Clonazepam as a therapeutic adjunct to improve the management of psychiatric disorders

Potential drug-drug interaction in Mexican patients with schizophrenia

OBJECTIVE

The aim of this study was to observe potential drug-drug interactions in the medication of Mexican schizophrenic patients.

METHODS

We performed a retrospective and cross-sectional study that was carried out in a psychiatric clinic. Only the prescriptions of patients with schizophrenia whose diagnoses were based on the DSM-IV instrument were included in this study. The Drug Interactions Checker software ( http://www.drugs.com/drug_interactions.html ) was used in this study to analyse potential drug-drug interactions.

RESULTS

In total, 86 of 126 patients were at risk of potential drug-drug interactions. Haloperidol and biperiden was the most common drug pair of 232 pairs evaluated. In our study, 13.8% of drug-drug interaction showed a major level of severity, whereas in 83.2%, the interaction was moderate. Finally, central nervous system (CNS) depression and anticholinergic effect were the main possible effects of drug-drug interaction.

CONCLUSIONS

Our results revealed a high number of patients with schizophrenia receiving two or more drugs. The potential drug-drug interactions observed in the Mexican population are consistent with the concomitant use of antipsychotics, benzodiazepines, and antidepressants prescribed in schizophrenia that could cause central nervous system (CNS) depression and anticholinergic effect. Drug-drug interaction must be considered when the patient with schizophrenia is medicated.

Administration of the combination clonazepam-Deanxit as treatment for tinnitus

HYPOTHESIS

Present study investigates the combination of Deanxit and clonazepam (Rivotril) intake for relief of tinnitus complaints, respecting a double-blind placebo-controlled approach for Deanxit in a crossover setup.

BACKGROUND

Although several pharmacologic treatments--including antidepressants, prostaglandins, and aminobutyric acid (GABA)-active drugs--were already presented as promising in tinnitus treatment, no drug has yet been approved by the Food and Drug Administration and European Medicine Agency for the treatment of tinnitus.

METHODS

Patients were randomly assigned to patient group A or patient group B in a double-blind way. Patient group A first received 3 weeks of Deanxit, followed by 1 week of washout and 3 weeks of placebo. Treatment was given in opposite order to subjects from Patient group B.All patients received a daily treatment consisting of clonazepam 1 mg once daily, starting on Day 1.

RESULTS

Significant tinnitus reduction was seen after intake of the combination clonazepam-Deanxit, whereas no differences in tinnitus could be demonstrated after the administration of clonazepam-placebo. This was true for all patients according to the following parameters: time patients are annoyed by the tinnitus (p = 0.026) and the visual analogue scale for tinnitus annoyance (p = 0.024).

CONCLUSION

Although tinnitus reduction was recorded as modest, this article provides valuable data demonstrating a placebo-controlled tinnitus reduction after clonazepam and Deanxit intake.

Clonazepam as a therapeutic adjunct to improve the management of depression: a brief review

Clonazepam, first used for seizure disorders, is now increasingly used to treat affective disorders. We summarize the use of clonazepam to improve the management of depression. Clonazepam is useful for treatment-resistant and/or protracted depression, as well as for acceleration of response to conventional antidepressants. Clonazepam is at this time recommended for use in combination with SSRIs (fluoxetine, fluvoxamine, sertraline) as an antidepressant, and should be used at a dosage of 2.5-6.0 mg/day. If clonazepam is effective, a response should be observed within 2-4 weeks. It is significantly more effective for unipolar than for bipolar depression. Low-dose, long-term treatment with clonazepam exhibits a prophylactic effect against recurrence of depression. Although the mechanism of action of clonazepam has not yet been established, some investigators have been suggested that it involves enhancement of anti-anxiety effects, anticonvulsant effects on subclinical epilepsy, increase in 5-HT/monoamine synthesis or decrease in 5-HT receptor sensitivity mediated through the GABA system, and regulate in GABA activity.

Revised psychopharmacological algorithms for the treatment of mood disorders in Japan

Objective. To revise the psychopharmacology algorithms for the treatment of mood disorders published in 1999 in Japan. Methods. The algorithms were established based on clinical psychopharmacological evidence, the results of a questionnaire survey sent to 200 Japanese psychiatrists, and the consensus of all the research members. Results. Six categorized algorithms have been developed, i.e. mild or moderate major depression, severe non-psychotic major depression, psychotic depression, mania, bipolar depression, and rapid cycling mood disorder. Conclusion. The revised algorithms will be helpful for the treatment of mood disorders in Japan.

Possible predictors of response to clonazepam augmentation therapy in patients with protracted depression

INTRODUCTION

Clonazepam has been shown to be an effective supplementary treatment for depression. Thus, it would be useful to determine which patient characteristics are associated with response to clonazepam.

AIMS

The purpose of this study was to examine the possible predictors of response to clonazepam in the treatment of depression.

METHOD

A retrospective cohort analysis was carried out in 120 patients with protracted depression who were being treated with clonazepam.

RESULTS

A variety of clinical factors, including age, gender, type of depression, frequency of episodes, family history; and daily dose of clonazepam, were analyzed as possible predictors of response to clonazepam. A Weibull regression analysis showed that the factors that best predicted improvement with clonazepam augmentation were negative family history of psychiatric illness (e(coef) = 0.378), daily clonazepam dose of 2.5-4.0 mg (e(coef) = 0.160), and unipolar depression (e(coef) = 0.147).

CONCLUSIONS

These factors should be considered when clonazepam augmentation therapy is selected for protracted depression.

Clonazepam increases in vivo striatal extracellular glucose in diabetic rats after glucose overload

Hyperglycemia modulates brain function, including neuronal excitability, neurotransmitter release and behavioral changes. There may be connections between the GABAergic system, glucose sensing neurons and glucose in the neuronal environment that shed light on the mechanism by which GABA(A) agents influence depressive behavior in diabetic rats submitted to the forced swimming test. We aimed to investigate whether clonazepam (CNZ), a GABA(A) receptor positive modulator, modifies in vivo striatal extracellular glucose levels in diabetic rats under fasting condition or after oral glucose overload. Streptozotocin diabetic and nondiabetic rats were submitted to in vivo striatal microdialysis. Perfusate samples were collected at baseline, during fasting and following administration of CNZ (0.25 mg/kg) and oral glucose overload. Blood glucose and striatal extracellular glucose were measured simultaneously at several time points. Fasting striatal glucose levels were higher in diabetic than in nondiabetic rats and the differences between these animals were maintained after glucose overload. The increases in extracellular striatal glucose after glucose overload were around 40% and blood to brain transference was decreased in diabetics. CNZ treatment paradoxically increased striatal glucose after glucose overload in diabetic rats, which may mark the dysfunction in brain glucose homeostasis.

A review of the history of traumatic stress studies in Japan: from traumatic neurosis to PTSD

Based on available literature, this review article investigates traumatic stress studies in Japan from the late 19th century to the present for English speaking audiences. First, traumatic neuroses of war victims, A-bomb survivors, and victims of work-related accidents are discussed. Second, traumatic stress studies of victims of other manmade disasters, such as the sarin gas attacks in Tokyo, domestic violence, and burn injuries. Third, psychological outcomes of natural disaster studies are discussed in relation to social support and help-seeking tendencies of Japan disaster victims.

Lower in vivo brain extracellular GABA concentration in diabetic rats during forced swimming

Diabetic rats are more immobile during the forced-swimming test (FST) and GABAergic drugs reverse this behavior. We investigated if there is in vivo changes of GABA levels of diabetic rats during the FST. In vivo basal striatal GABA levels of streptozotocin diabetic rats are similar to non-diabetic rats. Non-diabetic rats presented a significant increase in GABA levels after the FST while the increase was delayed and lower in diabetic rats. These results suggest that diabetes may change GABA homeostasis and modify behavioral responses in an animal model of depression.

Ethopharmacology of the antidepressant effect of clonazepam in diabetic rats

Diabetes-associated depression may occur due to changes in the quality of life imposed by treatment, or may be a consequence of the biochemical changes accompanying the disease. It was our objective to evaluate the behaviors of diabetic rats through an animal model of depression, and determine if a positive GABA modulator agent, clonazepam, is an effective antidepressant. Wistar male rats were submitted to the forced-swimming test after 26 days of the induction of diabetes with streptozotocin (60 mg/kg). Test and retest days analyzed with an ethological approach. Clonazepam (control, 0.25, 0. 5, and 1.0 mg/kg) was administered IP 24, 5, and 1 h before the retest. Diabetic rats presented longer immobility duration during test and retest of forced swimming. Diabetic rats dived significantly less during the test. Clonazepam 0.25 and 0.5 mg/kg decreased immobility of diabetic rats with no consequences on the behaviors of nondiabetic rats. These results demonstrate that diabetic rats present more intense depressive-like behavior, such as immobility and lack of interest in exploring the environment, when exposed to the forced-swimming test. It is possible that decreased GABA function is involved in depression associated with diabetes, because a benzodiazepine partially counteracts these changes without modifying blood glucose and glycogen parameters.