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Gärde M, Matheson GJ, Varnäs K, Svenningsson P, Hedman-Lagerlöf E, Lundberg J, Farde L, Tiger M. Altered Serotonin 1B Receptor Binding After Escitalopram for Depression Is Correlated With Treatment Effect. Int J Neuropsychopharmacol 2024; 27:pyae021. [PMID: 38695786 PMCID: PMC11119883 DOI: 10.1093/ijnp/pyae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is commonly treated with selective serotonin reuptake inhibitors (SSRIs). SSRIs inhibit the serotonin transporter (5-HTT), but the downstream antidepressant mechanism of action of these drugs is poorly understood. The serotonin 1B (5-HT1B) receptor is functionally linked to 5-HTT and 5-HT1B receptor binding and 5-HT1B receptor mRNA is reduced in the raphe nuclei after SSRI administration in primates and rodents, respectively. The effect of SSRI treatment on 5-HT1B receptor binding in patients with MDD has not been examined previously. This positron emission tomography (PET) study aimed to quantify brain 5-HT1B receptor binding changes in vivo after SSRI treatment for MDD in relation to treatment effect. METHODS Eight unmedicated patients with moderate to severe MDD underwent PET with the 5-HT1B receptor radioligand [11C]AZ10419369 before and after 3 to 4 weeks of treatment with the SSRI escitalopram 10 mg daily. Depression severity was assessed at time of PET and after 6 to 7 weeks of treatment with the Montgomery-Åsberg Depression Rating Scale. RESULTS We observed a significant reduction in [11C]AZ10419369 binding in a dorsal brainstem (DBS) region containing the median and dorsal raphe nuclei after escitalopram treatment (P = .036). Change in DBS [11C]AZ10419369 binding correlated with Montgomery-Åsberg Depression Rating Scale reduction after 3-4 (r = 0.78, P = .021) and 6-7 (r = 0.94, P < .001) weeks' treatment. CONCLUSIONS Our findings align with the previously reported reduction of 5-HT1B receptor binding in the raphe nuclei after SSRI administration and support future studies testing change in DBS 5-HT1B receptor binding as an SSRI treatment response marker.
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Affiliation(s)
- M Gärde
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - G J Matheson
- Department of Psychiatry, Columbia University, New York, USA
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - K Varnäs
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - P Svenningsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - E Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - J Lundberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - L Farde
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - M Tiger
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Kosaski DL, Cole KC, Wright JA, El Melik RM, Kung S, Nicholson WT, Leung JG. Impact of sex on antidepressant discontinuation in groups of similar cytochrome P450 phenotypes. Ment Health Clin 2023; 13:303-310. [PMID: 38058598 PMCID: PMC10696171 DOI: 10.9740/mhc.2023.12.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/25/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction Although there are studies assessing reasons for antidepressant discontinuation, little is known about the impact of sex differences or cytochrome P450 phenotypes. Our objective is to assess discontinuation rates between males and females and whether CYP450 phenotype influences discontinuation. Methods This is a retrospective review of patients previously enrolled in the Right Drug, Right Dose, Right Time: Using Genomic Data to Individualize Treatment database with major depressive disorder. Patients were evaluated for antidepressants trialed between January 1, 2009, and September 30, 2019. Survival analyses with competing risks were used to analyze discontinuation reasons. A Kaplan-Meier estimation method was used to assess the time to discontinuation and discontinuation rates. Analyses were also completed to assess discontinuation between men and women by phenotypic groups. All tests were two-sided, and p-values ≤ .05 were considered statistically significant. Results There were 620 antidepressant discontinuation events discovered from 1015 antidepressant trials included. Overall, the median time to discontinuation for males was 2.6 years and 1.9 years for females (hazard ratio [HR] 0.97 [95% confidence interval (CI): 0.80, 1.19], p = .77). The risk of discontinuation was not different between males and females in any of the phenotype groups, which was consistent in the multivariable analyses. Concomitant use of medications that inhibited or induced antidepressant metabolism increased the overall risk of discontinuation (HR 1.45, 95% CI [1.06, 1.99], p = .020) in a time-dependent analysis. Discussion We did not detect a significant difference in risk of antidepressant discontinuation rates between males and females even when accounting for cytochrome P450 phenotype. Future studies should account for whether medications that inhibit or induce antidepressant metabolism may be a crucial factor in antidepressant discontinuation.
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Affiliation(s)
- Dylan L Kosaski
- Pharmacist, Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
| | - Kristin C Cole
- Statistician, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Jessica A Wright
- Pharmacist, Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
| | - Razan M El Melik
- Pharmacist, Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
| | - Simon Kung
- Psychiatrist, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Wayne T Nicholson
- Physician, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jonathan G Leung
- Pharmacist, Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
- Statistician, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
- Pharmacist, Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
- Pharmacist, Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
- Psychiatrist, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
- Physician, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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Faraj P, Størset E, Hole K, Smith G, Molden E, Dietrichs ES. Pro-arrhythmic effect of escitalopram and citalopram at serum concentrations commonly observed in older patients - a study based on a cohort of 19,742 patients. EBioMedicine 2023; 95:104779. [PMID: 37639937 PMCID: PMC10474154 DOI: 10.1016/j.ebiom.2023.104779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND For a decade, patients have been advised against using high citalopram- and escitalopram-doses due to risk for ventricular arrhythmia and cardiac arrest. Still, these drugs are widely used to treat depression and anxiety especially in older patients. It is unclear why they are cardiotoxic and at what serum concentrations patients are at risk for arrhythmias. Thus, how many patients that are at risk for iatrogenic cardiac arrest is unknown. METHODS We studied the arrhythmogenic effects of citalopram, escitalopram and their metabolites on human cardiomyocytes. Concentrations showing pro-arrhythmic activity were compared with observed drug and metabolite serum concentrations in a cohort of 19,742 patients (age 12-105 years) using escitalopram or citalopram in Norway (2010-2019). As arrhythmia-risk is related to maximum serum concentration, this was simulated for different age-groups from the escitalopram patient material. FINDINGS Therapeutic concentrations of both citalopram and escitalopram but not their metabolites showed pro-arrhythmic changes in the human cardiac action potential. Due to age-dependent reduction of drug clearance, the proportion of patients above threshold for arrhythmia-risk increased with age. 20% of patients >65 years were predicted to reach potentially pro-arrhythmic concentrations, following intake of 10 mg escitalopram. INTERPRETATION All patients that are using escitalopram or citalopram and have genetic disposition for acquired long-QT syndrome, are >65 years, are using additional pro-arrhythmic drugs or have predisposition for arrhythmias, should be monitored with therapeutic drug monitoring (TDM) to avoid exposure to potentially cardiotoxic concentrations. Serum concentrations should be kept below 100 nM, to reduce arrhythmia-risk. FUNDING This study was funded by The Research Council of Norway (project number: 324062).
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Affiliation(s)
- Pari Faraj
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Elisabet Størset
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Kristine Hole
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway; Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway
| | - Godfrey Smith
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway; Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Erik Sveberg Dietrichs
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway; Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway; Institute of Oral Biology, University of Oslo, Oslo, Norway.
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Hart XM, Amann F, Brand J, Eichentopf L, Gründer G. Low Escitalopram Concentrations in Patients with Depression predict Treatment Failure: A Naturalistic Retrospective Study. PHARMACOPSYCHIATRY 2023; 56:73-80. [PMID: 36944330 PMCID: PMC10030201 DOI: 10.1055/a-2039-2829] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Cross sectional therapeutic drug monitoring (TDM) data mining introduces new opportunities for the investigation of medication treatment effects to find optimal therapeutic windows. Medication discontinuation has been proven useful as an objective surrogate marker to assess treatment failure. This study aimed to investigate the treatment effects of escitalopram and pharmacokinetic influences on blood levels using retrospectively assessed data from a TDM database. METHODS Data was collected from 134 patients longitudinally treated with escitalopram for whom TDM was requested to guide drug therapy. Escitalopram metabolism was estimated by the log-transformed dose-corrected concentrations and compared within subpopulations differing in age, gender, renal function, smoking status, body mass index, and comedication. RESULTS Patients with a depressive episode who were treated with escitalopram and discontinued the treatment within the hospital stay showed lower serum concentrations compared to patients who continued escitalopram treatment with a concentration of 15 ng/mL separating both groups. Variability was high between individuals and factors influencing blood levels, including dose, sex, and age. Comedication that inhibits cytochrome P450 (CYP) 2C19 isoenzymes were further found to influence escitalopram pharmacokinetics independent of dose, age or sex. DISCUSSION Medication switch is a valuable objective surrogate marker to assess treatment effects under real-world conditions. Of note, treatment discontinuation is not always a cause of insufficient response but may also be related to other factors such as medication side effects. TDM might not only be useful in addressing these issues but titrating drug concentrations into the currently recommended reference range for escitalopram will also increase response in non-responders and avoid treatment failure in underdosed patients.
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Affiliation(s)
- Xenia M Hart
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Friederike Amann
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jonas Brand
- Laboratory Limbach Analytics GmbH, Heidelberg, Germany
| | - Luzie Eichentopf
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Gerhard Gründer
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Dietrichs ES, Smith GL. Prediction of Ventricular Arrhythmias by QRS/QTc - Ratio in Citalopram or Escitalopram Intoxication. Front Med (Lausanne) 2022; 9:866454. [PMID: 35372426 PMCID: PMC8966227 DOI: 10.3389/fmed.2022.866454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background The U.S. Food and Drug Administration (FDA) has stated that citalopram and escitalopram should not be used at daily doses above 40 mg/20 mg due to risk for development of fatal ventricular arrhythmias like torsade de pointes (TdP). Yet, supratherapeutic serum concentrations of citalopram are common and predicting patients at risk for TdP is of high clinical value. Accordingly, we investigated whether QRS/QTc; developed for predicting TdP in hypothermic patients could be used in citalopram intoxication. Methods A total of 16 publications describing patients suffering from complications due to citalopram or escitalopram treatment, or intoxication with the same substances, were included after a systematic search. The main criterion for inclusion was admission ECG, either with given QRS and QTc values or with attached ECG-files that enabled calculation. Results QRS/QTc rather that QTc alone emerged as a marker of ventricular arrhythmia in the 16 included case reports, with highly significant (p < 0.0005) lower values in patients displaying ventricular arrhythmias. Conclusion Citalopram and escitalopram are extensively used in treatment of depressive disorders, and a large proportion of patients have supratherapeutic serum concentrations. Calculation of QRS/QTc in available case reports show that this novel ECG-marker has potential to predict patients at risk for developing ventricular arrhythmias.
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Affiliation(s)
- Erik Sveberg Dietrichs
- Experimental and Clinical Pharmacology Research Group, Department of Medical Biology, UiT, The Arctic University of Norway, Tromsø, Norway.,Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Godfrey L Smith
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
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Eichentopf L, Hiemke C, Conca A, Engelmann J, Gerlach M, Havemann-Reinecke U, Hefner G, Florio V, Kuzin M, Lieb K, Reis M, Riemer TG, Serretti A, Schoretsanitis G, Zernig G, Gründer G, Hart XM. Systematic review and meta-analysis on the therapeutic reference range for escitalopram: Blood concentrations, clinical effects and serotonin transporter occupancy. Front Psychiatry 2022; 13:972141. [PMID: 36325531 PMCID: PMC9621321 DOI: 10.3389/fpsyt.2022.972141] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION A titration within a certain therapeutic reference range presupposes a relationship between the blood concentration and the therapeutic effect of a drug. However, this has not been systematically investigated for escitalopram. Furthermore, the recommended reference range disagrees with mean steady state concentrations (11-21 ng/ml) that are expected under the approved dose range (10-20 mg/day). This work systematically investigated the relationships between escitalopram dose, blood levels, clinical effects, and serotonin transporter occupancy. METHODS Following our previously published methodology, relevant articles were systematically searched and reviewed for escitalopram. RESULTS Of 1,032 articles screened, a total of 30 studies met the eligibility criteria. The included studies investigated escitalopram blood levels in relationship to clinical effects (9 studies) or moderating factors on escitalopram metabolism (12 studies) or serotonin transporter occupancy (9 studies). Overall, the evidence for an escitalopram concentration/effect relationship is low (level C). CONCLUSION Based on our findings, we propose a target range of 20-40 ng/ml for antidepressant efficacy of escitalopram. In maintenance treatment, therapeutic response is expected, when titrating patients above the lower limit. The lower concentration threshold is strongly supported by findings from neuroimaging studies. The upper limit for escitalopram's reference range rather reflects a therapeutic maximum than a tolerability threshold, since the incidence of side effects in general is low. Concentrations above 40 ng/ml should not necessarily result in dose reductions in case of good clinical efficacy and tolerability. Dose-related escitalopram concentrations in different trials were more than twice the expected concentrations from guideline reports. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=215873], identifier [CRD42020215873].
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Affiliation(s)
- Luzie Eichentopf
- Department of Molecular Neuroimaging, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy, Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany.,Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany
| | - Andreas Conca
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany.,Department of Psychiatry, Central Hospital, Sanitary Agency of South Tyrol, Bolzano, Italy
| | - Jan Engelmann
- Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Manfred Gerlach
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Ursula Havemann-Reinecke
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany.,Department of Psychiatry and Psychosomatics, University of Göttingen, Göttingen, Germany
| | - Gudrun Hefner
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany.,Vitos Clinic for Forensic Psychiatry, Forensic Psychiatry, Eltville, Germany
| | - Vincenzo Florio
- Department of Psychiatry, Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | - Maxim Kuzin
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany.,Clienia Schlössli AG, Psychiatric and Psychotherapeutic Private Clinic, Academic Teaching Hospital of the University of Zurich, Oetwil am See, Switzerland
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Margareta Reis
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Chemistry and Pharmacology, Skåne University Hospital, Lund, Sweden
| | - Thomas G Riemer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Georgios Schoretsanitis
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Behavioral Health Pavilion, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, NY, United States.,Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, United States
| | - Gerald Zernig
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany.,Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria.,Private Practice for Psychotherapy and Court-Certified Witness, Hall in Tirol, Austria
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany.,Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany
| | - Xenia M Hart
- Department of Molecular Neuroimaging, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany.,Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany
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Strawn JR, Poweleit EA, Uppugunduri CRS, Ramsey LB. Pediatric Therapeutic Drug Monitoring for Selective Serotonin Reuptake Inhibitors. Front Pharmacol 2021; 12:749692. [PMID: 34658889 PMCID: PMC8517085 DOI: 10.3389/fphar.2021.749692] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/20/2021] [Indexed: 12/13/2022] Open
Abstract
Therapeutic drug monitoring (TDM) is uncommon in child and adolescent psychiatry, particularly for selective serotonin reuptake inhibitors (SSRIs)—the first-line pharmacologic treatments for depressive and anxiety disorders. However, TDM in children and adolescents offers the opportunity to leverage individual variability of antidepressant pharmacokinetics to shed light on non-response and partial response, understand drug-drug interactions, evaluate adherence, and characterize the impact of genetic and developmental variation in pharmacokinetic genes. This perspective aims to educate clinicians about TDM principles and examines evolving uses of TDM in SSRI-treated youths and their early applications in clinical practice, as well as barriers to TDM in pediatric patients. First, the impact of pharmacokinetic genes on SSRI pharmacokinetics in youths could be used to predict tolerability and response for some SSRIs (e.g., escitalopram). Second, plasma concentrations are significantly influenced by adherence, which may relate to decreased efficacy. Third, pharmacometric analyses reveal interactions with proton pump inhibitors, oral contraceptives, cannabinoids, and SSRIs in youths. Rapid developments in TDM and associated modeling have enhanced the understanding of variation in SSRI pharmacokinetics, although the treatment of anxiety and depressive disorders with SSRIs in youths often remains a trial-and-error process.
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Affiliation(s)
- Jeffrey R Strawn
- Anxiety Disorders Research Program, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, United States.,Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of Child and Adolescent Psychiatry, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Ethan A Poweleit
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of Research in Patient Services, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Chakradhara Rao S Uppugunduri
- CANSEARCH Research Platform in Pediatric Oncology and Hematology, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
| | - Laura B Ramsey
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of Research in Patient Services, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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8
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de Sousa CEM, Bedor NCTC, Sousa GD, de Oliveira GHO, Leal LB, Bedor DCG, de Castro WV, de Santana DP. Selective LC-MS/MS determination of citalopram enantiomers and application to a pharmacokinetic evaluation of generic and reference formulations. Biomed Chromatogr 2021; 36:e5237. [PMID: 34469601 DOI: 10.1002/bmc.5237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/04/2021] [Accepted: 08/26/2021] [Indexed: 11/07/2022]
Abstract
Two methods using LC-MS/MS were validated to quantify citalopram (CTP) racemate [(R/S)-CTP] and the enantiomers (R)-CTP and (S)-CTP in human plasma, respectively. Paroxetine hydrochloride was used as the internal standard, and samples were extracted by protein precipitation with acetonitrile. The non-enantioselective method was conducted using a C18 column, and the mobile phase consisted of water for solvent A and acetonitrile for solvent B, both with 0.1% formic acid. For the chiral method, an analytical column Lux Cellulose-1 was used. Mobile phase A was composed of water with 0.025% of formic acid and 0.05% of diethylamine, and mobile phase B consisted of acetonitrile:2-propanol (95:5, v/v). No significant matrix effects were observed at the retention times of analytes and internal standard. The mean recovery was 89%, and the assays were linear in the concentration range of 1-50 and 5-30 ng/mL for the non-enantioselective and enantioselective methods, respectively. The intra- and inter-day precisions of both methods were less than 12.30%, and the accuracies were less than 12.13%. The validated methods were successfully applied to a pharmacokinetic study in which 20-mg CTP tablets were administered to healthy volunteers, and their plasma levels were monitored over time in a bioequivalence study. HIGHLIGHTS: Simple and rapid LC-MS/MS method for the quantification of citalopram and its enantiomers in human plasma. Both methods were demonstrated to be selective, reliable, and sensitive. Both methods have sufficient sensitivity to quantify the steady state through concentrations already reported for citalopram and escitalopram. Validated method presented in this study can be suitably applied to pharmacokinetic studies involving citalopram and escitalopram. Bland-Altman analysis suggested that non-enantioselective and enantioselective methods can be applied in pharmacokinetic studies.
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Affiliation(s)
| | | | - Giovana Damasceno Sousa
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Brazil.,Center for Biological and Health Sciences, Federal University of Western Bahia, Barreiras, Bahia, Brazil
| | | | - Leila Bastos Leal
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Brazil
| | | | - Whocely Victor de Castro
- Graduate Program in Pharmaceutical Sciences, Federal University of São João del-Rei, Divinópolis, MG, Brazil
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Abstract
BACKGROUND Tobacco smoking rates in depressive patients are higher compared with the general population. Smoking was demonstrated to accelerate the metabolism of different drugs metabolized by CYP1A2, but possibly also by CYP2C19 and CYP3A4. The principle aim of the present investigation from 2015 to 2018 was to determine the differences in the pharmacokinetics of escitalopram between smokers and nonsmokers. METHODS A group of nonsmokers (n = 88) was compared with smokers (n = 36), both receiving escitalopram, using the Mann-Whitney U test. Linear regression analysis was used to account for the impact of escitalopram dose, age, and sex in addition to smoking on the steady-state serum concentration of escitalopram. RESULTS Smokers received by mean 17.6% higher doses of escitalopram (P = 0.026) but showed 31.9% lower serum concentrations (P = 0.031). To control for confounders, linear regression analysis showed that dose (P < 0.001), sex (P = 0.03), and smoking tobacco (P = 0.027) did significantly influence serum concentrations of escitalopram with higher levels in women and nonsmokers. CONCLUSIONS Notwithstanding higher daily doses, smokers had significantly lower serum concentrations of escitalopram. In concordance with previous results, besides CYP1A2, a possible induction of CYP2C19 and CYP3A4 by tobacco smoke, resulting in lower serum concentrations of escitalopram in smokers than in nonsmokers, is suggested. Therefore, to provide personalized therapy, clinicians should consider smoking status and inform patients on the interactions of smoking and escitalopram metabolism.
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Poweleit EA, Aldrich SL, Martin LJ, Hahn D, Strawn JR, Ramsey LB. Pharmacogenetics of Sertraline Tolerability and Response in Pediatric Anxiety and Depressive Disorders. J Child Adolesc Psychopharmacol 2019; 29:348-361. [PMID: 31066578 DOI: 10.1089/cap.2019.0017] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To determine whether genetic variants in a pharmacokinetic gene (the number of CYP2C19 reduced function alleles [RFAs]), and in pharmacodynamic genes (HTR2A, SLC6A4, and GRIK4) influence sertraline tolerability and response in a cohort of pediatric patients with anxiety and depressive disorders. Methods: A retrospective analysis was performed using the electronic medical record data of 352 patients <19 years of age being treated for anxiety and/or depressive disorders with sertraline and who underwent routine clinical CYP2C19 genotyping. Additional genotyping and analysis of variants in HTR2A, SLC6A4, and GRIK4 were conducted for 249 patients. Multivariate regression models testing for associations with CYP2C19 were adjusted for concomitant use of interacting medications. Combinatorial classification and regression tree (CART) analyses containing all pharmacokinetic and pharmacodynamic genes and clinical factors were performed. Results: The maximum sertraline dose during the initial titration period of sertraline was inversely associated with the number of CYP2C19 RFAs and sertraline dose at 60 (p = 0.025) and 90 days (p = 0.025). HTR2A rs6313 was associated with sertraline dose (p = 0.011) and time to the average maximum sertraline dose (p = 0.039). Regarding efficacy, the number of CYP2C19 RFAs was not associated with the sertraline dose at the time of response (p = 0.22), whereas for the pharmacodynamic genes, only HTR2A rs6313 was associated with response dose (p = 0.022). An association was observed between predicted expression levels of SLC6A4 and the duration on sertraline (p = 0.025). Combinatorial CART and multivariate regression analyses implicated that pharmacodynamic genes and clinical factors influence the maximum sertraline dose and response dose. The total number of side effects was not associated with any of the variants tested. Conclusion: Both pharmacokinetic and pharmacodynamic factors, in addition to clinical and demographic components, influence sertraline dose, response, and tolerability, thereby necessitating further research to assess for the validity of these pharmacogenetic associations in children and adolescents.
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Affiliation(s)
- Ethan A Poweleit
- 1 Division of Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stacey L Aldrich
- 2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lisa J Martin
- 2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,3 Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David Hahn
- 4 Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeffrey R Strawn
- 5 Anxiety Disorders Research Program, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio.,6 Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Laura B Ramsey
- 1 Division of Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,4 Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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11
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Analysis of smoking behavior on the pharmacokinetics of antidepressants and antipsychotics: evidence for the role of alternative pathways apart from CYP1A2. Int Clin Psychopharmacol 2019; 34:93-100. [PMID: 30557209 DOI: 10.1097/yic.0000000000000250] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Smoking is common among psychiatric patients and has been shown to accelerate the metabolism of different drugs. We aimed to determine the effect of smoking on the serum concentrations of psychopharmacological drugs in a naturalistic clinical setting. Dose-corrected, steady-state serum concentrations of individual patients were analyzed retrospectively by linear regression including age, sex, and smoking for amitriptyline (n=503), doxepin (n=198), mirtazapine (n=572), venlafaxine (n=534), clozapine (n=106), quetiapine (n=182), and risperidone (n=136). Serum levels of amitriptyline (P=0.038), clozapine (P=0.02), and mirtazapine (P=0.002) were significantly lower in smokers compared with nonsmokers after correction for age and sex. In addition, the ratios of nortriptyline/amitriptyline (P=0.001) and nordoxepin/doxepin (P=0.014) were significantly higher in smokers compared with nonsmokers. Smoking may not only induce CYP1A2, but may possibly also affect CYP2C19. Furthermore, CYP3A4, UGT1A3, and UGT1A4 might be induced by tobacco smoke. Hence, a different dosing strategy is required among smoking and nonsmoking patients. Nevertheless, the clinical relevance of the results remained unclear.
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12
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Aldrich SL, Poweleit EA, Prows CA, Martin LJ, Strawn JR, Ramsey LB. Influence of CYP2C19 Metabolizer Status on Escitalopram/Citalopram Tolerability and Response in Youth With Anxiety and Depressive Disorders. Front Pharmacol 2019; 10:99. [PMID: 30837874 PMCID: PMC6389830 DOI: 10.3389/fphar.2019.00099] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/24/2019] [Indexed: 01/04/2023] Open
Abstract
In pediatric patients, the selective serotonin reuptake inhibitors (SSRIs) escitalopram and citalopram (es/citalopram) are commonly prescribed for anxiety and depressive disorders. However, pharmacogenetic studies examining CYP2C19 metabolizer status and es/citalopram treatment outcomes have largely focused on adults. We report a retrospective study of electronic medical record data from 263 youth < 19 years of age with anxiety and/or depressive disorders prescribed escitalopram or citalopram who underwent routine clinical CYP2C19 genotyping. Slower CYP2C19 metabolizers experienced more untoward effects than faster metabolizers (p = 0.015), including activation symptoms (p = 0.029) and had more rapid weight gain (p = 0.018). A larger proportion of slower metabolizers discontinued treatment with es/citalopram than normal metabolizers (p = 0.007). Meanwhile, faster metabolizers responded more quickly to es/citalopram (p = 0.005) and trended toward less time spent in subsequent hospitalizations (p = 0.06). These results highlight a disparity in treatment outcomes with es/citalopram treatment in youth with anxiety and/or depressive disorders when standardized dosing strategies were used without consideration of CYP2C19 metabolizer status. Larger, prospective trials are warranted to assess whether tailored dosing of es/citalopram based on CYP2C19 metabolizer status improves treatment outcomes in this patient population.
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Affiliation(s)
- Stacey L. Aldrich
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Ethan A. Poweleit
- Division of Research in Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Cynthia A. Prows
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Division of Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Lisa J. Martin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Jeffrey R. Strawn
- Anxiety Disorders Research Program, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, United States
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Laura B. Ramsey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Research in Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
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13
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ElKady EF, Abo Elwafa AA, Farouk F. Optimized bio-analytical methods development and comparative pharmacokinetic studies of four antidepressants in Egyptian population based on gender difference. J Chromatogr B Analyt Technol Biomed Life Sci 2018; 1102-1103:135-142. [PMID: 30388703 DOI: 10.1016/j.jchromb.2018.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/02/2018] [Accepted: 10/18/2018] [Indexed: 02/07/2023]
Abstract
The pharmacokinetics (PK) and pharmacodynamics of many oral antidepressants (OADs) vary substantially among different genders and ethnicities. Likewise is their therapeutic effectiveness, time to response and the incidence of adverse drug events. The aim of this study is to compare the PK of four OADs (desvenlafaxine; DSV, venlafaxine; VLX, escitalopram; ESP, and agomelatine; AGT) among Egyptian males and females. In this study, LC-MS/MS methods were developed and validated for determining the four OADs in human plasma. Samples were prepared by liquid-liquid extraction. Chromatographic separation was performed on reversed-phase C18 columns followed by positive-ion electrospray ionization and MS/MS detection. The assays were applied for the assessment of PK parameters in human volunteers (n = 95). The developed methods were linear, accurate, and precise for the determination of DSV, VLX, ESP and AGT with extraction recovery of 90 ± 2.0, 98 ± 1.0, 90 ± 1.3 and 87 ± 4.3%, respectively. OADs levels were successfully measured in subjects' plasma and PK parameters were calculated. A prevalent inter-individual variation in PK of the studied OAD was observed. The PK profile of DSV, VLX or ESP did not vary significantly between male and female subjects (p = 0.07-0.98; confidence level (CL) = 95) while the PK of AGT exhibited a significant gender-based variation in both the Cmax and the AUC∞ (p = 0.047 and 0.0015; CL = 95). Our results highlight the significance of therapeutic drug monitoring of OADs. Further, it indicates the dose adjustment based on gender difference may not be relevant for DSV, VLX and ESP while it may be considered for AGT.
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Affiliation(s)
- Ehab F ElKady
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
| | - Ahmed A Abo Elwafa
- Pharmaceutics and Industrial Pharmacy Department, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
| | - Faten Farouk
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Ahram Canadian University, Giza 12566, Egypt.
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14
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Canbolat F, Tasdemir Erinç DM, Evrensel A, Aydın A, Tarhan KN. Quantitation of escitalopram and its metabolites by liquid chromatography-tandem mass spectrometry in psychiatric patients: New metabolic ratio establishment. Basic Clin Pharmacol Toxicol 2018; 124:285-297. [PMID: 30220109 DOI: 10.1111/bcpt.13133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 09/10/2018] [Indexed: 02/06/2023]
Abstract
Therapeutic drug monitoring (TDM) is used to determine the concentration of drug in plasma/serum to adjust the dose of the therapeutic drug. Selective and sensitive analytical methods are used to determine drug and metabolite levels for the successful application of TDM. The aim of the study was to develop and validate using LC-MS/MS to analyse quantitative assay of escitalopram (S-CT) and metabolites in human plasma samples. In order to provide a convenient and safe treatment dose, it was aimed to determine the levels of S-CT and its metabolites in the patients' plasma. A new method with short sample preparation and analysis time was developed and validated using LC-MS/MS to analyse quantitative assay of S-CT and its metabolites in plasma. Also, plasma samples of 30 patients using 20 mg S-CT between the ages of 18 and 65 years were analysed by the validated method. The mean values of S-CT, demethyl escitalopram and didemethyl escitalopram in plasma of patients were 27.59, 85.52 and 44.30 ng/mL, respectively. At the end of the analysis, the metabolic ratio of S-CT and metabolites was calculated. It is considered that the method for the quantitative analysis of S-CT and its metabolites in human plasma samples may contribute to the literature on account of its sensitive and easy application. Additionally, the use of our data by physicians will contribute to the effective drug treatment for their patients who take S-CT.
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Affiliation(s)
- Fadime Canbolat
- Clinical Pharmacogenetic Laboratory, NP Brain Hospital, Üsküdar University, Istanbul, Turkey
| | | | | | - Ahmet Aydın
- Department of Toxicology, Faculty of Pharmacy, Yeditepe University, Istanbul, Turkey
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15
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Interindividual and Intraindividual Variation of Methylphenidate Concentrations in Serum and Saliva of Patients With Attention-Deficit/Hyperactivity Disorder. Ther Drug Monit 2018; 40:435-442. [DOI: 10.1097/ftd.0000000000000520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Oliveira P, Ribeiro J, Donato H, Madeira N. Smoking and antidepressants pharmacokinetics: a systematic review. Ann Gen Psychiatry 2017; 16:17. [PMID: 28286537 PMCID: PMC5340025 DOI: 10.1186/s12991-017-0140-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/24/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Despite an increasingly recognized relationship between depression and smoking, little is known about how smoking influences antidepressant response and treatment outcomes. The aim of this study was to systematically review the evidence of the impact of smoking on new-generation antidepressants with an emphasis on the pharmacokinetic perspective. METHODS We present a systematic review of clinical trials comparing the serum levels of new-generation antidepressants in smokers and nonsmokers. Data were obtained from MEDLINE/PubMed, Embase, and other sources. Risk of bias was assessed for selection, performance, detection, attrition, and reporting of individual studies. RESULTS Twenty-one studies met inclusion criteria; seven involved fluvoxamine, two evaluated fluoxetine, sertraline, venlafaxine, duloxetine or mirtazapine, and escitalopram, citalopram, trazodone and bupropion were the subject of a single study. No trials were found involving other common antidepressants such as paroxetine or agomelatine. Serum levels of fluvoxamine, duloxetine, mirtazapine and trazodone were significantly higher in nonsmokers compared with smokers. CONCLUSIONS There is evidence showing a reduction in the concentration of serum levels of fluvoxamine, duloxetine, mirtazapine and trazodone in smoking patients as compared to nonsmokers. The evidence regarding other commonly used antidepressants is scarce. Nonetheless, smoking status should be considered when choosing an antidepressant treatment, given the risk of pharmacokinetic interactions.
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Affiliation(s)
- Pedro Oliveira
- Psychiatry Department, Coimbra Hospital University Centre, Praceta Mota Pinto, 3000-075 Coimbra, Portugal
| | - Joana Ribeiro
- Psychiatry Department, Coimbra Hospital University Centre, Praceta Mota Pinto, 3000-075 Coimbra, Portugal
| | - Helena Donato
- Documentation Department, Coimbra Hospital University Centre, Coimbra, Portugal
| | - Nuno Madeira
- Psychiatry Department, Coimbra Hospital University Centre, Praceta Mota Pinto, 3000-075 Coimbra, Portugal
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17
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Berry-Bibee EN, Kim MJ, Simmons KB, Tepper NK, Riley HEM, Pagano HP, Curtis KM. Drug interactions between hormonal contraceptives and psychotropic drugs: a systematic review. Contraception 2016; 94:650-667. [PMID: 27444984 PMCID: PMC11283812 DOI: 10.1016/j.contraception.2016.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine whether the co-administration of hormonal contraceptives (HC) and psychotropic drugs commonly used to treat anxiety and/or depression results in safety or efficacy concerns for either drug. METHODS We searched PubMed and Cochrane libraries for clinical or pharmacokinetic (PK) studies that examined co-administration of any HC with psychotropic drugs [selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), oral benzodiazepines, bupropion, mirtazapine, trazadone, buspirone, hydroxyzine, monoamine oxidase inhibitors (MAOIs), or atypical antipsychotics] in reproductive aged women. RESULTS Of 555 articles identified, 22 articles (18 studies) met inclusion criteria. We identified 5 studies on SSRIs, four on TCAs, one on bupropion, three on atypical antipsychotics and five on oral benzodiazepines. No articles met inclusion criteria for SNRIs, mirtazapine, trazadone, buspirone, hydroxyzine or MAOIs. Overall, clinical studies did not demonstrate differences in unintended pregnancy rates when HCs were administered with and without psychotropic drugs or in psychotropic drug treatment outcomes when psychotropic drugs were administered with and without HCs. PK studies did not demonstrate changes in drug exposure related to contraceptive safety, contraceptive effectiveness or psychotropic drug effectiveness for most classes of psychotropic drugs. However, limited PK data raise concern for HCs increasing systemic exposure of amitriptyline and imipramine (both TCAs), theoretically posing safety concerns. CONCLUSION Limited quality and quantity evidence on use of psychotropic drugs and HCs suggests low concern for clinically significant interactions, though no data exist specifically for non-oral formulations of HC. Given the high frequency of use for both HCs and psychotropic drugs among reproductive-age women in the US, this review highlights a need for further research in this area.
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Affiliation(s)
- Erin N Berry-Bibee
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Myong-Jin Kim
- Office of Clinical Pharmacology, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Katharine B Simmons
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Naomi K Tepper
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Halley E M Riley
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - H Pamela Pagano
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kathryn M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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18
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Gingnell M, Frick A, Engman J, Alaie I, Björkstrand J, Faria V, Carlbring P, Andersson G, Reis M, Larsson EM, Wahlstedt K, Fredrikson M, Furmark T. Combining escitalopram and cognitive-behavioural therapy for social anxiety disorder: randomised controlled fMRI trial. Br J Psychiatry 2016; 209:229-35. [PMID: 27340112 DOI: 10.1192/bjp.bp.115.175794] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 02/15/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioural therapy (CBT) are often used concomitantly to treat social anxiety disorder (SAD), but few studies have examined the effect of this combination. AIMS To evaluate whether adding escitalopram to internet-delivered CBT (ICBT) improves clinical outcome and alters brain reactivity and connectivity in SAD. METHOD Double-blind, randomised, placebo-controlled neuroimaging trial of ICBT combined either with escitalopram (n = 24) or placebo (n = 24), including a 15-month clinical follow-up (trial registration: ISRCTN24929928). RESULTS Escitalopram+ICBT, relative to placebo+ICBT, resulted in significantly more clinical responders, larger reductions in anticipatory speech state anxiety at post-treatment and larger reductions in social anxiety symptom severity at 15-month follow-up and at a trend-level (P = 0.09) at post-treatment. Right amygdala reactivity to emotional faces also decreased more in the escitalopram+ICBT combination relative to placebo+ICBT, and in treatment responders relative to non-responders. CONCLUSIONS Adding escitalopram improves the outcome of ICBT for SAD and decreased amygdala reactivity is important for anxiolytic treatment response.
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Affiliation(s)
- Malin Gingnell
- Malin Gingnell, MD, PhD, Andreas Frick, PhD, Jonas Engman, MSc, Iman Alaie, MSc, Johannes Björkstrand, MSc, Department of Psychology, Uppsala University, Uppsala, Sweden; Vanda Faria, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden, and Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Per Carlbring, PhD, Department of Psychology, Stockholm University, Stockholm, Sweden; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Margareta Reis, PhD, Division of Drug Research/Clinical Pharmacology, Department of Health Sciences, Linköping University, Linköping, Sweden; Elna-Marie Larsson, MD, PhD, Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden; Kurt Wahlstedt, MD, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden; Mats Fredrikson, DMSc, PhD, Department of Psychology, Uppsala University, Uppsala, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Tomas Furmark, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Andreas Frick
- Malin Gingnell, MD, PhD, Andreas Frick, PhD, Jonas Engman, MSc, Iman Alaie, MSc, Johannes Björkstrand, MSc, Department of Psychology, Uppsala University, Uppsala, Sweden; Vanda Faria, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden, and Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Per Carlbring, PhD, Department of Psychology, Stockholm University, Stockholm, Sweden; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Margareta Reis, PhD, Division of Drug Research/Clinical Pharmacology, Department of Health Sciences, Linköping University, Linköping, Sweden; Elna-Marie Larsson, MD, PhD, Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden; Kurt Wahlstedt, MD, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden; Mats Fredrikson, DMSc, PhD, Department of Psychology, Uppsala University, Uppsala, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Tomas Furmark, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Jonas Engman
- Malin Gingnell, MD, PhD, Andreas Frick, PhD, Jonas Engman, MSc, Iman Alaie, MSc, Johannes Björkstrand, MSc, Department of Psychology, Uppsala University, Uppsala, Sweden; Vanda Faria, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden, and Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Per Carlbring, PhD, Department of Psychology, Stockholm University, Stockholm, Sweden; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Margareta Reis, PhD, Division of Drug Research/Clinical Pharmacology, Department of Health Sciences, Linköping University, Linköping, Sweden; Elna-Marie Larsson, MD, PhD, Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden; Kurt Wahlstedt, MD, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden; Mats Fredrikson, DMSc, PhD, Department of Psychology, Uppsala University, Uppsala, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Tomas Furmark, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Iman Alaie
- Malin Gingnell, MD, PhD, Andreas Frick, PhD, Jonas Engman, MSc, Iman Alaie, MSc, Johannes Björkstrand, MSc, Department of Psychology, Uppsala University, Uppsala, Sweden; Vanda Faria, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden, and Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Per Carlbring, PhD, Department of Psychology, Stockholm University, Stockholm, Sweden; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Margareta Reis, PhD, Division of Drug Research/Clinical Pharmacology, Department of Health Sciences, Linköping University, Linköping, Sweden; Elna-Marie Larsson, MD, PhD, Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden; Kurt Wahlstedt, MD, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden; Mats Fredrikson, DMSc, PhD, Department of Psychology, Uppsala University, Uppsala, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Tomas Furmark, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Johannes Björkstrand
- Malin Gingnell, MD, PhD, Andreas Frick, PhD, Jonas Engman, MSc, Iman Alaie, MSc, Johannes Björkstrand, MSc, Department of Psychology, Uppsala University, Uppsala, Sweden; Vanda Faria, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden, and Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Per Carlbring, PhD, Department of Psychology, Stockholm University, Stockholm, Sweden; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Margareta Reis, PhD, Division of Drug Research/Clinical Pharmacology, Department of Health Sciences, Linköping University, Linköping, Sweden; Elna-Marie Larsson, MD, PhD, Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden; Kurt Wahlstedt, MD, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden; Mats Fredrikson, DMSc, PhD, Department of Psychology, Uppsala University, Uppsala, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Tomas Furmark, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Vanda Faria
- Malin Gingnell, MD, PhD, Andreas Frick, PhD, Jonas Engman, MSc, Iman Alaie, MSc, Johannes Björkstrand, MSc, Department of Psychology, Uppsala University, Uppsala, Sweden; Vanda Faria, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden, and Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Per Carlbring, PhD, Department of Psychology, Stockholm University, Stockholm, Sweden; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Margareta Reis, PhD, Division of Drug Research/Clinical Pharmacology, Department of Health Sciences, Linköping University, Linköping, Sweden; Elna-Marie Larsson, MD, PhD, Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden; Kurt Wahlstedt, MD, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden; Mats Fredrikson, DMSc, PhD, Department of Psychology, Uppsala University, Uppsala, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Tomas Furmark, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Per Carlbring
- Malin Gingnell, MD, PhD, Andreas Frick, PhD, Jonas Engman, MSc, Iman Alaie, MSc, Johannes Björkstrand, MSc, Department of Psychology, Uppsala University, Uppsala, Sweden; Vanda Faria, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden, and Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Per Carlbring, PhD, Department of Psychology, Stockholm University, Stockholm, Sweden; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Margareta Reis, PhD, Division of Drug Research/Clinical Pharmacology, Department of Health Sciences, Linköping University, Linköping, Sweden; Elna-Marie Larsson, MD, PhD, Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden; Kurt Wahlstedt, MD, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden; Mats Fredrikson, DMSc, PhD, Department of Psychology, Uppsala University, Uppsala, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Tomas Furmark, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Gerhard Andersson
- Malin Gingnell, MD, PhD, Andreas Frick, PhD, Jonas Engman, MSc, Iman Alaie, MSc, Johannes Björkstrand, MSc, Department of Psychology, Uppsala University, Uppsala, Sweden; Vanda Faria, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden, and Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Per Carlbring, PhD, Department of Psychology, Stockholm University, Stockholm, Sweden; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Margareta Reis, PhD, Division of Drug Research/Clinical Pharmacology, Department of Health Sciences, Linköping University, Linköping, Sweden; Elna-Marie Larsson, MD, PhD, Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden; Kurt Wahlstedt, MD, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden; Mats Fredrikson, DMSc, PhD, Department of Psychology, Uppsala University, Uppsala, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Tomas Furmark, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Margareta Reis
- Malin Gingnell, MD, PhD, Andreas Frick, PhD, Jonas Engman, MSc, Iman Alaie, MSc, Johannes Björkstrand, MSc, Department of Psychology, Uppsala University, Uppsala, Sweden; Vanda Faria, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden, and Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Per Carlbring, PhD, Department of Psychology, Stockholm University, Stockholm, Sweden; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Margareta Reis, PhD, Division of Drug Research/Clinical Pharmacology, Department of Health Sciences, Linköping University, Linköping, Sweden; Elna-Marie Larsson, MD, PhD, Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden; Kurt Wahlstedt, MD, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden; Mats Fredrikson, DMSc, PhD, Department of Psychology, Uppsala University, Uppsala, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Tomas Furmark, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Malin Gingnell, MD, PhD, Andreas Frick, PhD, Jonas Engman, MSc, Iman Alaie, MSc, Johannes Björkstrand, MSc, Department of Psychology, Uppsala University, Uppsala, Sweden; Vanda Faria, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden, and Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Per Carlbring, PhD, Department of Psychology, Stockholm University, Stockholm, Sweden; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Margareta Reis, PhD, Division of Drug Research/Clinical Pharmacology, Department of Health Sciences, Linköping University, Linköping, Sweden; Elna-Marie Larsson, MD, PhD, Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden; Kurt Wahlstedt, MD, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden; Mats Fredrikson, DMSc, PhD, Department of Psychology, Uppsala University, Uppsala, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Tomas Furmark, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Kurt Wahlstedt
- Malin Gingnell, MD, PhD, Andreas Frick, PhD, Jonas Engman, MSc, Iman Alaie, MSc, Johannes Björkstrand, MSc, Department of Psychology, Uppsala University, Uppsala, Sweden; Vanda Faria, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden, and Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Per Carlbring, PhD, Department of Psychology, Stockholm University, Stockholm, Sweden; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Margareta Reis, PhD, Division of Drug Research/Clinical Pharmacology, Department of Health Sciences, Linköping University, Linköping, Sweden; Elna-Marie Larsson, MD, PhD, Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden; Kurt Wahlstedt, MD, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden; Mats Fredrikson, DMSc, PhD, Department of Psychology, Uppsala University, Uppsala, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Tomas Furmark, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Mats Fredrikson
- Malin Gingnell, MD, PhD, Andreas Frick, PhD, Jonas Engman, MSc, Iman Alaie, MSc, Johannes Björkstrand, MSc, Department of Psychology, Uppsala University, Uppsala, Sweden; Vanda Faria, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden, and Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Per Carlbring, PhD, Department of Psychology, Stockholm University, Stockholm, Sweden; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Margareta Reis, PhD, Division of Drug Research/Clinical Pharmacology, Department of Health Sciences, Linköping University, Linköping, Sweden; Elna-Marie Larsson, MD, PhD, Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden; Kurt Wahlstedt, MD, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden; Mats Fredrikson, DMSc, PhD, Department of Psychology, Uppsala University, Uppsala, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Tomas Furmark, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Tomas Furmark
- Malin Gingnell, MD, PhD, Andreas Frick, PhD, Jonas Engman, MSc, Iman Alaie, MSc, Johannes Björkstrand, MSc, Department of Psychology, Uppsala University, Uppsala, Sweden; Vanda Faria, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden, and Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Per Carlbring, PhD, Department of Psychology, Stockholm University, Stockholm, Sweden; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Margareta Reis, PhD, Division of Drug Research/Clinical Pharmacology, Department of Health Sciences, Linköping University, Linköping, Sweden; Elna-Marie Larsson, MD, PhD, Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden; Kurt Wahlstedt, MD, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden; Mats Fredrikson, DMSc, PhD, Department of Psychology, Uppsala University, Uppsala, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Tomas Furmark, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden
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Park H, Kim EJ, Han J, Han J, Kang D. Effects of analgesics and antidepressants on TREK-2 and TRESK currents. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2016; 20:379-85. [PMID: 27382354 PMCID: PMC4930906 DOI: 10.4196/kjpp.2016.20.4.379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 01/18/2023]
Abstract
TWIK-related K+ channel-2 (TREK-2) and TWIK-related spinal cord K+ (TRESK) channel are members of two-pore domain K+ channel family. They are well expressed and help to set the resting membrane potential in sensory neurons. Modulation of TREK-2 and TRESK channels are involved in the pathogenesis of pain, and specifi c activators of TREK-2 and TRESK may be benefi cial for the treatment of pain symptoms. However, the effect of commonly used analgesics on TREK-2 and TRESK channels are not known. Here, we investigated the effect of analgesics on TREK-2 and TRESK channels. The effects of analgesics were examined in HEK cells transfected with TREK-2 or TRESK. Amitriptyline, citalopram, escitalopram, and fluoxetine significantly inhibited TREK-2 and TRESK currents in HEK cells (p<0.05, n=10). Acetaminophen, ibuprofen, nabumetone, and bupropion inhibited TRESK, but had no effect on TREK-2. These results show that all analgesics tested in this study inhibit TRESK activity. Further study is needed to identify the mechanisms by which the analgesics modulate TREK-2 and TRESK differently.
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Affiliation(s)
- Hyun Park
- Department of Neurosurgery, Gyeongsang National University Hospital, College of Medicine and Institute of Health Sciences, Gyeongsang National University, Jinju 52727, Korea
| | - Eun-Jin Kim
- Department of Physiology, College of Medicine and Institute of Health Sciences, Gyeongsang National University, Jinju 52727, Korea
| | - Jaehee Han
- Department of Physiology, College of Medicine and Institute of Health Sciences, Gyeongsang National University, Jinju 52727, Korea
| | - Jongwoo Han
- Department of Neurosurgery, Gyeongsang National University Hospital, College of Medicine and Institute of Health Sciences, Gyeongsang National University, Jinju 52727, Korea
| | - Dawon Kang
- Department of Physiology, College of Medicine and Institute of Health Sciences, Gyeongsang National University, Jinju 52727, Korea
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Abstract
BACKGROUND There is a high coincidence between obesity and psychiatric disorders including depression. Depressive disorders are commonly treated with antidepressants, including the selective serotonin reuptake inhibitor Lexapro (escitalopram). Although candidates for elective Roux-en-Y gastric bypass (RYGB) surgery may be treated with escitalopram, drug dosing strategies are typically not adjusted postoperatively. Therefore, studies are needed to better characterize escitalopram drug concentrations in a postsurgical setting. METHODS Turbulent flow-liquid chromatographic-tandem mass spectrometric methods were used to quantify escitalopram concentrations in serum in study participants approved for RYGB. Blood was collected from study subjects 2 weeks before surgery, and 2 and 6 weeks postoperatively, to assess the impact of RYGB on systemic drug concentrations. RESULTS Twelve samples from 4 study participants were collected and analyzed for serum escitalopram concentrations. Two weeks post-RYGB, although there were minimal changes in each participant's body mass index (<5%), drug concentrations were 33% (4%-71%) decreased as compared with presurgical serum concentrations. There were further decreases in drug concentrations 6 weeks postsurgery. All clinical laboratory values were within normal reference intervals. CONCLUSIONS RYGB significantly alters the gastrointestinal tract and impacts escitalopram drug concentrations, even shortly after surgery.
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Hefner G, Laib AK, Sigurdsson H, Hohner M, Hiemke C. The value of drug and metabolite concentration in blood as a biomarker of psychopharmacological therapy. Int Rev Psychiatry 2013; 25:494-508. [PMID: 24151798 DOI: 10.3109/09540261.2013.836475] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Desirable and undesirable effects of a drug are related to its concentration at various sites of actions. For many psychotropic drugs, it has been shown that drug concentration in brain correlates with concentration in blood. The latter is also an available estimate of clearance and bioavailability. Its monitoring enables identification of multiple factors that have an impact on clinical outcomes, especially uncertain compliance and pharmacokinetic peculiarities. For this review we analysed for antidepressants if drug concentration in blood can be used as biomarker for psychopharmacological treatment. Systematic review of the literature revealed for new and old antidepressant drugs that drug and metabolite concentrations in blood are measures of the pharmacokinetic phenotype and related differentially to occupancy of primary target structures, therapeutic effects and unwanted anticholinergic, cardiac and other side effects. Drug concentration in blood can therefore be used as biomarker in clinical practice to guide psychopharmacological treatment with established antidepressant drugs. Monitoring of drug concentration is suitable to improve efficacy and safety of the pharmacotherapy, especially in elderly patients who require complex pharmacological therapies.
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Affiliation(s)
- Gudrun Hefner
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz , Germany
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Effect of a single dose of escitalopram on serotonin concentration in the non-human and human primate brain. Int J Neuropsychopharmacol 2013; 16:1577-86. [PMID: 23351590 DOI: 10.1017/s1461145712001617] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed for treatment of psychiatric disorders. The exact mechanism underlying the clinical effects of SSRIs remains unclear, although increased synaptic serotonin concentrations have been hypothesized to be an initial step. [¹¹C]AZ10419369 is a novel 5-HT(1B) receptor selective radioligand, which is sensitive to changes in endogenous serotonin concentrations. To assess whether a single dose of the SSRI escitalopram affects endogenous serotonin concentrations in serotonergic projection areas and in the raphe nuclei (RN), three cynomolgus monkeys and nine human subjects underwent PET examinations with [¹¹C]AZ10419369 at baseline conditions and after escitalopram administration. In monkeys, the binding potential (BP(ND)) was significantly lower post dose compared to baseline in dorsolateral prefrontal cortex, occipital cortex, thalamus, midbrain and RN (p < 0.05). In humans, the BP(ND) tended to decrease in RN post dose (p = 0.08). In all serotonergic projection areas, the BP(ND) was conversely higher post dose compared to baseline. The increase was significant in a combined region of all projection areas (p = 0.01) and in occipital and temporal cortex (p < 0.05). SSRIs are generally assumed to elevate endogenous serotonin concentrations in projection areas, evoking the antidepressant effect. In the present study, a single, clinically relevant, dose of escitalopram was found to decrease serotonin concentrations in serotonergic projection areas in humans. Hypothetically, desensitization of inhibitory serotonergic autoreceptors will cause the serotonin concentration in projection areas to increase over time with chronic administration. Thus, the findings in the present study might aid in understanding the mechanism of SSRIs' delayed onset of clinical effect.
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Abstract
Data on the specific effects of sex on pharmacokinetics, as well as tolerability, safety, and efficacy of psychotropic medications are still meager, mainly because only recently sex-related issues have attracted a certain degree of interest within the pharmacological domain. Therefore, with the present study, we aimed to provide a comprehensive review of the literature on this topic, through careful MEDLINE and PubMed searches of the years 1990-2012. Generally, data on pharmacokinetics are more consistent and numerous than those on pharmacodynamics. Sex-related differences have been reported for several parameters that influence pharmacokinetics, such as gastric acidity, intestinal motility, body weight and composition, blood volume, liver enzymes (mainly the cytochrome P450), or renal excretion, which may alter plasma drug levels. Sex-related peculiarities may also account for a different sensitivity of men and women to side effects and toxicity of psychotropic drugs. Further, some differences in drug response, mainly to antipsychotics and antidepressants, have been described. Further studies are, however, necessary to explore more thoroughly the impact of sex on the pharmacokinetics and pharmacodynamics of psychotropic drugs, in order to reach the most appropriate and tailored prescription for each patient.
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Dell'osso B, Arici C, Dobrea C, Camuri G, Benatti B, Altamura AC. Escitalopram tolerability as mono- versus augmentative therapy in patients with affective disorders: a naturalistic study. Neuropsychiatr Dis Treat 2013; 9:205-9. [PMID: 23429980 PMCID: PMC3573802 DOI: 10.2147/ndt.s39322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Escitalopram is a selective serotonin reuptake inhibitor, widely used in the treatment of affective disorders. The purpose of this study was to examine its safety and tolerability, as mono- versus augmentative therapy, in a group of patients with affective disorders. MATERIALS AND METHODS The sample consisted of 131 patients suffering from different affective disorders, including major depressive disorder, bipolar disorder, and generalized anxiety disorder, who received escitalopram for at least 4 weeks. Data were analyzed on the basis of mono- versus augmentative therapy, as well as age, gender, mean daily dosage, and patterns of combination therapy. RESULTS Sixty-seven (51.1%) patients were treated with monotherapy (mean dose of 11.76 mg/day) and 64 (48.9%) with augmentative escitalopram (mean dose of 12.81 mg/day). The mean duration of escitalopram treatment was 14 months. The most frequently combined compounds were: other antidepressants (36.5%), mood stabilizers (33.4%), and atypical antipsychotics (30.1%). Side effects were reported in 5.3% of the total sample and the most common were insomnia (2.3%), nausea (2.3%), and dizziness (0.8%). No significant difference, in terms of tolerability, in mono- versus augmentative therapy groups was found. In addition, neither age nor gender was significantly correlated with a greater presence of side effects. Finally, no significant correlation between dosage and side effects was observed. CONCLUSION Over a 14-month observation period, escitalopram, either as monotherapy or an augmentative treatment, was found to be well tolerated in a large sample of patients with affective disorders, with an overall low rate of side effects.
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Affiliation(s)
- Bernardo Dell'osso
- University of Milan, Department of Psychiatry, Fondazione IRCSS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
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Unterecker S, Riederer P, Proft F, Maloney J, Deckert J, Pfuhlmann B. Effects of gender and age on serum concentrations of antidepressants under naturalistic conditions. J Neural Transm (Vienna) 2012; 120:1237-46. [PMID: 23254926 DOI: 10.1007/s00702-012-0952-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 12/04/2012] [Indexed: 11/27/2022]
Abstract
Therapeutic drug monitoring (TDM) data of antidepressant drugs are often evaluated using homogeneous samples of selected individuals without psychiatric or somatic comorbidity. These data may have limitations in transferability to everyday clinical practice. Hence, studies under naturalistic conditions are important to clarify the full clinical relevance of TDM of antidepressants. TDM analyses were retrospectively evaluated for a 3-year period from 2008 to 2010. The influence of gender and age on dose-corrected serum concentrations of antidepressants was examined in a standard clinical setting. 693 TDM analyses of amitriptyline and nortriptyline (AMI + NOR), 160 of citalopram (CIT), 152 of clomipramine and N-clomipramine (CLO + N-CLO), 272 of doxepine and N-doxepine (DOX + N-DOX), 359 of escitalopram (ESC), 198 of fluoxetine and N-fluoxetine (FLU + N-FLU), 92 of maprotiline (MAP), 888 of mirtazapine (MIR), and 77 of sertraline (SER) remained in the sample. Females had significantly higher dose-corrected serum concentrations of AMI + NOR (32 %), CIT (29 %), DOX + N-DOX (29 %), and MIR (20 %), and patients older than 60 years had significantly higher dose-corrected serum concentrations of AMI + NOR (21 %), CIT (40 %), DOX + N-DOX (48 %), MAP (46 %), MIR (24 %), and SER (67 %). Comparing the two extreme groups, females >60 years showed a remarkably higher dose-corrected serum concentration of AMI + NOR (52 %), CIT (78 %), DOX + N-DOX (86 %), and MIR (41 %) in contrast to males ≤60 years. Gender and age have a significant influence on the serum concentrations of different antidepressant drugs, and additive effects must be considered. TDM is recommended to reduce the risk of adverse effects due to supratherapeutic serum levels, also in a naturalistic clinical setting.
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Affiliation(s)
- S Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Füchsleinstrasse 15, 97080, Würzburg, Germany.
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Borad MJ, Curtis KK, Babiker HM, Benjamin M, Tibes R, Ramanathan RK, Wright K, Dueck AC, Jameson G, Von Hoff DD. The impact of concomitant medication use on patient eligibility for phase I cancer clinical trials. J Cancer 2012; 3:345-53. [PMID: 22962561 PMCID: PMC3434362 DOI: 10.7150/jca.4714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 07/14/2012] [Indexed: 01/17/2023] Open
Abstract
UNLABELLED Concomitant medication (CM) use may result in Phase I cancer clinical trial ineligibility due to concern for potential CM-investigational drug interactions or alteration of investigational drug absorption. Few studies have examined the impact of CM use on trial eligibility. METHODS We reviewed records of 274 patients on Phase I trials at a single academic institution. Demographics, CM identities and classes, CM discontinuation, reasons, and incidence of CM substitution were recorded. CM-investigational drug cytochrome P450 (CYP) enzyme interactions were documented. Statistical analysis was performed using descriptive statistics. RESULTS 273 of 274 patients (99.6%, 95% confidence interval [CI] 98.9-100%) took CM, with a median of 8 CM per patient (range 0 - 42). CM discontinuation occurred in 67 cases (25%, 95% CI 19-30%). The most common CM classes discontinued were herbal (17 cases, 25%, 95% CI 16-37%) and proton pump inhibitors (15 cases, 22%, 95% CI 12-32%). CM discontinuation reasons were: protocol prohibition (32 cases, 48%, 95% CI 36-60%); potential CM-investigational drug interaction (25 cases, 37%, 95% CI 26-49%); other (10 cases, 15%, 95% CI 6-23%). A potential CM-investigational drug CYP interaction was noted in 122 cases (45%, 95% CI 39-50%). CM potentially weakly decreased investigational drug metabolism in 52 cases (43%, 95% CI 34-51%), and potentially strongly decreased investigational drug metabolism in 17 cases (14%, 95% CI 8-20%). Investigational drug potentially weakly decreased CM metabolism in 39 cases (32%, 95% CI 24-40%), and potentially strongly decreased CM metabolism in 28 cases (23%, 95% CI 15-30%). CM substitution occurred in 36/67 cases (54%, 95% CI 41-66%) where CM were discontinued to allow for eventual participation in clinical trials. Overall in 2 cases (0.7%, 95% CI 0.1-2.6%), patients were protocol ineligible because CM could not be discontinued or substituted. CONCLUSIONS This study highlights the high prevalence of concomitant medication use among cancer patients enrolled in phase I clinical trials. Most patients did meet trial eligibility criteria with careful substitution and discontinuation of CM. The most common reason for discontinuation of CM was protocol prohibition. The most common medications discontinued were herbal, proton pump inhibitors, selective serotonin reuptake inhibitor anti-depressants, and non-steroidal anti-inflammatory drugs.
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Affiliation(s)
- Mitesh J Borad
- 1. Department of Internal Medicine, Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ
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Howland RH. A question about the potential cardiac toxicity of escitalopram. J Psychosoc Nurs Ment Health Serv 2012; 50:17-20. [PMID: 22421011 DOI: 10.3928/02793695-20120307-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Previous reviews have focused on the potential cardiac toxicity of the racemic drug citalopram (Celexa(®)). Evaluating the safety of escitalopram (Lexapro(®)) is an important issue to consider, since it is the S-enantiomer of citalopram. Escitalopram has a small effect on the QTc interval. A prolonged QTc was seen in 2% to 14% of escitalopram overdose cases, without serious cardiac sequelae. The QTc prolongation effect of citalopram in beagle dogs has been attributed to the minor metabolite racemic didemethylcitalopram (DDCT). Whether the escitalopram minor metabolite S-DDCT has this effect is not known. Concentrations of S-DDCT are lower than DDCT, but for a broad range of doses of escitalopram and citalopram, the S-DDCT and DDCT concentrations are well below the QTc prolonging concentrations reported in dogs. There is no strong evidence from human and animal studies that the cardiac safety of escitalopram is significantly superior to that of citalopram.
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Affiliation(s)
- Robert H Howland
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Antidepressant drugs in children and adolescents: analytical and demographic data in a naturalistic, clinical study. J Clin Psychopharmacol 2011; 31:98-102. [PMID: 21192151 DOI: 10.1097/jcp.0b013e318205e66d] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pharmacokinetics of antidepressant drugs (ATDs), in terms of steady-state and trough values, in patients from Child and Adolescent Psychiatry centers in the midsouth-eastern part of Sweden, were evaluated, and the use of ATDs in this population were described. Patients to be prescribed an ATD were studied between 2002 and 2004. Two hundred eleven children, 64% girls and 36% boys (ages 8-20 years) were evaluated. The primary indication for the antidepressant treatment was depression in 69% of subjects. The median body mass index was 20.2 kg/m² (range, 12.4-38.6 kg/m²). Suspected adverse drug reactions were spontaneously reported in 31% (no serious). Monotherapy was indicated in 49% of request forms. The most common drug combination with the ATD was oral contraceptives. The concentrations of drugs in the patient evaluated population to referenced data for adults from the dose administered were as expected in 63%, higher than expected in 26% and lower than expected in 11%. The most prescribed ATD was sertraline (SERT). Dose-concentration relationships for SERT and metabolite desmethylsertraline (DSERT) were seen, rs = 0.48 and rs = 0.5, respectively. No relationship was found between dose and ratio DSERT/SERT. The median daily dose was 50 mg (range, 12.5-150 mg), SERT concentration 16 ng/mL (range, 3-88 ng/mL), and DSERT 33 ng/mL (range, 0-253 ng/mL). CYP2D6*4 was the most common poor metabolizer allele. Therapeutic drug monitoring may provide support to prescribing physicians to individual dose optimizing and to assess drug compliance, above all when ATDs are not well studied in pediatric patients before approval for general prescription.
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Kokras N, Dalla C, Papadopoulou-Daifoti Z. Sex differences in pharmacokinetics of antidepressants. Expert Opin Drug Metab Toxicol 2010; 7:213-26. [DOI: 10.1517/17425255.2011.544250] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Bigos KL, Pollock BG, Stankevich BA, Bies RR. Sex differences in the pharmacokinetics and pharmacodynamics of antidepressants: an updated review. ACTA ACUST UNITED AC 2010; 6:522-43. [PMID: 20114004 DOI: 10.1016/j.genm.2009.12.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2009] [Indexed: 01/05/2023]
Abstract
BACKGROUND An increasing number of studies have reported differences in the pharmacokinetics and/or pharmacodynamics of antidepressants between women and men. OBJECTIVES This article updates previously published literature describing sex differences in the pharmacokinetics and pharmacodynamics of antidepressants, and examines specific issues that face women with psychiatric illness. METHODS An English-language literature search was performed with the PubMed database (March 2003-December 2008) using combinations of the search terms sex, gender, and antidepressants. In addition, each antidepressant was identified in the 63rd edition of the Physicians' Desk Reference. RESULTS The current data suggest that the pharmacokinetics of antidepressants can be substantially different between women and men. Likewise, the response to antidepressants can be quite variable, including sex differences in adverse effects and time to response. CONCLUSIONS Despite the many sex differences reported, there is still little published work systematically evaluating potential sex differences in antidepressant pharmacokinetics and pharmacodynamics. More research is needed to guide the treatment of depression and other mental illnesses.
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Affiliation(s)
- Kristin L Bigos
- Clinical Brain Disorders Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Drueke B, Baetz J, Boecker M, Moeller O, Hiemke C, Gründer G, Gauggel S. Differential effects of escitalopram on attention: a placebo-controlled, double-blind cross-over study. Psychopharmacology (Berl) 2009; 207:213-23. [PMID: 19756527 DOI: 10.1007/s00213-009-1649-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 08/17/2009] [Indexed: 11/29/2022]
Abstract
RATIONALE The role of serotonin (5-HT) in attention is not fully understood yet. OBJECTIVE We aimed to investigate whether attention is modulated after treatment with escitalopram, a selective serotonin reuptake inhibitor (SSRI). METHODS We administered 10 mg of escitalopram to 20 healthy subjects in a placebo-controlled, double-blind cross-over design for 1 day or to another 20 participants for a period of 7 days. Attention was assessed at time of plasma peak escitalopram concentration using the computerised Attention Network Test (ANT), which is a combined flanker and cued reaction time task. RESULTS The results showed differential effects of serotonergic manipulation on attention depending on sequence of intake. For the acute treatment, we found significant differences between escitalopram and placebo for all warning conditions dependent of sequence of intake: participants receiving escitalopram as first treatment showed significant slower reaction times in all warning conditions as compared with placebo while participants receiving escitalopram as second treatment showed significant faster reaction times as compared with placebo. For the sub-chronic treatment, we found significant differences between escitalopram and placebo depending on sequence of intake, but only for the flanker condition: participants receiving escitalopram first had significant slower reaction times in incongruent trials with escitalopram as compared with placebo while participants starting with placebo had significant shorter reaction times in incongruent trials with escitalopram. CONCLUSIONS Thus, the results showed a differential effect of escitalopram in cognition, especially in attention, and are discussed with regard to an interaction between serotonin and familiarity with the attention test.
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Affiliation(s)
- Barbara Drueke
- Department of Medical Psychology and Medical Sociology, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
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Abstract
Chiral substances possess a unique architecture such that, despite sharing identical molecular formulas, atom-to-atom linkages, and bonding distances, they cannot be superimposed. Thus, in the environment of living systems, where specific structure-activity relationships may be required for effect (e.g., enzymes, receptors, transporters, and DNA), the physiochemical and biochemical properties of racemic mixtures and individual stereoisomers can differ significantly. In drug development, enantiomeric selection to maximize clinical effects or mitigate drug toxicity has yielded both success and failure. Further complicating genetic polymorphisms in drug disposition, stereoselective metabolism of chiral compounds can additionally influence pharmacokinetics, pharmacodynamics, and toxicity. Optically pure pharmaceuticals may undergo racemization in vivo, negating single enantiomer benefits or inducing unexpected effects. Appropriate chiral antidotes must be selected for therapeutic benefit and to minimize adverse events. Enantiomers may possess different carcinogenicity and teratogenicity. Environmental toxicology provides several examples in which compound bioaccumulation, persistence, and toxicity show chiral dependence. In forensic toxicology, chiral analysis has been applied to illicit drug preparations and biological specimens, with the potential to assist in determination of cause of death and aid in the correct interpretation of substance abuse and "doping" screens. Adrenergic agonists and antagonist, nonsteroidal anti-inflammatory agents, SSRIs, opioids, warfarin, valproate, thalidomide, retinoic acid, N-acetylcysteine, carnitine, penicillamine, leucovorin, glucarpidase, pesticides, polychlorinated biphenyls, phenylethylamines, and additional compounds will be discussed to illustrate important concepts in "chiral toxicology."
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Affiliation(s)
- Silas W Smith
- New York University School of Medicine, New York, New York 10016, USA.
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Serum concentrations of antidepressant drugs in a naturalistic setting: compilation based on a large therapeutic drug monitoring database. Ther Drug Monit 2009; 31:42-56. [PMID: 19077925 DOI: 10.1097/ftd.0b013e31819114ea] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A compilation of therapeutic drug monitoring data for 15 antidepressant drugs in a naturalistic routine clinical setting is presented. A substantial number of serum concentrations, at different daily doses, are outlined, and the intraindividual and overall serum concentration coefficient of variation for a respective substance is presented. Also, concentration comparisons between women and men, and patients older or younger than 65 years are made. The drugs included are amitriptyline (n = 394), citalopram (n = 5457), clomipramine (n = 400), escitalopram (n = 3066), fluoxetine (n = 793), fluvoxamine (n = 165), mianserin (n = 1063), mirtazapine (n = 1427), moclobemide (n = 200), nortriptyline (n = 206), paroxetine (n = 1677), reboxetine (n = 85), sertraline (n = 2998), trimipramine (n = 158), and venlafaxine (n = 1781). Of the 9 drugs exhibiting linear (first order) kinetics, all but reboxetine gave a significant negative dose-to-dose-normalized correlation with concentrations, that is an increased clearance with higher dose. When dose was correlated to the metabolite:parent substance ratio for drugs exhibiting linear kinetics, citalopram and mianserin gave a positive slope, contrary to a negative slope shown for sertraline and venlafaxine. The intraindividual variations of the serum concentrations were lower than the overall variations, and the intraindividual variation of the metabolite:parent substance ratio was lower than the intraindividual variation of respective parent substance (except clomipramine and mianserin). Women had significantly higher serum concentrations than men (significant for citalopram, escitalopram, mianserin, mirtazapine, and venlafaxine), and patients older than 65 years had higher serum concentrations than the younger ones for all drugs except amitriptyline, moclobemide, and trimipramine. By presenting a comprehensive compilation of therapeutic drug monitoring data for each drug, a reference tool is created, in addition to improved pharmacokinetic knowledge of antidepressant drugs.
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