Saliva secretion following long-term antidepressant treatment with nortriptyline controlled by plasma levels

Xerostomia and hyposalivation: causes, consequences and treatment in the elderly

Xerostomia and salivary gland hypofunction (SGH) are prevalent in elderly populations, causing much discomfort and even difficulties in eating. SGH also increases the occurrence and severity of oral diseases and makes the patient susceptible to candidiasis. The principal causes of SGH and xerostomia are systemic diseases and drugs used daily. The diagnosis of SGH and xerostomia is based on simple methods, of which measuring both unstimulated and stimulated salivary flow rate is the most important. Treatment calls for proper management of underlying disease, avoidance of all unnecessary medications, and topical remedies such as artificial saliva substitutes. However, good hydration is essential in the elderly with SGH and xerostomia, and water is the drink of choice. In extremely difficult cases, for instance in patients receiving radiotherapy for cancer of the head and neck regions, parasympathomimetic drugs may be administered if no contraindications exist.

Heart rate variation in patients treated with antidepressants. An index of anticholinergic effects?

The aim of the present study was to investigate whether heart rate variation as obtained simply from an electrocardiographic registration is influenced in subjects given antidepressive medication. The mean difference between consecutive R-R intervals (MCD) was reduced in patients (n = 23) treated with various doses of tri- or tetracyclic antidepressants [7.7 (1.8-32.3) ms in patients versus 24.8 (7.0-87.7) ms in controls]. Among those receiving 1.67 mg tricyclic antidepressant or more per kilogram body wt (n = 12) MCD was further reduced [5.0 (2.1-12.0) ms] with no overlapping of values as compared to controls (n = 9). In a subgroup of patients treated with clomipramine the MCD was related inversely to the dosage (R = 0.78, P less than 0.02). In an additional group of seven patients, MCD was reduced following a few days of treatment with antidepressants as compared to pretreatment values (P less than 0.02), indicating that the reduction is a result of therapy and not a concomitant of the affective state. We suggest that measurements of heart rate variation could be a useful tool to measure anticholinergic effects of antidepressants.

Effect of single oral doses of various neuroleptic drugs on salivary secretion rate, pH, and buffer capacity in healthy subjects

The effects of melperone, thioridazine, levomepromazine, and chlorprotixene on salivary secretion rate, pH, and buffer capacity was studied in eight healthy volunteers given single oral doses of placebo or 10, 25, and 50 mg of the drugs in a single-blind crossover design. Both resting and stimulated saliva samples were collected before and every hour for 6h after administration. All drugs reduced secretion rate and lowered pH and buffer capacity, mostly in a dose-dependent manner. The effects of levomepromazine and chlorprotixene were more pronounced than those of melperone and thioridazine.