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Pankajkumar-Patel N, Peris-García E, Ruiz-Angel M, García-Alvarez-Coque M. Analysis of tricyclic antidepressants in pharmaceuticals by microemulsion liquid chromatography. Microchem J 2021. [DOI: 10.1016/j.microc.2020.105659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Suitability of 1-hexyl-3-methylimidazolium ionic liquids for the analysis of pharmaceutical formulations containing tricyclic antidepressants. J Chromatogr A 2018; 1559:118-127. [DOI: 10.1016/j.chroma.2017.11.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/21/2017] [Accepted: 11/26/2017] [Indexed: 11/17/2022]
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Mosheva M, Mekori E, Kantor S, Berg Y, Weizman A, Gothelf D. Do Antidepressants Induce Psychosis in Children and Adolescents? A Naturalistic Study in Ambulatory Pediatric Population. J Child Adolesc Psychopharmacol 2016; 26:478-84. [PMID: 27166781 DOI: 10.1089/cap.2015.0229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of the present study was to examine if selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) induce psychotic symptoms in children and adolescent outpatients. We secondarily aimed to assess the occurrence of adverse events (AE), with particular interest in psychiatric adverse events (PAE), timing of their onset, and the effectiveness of antidepressants in children and adolescents. METHODS We retrospectively evaluated the computerized medical records of children and adolescents treated with antidepressants (SSRIs or SNRIs) for depressive disorders, anxiety disorders, and obsessive-compulsive disorders. AE and Clinical Global Impressions scores were recorded. RESULTS Sixty-nine children and adolescents aged 13.3 ± 3.0 years were included. None of the patients treated presented with acute psychotic symptoms (delusions, hallucinations, and disorganized thinking or behavior). Duration of treatment extended over 13.4 ± 11.8 months. PAE occurred in 39% of cases. Of these, 16% included suicidality (ideations or attempts), and 3% included nonpsychotic hypomanic symptoms. Significant clinical improvement was achieved in 41% of patients. CONCLUSIONS In contrast to the clinical impression of some clinicians, antidepressant treatment in pediatric ambulatory population was not associated with emergence of psychotic symptoms.
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Affiliation(s)
- Mariela Mosheva
- 1 The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Tel Hashomer, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Ehud Mekori
- 1 The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Tel Hashomer, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Shir Kantor
- 3 University of Maryland, College Park , Maryland
| | - Yael Berg
- 1 The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Tel Hashomer, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Abraham Weizman
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel .,4 Research Unit, Geha Mental Health Center , Petah Tikva, Israel
| | - Doron Gothelf
- 1 The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Tel Hashomer, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
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Bailly D. [Pharmacological treatment of bipolar disorder in children and adolescents]. Encephale 2016; 43:254-258. [PMID: 27198073 DOI: 10.1016/j.encep.2016.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/08/2015] [Accepted: 01/04/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review the options for acute and maintenance pharmacological treatment of bipolar disorder in children and adolescents. METHODS A comprehensive literature review of randomized clinical trials and open-label studies was conducted. RESULTS Published data from randomized controlled trials show that antipsychotics are significantly more effective than mood stabilizers in the treatment of manic or mixed episodes. Few data are available related to the treatment of depressive episodes. No trials of selective serotonin reuptake inhibitors have been conducted. Only open trials suggest that lithium and lamotrigine may be effective, whereas quetiapine did not demonstrate efficacy relative to placebo in two studies. Studies regarding the effectiveness of antipsychotics and mood stabilizers for the comorbid disorders are also few and inconclusive. Although long-term treatment is a core aspect of the management of children and adolescents with bipolar disorder, there is a lack of consistent efficacy data. If non-controlled trials suggest that lithium, lamotrigine, quetiapine, ziprazidone, and the combination of risperidone and divalproex or lithium may be useful in some conditions, only aripiprazole has shown efficacy relative to placebo for long-term symptom reduction and relapse prevention. Safety data show that the most frequently reported adverse events in children and adolescents treated with mood stabilizers are gastrointestinal and neurological, whereas use of antipsychotics is mainly related to weight gain and sedation. Lastly, while results from studies having evaluated the impact of pharmacological treatment on neuropsychological functioning are inconsistent, some of them nevertheless suggest that treatment with mood stabilizers may be associated with specific impairments. CONCLUSION Despite recent developments in identifying effective pharmacological interventions, numerous critical gaps remain.
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Affiliation(s)
- D Bailly
- AP-HM, hôpital Sainte-Marguerite, pôle universitaire de psychiatrie, 270, boulevard de Sainte-Marguerite, 13374 Marseille cedex 09, France; Aix-Marseille université, 13284 Marseille, France.
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Murthy S, Mandl KD, Bourgeois F. Analysis of pediatric clinical drug trials for neuropsychiatric conditions. Pediatrics 2013; 131:1125-31. [PMID: 23650305 PMCID: PMC4074660 DOI: 10.1542/peds.2012-2694] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Neuropsychiatric conditions represent a large and increasing disease burden in children. A number of drugs are available for the treatment of these conditions, but most drugs have not been adequately tested in children, and off-label drug use remains widespread. We sought to define and quantify recent and ongoing clinical research on the use of neuropsychiatric drugs in children. METHODS Drug trials registered in ClinicalTrials.gov between 2006 and 2011 and studying neuropsychiatric conditions were selected and classified based on the drug's Food and Drug Administration (FDA) approval status in children. We measured the proportion of trials seeking to expand the use of a drug to pediatric patients and the proportion of available drugs studied in children. RESULTS Only 10% of neuropsychiatric trials focused on children. Of 303 drugs studied in both pediatric and adult populations, 90% lacked FDA approval in children and 97% were not approved in children for the indication studied. However, only 19% of all neuropsychiatric drugs were under study in pediatric populations, with as few as 8% of either antidepressant or antipsychotic drugs. Overall, 76% of pediatric drug trials examined a drug previously unapproved in children and 26% explored the use of a drug for a new indication. CONCLUSIONS Despite the rising prevalence of neuropsychiatric disease and the paucity of FDA-approved pediatric drugs, only a small proportion of trials focus on pediatric populations and these trials cover only a fraction of available drugs. This deficiency is most pronounced for depression and schizophrenia.
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Affiliation(s)
- Srinivas Murthy
- Department of Critical Care, Hospital for Sick Children, Toronto, ON, Canada.
| | - Kenneth D. Mandl
- Division of Emergency Medicine, and,Children’s Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology, Boston Children’s Hospital, Boston, Massachusetts; and,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Florence Bourgeois
- Division of Emergency Medicine, and,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Fernández-Navarro JJ, Ruiz-Ángel MJ, García-Álvarez-Coque MC. Reversed-phase liquid chromatography without organic solvent for determination of tricyclic antidepressants. J Sep Sci 2012; 35:1303-9. [DOI: 10.1002/jssc.201101106] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Taurines R, Gerlach M, Warnke A, Thome J, Wewetzer C. Pharmacotherapy in depressed children and adolescents. World J Biol Psychiatry 2011; 12 Suppl 1:11-5. [PMID: 21905988 DOI: 10.3109/15622975.2011.600295] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In children and adolescents, antidepressants are used in the treatment of depressive symptoms and several other psychiatric conditions. In the treatment of mild and moderate depressive symptoms, non-pharmacological approaches such as psychotherapy play a major role, a severe symptomatology may demand a combination with antidepressants. As first-choice medication for the treatment of juvenile depression, the selective serotonin reuptake inhibitor (SSRI) fluoxetine is recommended, due to its efficacy and approval. As second-choice antidepressants the SSRIs sertraline, escitalopram and citalopram might be used. Other antidepressants - such as tricyclic antidepressants, α(2)-adrenoceptor antagonists, selective noradrenalin reuptake inhibitors (SNRI) - may be alternatively used, but not as first- or second-choice medications. In the case of "off-label" use, patients and parents have to be carefully informed prior to the start of medication, after a thorough risk-benefit analysis. In the following overview we address a general framework, therapeutic strategies and the issues of antidepressant pharmacotherapy for the treatment of unipolar depression in childhood and adolescence.
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Affiliation(s)
- Regina Taurines
- Hospital of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany.
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West CHK, Ritchie JC, Weiss JM. Paroxetine-induced increase in activity of locus coeruleus neurons in adolescent rats: implication of a countertherapeutic effect of an antidepressant. Neuropsychopharmacology 2010; 35:1653-63. [PMID: 20357759 PMCID: PMC2888691 DOI: 10.1038/npp.2010.34] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 12/22/2009] [Accepted: 02/18/2010] [Indexed: 11/08/2022]
Abstract
The concern that antidepressant (AD) drugs, especially selective serotonin reuptake inhibitors and paroxetine (PAR) in particular, can increase suicidality during the early treatment of juvenile patients (children and adolescents) has created a dilemma for clinicians treating depressives. Although preclinical research cannot resolve controversy in this area, our present findings may provide insight into how AD drugs might, under certain conditions, exacerbate rather than ameliorate the depressive state. Both clinical and preclinical evidences indicate that the principal noradrenergic cell group in the brain, the locus coeruleus (LC), is overactive in depressives and that, conversely, effective AD treatments decrease the activity of LC neurons. We report here that short-term (2 and 4 days) administration of PAR produces an increase in the activity of LC neurons (spontaneous firing rate and sensory-evoked responses) in young rats, contrary to the 'therapeutic' decrease in activity typically observed in adult rats. Blood levels of PAR were lower in young rats than in adult rats, although similar low blood levels produced by a lower dose of PAR in adult rats failed to produce an increase in LC activity. In addition, activity of young rats in the swim test was determined to assess depressive-like responses. The same dose/durations of PAR, which produced the largest increases in LC activity in young rats, produced decreases in swim-test activity, indicating that brief administration of PAR in young rats can promote, rather than reduce, the depressive state. These results offer a model that may help screen potential adjunctive treatments to avoid early adverse effects of ADs.
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Mercolini L, Mandrioli R, Finizio G, Boncompagni G, Raggi MA. Simultaneous HPLC determination of 14 tricyclic antidepressants and metabolites in human plasma. J Sep Sci 2010; 33:23-30. [PMID: 20091716 DOI: 10.1002/jssc.200900493] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A HPLC method has been developed for the simultaneous determination of seven tricyclic antidepressants (TCAs) and seven metabolites in human plasma. The analyte separation was obtained using a C8 reversed phase column and a mobile phase composed of 68% aqueous phosphate buffer at pH 3.0 and 32% ACN. The UV detector was set at 220 nm and loxapine was used as the internal standard. A careful pre-treatment procedure for plasma samples was developed, using SPE on C2 cartridges, which gives satisfactory extraction yields (>80%) and good sample purification. The LOQs were always lower than 9.1 ng/mL and the LODs always lower than 3.1 ng/mL for all analytes. The method was successfully applied to plasma samples from depressed patients undergoing therapy with one or more TCA drugs. Precision data (RSD <8.1%), as well as accuracy results (recovery >80%), were satisfactory and no interference from other drugs was found. Hence the method seems to be suitable for the therapeutic drug monitoring of patients treated with TCAs under monotherapy or polypharmacy regimens.
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Affiliation(s)
- Laura Mercolini
- Laboratory of Pharmaco-Toxicological Analysis, Department of Pharmaceutical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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Bailly D. [Antidepressant use in children and adolescents]. Arch Pediatr 2009; 16:1415-8. [PMID: 19740636 DOI: 10.1016/j.arcped.2009.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 03/11/2009] [Accepted: 03/31/2009] [Indexed: 10/20/2022]
Abstract
Relative to placebo, selective serotonin reuptake inhibitors (SSRI) are efficacious for paediatric affective disorders, although their clinical effects appear relatively modest in major depressive disorder, intermediate in obsessive-compulsive disorder, and stronger in anxiety disorders. If SSRIs modestly increase the risk of occurrence of suicidal ideation and behavior, several studies show that their use is associated with a significant decrease in the suicide rates in children and adolescents, probably because of their efficacy, compliance, and low toxicity in overdose.
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Affiliation(s)
- D Bailly
- Pôle universitaire de psychiatrie, hôpital Sainte-Marguerite, 270 boulevard de Sainte-Marguerite, Marseille, France.
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