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The Impact of Serotonin Transporter Binding Affinity on the Risk of Bleeding Related to Antidepressants. J Clin Psychopharmacol 2021; 41:470-473. [PMID: 34181363 DOI: 10.1097/jcp.0000000000001411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND The alleged primary mechanism underlying bleeding events associated with antidepressants is inhibition of serotonin uptake in platelets resulting in reduced platelet aggregability and activity, and prolonged bleeding time. There is some evidence that a substance's degree of serotonin reuptake inhibition in terms of its binding affinity to the serotonin transporter (SERT) affects the magnitude of bleeding risk increase. METHODS/PROCEDURE To test this hypothesis, we performed data mining in the worldwide largest pharmacovigilance database (VigiBase) and conducted pharmacodynamically informed quantitative signal detection. Reporting odds ratios related to the standardized Medical Dictionary of Regulatory Activities query term "haemorrhages" and 24 antidepressants were calculated, and SERT binding affinities (pKi) were obtained and correlated (Pearson correlation). FINDINGS/RESULTS A strong and statistically significant correlation between substance-related reporting odds ratios and SERT binding affinities was found (r = 0.63; 95% confidence interval, 0.30-0.82; P = 0.00097). IMPLICATIONS/CONCLUSIONS Our findings strengthen the hypothesis that inhibition of serotonin uptake contributes to the antidepressant-related bleeding risk and suggest an association between the degree of the SERT binding affinity and the bleeding risk. This supports the preferential use of antidepressants with low or no SERT binding affinity in depressed patients at risk of bleeding.
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Tully PJ, Alpérovitch A, Soumaré A, Mazoyer B, Debette S, Tzourio C. Association Between Cerebral Small Vessel Disease With Antidepressant Use and Depression: 3C Dijon Magnetic Resonance Imaging Study. Stroke 2019; 51:402-408. [PMID: 31826735 DOI: 10.1161/strokeaha.119.026712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Evidence links antidepressant use with cerebral small vessel disease; however, it remains unclear whether people with depression face comparable risk. This study aims to determine the association between antidepressant drug use and depression with markers of cerebral small vessel disease. Methods- One thousand nine hundred five participants (mean age, 72.5 years; 60% women) without stroke or dementia history underwent brain magnetic resonance imaging at baseline, and 1402 individuals underwent a second magnetic resonance imaging at 4 years. Outcomes were lacunes 3 to 15 mm and white matter hyperintensity volume (cm3) at baseline and follow-up. Exposure to antidepressants was grouped as (1) selective serotonin reuptake inhibitors (n=68), (2) tricyclics (n=40), (3) atypicals (n=24), (4) depressed nonusers (n=303), and (5) nondepressed/nonuser group (reference group, n=1470). Statistical analyses adjusted for propensity scores due to the nonrandomized exposure to antidepressant drugs. Results- There was an association between use of atypical antidepressants with lacunes at baseline (adjusted rate ratio, 2.59 [95% CI, 1.14-5.88]; P=0.023) and follow-up (adjusted rate ratio, 3.05 [95% CI, 1.25-7.43]; P=0.014). Lacunes at baseline were also associated with depressed nonusers (adjusted rate ratio, 1.53 [95% CI, 1.06-2.21]; P=0.023). Selective serotonin reuptake inhibitor users and depressed nonusers displayed higher total, periventricular, and deep white matter hyperintensity volumes at baseline. Selective serotonin reuptake inhibitor users had higher deep white matter hyperintensity volumes at follow-up. Conclusions- Users of atypical antidepressants, selective serotonin reuptake inhibitors, and depressed people without any antidepressant exposure all displayed markers of cerebral small vessel disease higher than the nondepressed/nonuser group. The findings suggest that cerebral small vessel disease is associated with depression and exposure to antidepressants.
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Affiliation(s)
- Phillip J Tully
- From the Inserm, Bordeaux Population Health Research Center, UMR 1219 (P.J.T., A.A., A.S., S.D., C.T.), University of Bordeaux, France
- Discipline of Medicine, School of Medicine, The University of Adelaide, Australia (P.J.T.)
| | - Annick Alpérovitch
- From the Inserm, Bordeaux Population Health Research Center, UMR 1219 (P.J.T., A.A., A.S., S.D., C.T.), University of Bordeaux, France
| | - Aicha Soumaré
- From the Inserm, Bordeaux Population Health Research Center, UMR 1219 (P.J.T., A.A., A.S., S.D., C.T.), University of Bordeaux, France
| | - Bernard Mazoyer
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, UMR5293 (B.M.), University of Bordeaux, France
- Centre National de la Recherche Scientifique, Institut des Maladies Neurodégénératives, UMR5293, Bordeaux, France (B.M.)
- Commissariat à l'Énergie atomique et aux énergies alternatives, Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, UMR5293, Bordeaux, France (B.M.)
| | - Stephanie Debette
- From the Inserm, Bordeaux Population Health Research Center, UMR 1219 (P.J.T., A.A., A.S., S.D., C.T.), University of Bordeaux, France
- Department of Neurology, Bordeaux University Hospital, France (S.D.)
- Department of Neurology, Framingham Heart Study, Boston University School of Medicine, MA (S.D.)
| | - Christophe Tzourio
- From the Inserm, Bordeaux Population Health Research Center, UMR 1219 (P.J.T., A.A., A.S., S.D., C.T.), University of Bordeaux, France
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Depressive symptom prevalence after intracerebral hemorrhage: a multi-center study. J Patient Rep Outcomes 2018; 2:55. [PMID: 30470937 PMCID: PMC6251938 DOI: 10.1186/s41687-018-0083-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 11/06/2018] [Indexed: 11/10/2022] Open
Abstract
Introduction Depressive symptoms in patients with intracerebral hemorrhage (ICH) are common and are associated with worse outcomes. It is not well described how often depressive symptoms are ascertained and treated in large unselected cohorts of patients, and whether depressive symptoms would be a potential target for improving outcomes. Methods Data were electronically retrieved from a multi-center EHR repository in Chicago, IL, from 2006 to 2012 (“multicenter cohort”). In the multicenter cohort, we retrieved diagnostic codes and medication data from four university health systems across Chicago. In the single center cohort, we prospectively screened for depressive symptoms (NIH Patient Reported Outcomes Measurement Information System, PROMIS, T Score ≥ 60), at one, three and twelve months after ICH onset. It should be noted that not all depressive symptoms are optimally characterized through diagnostic codes. Results Diagnostic codes for depressive symptoms up to three months after ICH onset were recorded in 132 of 3422 (3.8%) of the multicenter cohort; fewer than 10% of patients received a typical medication to treat depressive symptoms, and < 2% one month later. In the single-center cohort, PROMIS assessments were indicative of depressive symptoms in 26 of 116 (22.4%), and depressive symptoms were more likely to be found with screening (OR 7.20, 95% CI 4.5–11.5, P < 0.0001). Results were similar up to 12 months after ICH. Conclusions Depressive symptoms in patients with ICH are more common than medication treatment or a coded diagnosis in a multi-center cohort, and are a potential opportunity for additional treatment to improve outcomes. There are currently no AHA/ASA treatment guidelines for depression screening of patients with ICH.
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Bixby AL, VandenBerg A, Bostwick JR. Clinical Management of Bleeding Risk With Antidepressants. Ann Pharmacother 2018; 53:186-194. [DOI: 10.1177/1060028018794005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: This nonsystematic review describes risk of bleeding in treatment with serotonin reuptake inhibitors (SRIs) and provide recommendations for the management of patients at risk of bleeding. Data Sources: Articles were identified by English-language MEDLINE search published prior to June 2018 using the terms SRI, serotonin and noradrenaline reuptake inhibitors, OR antidepressive agents, AND hemorrhage OR stroke. Study Selection and Data Extraction: Meta-analyses were utilized to identify information regarding risk of bleeding with antidepressants. Individual studies were included if they had information regarding bleeding risk with specific SRIs, timing of risk, or risk with medications of interest. Data Synthesis: SRIs increase risk of bleeding by 1.16- to 2.36-fold. The risk is synergistic between SRIs and nonsteroidal anti-inflammatory drugs (NSAIDs; odds ratio [OR] range between studies 3.17-10.9). Acid-reducing medications may mitigate risk of gastrointestinal bleeds in chronic NSAIDs and SRI users (OR range between studies 0.98-1.1). Antidepressants with low or no affinity for the serotonin transporter, such as bupropion or mirtazapine, may be appropriate alternatives for patients at risk of bleeding. Relevance to Patient Care and Clinical Practice: This review includes data regarding bleeding risk for specific antidepressants, concomitant medications, and risk related to duration of SRI use. Considerations and evidence-based recommendations are provided for management of SRI users at high bleeding risk. Conclusions: Clinicians must be aware of the risk of bleeding with SRI use, especially for patients taking NSAIDs. Patient education is prudent for those prescribed NSAIDs and SRIs concurrently.
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Wang R, Liu K, Ye X, Yan S. Association Between Cerebral Microbleeds and Depression in the General Elderly Population: A Meta-Analysis. Front Psychiatry 2018; 9:94. [PMID: 29615939 PMCID: PMC5868197 DOI: 10.3389/fpsyt.2018.00094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/07/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND It remains unclear whether cerebral microbleeds (CMBs) are associated with depression in the general elderly population. We thus performed a meta-analysis to evaluate the relationship between depression and CMBs. METHODS A systematic literature search was conducted in EBSCO, PubMed, and Web of Science for relevant studies that assessed the relationship between depression and the prevalence of CMBs. RESULTS Five eligible studies including 7,328 patients were pooled in meta-analysis. The prevalence of CMBs was 18.0%. The prevalence of depression was 11.1%. The pooled analysis demonstrated odds ratio for CMBs and depression to be 1.187 (95% confidence interval 1.005-1.403; p = 0.043) with no evidence of statistical heterogeneity (I2 = 0.0%, p = 0.621). CONCLUSION Our meta-analysis of available published data indicated an increased prevalence of depression in the subjects with pre-existing CMBs. This finding supports the vascular depression hypothesis. Further studies are needed to investigate the role of CMBs in the pathogenesis and progression of depression, which might provide a potential target for the prevention and treatment.
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Affiliation(s)
- Ruiming Wang
- Department of Emergency, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Keqin Liu
- Department of Neurology, Hangzhou First People's Hospital, Hangzhou, China
| | - Xiaoyun Ye
- Department of Nursing Education, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Shenqiang Yan
- Department of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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Leeuwis AE, Prins ND, Hooghiemstra AM, Benedictus MR, Scheltens P, Barkhof F, van der Flier WM. Microbleeds are associated with depressive symptoms in Alzheimer's disease. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2017; 10:112-120. [PMID: 29780860 PMCID: PMC5956804 DOI: 10.1016/j.dadm.2017.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Co-occurrence of cerebrovascular disease and depression led to the "vascular depression hypothesis". White matter hyperintensities (WMHs) have been associated with depressive symptoms in population-based studies. We studied the association between small vessel disease and depressive symptoms in a memory clinic population. METHODS We included >2000 patients with subjective cognitive decline (SCD), mild cognitive impairment, and Alzheimer's disease (AD). Magnetic resonance imaging was rated for WMHs, lacunes, and microbleeds. Depressive symptoms were assessed using the Geriatric Depression Scale. We performed logistic regression analysis. RESULTS Depressive symptoms were present in AD: 17%; mild cognitive impairment: 25%; and SCD: 23%. SCD patients with WMHs showed higher propensity of depressive symptoms than AD patients with WMHs. AD patients with microbleeds were more likely to have depressive symptoms compared with AD patients without microbleeds (odds ratio = 1.70; 95% confidence interval: 1.08-2.68). DISCUSSION Microbleeds are associated with depressive symptoms in AD, supporting a potential role of cerebral amyloid angiopathy in the occurrence of depressive symptoms in AD.
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Affiliation(s)
- Anna E. Leeuwis
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels D. Prins
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Astrid M. Hooghiemstra
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Marije R. Benedictus
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
- Institutes of Neurology and Healthcare Engineering, University College London, London, United Kingdom
| | - Wiesje M. van der Flier
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
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Biffi A, Scotti L, Corrao G. Use of antidepressants and the risk of cardiovascular and cerebrovascular disease: a meta-analysis of observational studies. Eur J Clin Pharmacol 2017; 73:487-497. [DOI: 10.1007/s00228-016-2187-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/19/2016] [Indexed: 01/11/2023]
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Jiang HY, Xu LL, Li YC, Deng M, Peng CT, Ruan B. Antidepressant use during pregnancy and risk of postpartum hemorrhage: A systematic review and meta-analysis. J Psychiatr Res 2016; 83:160-167. [PMID: 27637098 DOI: 10.1016/j.jpsychires.2016.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/28/2016] [Accepted: 09/02/2016] [Indexed: 12/11/2022]
Abstract
Evidence about relationship between antidepressant use during pregnancy and the risk of postpartum hemorrhage (PPH) is conflicting. The aim of this meta-analysis was to systematically assess this relationship. To identify relevant studies, we conducted systematic searches in PubMed and Embase of articles published through May 2016. Random-effects models were adopted to estimate overall relative risk. In total, eight studies involving more than 40,000 PPH cases were included in our meta-analysis. After pooling the estimates, the odds for developing PPH were 1.32-fold higher (risk ratio, RR = 1.32; 95% confidence interval, CI = 1.17-1.48) in antidepressant users compared with individuals who had not taken antidepressants. In subgroup analyses, the associations still exist for women with exposure to non-SRI (RR = 1.31, 95% CI = 1.1-1.56), SRIs (RR = 1.23, 95% CI = 1.06-1.44), SSRIs (RR = 1.2, 95% CI = 1.04-1.38), and SNRIs (RR = 1.62, 95% CI = 1.41-1.85). Based on exposure window, we found an increased risk of PPH among current (RR = 1.37, 95% CI = 1.09-1.71) and recent users (RR = 1.32, 95% CI = 1.15-1.51), but not past users (RR = 1.08, 95% CI = 0.88-1.31). The findings of this meta-analysis support an increased risk of PPH in women exposure to antidepressant during late gestation.
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Affiliation(s)
- Hai-Yin Jiang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Lian-Lian Xu
- Department of Psychiatry, Hangzhou Seventh People's Hospital, Hangzhou, 310013, China
| | - Yu-Cuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Min Deng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Chun-Ting Peng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Bing Ruan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
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Würtz M, Schmidt M, Grove EL, Horváth-Puhó E, Christiansen CF, Sørensen HT. Preadmission use of selective serotonin reuptake inhibitors and short-term mortality in diabetic patients hospitalized due to stroke. J Intern Med 2016; 280:407-18. [PMID: 27138221 DOI: 10.1111/joim.12512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with diabetes have an increased risk of stroke with a poor prognosis. Moreover, diabetic patients are at increased risk of depression and therefore likely to use selective serotonin reuptake inhibitors (SSRIs). We examined whether preadmission SSRI use was associated with increased mortality in diabetic patients hospitalized due to stroke. METHODS Population-based medical databases were used to identify all first-time stroke-related hospitalizations and subsequent mortality in diabetic patients in Denmark between 2004 and 2012 (n = 12 620). Based on redeemed prescriptions, SSRI use was categorized as current (new or long term), former or nonuse, and absolute 30-day mortality and mortality rate ratios (MRRs) were computed using Cox regression controlling for confounding factors. RESULTS Amongst SSRI nonusers, 30-day stroke mortality was 15.8% (10.4% for ischaemic stroke, 41.8% for intracerebral haemorrhage and 27.3% for subarachnoid haemorrhage). Amongst current SSRI users, 30-day stroke mortality was 23.3% (17.1% for ischaemic stroke, 50.7% for intracerebral haemorrhage and 28.6% for subarachnoid haemorrhage). Current SSRI use was associated with increased 30-day stroke mortality compared with nonuse [adjusted MRR 1.3, 95% confidence interval (CI) 1.1-1.5], with the highest risk observed amongst new users (MRR 1.5, 95% CI 1.2-1.8). Overall stroke mortality was driven by increased mortality due to ischaemic stroke, with adjusted MRRs of 1.3 (95% CI 1.1-1.7) for current users and 1.7 (95% CI 1.2-2.4) for new users. Propensity score-matched results were similar and robust across subgroups. CONCLUSION In patients with diabetes, preadmission SSRI use was associated with increased mortality following ischaemic stroke, compared with nonuse.
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Affiliation(s)
- M Würtz
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. .,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. .,Department of Internal Medicine, Regional Hospital West Jutland, Herning, Denmark.
| | - M Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - E L Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - E Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - C F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Chen S, Chan P, Sun S, Chen H, Zhang B, Le W, Liu C, Peng G, Tang B, Wang L, Cheng Y, Shao M, Liu Z, Wang Z, Chen X, Wang M, Wan X, Shang H, Liu Y, Xu P, Wang J, Feng T, Chen X, Hu X, Xie A, Xiao Q. The recommendations of Chinese Parkinson's disease and movement disorder society consensus on therapeutic management of Parkinson's disease. Transl Neurodegener 2016; 5:12. [PMID: 27366321 PMCID: PMC4928283 DOI: 10.1186/s40035-016-0059-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/27/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a chronic, progressive and debilitating disease, which affects over 2.5 million people in China. PD is characterized clinically by resting tremor, muscular rigidity, bradykinesia and postural instability. As the disease progresses, additional complications can arise such as non-motor and neurobehavioral symptoms. Pharmacological treatment and surgical intervention for PD have been implemented in China. Until 10 years ago, there was lack of standardization for the management of PD in different regions and among different physicians, leading to different treatment levels in different regions and different physicians. Since then, the Chinese Parkinson's Disease and Movement Disorder Society have published three versions of guidelines for the management of PD in China, in 2006, 2009 and 2014, respectively. Correspondingly, the overall level of treatment for PD in China improved. OBJECTIVES To update the treatment guidelines based on current foreign and domestic practice guidelines and clinical evidence, and to improve the treatment options available to physicians in the management of PD. SUMMARY A variety of treatment recommendations in the treatment guidelines have been proposed, including physical activity and disease-modifying medication, which should be initiated at the early-stage of the disease. The principles of dosage titration should be followed to avoid acute adverse reactions to the drugs, to achieve a satisfactory clinical effect with a low dose and to reduce the incidence of long-term motor complications. Moreover, different treatment strategies should be considered at different stages of the disease. Importantly, treatment guidelines and personalized treatments should be valued equally. A set of treatment recommendations has been developed to assist physicians to improve and optimize clinical outcomes for patients with PD in China.
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Affiliation(s)
- Shengdi Chen
- />Department of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Piu Chan
- />Xuanwu Hospital affiliated to Capital Medical University, Beijing, China
| | - Shenggang Sun
- />Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | | | - Baorong Zhang
- />The Second Hospital affiliated to Zhejiang University School of Medicine, Hangzhou, China
| | - Weidong Le
- />The First Hospital affiliated to Dalian Medical University, Dalian, China
| | - Chunfeng Liu
- />The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Guoguang Peng
- />The First Hospital affiliated to Chongqing Medical University, Chongqing, China
| | - Beisha Tang
- />Xiangya Hospital, Central South University, Changsha, China
| | - Lijuan Wang
- />Guangdong General Hospital, Guangzhou, China
| | - Yan Cheng
- />General Hospital affiliated to Tianjin Medical University, Tianjin, China
| | - Ming Shao
- />Sichuan Rehabilitation Hospital, Chengdu, China
| | - Zhenguo Liu
- />Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhenfu Wang
- />Chinese PLA General Hospital, Beijing, China
| | - Xiaochun Chen
- />Fujian Medical University Union Hospital, Fuzhou, China
| | - Mingwei Wang
- />The First Hospital affiliated to Hebei Medical University, Shijiazhuang, China
| | - Xinhua Wan
- />Peking Union Medical College Hospital, Beijing, China
| | - Huifang Shang
- />West China Hospital affiliated to Sichuan University, Chengdu, China
| | - Yiming Liu
- />Qilu Hospital affiliated to Shandong University, Jinan, China
| | - Pingyi Xu
- />The First Hospital affiliated to Guangzhou Medical University, Guangzhou, China
| | - Jian Wang
- />Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Tao Feng
- />Tiantan Hospital affiliated to Capital Medical University, Beijing, China
| | - Xianwen Chen
- />The First Hospital affiliated to Anhui Medical University, Hefei, China
| | - Xingyue Hu
- />Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine, Hangzhou, China
| | - Anmu Xie
- />The Affiliated Hospital, Qingdao University School of Medicine, Qingdao, China
| | - Qin Xiao
- />Department of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
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Akoudad S, Aarts N, Noordam R, Ikram MA, Tiemeier H, Hofman A, Stricker BH, Vernooij MW, Visser LE. Antidepressant Use Is Associated With an Increased Risk of Developing Microbleeds. Stroke 2016; 47:251-4. [DOI: 10.1161/strokeaha.115.011574] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 10/14/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Saloua Akoudad
- From the Departments of Epidemiology (S.A., N.A., R.N., M.A.I., H.T., A.H., B.H.S., M.W.V., L.E.V.), Radiology (S.A., M. A.I., M.W.V.), Neurology (S.A., M.A.I.), Internal Medicine (N.A., R.N., B.H.S., L.E.V.), Psychiatry (H.T.), and Department of Child and Adolescent Psychiatry (H.T.), Erasmus MC–University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Inspectorate of Health Care, Utrecht, The
| | - Nikkie Aarts
- From the Departments of Epidemiology (S.A., N.A., R.N., M.A.I., H.T., A.H., B.H.S., M.W.V., L.E.V.), Radiology (S.A., M. A.I., M.W.V.), Neurology (S.A., M.A.I.), Internal Medicine (N.A., R.N., B.H.S., L.E.V.), Psychiatry (H.T.), and Department of Child and Adolescent Psychiatry (H.T.), Erasmus MC–University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Inspectorate of Health Care, Utrecht, The
| | - Raymond Noordam
- From the Departments of Epidemiology (S.A., N.A., R.N., M.A.I., H.T., A.H., B.H.S., M.W.V., L.E.V.), Radiology (S.A., M. A.I., M.W.V.), Neurology (S.A., M.A.I.), Internal Medicine (N.A., R.N., B.H.S., L.E.V.), Psychiatry (H.T.), and Department of Child and Adolescent Psychiatry (H.T.), Erasmus MC–University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Inspectorate of Health Care, Utrecht, The
| | - M. Arfan Ikram
- From the Departments of Epidemiology (S.A., N.A., R.N., M.A.I., H.T., A.H., B.H.S., M.W.V., L.E.V.), Radiology (S.A., M. A.I., M.W.V.), Neurology (S.A., M.A.I.), Internal Medicine (N.A., R.N., B.H.S., L.E.V.), Psychiatry (H.T.), and Department of Child and Adolescent Psychiatry (H.T.), Erasmus MC–University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Inspectorate of Health Care, Utrecht, The
| | - Henning Tiemeier
- From the Departments of Epidemiology (S.A., N.A., R.N., M.A.I., H.T., A.H., B.H.S., M.W.V., L.E.V.), Radiology (S.A., M. A.I., M.W.V.), Neurology (S.A., M.A.I.), Internal Medicine (N.A., R.N., B.H.S., L.E.V.), Psychiatry (H.T.), and Department of Child and Adolescent Psychiatry (H.T.), Erasmus MC–University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Inspectorate of Health Care, Utrecht, The
| | - Albert Hofman
- From the Departments of Epidemiology (S.A., N.A., R.N., M.A.I., H.T., A.H., B.H.S., M.W.V., L.E.V.), Radiology (S.A., M. A.I., M.W.V.), Neurology (S.A., M.A.I.), Internal Medicine (N.A., R.N., B.H.S., L.E.V.), Psychiatry (H.T.), and Department of Child and Adolescent Psychiatry (H.T.), Erasmus MC–University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Inspectorate of Health Care, Utrecht, The
| | - Bruno H. Stricker
- From the Departments of Epidemiology (S.A., N.A., R.N., M.A.I., H.T., A.H., B.H.S., M.W.V., L.E.V.), Radiology (S.A., M. A.I., M.W.V.), Neurology (S.A., M.A.I.), Internal Medicine (N.A., R.N., B.H.S., L.E.V.), Psychiatry (H.T.), and Department of Child and Adolescent Psychiatry (H.T.), Erasmus MC–University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Inspectorate of Health Care, Utrecht, The
| | - Meike W. Vernooij
- From the Departments of Epidemiology (S.A., N.A., R.N., M.A.I., H.T., A.H., B.H.S., M.W.V., L.E.V.), Radiology (S.A., M. A.I., M.W.V.), Neurology (S.A., M.A.I.), Internal Medicine (N.A., R.N., B.H.S., L.E.V.), Psychiatry (H.T.), and Department of Child and Adolescent Psychiatry (H.T.), Erasmus MC–University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Inspectorate of Health Care, Utrecht, The
| | - Loes E. Visser
- From the Departments of Epidemiology (S.A., N.A., R.N., M.A.I., H.T., A.H., B.H.S., M.W.V., L.E.V.), Radiology (S.A., M. A.I., M.W.V.), Neurology (S.A., M.A.I.), Internal Medicine (N.A., R.N., B.H.S., L.E.V.), Psychiatry (H.T.), and Department of Child and Adolescent Psychiatry (H.T.), Erasmus MC–University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Inspectorate of Health Care, Utrecht, The
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Gahr M, Zeiss R, Lang D, Connemann BJ, Hiemke C, Muche R, Freudenmann RW, Schönfeldt-Lecuona C. Association between haemorrhages and treatment with selective and non-selective serotonergic antidepressants: Possible implications of quantitative signal detection. Psychiatry Res 2015. [PMID: 26208982 DOI: 10.1016/j.psychres.2015.07.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Inhibition of serotonin uptake in platelets seems to be the crucial mechanism underlying SSRI-associated haemorrhages. This effect is also present in antidepressants featuring non-selective serotonin reuptake inhibition (non-SSRI). Impact of selectivity of serotonin reuptake and/or affinity to the serotonin reuptake transporter on the bleeding risk have not yet been studied sufficiently. We retrieved country- and SSRI-/non-SSRI-specific data from the Uppsala Monitoring Centre and used a case/non-case approach to calculate substance-specific reporting odds ratios (ROR) to evaluate the statistical association of treatment with SSRI/non-SSRI and haemorrhages. Country-specific analysis revealed no clear trends towards an increased risk of bleeding related to particular agents of group SSRI/non-SSRI (sporadically ROR>1 for citalopram, duloxetine, escitalopram, fluvoxamine, paroxetine, sertraline, St. John's wort). There was a clear trend in the total dataset towards a "reduced protective effect" (suggested by ROR<1) on the development of haemorrhages with agents featuring comparatively high affinity to the 5-HTT and/or selective serotonin reuptake inhibition (as with escitalopram, citalopram, duloxetine or venlafaxine) in comparison to agents with lower affinity or non-selective serotonin reuptake inhibition (as with mirtazapine or doxepin). Comparison of group-specific aggregated data (SSRI vs. non-SSRI) revealed significant differences regarding the "protective effect" on the development of haemorrhages between groups SSRI vs. non-SSRI in favour of non-SSRI in nearly all countries as well as in the total dataset. Our findings provide preliminary evidence that agents with increased affinity to the 5-HTT and/or selective serotonin reuptake inhibition may be associated with an increased risk of bleeding.
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Affiliation(s)
- Maximilian Gahr
- University of Ulm, Department of Psychiatry and Psychotherapy III, Leimgrubenweg 12-14, 89075 Ulm, Germany.
| | - René Zeiss
- University of Ulm, Department of Psychiatry and Psychotherapy III, Leimgrubenweg 12-14, 89075 Ulm, Germany
| | - Dirk Lang
- University of Ulm, Department of Psychosomatic Medicine and Psychotherapy, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Bernhard J Connemann
- University of Ulm, Department of Psychiatry and Psychotherapy III, Leimgrubenweg 12-14, 89075 Ulm, Germany
| | - Christoph Hiemke
- University Medical Center of Mainz, Department of Psychiatry and Psychotherapy, Untere Zahlbacherstr. 8, 55131 Mainz, Germany
| | - Rainer Muche
- University of Ulm, Institute of Epidemiology and Medical Biometry, Medical Faculty, Schwabstr. 13, 89075 Ulm, Germany
| | - Roland W Freudenmann
- University of Ulm, Department of Psychiatry and Psychotherapy III, Leimgrubenweg 12-14, 89075 Ulm, Germany
| | - Carlos Schönfeldt-Lecuona
- University of Ulm, Department of Psychiatry and Psychotherapy III, Leimgrubenweg 12-14, 89075 Ulm, Germany
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Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over 1200 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Cramer SC. Drugs to Enhance Motor Recovery After Stroke. Stroke 2015; 46:2998-3005. [PMID: 26265126 DOI: 10.1161/strokeaha.115.007433] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/15/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Steven C Cramer
- From the Deparments of Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, University of California, Irvine, CA.
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Khaleeli Z, Jaunmuktane Z, Beaufort N, Houlden H, Haffner C, Brandner S, Dichgans M, Werring D. A novel HTRA1 exon 2 mutation causes loss of protease activity in a Pakistani CARASIL patient. J Neurol 2015; 262:1369-72. [PMID: 25957642 DOI: 10.1007/s00415-015-7769-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 04/24/2015] [Accepted: 04/26/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Zhaleh Khaleeli
- National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, England, UK
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Mortensen JK, Andersen G. Safety of selective serotonin reuptake inhibitor treatment in recovering stroke patients. Expert Opin Drug Saf 2015; 14:911-9. [DOI: 10.1517/14740338.2015.1033396] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Clerget A. Iatrogénie des antidépresseurs. Eur Psychiatry 2014. [DOI: 10.1016/j.eurpsy.2014.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Les inhibiteurs sélectifs de la recapture de la sérotonine (ISRS) sont à ce jour les antidépresseurs les plus prescrits dans le traitement de l’épisode dépressif caractérisé. Cependant de plus en plus d’études s’interrogent sur leurs risques de saignements dus à une inhibition de l’agrégation plaquettaire ainsi qu’à une augmentation de la sécrétion d’acide gastrique. Ces effets dépendent du degré d’inhibition de la recapture de la sérotonine de la molécule. Le risque hémorragique semble essentiellement situé au niveau gastro-intestinal haut, avec peu de micro saignements cérébraux en population générale. La co-prescription d’acide acétyl salicylique et/ou d’anti-inflammatoires non stéroïdiens majore le risque, alors que celui-ci semble atténué par la prescription d’inhibiteurs de la pompe à protons. Via l’inhibition du cytochrome P450, le risque est majoré lorsque l’antidépresseur est associé au Warfarin ou au Clopidogrel, plus particulièrement pour la Fluoxétine et la Fluoxamine, et de manière moins importante pour la Sertraline et le Citalopram. Il est également discuté l’arrêt du traitement ou, en fonction de l’évaluation clinique, du switch par une autre classe d’antidépresseurs 15 jours avant une chirurgie chez les patients à hauts risques de saignements. Ces données doivent être prises en considération dans l’évaluation de la balance/bénéfice risque lors de la prescription d’un traitement antidépresseur.
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Affiliation(s)
- Graeme J. Hankey
- From the School of Medicine and Pharmacology, The University of Western Australia, Nedlands, Western Australia, Australia; and Department of Neurology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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