Effect of Citalopram for the Treatment of Neurocardiogenic Syncope

Off-label Uses of Selective Serotonin Reuptake Inhibitors (SSRIs)

Psychiatric drugs have primacy for off-label prescribing. Among those, selective serotonin reuptake inhibitors (SSRIs) are highly versatile and, therefore, widely prescribed. Moreover, they are commonly considered as having a better safety profile compared to other antidepressants. Thus, when it comes to off-label prescribing, SSRIs rank among the top positions. In this review, we present the state of the art of off-label applications of selective serotonin reuptake inhibitors, ranging from migraine prophylaxis to SARS-CoV-2 antiviral properties. Research on SSRIs provided significant evidence in the treatment of premature ejaculation, both with the on-label dapoxetine 30 mg and the off-label paroxetine 20 mg. However, other than a serotoninergic syndrome, serious conditions like increased bleeding rates, hyponatremia, hepatoxicity, and post-SSRIs sexual dysfunctions, are consistently more prominent when using such compounds. These insidious side effects might be frequently underestimated during common clinical practice, especially by nonpsychiatrists. Thus, some points must be addressed when using SSRIs. Among these, a psychiatric evaluation before every administration that falls outside the regulatory agencies-approved guidelines has to be considered mandatory. For these reasons, we aim with the present article to identify the risks of inappropriate uses and to advocate the need to actively boost research encouraging future clinical trials on this topic.

The relationship between clinical characteristics and psychological status and quality of life in patients with vasovagal syncope

OBJECTIVE:

Syncope is characterized by sudden and short-term loss of postural tone and consciousness. Vasovagal syncope (VVS) episode is usually self-limiting, and it may affect patients’ quality of life. In this study, we aimed to investigate the relationship between quality of life, Beck-depression and Beck-anxiety scales and clinical characteristics of the VVS patients.

METHODS:

The present study included 88 patients with VVS. Tilt table test was performed to all the patients. Patients filled out the Quality of life, Beck-depression, and Beck-anxiety scale forms. Demographics, medical history, echocardiography, blood pressures, electrocardiography and physical examination findings were recorded.

RESULTS:

There was a significant and negative correlation between the total syncope episodes (TSE) and EQ-5D index and EQ-5D-VAS index, respectively (p<0.001, r: -0.649; p<0.001, r: -0.587). TSE was significantly and positively correlated with the Beck-anxiety scale and Beck-depression scale. EQ-5D index, EQ-5D-VAS index, Beck-depression scale, and Beck-anxiety scales were defined as an independent predictor of TSE in VVS patients.

CONCLUSION:

Psychological factors play an essential role in VVS patients. EQ-5D index, EQ-5D-VAS index, Beck-depression, and Beck-anxiety scales were an independent predictor of the TSE in patients with VVS.