other ethnic groups. Reasons for these disparities are not understood. Depression, more common in women than men, has been linked to endothelial dysfunction, inflammation, metabolic and hematologic abnormalities, and increased sympathetic nervous system activity--all factors associated with cardiovascular disease. A descriptive correlational design was used to test the following hypotheses: 1) African-American women with higher levels of depression will have higher blood pressure (BP) levels, more cardiovascular risk factors, greater stress, and lower social support; and 2) depression will mediate the relationship between stress and BP. A convenience sample of 245 hypertensive African-American women (mean age, 61+/-12.7 years) was recruited through free BP screenings offered in the community. All data were collected during a structured interview and brief physical examination. Pearson r correlation coefficients, analysis of variance, and multiple regression analyses were used to analyze the hypotheses. Women with higher levels of depression had higher diastolic BP and were more likely to smoke, eat fewer fruits and vegetables, and have more stress and less social support. Depression mediated the relationship between stress and diastolic BP. The findings emphasize the importance of assessing both behavioral and psychosocial factors in urban African-American women with hypertension.
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Affiliation(s)
- Nancy T Artinian
- College of Nursing, Wayne State University, Detroit, MI 48202, USA.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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