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Corral R, Bojórquez E, Cetkovich-Bakmas M, Córdoba R, Chestaro J, Gama C, Bonetto GG, Jaramillo CL, Moreno RA, Ng B, de Leon EP, Risco L, Silva H, Vazquez G. Latin American consensus recommendations for the management and treatment of patients with treatment-resistant depression (TRD). SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00013-3. [PMID: 38592432 DOI: 10.1016/j.sjpmh.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 04/10/2024]
Abstract
Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD, and available treatment pathways for the management of TRD vary across the Latin American region, highlighting the need for a uniform definition and treatment principles to optimize the management of TRD in Latin America. METHODS Following a thematic literature review and pre-meeting survey, a Latin America expert panel comprising 14 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA appropriateness method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management. RESULTS The expert panel agreed that 'treatment-resistant depression' (TRD) is defined as 'failure of two drug treatments of adequate doses, for 4-8 weeks duration with adequate adherence, during a major depressive episode'. A stepwise treatment approach should be employed for the management of TRD - treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Nonpharmacological treatments, such as electroconvulsive therapy, are also appropriate options for patients with TRD. CONCLUSION These consensus recommendations on the operational definition of TRD and approved treatments for its management can be adapted to local contexts in the Latin American countries but should not replace clinical judgement. Individual circumstances and benefit-risk balance should be carefully considered while determining the most appropriate treatment option for patients with TRD.
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Affiliation(s)
- Ricardo Corral
- Department of Psychiatry, Jose T. Borda Hospital, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Marcelo Cetkovich-Bakmas
- Institute of Cognitive and Translational Neurosciences (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Rodrigo Córdoba
- UR Center for Mental Health - CeRSaME, School of Medicine and Health Sciences - EMCS, University of Rosario, Bogotá, Colombia
| | - Julio Chestaro
- Catholic University of Cibao, La Vega, Dominican Republic; Traumatological Hospital Juan Bosch, La Vega, Dominican Republic
| | - Clarissa Gama
- Department of Psychiatry and Legal Medicine, UFRGS, Research Unit, HCPA, Porto Alegre, Brazil
| | | | - Carlos López Jaramillo
- Department of Psychiatry, School of Medicine, University of Antioquia, Medellin, Colombia
| | | | - Bernardo Ng
- Geriatric Center Nuevo Atardecer and Department of Psychiatry, University of California San Diego, Sun Valley Behavioral and Research Centers, California, USA
| | | | - Luis Risco
- Department of Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Hernán Silva
- Department of Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Gustavo Vazquez
- Research Center on Neurosciences, University of Palermo, Buenos Aires, Argentina; Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
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Weerasinghe DK, Hodge JM, Pasco JA, Samarasinghe RM, Azimi Manavi B, Williams LJ. Antipsychotic-induced bone loss: the role of dopamine, serotonin and adrenergic receptor signalling. Front Cell Dev Biol 2023; 11:1184550. [PMID: 37305679 PMCID: PMC10248006 DOI: 10.3389/fcell.2023.1184550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Antipsychotics are commonly used in treating psychiatric disorders. These medications primarily target dopamine the serotonin receptors, they have some affinity to adrenergic, histamine, glutamate and muscarinic receptors. There is clinical evidence that antipsychotic use decreases BMD and increases fracture risk, with dopamine, serotonin and adrenergic receptor-signalling becoming an increasing area of focus where the presence of these receptors in osteoclasts and osteoblasts have been demonstrated. Osteoclasts and osteoblasts are the most important cells in the bone remodelling and the bone regeneration process where the activity of these cells determine the bone resorption and formation process in order to maintain healthy bone. However, an imbalance in osteoclast and osteoblast activity can lead to decreased BMD and increased fracture risk, which is also believed to be exacerbated by antipsychotics use. Therefore, the aim of this review is to provide an overview of the mechanisms of action of first, second and third generation antipsychotics and the expression profiles of dopamine, serotonin and adrenergic receptors during osteoclastogenesis and osteoblastogenesis.
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Affiliation(s)
- D. Kavindi Weerasinghe
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Jason M. Hodge
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
| | - Julie A. Pasco
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine—Western Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rasika M. Samarasinghe
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Behnaz Azimi Manavi
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Lana J. Williams
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
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Fornaro M, Fusco A, Anastasia A, Cattaneo CI, De Berardis D. Brexpiprazole for treatment-resistant major depressive disorder. Expert Opin Pharmacother 2019; 20:1925-1933. [DOI: 10.1080/14656566.2019.1654457] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Michele Fornaro
- Neuroscience, Reproductive Science and Dentistry, Federico II University of Naples, Naples, Italy
| | - Andrea Fusco
- Neuroscience, Reproductive Science and Dentistry, Federico II University of Naples, Naples, Italy
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Cha DS, Luo X, Ahmed J, Becirovic L, Cha RH, McIntyre RS. Brexpiprazole as an augmentation agent to antidepressants in treatment resistant major depressive disorder. Expert Rev Neurother 2019; 19:777-783. [DOI: 10.1080/14737175.2019.1653759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Danielle S. Cha
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- School of Medicine, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Xinyi Luo
- School of Medicine, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Juhie Ahmed
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Larissa Becirovic
- School of Medicine, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Rebekah H. Cha
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Brain and Cognition Discovery Foundation (BCDF), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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