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Siddiqui F, Barbateskovic M, Juul S, Katakam KK, Munkholm K, Gluud C, Jakobsen JC. Duloxetine versus 'active' placebo, placebo or no intervention for major depressive disorder; a protocol for a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis. Syst Rev 2021; 10:171. [PMID: 34108032 PMCID: PMC8191126 DOI: 10.1186/s13643-021-01722-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/28/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Major depression significantly impairs quality of life, increases the risk of suicide, and poses tremendous economic burden on individuals and societies. Duloxetine, a serotonin norepinephrine reuptake inhibitor, is a widely prescribed antidepressant. The effects of duloxetine have, however, not been sufficiently assessed in earlier systematic reviews and meta-analyses. METHODS/DESIGN A systematic review will be performed including randomised clinical trials comparing duloxetine with 'active' placebo, placebo or no intervention for adults with major depressive disorder. Bias domains will be assessed, an eight-step procedure will be used to assess if the thresholds for clinical significance are crossed. We will conduct meta-analyses. Trial sequential analysis will be conducted to control random errors, and the certainty of the evidence will be assessed using GRADE. To identify relevant trials, we will search Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, PsycINFO, Science Citation Index Expanded, Social Sciences Citation Index, Conference Proceedings Citation Index-Science and Conference Proceedings Citation Index-Social Science & Humanities. We will also search Chinese databases and Google Scholar. We will search all databases from their inception to the present. Two review authors will independently extract data and perform risk of bias assessment. Primary outcomes will be the difference in mean depression scores on Hamilton Depression Rating Scale between the intervention and control groups and serious adverse events. Secondary outcomes will be suicide, suicide-attempts, suicidal ideation, quality of life and non-serious adverse events. DISCUSSION No former systematic review has systematically assessed the beneficial and harmful effects of duloxetine taking into account both the risks of random errors and the risks of systematic errors. Our review will help clinicians weigh the benefits of prescribing duloxetine against its adverse effects and make informed decisions. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2016 CRD42016053931.
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Affiliation(s)
- Faiza Siddiqui
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marija Barbateskovic
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sophie Juul
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Kiran Kumar Katakam
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Heath Sciences, University of Southern Denmark, Odense, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Heath Sciences, University of Southern Denmark, Odense, Denmark
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Barry DT, Beitel M, Cutter CJ, Fiellin DA, Madden LM, Lipkind N, Bollampally P, Liong C, Schottenfeld RS. Psychiatric comorbidity and order of condition onset among patients seeking treatment for chronic pain and opioid use disorder. Drug Alcohol Depend 2021; 221:108608. [PMID: 33667784 PMCID: PMC8026725 DOI: 10.1016/j.drugalcdep.2021.108608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/09/2021] [Accepted: 01/26/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The study objective was to compare psychiatric comorbidity among patients seeking treatment for chronic pain and opioid use disorder (OUD) by order of condition onset (i.e., "Pain First," "OUD First," "Same Time"). METHODS Data from 170 patients entering two clinical trials of treatments for current comorbid chronic pain and OUD conducted between March 2009 and July 2013 were compared by order of condition onset. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders (Axis II) were performed by doctoral-level providers using a standardized training protocol. Age of onset group differences on specific diagnostic variables were examined using multinomial logistic regression. RESULTS Fifty-two percent were in the "Pain First" group (n = 89), 35 % in the "OUD First" group (n = 59), and 13 % in the "Same Time" group (n = 22). Compared with the Pain First group, the Same Time group was less likely to report heroin (vs. prescription opioids) as the primary drug used (OR = 0.20, 95 % CI = 0.06-0.72) or meet criteria for an Axis II disorder (OR = 0.24, 95 % CI = 0.07-0.83). Compared with the Pain First group, the OUD First group was more likely to meet criteria for a current nonopioid substance use disorder (OR = 3.20, 95 % CI = 1.22-8.40). CONCLUSIONS Our findings regarding differences in psychiatric comorbidity associated with order of condition onset indicate that varying pathways may exist for the emergence of chronic pain and OUD; further research should investigate potential treatment implications.
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Affiliation(s)
- Declan T Barry
- Yale School of Medicine, 333 Cedar Street New Haven, CT 06510, USA; Yale Child Study Center, 230 South Frontage Road New Haven, CT 06519, USA; APT Foundation Pain Treatment Services, 495 Congress Avenue New Haven, CT 06519, USA.
| | - Mark Beitel
- Yale School of Medicine, 333 Cedar Street New Haven, CT 06510, USA; Yale Child Study Center, 230 South Frontage Road New Haven, CT 06519, USA; APT Foundation Pain Treatment Services, 495 Congress Avenue New Haven, CT 06519, USA
| | - Christopher J Cutter
- Yale School of Medicine, 333 Cedar Street New Haven, CT 06510, USA; Yale Child Study Center, 230 South Frontage Road New Haven, CT 06519, USA; APT Foundation Pain Treatment Services, 495 Congress Avenue New Haven, CT 06519, USA
| | - David A Fiellin
- Yale School of Medicine, 333 Cedar Street New Haven, CT 06510, USA; Yale School of Public Health, 60 College Street New Haven, CT 06510, USA
| | - Lynn M Madden
- Yale School of Medicine, 333 Cedar Street New Haven, CT 06510, USA; APT Foundation Pain Treatment Services, 495 Congress Avenue New Haven, CT 06519, USA
| | - Nathan Lipkind
- APT Foundation Pain Treatment Services, 495 Congress Avenue New Haven, CT 06519, USA
| | - Pooja Bollampally
- APT Foundation Pain Treatment Services, 495 Congress Avenue New Haven, CT 06519, USA; Yale School of Public Health, 60 College Street New Haven, CT 06510, USA
| | - Christopher Liong
- APT Foundation Pain Treatment Services, 495 Congress Avenue New Haven, CT 06519, USA
| | - Richard S Schottenfeld
- Yale School of Medicine, 333 Cedar Street New Haven, CT 06510, USA; Howard University College of Medicine and Hospital, 2041 Georgia Avenue NW, Washington, DC 20059, USA
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Parisi A, Pensieri MV, Cortellini A, D'Orazio C, Ficorella C, Verna L, Porzio G. Haloperidol for the treatment of opioid addiction in advanced cancer patients: a case series. J Addict Dis 2020; 38:229-234. [PMID: 32207385 DOI: 10.1080/10550887.2020.1742560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Opioid addiction, if not well diagnosed and treated, can be a significant challenge for optimal pain management even in cancer patients. To date there is no definitive pharmacological standard of care for treating addiction, especially in this setting of patients. We present a clinical case series of three opioid-addicted advanced cancer patients, effectively treated with haloperidol, a well-known first-generation typical antipsychotic.
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Affiliation(s)
- Alessandro Parisi
- Medical Oncology, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria Vittoria Pensieri
- Medical Oncology, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessio Cortellini
- Medical Oncology, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carla D'Orazio
- Medical Oncology, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Corrado Ficorella
- Medical Oncology, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lucilla Verna
- Medical Oncology, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giampiero Porzio
- Medical Oncology, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Kumar R, Sarwal A, Dahiya L, Gupta D, Sinha VR. Experimental investigations, cytotoxicity and cellular uptake outcomes of physically modified duloxetine HCl inclusion complexes. Polym Bull (Berl) 2019. [DOI: 10.1007/s00289-019-02686-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Go SI, Song HN, Lee SJ, Bruera E, Kang JH. Craving Behavior from Opioid Addiction Controlled with Olanzapine in an Advanced Cancer Patient: A Case Report. J Palliat Med 2018; 21:1367-1370. [PMID: 30070936 DOI: 10.1089/jpm.2017.0636] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Opioid addiction, although uncommon in cancer patients, can be a significant challenge for optimal pain management in certain patients. We present a case of a 59-year-old man with advanced colon cancer whose compulsive craving for the buccal tablet of fentanyl citrate (BTFC) was improved with the use of olanzapine. He was hospitalized for abdominal pain caused by disease progression. He had visited several times at outpatient follow-up to obtain a prescription for BTFC because he took all medications before the appointed times. After admission, intravenous infusion of oxycodone and opioid rotation were applied to the patient to control his pain. However, he complained that the pain was not relieved at all and persistently asked for only BTFC 7 to 15 times per day. With the diagnosis of opioid addiction, the transdermal buprenorphine patch was applied, but was ineffective for controlling the addictive behaviors. Finally, olanzapine (10 mg/day per os), a dopamine receptor antagonist, was given to control the craving behavior because psychological dependence is mediated by the dopaminergic system. Three days later, opioid craving was reduced from five to one on a 5-point Likert scale. The pain was well controlled to numeric rating scale 1 or 2 without cravings for BTFC. Craving behavior as a result of opioid addiction may be controlled with olanzapine. Further prospective studies on this issue are warranted.
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Affiliation(s)
- Se-Il Go
- 1 Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, College of Medicine, Gyeongsang National University , Changwon, South Korea
| | - Haa-Na Song
- 2 Department of Internal Medicine, College of Medicine, Gyeongsang National University , Jinju, South Korea
| | - So-Jin Lee
- 3 Department of Psychiatry, College of Medicine, Gyeongsang National University , Jinju, South Korea
| | - Eduardo Bruera
- 4 Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center , Houston, Texas
| | - Jung Hun Kang
- 2 Department of Internal Medicine, College of Medicine, Gyeongsang National University , Jinju, South Korea
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Siddiqui SH, Memon NA, Shanker R. Drug-induced movement disorder and confusion associated with duloxetine. BMJ Case Rep 2018; 2018:bcr-2016-216746. [DOI: 10.1136/bcr-2016-216746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ojagbemi A, Owolabi M, Akinyemi R, Arulogun O, Akinyemi J, Akpa O, Sarfo FS, Uvere E, Saulson R, Hurst S, Ovbiagele B. Prevalence and predictors of anxiety in an African sample of recent stroke survivors. Acta Neurol Scand 2017; 136:617-623. [PMID: 28417454 DOI: 10.1111/ane.12766] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Studies considering emotional disturbances in the setting of stroke have primarily focused on depression and been conducted in high-income countries. Anxiety in stroke survivors, which may be associated with its own unique sets of risk factors and clinical parameters, has been rarely investigated in sub-Saharan Africa (SSA). We assess the characteristics of anxiety and anxiety-depression comorbidity in a SSA sample of recent stroke survivors. MATERIALS AND METHODS We assessed baseline data being collected as part of an intervention to improve one-year blood pressure control among recent (≤1 month) stroke survivors in SSA. Anxiety in this patient population was measured using the Hospital Anxiety and Depression Scale (HADS), while the community screening instrument for dementia was used to evaluate cognitive functioning. Independent associations were assessed using logistic regression analysis. RESULTS Among 391 participants, clinically significant anxiety (HADS anxiety score≥11) was found in 77 (19.7%). Anxiety was comorbid with depression in 55 (14.1%). Female stroke survivors were more likely than males to have anxiety (OR=2.4, 95% CI=1.5-4.0). Anxiety was significantly associated with the presence of cognitive impairment after adjusting for age, gender and education (OR=6.8, 95% CI=2.6-18.0). CONCLUSIONS One in five recent stroke survivors in SSA has clinically significant anxiety, and well over 70% of those with anxiety also have depression. Future studies will need to determine what specific impact post-stroke anxiety may have on post-stroke clinical processes and outcomes.
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Affiliation(s)
- A. Ojagbemi
- College of Medicine University of Ibadan; Ibadan Nigeria
| | - M. Owolabi
- College of Medicine University of Ibadan; Ibadan Nigeria
| | - R. Akinyemi
- College of Medicine University of Ibadan; Ibadan Nigeria
| | - O. Arulogun
- College of Medicine University of Ibadan; Ibadan Nigeria
| | - J. Akinyemi
- College of Medicine University of Ibadan; Ibadan Nigeria
| | - O. Akpa
- College of Medicine University of Ibadan; Ibadan Nigeria
| | | | - E. Uvere
- College of Medicine University of Ibadan; Ibadan Nigeria
| | - R. Saulson
- Medical University of South Carolina; Charleston SC USA
| | - S. Hurst
- University of California; San Diego CA USA
| | - B. Ovbiagele
- Medical University of South Carolina; Charleston SC USA
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Ojagbemi A, Owolabi M, Akinyemi J, Ovbiagele B. Proposing a new stroke-specific screening tool for depression: Examination of construct validity and reliability. eNeurologicalSci 2017; 9:14-18. [PMID: 29202106 PMCID: PMC5709821 DOI: 10.1016/j.ensci.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objectives The optimal tool for identifying depression after stroke is yet to be identified. In the present study, we propose a new context-specific screening tool for PSD and examined its construct validity and reliability within existing data on recent stroke survivors. Methods We assessed baseline data being collected as part of an intervention to improve one-year blood pressure control among recent (≤ one month) stroke survivors. Depression was measured using the Hospital Anxiety and Depression Scale (HADS-D). We also independently administered the 26-items Health Related Quality of Life in Stroke Patients (HRQOLISP-26), a stroke-specific measure developed from a large cross-cultural sample. Using standard protocol, we identified 6 psychoemotional-domain items of the HRQOLISP-26 fitting a single dimensional model with phenomenological and conceptual overlap with the depression framework in the 10th revision of the International Classification of Diseases (ICD-10). We examined construct validity by comparing HRQOLISP-E with the HADS-D, and known group validity by comparing with age, gender, and stroke severity using both the Pearson product moment coefficient and multivariate regression analyses. Internal consistency and split-half reliability were also determined. Results Each HRQOLISP-E item (r = − 0.40 to − 0.53, all p < 0.001), as well as the total HRQOLISP-E score (− 0.53, p < 0.001) showed significant correlation with the HADS-D. The HRQOLISP-E scores also correlated significantly with age and stroke severity. Depression assessed using the HRQOLIPS-E was independently associated with older age and stroke severity. All HRQOLISP-E items scale correlations were > 0.8 (0.81–0.93) compared with 0.56–0.68 for the HADS-D (Cronbach's alpha = 0.939, versus 0.742 for the HADS-D, Split-half reliability = 0.899, versus 0.739 for HADS-D). Conclusion These results provides preliminary support for further development of the HRQOLISP-E as a context-specific screening tool for PSD through an investigation comparing the proposed measure against a referent-standard clinical diagnostic criteria such as the ICD 10 or Diagnostic and Statistical Manual of Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders. The optimal tool for identifying post-stroke depression (PSD) is yet to be identified. We derived HRQOLISPE from a context-specific tool, the Health Related Quality of Life in Stroke Patients. HRQOLISPE demonstrated good construct validity. HRQOLISPE had better reliability compared with Hospital Anxiety and Depression Rating Scale. We propose the HRQOLISPE as a context-specific screening tool for PSD.
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Barry DT, Cutter CJ, Beitel M, Kerns RD, Liong C, Schottenfeld RS. Psychiatric Disorders Among Patients Seeking Treatment for Co-Occurring Chronic Pain and Opioid Use Disorder. J Clin Psychiatry 2016; 77:1413-1419. [PMID: 27574837 PMCID: PMC6296217 DOI: 10.4088/jcp.15m09963] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 12/01/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Psychiatric comorbidities complicate treatment of patients with chronic pain and opioid use disorder, but the prevalence of specific comorbid psychiatric disorders in this population has not been systematically investigated. METHODS 170 consecutive participants entering a treatment research program for co-occurring chronic pain and opioid use disorder between March 2009 and July 2013 were evaluated with the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I/P) and the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). RESULTS The prevalence of any lifetime (and current) comorbid Axis I disorder was 91% (75%); 52% met criteria for lifetime anxiety disorder (48% current), 57% for lifetime mood disorder (48% current), and 78% for lifetime nonopioid substance use disorder (34% current). Common current anxiety diagnoses were posttraumatic stress disorder (21%), generalized anxiety disorder (16%), and panic disorder without agoraphobia (16%). Common current mood diagnoses were major depressive disorder (40%) and dysthymia (11%). A majority of patients had a personality disorder (52%). CONCLUSIONS High rates and persistence of co-occurring psychiatric disorders, including anxiety or mood disorders, may explain in part the difficulty providers have treating patients with co-occurring opioid use disorder and chronic pain and suggest possible targets for improving treatment. TRIAL REGISTRATION ClinicalTrials.gov identifiers: buprenorphine/naloxone treatment (NCT00634803), opioid treatment program-based methadone maintenance treatment (NCT00727675).
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Affiliation(s)
- Declan T. Barry
- Yale University School of Medicine, New Haven, CT 06519 USA,The APT Foundation Pain Treatment Services, New Haven, CT 06519 USA
| | - Christopher J. Cutter
- Yale University School of Medicine, New Haven, CT 06519 USA,The APT Foundation Pain Treatment Services, New Haven, CT 06519 USA
| | - Mark Beitel
- Yale University School of Medicine, New Haven, CT 06519 USA,The APT Foundation Pain Treatment Services, New Haven, CT 06519 USA
| | - Robert D. Kerns
- Yale University School of Medicine, New Haven, CT 06519 USA,VA Connecticut Healthcare System, West Haven, CT 06516 USA
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Bilodeau M, Simon T, Beauchamp MH, Lespérance P, Dubreucq S, Dorée JP, Tourjman SV. Duloxetine in adults with ADHD: a randomized, placebo-controlled pilot study. J Atten Disord 2014; 18:169-75. [PMID: 22582349 DOI: 10.1177/1087054712443157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the effect of duloxetine on ADHD in adults. METHOD In a 6-week double-blind trial, 30 adults with ADHD received placebo or duloxetine 60 mg daily. The Conners' Adult ADHD Rating Scale (CAARS) and the Clinical Global Impression Scales (CGI) were used to assess symptom severity and clinical improvement. The Hamilton Anxiety Rating Scale (HARS) and the Hamilton Depression Rating Scale (HDRS) were used to measure the effect on anxiety and depressive symptoms. RESULTS The Duloxetine group showed lower score on CGI-Severity at Week 6 (3.00 vs. 4.07 for placebo, p < .001), greater improvement on CGI-Improvement (2.89 vs. 4.00 at Week 6, p < .001), and greater decreases on five of eight subscales of the CAARS. There was no treatment group effect on HDRS or HARS scores. CONCLUSION Duloxetine may be a therapeutic option for adults with ADHD, but further studies are required to replicate these findings in larger samples.
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Pergolizzi JV, Raffa RB, Taylor R, Rodriguez G, Nalamachu S, Langley P. A review of duloxetine 60 mg once-daily dosing for the management of diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain due to chronic osteoarthritis pain and low back pain. Pain Pract 2012; 13:239-52. [PMID: 22716295 DOI: 10.1111/j.1533-2500.2012.00578.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Duloxetine is a selective dual neuronal serotonin (5-Hydroxytryptamine, 5-HT) and norepinephrine reuptake inhibitor (SSNRI). It is indicated in the United States for treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD), and several chronic pain conditions, including management of diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain due to chronic osteoarthritis (OA) pain and chronic low back pain (LBP). Its use for antidepressant and anxiolytic actions has been extensively reviewed previously. We here review the evidence for the efficacy of 60 mg once-daily dosing of duloxetine for chronic pain conditions. METHOD The literature was searched for clinical trials in humans conducted in the past 10 years involving duloxetine. RESULTS There were 199 results in the initial search. Studies not in the English language were excluded. We then included only studies of diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain (OA and LBP). Studies of painful symptoms reported in mental health studies were excluded. This resulted in 32 studies. Articles that did not include a 60 mg/day daily dose as a study arm were excluded. This resulted in 30 studies, broken down as follows: 12 for diabetic peripheral neuropathy, 9 for fibromyalgia, 6 for LBP, and 3 for OA pain. CONCLUSIONS The studies reviewed report that duloxetine 60 mg once-daily dosing is an effective option for the management of diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain due to chronic OA pain and chronic LBP. As these pains are often comorbid with MDD or GAD, duloxetine might possess the pharmacologic properties to be a versatile agent able to address several symptoms in these patients. With adequate attention to FDA prescribing guidance regarding safety and drug-drug interactions, duloxetine 60 mg once-daily dosing appears to be an effective option in the appropriate pain patient population.
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Kim JT, Park MS, Yoon GJ, Jung HJ, Choi KH, Nam TS, Lee SH, Choi SM, Kim BC, Kim MK, Cho KH. White Matter Hyperintensity as a Factor Associated with Delayed Mood Disorders in Patients with Acute Ischemic Stroke. Eur Neurol 2011; 66:343-9. [DOI: 10.1159/000332585] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Reinhold JA, Mandos LA, Rickels K, Lohoff FW. Pharmacological treatment of generalized anxiety disorder. Expert Opin Pharmacother 2011; 12:2457-67. [PMID: 21950420 DOI: 10.1517/14656566.2011.618496] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Generalized anxiety disorder (GAD) is a chronic, relapsing, debilitating disorder, associated with markedly impaired social and occupational functioning. Pharmacological treatment is considered standard care and several drug classes are now FDA approved for the treatment of GAD. While there are clear data for the efficacy of short-term acute treatment, long-term treatment and treatment-resistant GAD remain challenging. AREAS COVERED This article describes current pharmacological treatment options for GAD, with focus on benzodiazepines, azapirones, antidepressants and anticonvulsant and antipsychotic drugs. Recent findings from placebo-controlled clinical trials are reviewed and evidence-based clinical implications are discussed. A PubMed search was completed using the terms: 'generalized anxiety disorder AND treatment' and 'generalized anxiety disorder AND therapy'. Additional pivotal trials were included for a historical perspective (older landmark trials that established efficacy and safety for older drug classes in the treatment of GAD). EXPERT OPINION Efficacy for treatment of GAD has been established for several different drug classes. At present, based on clear efficacy and good tolerability, first-line treatment with either a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinephrine reuptake inhibitor (SNRI) is indicated. If an initial, at least moderate, clinical response is achieved under antidepressant therapy, treatment should be at least continued for 12 months.
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Affiliation(s)
- Jennifer A Reinhold
- University of the Sciences, Philadelphia College of Pharmacy, Department of Pharmacy Practice/Pharmacy Administration, PA, USA
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Torta R, Leombruni P, Borio R, Castelli L. Duloxetine for the treatment of mood disorder in cancer patients: a 12-week case-control clinical trial. Hum Psychopharmacol 2011; 26:291-9. [PMID: 21751250 DOI: 10.1002/hup.1202] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 03/15/2011] [Accepted: 03/29/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the efficacy and tolerability of duloxetine in cancer patients with mood disorder (MD) by means of a comparison with a matched control group of patients with MD without medical illness. METHODS Fifty-nine consecutive patients with MD were enrolled in this prospective case-control study and received duloxetine 60/120 mg per day for 12 weeks. Twenty-seven patients were affected by cancer, whereas 32 had an MD without cancer. All the patients were assessed by means of efficacy and effectiveness tolerability scales for depression (Montgomery-Asberg Depression Rating Scale and Hospital Anxiety and Depression Scale), anxiety (State-Trait Anxiety Inventory-Y1/Y2) and severity of symptoms (Clinical Global Impression (CGI)-Severity) at baseline (T0), after 4 weeks (T1) and 12 weeks (T2). The CGI-Improvement, CGI-Effectiveness Index and Dosage Record Treatment Emergent Symptom Scale were administered at T1 and T2. RESULTS A significant global improvement in all the efficacy measures was found. The results showed no significant interaction 'Time X Group', suggesting a similar improvement in efficacy scores for cancer-depressed patients and depressed patients without cancer. No difference was found between the two groups with regard to drop-out percentage, effectiveness and tolerability. CONCLUSION Although the results of this case-control study are preliminary, they suggest that duloxetine can be considered a good option for the treatment of MD in cancer patients.
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Affiliation(s)
- Riccardo Torta
- Clinical and Oncological Psychology Unit, Department of Neuroscience, University of Turin, Turin, Italy.
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Abstract
INTRODUCTION Untreated or inadequately treated depression is the largest risk factor for suicide. However, treatment with different antidepressants can have considerable adverse effects, including the increase of the frequency of suicidal thoughts and behavior. This review summarizes the frequency and severity of adverse events observed during the treatment of depression with duloxetine and considers their relevance to clinical practice. AREAS COVERED A comprehensive review of the literature was conducted using PubMed and Medline databases listing data published until December 2010. Articles describing safety and tolerability of duloxetine were selected and reference lists of these articles were scrutinized for further relevant papers. In addition, US and EU Summaries of Product Characteristics were studied. EXPERT OPINION Treatment with duloxetine was associated with mild to moderate adverse events; sexual dysfunction, nausea, headache, dry mouth, somnolence and dizziness being the most frequent among them. No increase in death from suicide and suicidal thoughts and behavior were detected as compared to placebo. So as to avoid discontinuation syndrome as a consequence of abrupt withdrawal of duloxetine, 2 weeks tapering has been recommended before discontinuation. Overall, duloxetine was found to be well tolerated and can be safely administered even in older patients and in those with concomitant illnesses.
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Affiliation(s)
- Istvan Bitter
- Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, Hungary.
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