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Proteomic Analysis of the Antidepressant Effects of Shen–Zhi–Ling in Depressed Patients: Identification of Proteins Associated with Platelet Activation and Lipid Metabolism. Cell Mol Neurobiol 2018; 38:1123-1135. [DOI: 10.1007/s10571-018-0582-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/16/2018] [Indexed: 12/12/2022]
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2
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Anderson I. Lessons to be learnt from meta-analyses of newer versus older antidepressants. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.3.1.58] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Meta-analysis is the use of statistical techniques to analyse the findings of many individual analyses (Glass, 1977). It covers all aspects of the review process involving formulating relevant research questions, searching the literature, assessing the quality of studies and choosing relevant ones, extracting and combining the data (for review see Henry & Wilson, 1992; Wilson & Henry, 1992). Meta-analysis as part of a systematic review has advantages over a narrative review but there are problems in applying it in practice (Box 1).
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Undurraga J, Baldessarini RJ. Direct comparison of tricyclic and serotonin-reuptake inhibitor antidepressants in randomized head-to-head trials in acute major depression: Systematic review and meta-analysis. J Psychopharmacol 2017. [PMID: 28633600 DOI: 10.1177/0269881117711709] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A comparison across trials conducted over several decades suggested superior efficacy of tricyclic antidepressants (TCAs) over selective serotonin-reuptake inhibitors (SSRIs). However, this outcome may reflect a selective secular decline of responses after randomization to placebo. Remaining uncertainty encouraged direct comparison of the drug-types in trials involving randomized, head-to-head comparisons. METHODS We systematically identified reports of randomized trials of TCAs versus SSRIs for major depression in several digital databases, and applied standard meta-analytic and multiple-factor regression methods to analyze and pool the findings. RESULTS In 89 head-to-head trials, there was no detectable overall difference in responder rates or percent-improvement between TCAs and SSRIs. In addition to non-difference between drug-types, outcomes were unrelated to reporting-year, trial-size or nominal duration, proportion of women participants, initial depression ratings, rating scales, subjects/arm, imipramine-equivalent mg/day drug dose, or dropout rate. Trial size and duration increased significantly over the years 1980-2016. CONCLUSIONS Previous evidence suggesting superior benefits of TCAs over SSRIs for the treatment of acute major depression is probably an artifact of a selective secular decline in responses to placebo, as no difference was found in a large series of direct comparisons of these antidepressant-types.
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Affiliation(s)
- Juan Undurraga
- 1 International Consortium for Mood & Psychotic Disorder Research, Mailman Research Center, McLean Hospital, Belmont, USA.,2 Department of Psychiatry, Faculty of Medicine, Clinica Alemana Universidad del Desarrollo, Santiago, Chile.,3 Early Intervention Program, J Horwitz-Barak Psychiatric Institute, Santiago, Chile
| | - Ross J Baldessarini
- 1 International Consortium for Mood & Psychotic Disorder Research, Mailman Research Center, McLean Hospital, Belmont, USA.,4 Department of Psychiatry, Harvard Medical School, Boston, USA
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4
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Degnan AP, Tora GO, Huang H, Conlon DA, Davis CD, Hanumegowda UM, Hou X, Hsiao Y, Hu J, Krause R, Li YW, Newton AE, Pieschl RL, Raybon J, Rosner T, Sun JH, Taber MT, Taylor SJ, Wong MK, Zhang H, Lodge NJ, Bronson JJ, Macor JE, Gillman KW. Discovery of Indazoles as Potent, Orally Active Dual Neurokinin 1 Receptor Antagonists and Serotonin Transporter Inhibitors for the Treatment of Depression. ACS Chem Neurosci 2016; 7:1635-1640. [PMID: 27744678 DOI: 10.1021/acschemneuro.6b00337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Combination studies of neurokinin 1 (NK1) receptor antagonists and serotonin-selective reuptake inhibitors (SSRIs) have shown promise in preclinical models of depression. Such a combination may offer important advantages over the current standard of care. Herein we describe the discovery and optimization of an indazole-based chemotype to provide a series of potent dual NK1 receptor antagonists/serotonin transporter (SERT) inhibitors to overcome issues of ion channel blockade. This effort culminated in the identification of compound 9, an analogue that demonstrated favorable oral bioavailability, excellent brain uptake, and robust in vivo efficacy in a validated depression model. Over the course of this work, a novel heterocycle-directed asymmetric hydrogenation was developed to facilitate installation of the key stereogenic center.
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Affiliation(s)
- Andrew P. Degnan
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - George O. Tora
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - Hong Huang
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - David A. Conlon
- Chemical
Development, Bristol-Myers Squibb Company, New Brunswick, New Jersey 08903, United States
| | - Carl D. Davis
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - Umesh M. Hanumegowda
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - Xiaoping Hou
- Department of Chemical Synthesis, Bristol-Myers Squibb Company, Princeton, New Jersey 08543, United States
| | - Yi Hsiao
- Chemical
Development, Bristol-Myers Squibb Company, New Brunswick, New Jersey 08903, United States
| | - Joanna Hu
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - Rudolph Krause
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - Yu-Wen Li
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - Amy E. Newton
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - Rick L. Pieschl
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - Joseph Raybon
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - Thorsten Rosner
- Chemical
Development, Bristol-Myers Squibb Company, New Brunswick, New Jersey 08903, United States
| | - Jung-Hui Sun
- Department of Chemical Synthesis, Bristol-Myers Squibb Company, Princeton, New Jersey 08543, United States
| | - Matthew T. Taber
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - Sarah J. Taylor
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - Michael K. Wong
- Department of Chemical Synthesis, Bristol-Myers Squibb Company, Princeton, New Jersey 08543, United States
| | - Huiping Zhang
- Department of Chemical Synthesis, Bristol-Myers Squibb Company, Princeton, New Jersey 08543, United States
| | - Nicholas J. Lodge
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - Joanne J. Bronson
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - John E. Macor
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
| | - Kevin W. Gillman
- Research and Development, Bristol-Myers Squibb Company, Wallingford, Connecticut 06492, United States
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Darmon M, Al Awabdh S, Emerit MB, Masson J. Insights into Serotonin Receptor Trafficking: Cell Membrane Targeting and Internalization. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2015; 132:97-126. [PMID: 26055056 DOI: 10.1016/bs.pmbts.2015.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Serotonin receptors (5-HTRs) mediate both central and peripheral control on numerous physiological functions such as sleep/wake cycle, thermoregulation, food intake, nociception, locomotion, sexual behavior, gastrointestinal motility, blood coagulation, and cardiovascular homeostasis. Six families of the G-protein-coupled receptors comprise most of serotonin receptors besides the conserved 5-HT3R Cys-loop type which belongs to the family of Cys-loop ligand-gated cation channel receptors. Many of these receptors are targets of pharmaceutical drugs, justifying the importance for elucidating their coupling, signaling and functioning. Recently, special interest has been focused on their trafficking inside cell lines or neurons in conjunction with their interaction with partner proteins. In this review, we describe the trafficking of 5-HTRs including their internalization, desensitization, or addressing to the plasma membrane depending on specific mechanisms which are peculiar for each class of serotonin receptor.
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Affiliation(s)
- Michèle Darmon
- INSERM U894, Centre de Psychiatrie et Neurosciences, Paris, France; Centre de Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Sana Al Awabdh
- INSERM U894, Centre de Psychiatrie et Neurosciences, Paris, France; Centre de Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Michel-Boris Emerit
- INSERM U894, Centre de Psychiatrie et Neurosciences, Paris, France; Centre de Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Justine Masson
- INSERM U894, Centre de Psychiatrie et Neurosciences, Paris, France; Centre de Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Stockdale TP, Williams CM. Pharmaceuticals that contain polycyclic hydrocarbon scaffolds. Chem Soc Rev 2015; 44:7737-63. [DOI: 10.1039/c4cs00477a] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This review comprehensively explores approved pharmaceutical compounds that contain polycyclic scaffolds and the properties that these skeletons convey.
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Affiliation(s)
- Tegan P. Stockdale
- School of Chemistry and Molecular Biosciences
- University of Queensland
- St Lucia
- Australia
| | - Craig M. Williams
- School of Chemistry and Molecular Biosciences
- University of Queensland
- St Lucia
- Australia
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Wu R, Zhu D, Xia Y, Wang H, Tao W, Xue W, Xia B, Ren L, Zhou X, Li G, Chen G. A role of Yueju in fast-onset antidepressant action on major depressive disorder and serum BDNF expression: a randomly double-blind, fluoxetine-adjunct, placebo-controlled, pilot clinical study. Neuropsychiatr Dis Treat 2015; 11:2013-21. [PMID: 26273204 PMCID: PMC4532216 DOI: 10.2147/ndt.s86585] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Conventional antidepressants, including fluoxetine, have a major disadvantage in delayed onset of efficacy. Yueju, an herbal medicine used to treat mood disorders was recently found to exhibit rapid antidepressant effects. The present study was conducted to evaluate the role of Yueju in rapidly acting on major depressive disorder (MDD). METHODS Participants were MDD patients with scores of 24-item Hamilton Depression Rating Scale (HDRS-24) ≥20 and without history of antidepressant use. They randomly received daily oral doses of Yueju (23 g/day) plus fluoxetine (20 mg/day) (experimental group) or placebo plus fluoxetine (control group) for 7 days. HDRS-24 was used as the primary outcome measurement at baseline, and on days 1, 3, 5, and 7. Concentrations of serum brain-derived neurotrophic factor (BDNF) were assessed at baseline and on days 1 and 7. RESULTS In all, 18 participants met the criteria for data analysis. Compared to baseline level, only experimental group showed significant decrease of HDRS-24 score from day 3 to day 7 (P<0.05). Experimental group also showed significant improvement compared with control group from day 3 to day 7 (P<0.05). No correlation between treatment outcomes with serum BDNF levels was observed. However, experimental group showed significant correlation for serum BDNF level on day 1 with day 7 (r=0.721, P=0.028), whereas the control group did not. CONCLUSION Yueju likely contributes to fast-onset antidepressant effects on MDD. Further investigation is necessary to firmly establish the ancient formula as a safe, efficacious, and rapidly acting alternative medicine for MDD treatment.
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Affiliation(s)
- Ruyan Wu
- Center for Translational Systems Biology and Neuroscience, Key Laboratory of Integrative Biomedicine of Brain Diseases, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Dandan Zhu
- Center for Translational Systems Biology and Neuroscience, Key Laboratory of Integrative Biomedicine of Brain Diseases, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Youchun Xia
- The Fourth People's Hospital of Taizhou, Taizhou, People's Republic of China
| | - Haosen Wang
- The Fourth People's Hospital of Taizhou, Taizhou, People's Republic of China
| | - Weiwei Tao
- Center for Translational Systems Biology and Neuroscience, Key Laboratory of Integrative Biomedicine of Brain Diseases, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Wenda Xue
- Center for Translational Systems Biology and Neuroscience, Key Laboratory of Integrative Biomedicine of Brain Diseases, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Baomei Xia
- Center for Translational Systems Biology and Neuroscience, Key Laboratory of Integrative Biomedicine of Brain Diseases, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Li Ren
- Center for Translational Systems Biology and Neuroscience, Key Laboratory of Integrative Biomedicine of Brain Diseases, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Xin Zhou
- Center for Translational Systems Biology and Neuroscience, Key Laboratory of Integrative Biomedicine of Brain Diseases, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Guochun Li
- School of Basic Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Gang Chen
- Center for Translational Systems Biology and Neuroscience, Key Laboratory of Integrative Biomedicine of Brain Diseases, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
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9
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Abstract
BACKGROUND This is an update of a Cochrane review first published in The Cochrane Library in Issue 4, 2006 and previously updated in 2009.Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. It has been compared with chronic pain, and may be associated with depression or depressive symptoms which can affect quality of life and the ability to work. Antidepressant drugs have been used to treat tinnitus in patients with and without depressive symptoms. OBJECTIVES To assess the effectiveness of antidepressants in the treatment of tinnitus and to ascertain whether any benefit is due to a direct tinnitus effect or a secondary effect due to treatment of concomitant depressive states. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; PsycINFO; CINAHL; Web of Science; BIOSIS; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 5 January 2012. SELECTION CRITERIA Randomised controlled clinical studies of antidepressant drugs versus placebo in patients with tinnitus. DATA COLLECTION AND ANALYSIS Two authors critically appraised the retrieved studies and extracted data independently. Where necessary we contacted study authors for further information. MAIN RESULTS Six trials involving 610 patients were included. Trial quality was generally low. Four of the trials looked at the effect of tricyclic antidepressants on tinnitus, investigating 405 patients. One trial investigated the effect of a selective serotonin reuptake inhibitor (SSRI) in a group of 120 patients. One study investigated trazodone, an atypical antidepressant, versus placebo. Only the trial using the SSRI drug reached the highest quality standard. None of the other included trials met the highest quality standard, due to use of inadequate outcome measures, large drop-out rates or failure to separate the effects on tinnitus from the effects on symptoms of anxiety and depression. All the trials assessing tricyclic antidepressants suggested that there was a slight improvement in tinnitus but these effects may have been attributable to methodological bias. The trial that investigated the SSRI drug found no overall improvement in any of the validated outcome measures that were used in the study although there was possible benefit for a subgroup that received higher doses of the drug. This observation merits further investigation. In the trial investigating trazodone, the results showed an improvement in tinnitus intensity and in quality of life after treatment, but in neither case reached statistical significance. Reports of side effects including sedation, sexual dysfunction and dry mouth were common. AUTHORS' CONCLUSIONS There is as yet insufficient evidence to say that antidepressant drug therapy improves tinnitus.
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Affiliation(s)
- Paolo Baldo
- Pharmacy Unit, Drug Information Centre, CRO Aviano - Centro di RiferimentoOncologico IRCCS, Aviano (PN), Italy. .
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Koren G, Nordeng H. Antidepressant use during pregnancy: the benefit-risk ratio. Am J Obstet Gynecol 2012; 207:157-63. [PMID: 22425404 DOI: 10.1016/j.ajog.2012.02.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 01/14/2012] [Accepted: 02/14/2012] [Indexed: 11/25/2022]
Abstract
Antidepressants are used commonly in pregnancy. Physicians who provide health care for pregnant women with depression must balance maternal well-being with potential fetal risks of these medications. Over the last decade, scores of original and review articles have discussed whether selective serotonin reuptake inhibitors-selective serotonin norepinephrine reuptake inhibitors possess risks to the fetus; however, very little has been done to integrate these potential risks, if they exist, into an overall context of a benefit:risk ratio. This review aims at presenting an updated analysis of fetal and maternal exposure to selective serotonin or norepinephrine reuptake inhibitors to allow an evidence-based benefit:risk ratio. When a psychiatric condition necessitates pharmacotherapy, the benefits of such therapy far outweigh the potential minimal risks of cardiac malformations, primary pulmonary hypertension of the newborn infant, or poor neonatal adaptation syndrome.
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Paterson NE, Balci F, Campbell U, Olivier BE, Hanania T. The triple reuptake inhibitor DOV216,303 exhibits limited antidepressant-like properties in the differential reinforcement of low-rate 72-second responding assay, likely due to dopamine reuptake inhibition. J Psychopharmacol 2011; 25:1357-64. [PMID: 20305042 DOI: 10.1177/0269881110364272] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is a need for antidepressants with novel mechanisms of action. One approach has been to develop compounds that inhibit reuptake of all three monoamines in the central nervous system, for example DOV216,303. Differential reinforcement of low-rate (72-s) responding is a behavioral test that is predictive of antidepressant-like properties. The effects of antidepressant compounds belonging to multiple classes, the anxiolytic diazepam and the antipsychotic haloperidol, were assessed in the DRL-72s task. Subsequently, the antidepressant-like properties of acute DOV216,303 were assessed. The selective serotonin reuptake inhibitor fluvoxamine, the preferential norepinephrine reuptake inhibitor desipramine and the tricyclic antidepressant imipramine exhibited antidepressant-like properties in the DRL-72s task. The atypical antidepressant bupropion, which inhibits dopamine and norepinephrine reuptake, and the selective dopamine transporter inhibitor GBR12909, changed reinforcement and response rates and inter-response time distribution in an opposite direction compared with the antidepressant compounds tested. The antipsychotic haloperidol exhibited antidepressant-like properties by increasing reinforcement rate, but failed to alter inter-response time distribution. Diazepam did not change reinforcement or response rates or inter-response time distribution. The triple reuptake inhibitor DOV216,303 significantly enhanced reinforcement rate at one intermediate dose, but exhibited similar effects as bupropion and GBR12909 on inter-response time distribution. The studies identified limited antidepressant-like properties of the triple reuptake inhibitor DOV216,303, likely due to dopamine transporter inhibition counteracting the effects of norepinephrine and serotonin transporter inhibition.
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Mcferran D, Baguley D. The efficacy of treatments for depression used in the management of tinnitus. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/16513860801945224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Holmes AM, Rudd JA, Tattersall FD, Aziz Q, Andrews PLR. Opportunities for the replacement of animals in the study of nausea and vomiting. Br J Pharmacol 2009; 157:865-80. [PMID: 19371333 PMCID: PMC2737646 DOI: 10.1111/j.1476-5381.2009.00176.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 11/17/2008] [Accepted: 01/08/2009] [Indexed: 12/24/2022] Open
Abstract
Nausea and vomiting are among the most common symptoms encountered in medicine as either symptoms of disease or side effects of treatments. Developing novel anti-emetics and identifying emetic liability in novel chemical entities rely on models that can recreate the complexity of these multi-system reflexes. Animal models (especially the ferret and dog) are the current gold standard; however, the selection of appropriate models is still a matter of debate, especially when studying the subjective human sensation of nausea. Furthermore, these studies are associated with animal suffering. Here, following a recent workshop held to review the utility of animal models in nausea and vomiting research, we discuss the limitations of some of the current models in the context of basic research, anti-emetic development and emetic liability detection. We provide suggestions for how these limitations may be overcome using non-animal alternatives, including greater use of human volunteers, in silico and in vitro techniques and lower organisms.
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Affiliation(s)
- A M Holmes
- National Centre for the Replacement, Refinement and Reduction of Animals in Research, London, W1B 1AL, UK.
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14
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¿Fármacos en la depresión menor? Med Clin (Barc) 2009; 132:142-3. [DOI: 10.1016/j.medcli.2008.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 06/09/2008] [Indexed: 11/23/2022]
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Vezmar S, Miljkovic B, Vucicevic K, Timotijevic I, Prostran M, Todorovic Z, Pokrajac M. Pharmacokinetics and Efficacy of Fluvoxamine and Amitriptyline in Depression. J Pharmacol Sci 2009; 110:98-104. [DOI: 10.1254/jphs.09013fp] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Halbreich U, Kahn LS. Atypical depression, somatic depression and anxious depression in women: are they gender-preferred phenotypes? J Affect Disord 2007; 102:245-58. [PMID: 17092565 DOI: 10.1016/j.jad.2006.09.023] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Both depression and anxiety disorders affect women at rates significantly greater than men. Women also have a documented higher frequency of comorbid depression and anxiety disorders, and a three-fold higher prevalence of atypical depression. HYPOTHESES These gender differences are mainly due to specific depressive phenotypes including anxious depression and atypical depression. The prevalence of comorbid anxiety and depression strongly suggests overlap of pathophysiological mechanisms-which in women are also affected by fluctuations in gonadal hormones. Similar efficacy of serotonergic antidepressants as treatment for anxiety disorders as well as depressions further underscores the blurred boundaries between these two descriptive entities. CONCLUSIONS Symptoms of depression and anxiety may be a departure point for differential diagnosis in which dimensionally-based phenotypes substantiated by pathobiology would replace current descriptive entities. It is suggested that at least some biologically-based dysphorias may be specific to women, ensuing from the combination of specific vulnerabilities, and complex interactions between brain mechanisms and gonadal hormones.
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Affiliation(s)
- Uriel Halbreich
- Biobehavior Research, State University of New York at Buffalo, Hayes Annex C Ste # 1, 3435 Main Street, Buffalo, NY 14214, USA.
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Khan A, Schwartz K, Kolts RL, Ridgway D, Lineberry C. Relationship between depression severity entry criteria and antidepressant clinical trial outcomes. Biol Psychiatry 2007; 62:65-71. [PMID: 17141744 DOI: 10.1016/j.biopsych.2006.08.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Revised: 07/19/2006] [Accepted: 08/19/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND We assessed whether increasing the minimum prerandomization Hamilton Depression Rating Scale (HAM-D) score to enrich the severity of the depressed sample affects antidepressant trial outcome. METHODS Using the Food and Drug Administration Summary Basis of Approval reports, we examined outcome data from 51 clinical trials (11,270 depressed patients) evaluating 10 investigational antidepressants. RESULTS Using four categories of trials with increasing minimum HAM-D entry trial criteria, we found no statistically significant relationship between prerandomization categories and trial outcome overall. Although there were minor differences in trial outcome among the three categories with the lowest entry criteria (mean 49%, range, 44.4%-50.0%), the antidepressant trials requiring the highest prerandomization HAM-D score (> or = 20 HAM-D 17) had the lowest frequency of positive outcomes (20%), chi(2) = 4.04, df =1, p = .04. Paradoxically, high entry criteria requirements failed to increase reliably actual mean total prerandomization HAM-D scores, although mean total prerandomization HAM-D scores and use of flexible dosing were associated with higher rates of positive outcome. A greater placebo response was seen in trials requiring higher prerandomization depressive symptoms. CONCLUSIONS In summary, requiring higher prerandomization depressive symptoms was not associated with an increased rate of favorable outcomes among these 51 antidepressant trials.
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Affiliation(s)
- Arif Khan
- Northwest Clinical Research Center, Bellevue, Washington 98004, USA.
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Rambelomanana S, Depont F, Forest K, Hébert G, Blazejewski S, Fourrier-Réglat A, Molimard M, Moore N. Antidepressants: general practitioners' opinions and clinical practice. Acta Psychiatr Scand 2006; 113:460-7. [PMID: 16677222 DOI: 10.1111/j.1600-0447.2006.00793.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe and compare general practitioners' (GPs) opinions on antidepressant drugs and their prescriptions to depressed patients. METHOD Between November 2000 and July 2001 a representative sample of French GPs was asked their opinion of the 15 most prescribed antidepressants, and then to describe the treatments of the current depressive episode of four depressive patients each, their changes and the reasons thereof. RESULTS One hundred and eighty-one GPs and 778 patients participated. The best-ranked antidepressants by the GPs were paroxetine, fluoxetine, sertraline and clomipramine for efficacy, and paroxetine, tianeptine, sertraline and fluoxetine for tolerability. In patients, the drugs most often prescribed were fluoxetine, paroxetine, and sertraline. Those least often stopped for intolerance were moclobemide (0%), dosulepine (0%), venlafaxine (4.5%) and citalopram (5.0%), and maprotiline (0%), citalopram (1.7%) and venlafaxine (2.3%) for lack of efficacy. The best predictor for prescription of antidepressants was the GPs' overall ranking, itself depending on opinions of the tolerability and efficacy of the drug. However, opinions of tolerability and efficacy were not related to the rates of treatment discontinuation for intolerability or inefficacy. CONCLUSION Prescriber opinion does not seem related to actual product performance.
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Abstract
This paper provides a systematic, evidence-based review of the psychological issues confronted by patients at the end of life, drawing on recent literature. The epidemiology, approach to clinical assessment, clinical presentation, and therapeutic options related to common psychological issues that arise in end-stage illness are described. The spectrum of normal and dysfunctional reactions are identified, and approaches to enhancing coping and quality of life are emphasized. The learner will be able to describe: (1) normal coping responses of patients at the end of life; (2) epidemiology of common psychiatric disorders at the end of life; (3) the approach to clinical assessment of psychological distress at the end of life; and (4) therapeutic approaches to common psychological problems at the end of life.
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Affiliation(s)
- Susan D Block
- Division of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital and Harvard Medical School Center for Palliative Care, Boston, Massachusetts 02115, USA.
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21
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Suzuki Y, Sawamura K, Someya T. Polymorphisms in the 5-hydroxytryptamine 2A receptor and CytochromeP4502D6 genes synergistically predict fluvoxamine-induced side effects in japanese depressed patients. Neuropsychopharmacology 2006; 31:825-31. [PMID: 16205777 DOI: 10.1038/sj.npp.1300919] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
5-Hydroxytryptamine (5-HT) receptors are thought to be associated with the gastrointestinal side effects induced by selective serotonin reuptake inhibitors. CytochromeP450 (CYP) 2D6 may also be associated with the side effects induced by fluvoxamine, since the plasma fluvoxamine concentration depends on a CYP2D6 gene polymorphism. This study investigated whether 5-HT receptor and CYP2D6 gene polymorphisms could predict the occurrence of the side effects. The effects of 5-HT receptor and CYP2D6 gene polymorphisms on the incidence of gastrointestinal side effects induced by fluvoxamine were investigated in 100 depressed outpatients who gave written consent to participate in the study. The patients visited every 2 weeks until the week 12 end point and the fluvoxamine dose was changed in response to their clinical symptoms. All side effects, including the gastrointestinal side effects, were assessed at each visit. Polymerase chain reaction was used to determine A-1438G of the 5-HT2A receptor, C195T and Pro16Ser of the 5-HT3A receptor, Tyr129Ser of the 5-HT3B receptor, and the *5 and *10 alleles of CYP2D6. Both the A-1438G polymorphism of the 5-HT2A receptor gene and the CYP2D6 gene polymorphism had significant effects on the incidence of gastrointestinal side effects. Cox regression was used to analyze the combination effect of the two polymorphisms on the gastrointestinal side effects. Cox regression analysis showed that lower metabolizers (LMs) of CYP2D6 with the G/G genotype of the 5-HT2A A-1438G polymorphism had a 4.242-fold (P = 0.009) and LMs with the A/G genotype had a 4.147-fold (P = 0.004) higher risk of developing gastrointestinal side effects than normal metabolizers with the A/A genotype. The 5-HT3A and 3B gene polymorphisms had no significant effects on the incidence of gastrointestinal side effects. 5-HT2A receptor and CYP2D6 gene polymorphisms had a synergistic effect for the prediction of fluvoxamine-induced gastrointestinal side effects.
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Affiliation(s)
- Yutaro Suzuki
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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22
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Sugai T, Suzuki Y, Sawamura K, Fukui N, Inoue Y, Someya T. The effect of 5-hydroxytryptamine 3A and 3B receptor genes on nausea induced by paroxetine. THE PHARMACOGENOMICS JOURNAL 2006; 6:351-6. [PMID: 16534507 DOI: 10.1038/sj.tpj.6500382] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We investigated the effect of 5-hydroxytryptamine 3A and 3B receptor (HTR3A and HTR3B) gene polymorphisms on nausea induced by paroxetine in Japanese psychiatric patients. Blood samples were collected from 78 individuals after at least 2 weeks treatment with the same daily dose of paroxetine. The patients visited every 2 weeks and the paroxetine dose was changed in response to their clinical symptoms. Nausea was assessed at each visit. The Tyr129Ser polymorphism of the HTR3B gene had a significant effect on the incidence of nausea (P=0.038). Logistic regression analysis also showed that patients with the Tyr/Tyr genotype had a 3.95-fold (P=0.048) higher risk of developing nausea than patients with the Ser allele. HTR3A gene polymorphisms and the CYP2D6 gene polymorphisms had no significant effect on the incidence of nausea. The mean score of nausea severity was corrected by the Bonferroni test. HTR3B gene polymorphisms are significant predictors of paroxetine-induced nausea.
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Affiliation(s)
- T Sugai
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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23
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Kasper S, Olié JP. A meta-analysis of randomized controlled trials of tianeptine versus SSRI in the short-term treatment of depression. Eur Psychiatry 2004; 17 Suppl 3:331-40. [PMID: 15177089 DOI: 10.1016/s0924-9338(02)00651-x] [Citation(s) in RCA: 205] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A meta-analysis was performed to compare the efficacy of tianeptine and selective serotonin reuptake inhibitors (SSRI) in the short-term treatment of depression. Consecutive selection and inclusion processes allowed five studies to be selected: two studies on tianeptine versus fluoxetine, two studies on tianeptine versus paroxetine, and one study on tianeptine versus sertraline. A total of 1348 patients were included in the five studies; 681 subjects received an SSRI and 667 tianeptine. A strict step-by-step methodology was applied in order to legitimize this meta-analysis and to interpret the results. Considering all the patients or those with a Montgomery-Asberg Depression Rating Scale (MADRS) inclusion score greater than 28, none of the assessed parameters (MADRS total score and responder rate) revealed any significant difference between the two treatment groups. Further analysis based on clinical global impression (CGI) items found no significant difference, except for CGI item 3 (therapeutic index), where a tendency (P=0.06 or 0.07 depending on the methodology) was found in favor of tianeptine. All in all, this study confirmed that tianeptine is at least as effective as SSRI, with a trend for a better acceptability profile in the treatment of depressed patients.
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Affiliation(s)
- S Kasper
- Department of general Psychiatry, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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24
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Depont F, Rambelomanana S, Le Puil S, Begaud B, Verdoux H, Moore N. Antidepressants: psychiatrists' opinions and clinical practice. Acta Psychiatr Scand 2003; 108:24-31. [PMID: 12807374 DOI: 10.1034/j.1600-0447.2003.00088.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe and compare psychiatrists' opinion on antidepressant drugs and their prescriptions to depressed patients. METHOD Between January and September 1999 a representative sample of French psychiatrists was asked their opinion of the 15 most prescribed antidepressants, and then to describe the treatments of the current depressive episode of four depressive patients each, their changes and the reason thereof. RESULTS A total of 232 psychiatrists and 935 patients participated. The best ranked antidepressants were clomipramine, paroxetine and amitriptyline for efficacy, tianeptine, paroxetine and citalopram for tolerability. In patients, the most often prescribed were paroxetine, fluoxetine and venlafaxine. Those least often stopped for intolerance were tianeptine (2.9%), citalopram (5.2%), venlafaxine (3.3%) and amitriptyline (5.7%) for lack of efficacy. There was no difference in stopping rates for inefficacy of tricyclics and serotonin-selective agents. CONCLUSION The best predictors for the prescribed antidepressants were the psychiatrists' overall rankings and opinions of the tolerability of the drug.
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Affiliation(s)
- F Depont
- Departments of Pharmacology and Adult Psychiatry, Public Health Research Institute IFR99, Université Victor Segalen, Bordeaux, France
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Baca E, González de Chávez M, García-Toro M, Pérez-Arnau F, Porras-Chavarino A. Sertraline is more effective than imipramine in the treatment of non-melancholic depression: results from a multicentre, randomized study. Prog Neuropsychopharmacol Biol Psychiatry 2003; 27:493-500. [PMID: 12691786 DOI: 10.1016/s0278-5846(03)00038-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The acute treatment efficacy, tolerability, and effects on health-related quality of life of sertraline (50-200 mg/day) versus imipramine (75-225 mg/day) were compared in outpatients with non-melancholic depression. The study employed an open-label, parallel-group design. One hundred and sixteen patients were randomized to receive sertraline and 123 to receive imipramine for 8 weeks. In the intent-to-treat (ITT), last-observation-carried-forward (LOCF) analysis, sertraline produced statistically significantly greater improvements in depressive (21-item Hamilton Depression Rating Scale [HAM-D(21)] scores of 24.9 and 24.4 were reduced to 10.3 and 13.1 at endpoint, P<.005) and anxiety symptoms (Hamilton Anxiety Rating Scale [HAM-A] scores of 21.8 and 21.9 were reduced to 9.5 and 13.9, P<.01), as well as in response (69.0% versus 53.7% at endpoint, P=.016) and remission rates (51.3% versus 38.0% at endpoint, P=.041) from week 4 onwards compared with imipramine. The proportion of patients who were 'very much improved' or 'much improved' (Clinical Global Impressions Scale of Improvement [CGI-I] score of 1 or 2) was significantly higher at endpoint in the sertraline group (76.1%) than in the imipramine group (62.8%) (P=.028). At week 8, patients in both treatment groups showed clear improvements in quality of life, although nonstatistically significant differences were evident in the quality of life of sertraline- versus imipramine-treated patients. Sertraline was significantly superior in tolerability with less discontinuations due to adverse events (10.3%) compared with the imipramine group (24.4%) (P=.004). It was concluded that sertraline is more effective than imipramine in the acute treatment of depressive and anxiety symptoms in patients with non-melancholic depression.
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Affiliation(s)
- Enrique Baca
- Department of Psychiatry, Hospital Puerta de Hierro, Madrid, Spain
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26
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Long-term efficacy of sertraline in the prevention of alcoholic relapses in alcohol-dependent patients: A single-center, double-blind, randomized, placebo-controlled, parallel-group study. Curr Ther Res Clin Exp 2002. [DOI: 10.1016/s0011-393x(02)80096-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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27
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Yaryura-Obias MA, Pinto A, Neziroglu F. The integration of primary anorexia nervosa and obsessive-compulsive disorder. Eat Weight Disord 2001; 6:174-80. [PMID: 11808812 DOI: 10.1007/bf03339740] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
This paper explores the relationship between primary anorexia nervosa (PAN) and obsessive-compulsive disorder (OCD) in both their concomitant and their sequential presentation. Their clinical descriptions demonstrate the presence of obsessionality and compulsiveness that seem to interface during their course and overlap in their symptomatologies has been noted for over sixty years. However, recent research in this regard is scant. Commonalities in pathophysiology indicate disturbances in neurotransmitters, notably serotonin. Biological challenges have failed to establish a definitive correlation with PAN and OCD, whether in combination or individually. We may postulate that, with limitations, they share some anatomical pathways. The areas affected are the amygdala, cingulum and orbito-frontal cortex. Few studies, however, have been devoted to the treatment of concomitant PAN and OCD.
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Affiliation(s)
- M A Yaryura-Obias
- Department of Biopsychosocial Research, Bio-Behavioral Institute, Great Neck, New York 11021, USA.
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28
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Abstract
We investigated the association between fluvoxamine and nausea from various viewpoints. The incidence of nausea induced by fluvoxamine was 29% (12/41). Plasma 5-hydroxyindoleacetic acid (p5-HIAA) levels after fluvoxamine administration were significantly higher in patients with nausea (6.6+/-3.4 ng/ml) than in those without nausea (3.5+/-2.7 ng/ml). On the other hand, no significant differences were found between patients with and patients without nausea in terms of sex, age, initial and maximum dosages of fluvoxamine and its plasma concentrations, and clinical response to fluvoxamine. However, the incidence of nausea in patients who were initially administered fluvoxamine at under 50 mg/day was significantly lower than in those who were started at above 50 mg/day. In addition, mosapride, a member of the benzamide family, was effective in alleviating fluvoxamine-induced nausea. These results suggest that fluvoxamine-induced nausea is associated with hyperactivity in serotonergic neurons.
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Affiliation(s)
- N Ueda
- Department of Psychiatry, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanisi-ku, Kitakyusyu, Fukuoka, 807-8555, Japan.
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29
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Abstract
Citalopram is a selective serotonin (5-HT) reuptake inhibitor (SSRI) developed by H. Lundbeck A/S in Denmark. It is the most selective serotonin antidepressant with proven efficacy, a favourable pharmacokinetic profile and a low potential for interactions with other concomitant medication. The drug has a low incidence of side effects, even when compared to the other SSRIs and good patient compliance and satisfaction is a feature of this drug. These factors make the drug a good choice for depressed patients who require continuation and long-term treatment, as well as for elderly patients. Copyright 2000 John Wiley & Sons, Ltd.
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Affiliation(s)
- Andre F. Joubert
- Lundbeck Institute, Grevinde Danners Palæ, Skodsborg strandvej 113, DK 2942 Skodsburg, Denmark
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30
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Kasper S, el Giamal N, Hilger E. Reboxetine: the first selective noradrenaline re-uptake inhibitor. Expert Opin Pharmacother 2000; 1:771-82. [PMID: 11249515 DOI: 10.1517/14656566.1.4.771] [Citation(s) in RCA: 194] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Several treatment approaches are available for treatment of depression. However, reboxetine is the first selective noradrenaline re-uptake inhibitor. Whereas formerly only noradrenaline re-uptake inhibitors with a mixed mechanism of action were available. These included action not only at noradrenergic, but also at serotonergic and other neurotransmitter-sites. Thus, reboxetine represents the first of a new class of antidepressant agents with specificity for the noradrenergic system. Reboxetine has been shown to be an effective first-line treatment for patients with all grades of depression, to be effective in the prevention of relapse and recurrence and to offer significant benefits in terms of relieving the impaired social functioning associated with depressive disorders. Reboxetine was significantly superior to the serotonergic compound fluoxetine in improvement of social functioning in both the general depressed population and in those patients who achieved symptomatic remission, indicating a superior quality of remission. Altogether reboxetine was well tolerated during the acute and long-term treatment phase; side-effects such as increased sweating, constipation and dry mouth were the most prominent to be reported. The availability of reboxetine represents a significant addition to the currently available pharmacologic armamentarium for the treatment of depression.
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Affiliation(s)
- S Kasper
- Department of General Psychiatry, University of Vienna, Austria.
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31
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Anderson IM. Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. J Affect Disord 2000; 58:19-36. [PMID: 10760555 DOI: 10.1016/s0165-0327(99)00092-0] [Citation(s) in RCA: 701] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND A meta-analysis of the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) against tricyclic antidepressants (TCAs) in depressed patients was carried out. METHODS Efficacy data from 102 randomised controlled trials (10706 patients) were pooled to provide a summary variance-weighted effect size. Tolerability data from 95 studies (10553 patients) were combined to give variance-weighted relative risk of drop out for all reasons and for adverse effects from each study. The effect of age, treatment setting, severity and TCA dose were examined as well as the performance of individual SSRIs and TCAs where there were sufficient studies. RESULTS There is no overall difference in efficacy between SSRIs and TCAs (effect size -0.03, 95% confidence interval -0.09 to 0.03). TCAs do appear more effective in in-patients (-0.23, -0.40 to -0.05) and amitriptyline is more effective than SSRI comparators (-0.14, -0.25 to -0.03) but publication bias cannot be excluded. The SSRIs are better tolerated, with significantly lower rates of treatment discontinuations overall (relative risk 0.88, 0.83 to 0.93; number needed to treat 26) and due to side effects (0.73, 0.67 to 0.80; number needed to treat 33). Individual SSRIs show a similar advantage except for fluvoxamine which does not differ from the TCAs. Individual TCAs show a similar disadvantage in tolerability compared to SSRIs except for dothiepin against which SSRI treatment results in more side-effect related drop outs (2.64, 1.50 to 4.63; number needed to harm 12). LIMITATIONS The evidence is from short-term studies and subgroup analyses may result in chance results. CONCLUSIONS Overall efficacy between the two classes is comparable but SSRIs are not proven to be as effective as TCAs in in-patients and against amitriptyline. SSRIs have a modest advantage in terms of tolerability against most TCAs.
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Affiliation(s)
- I M Anderson
- Neuroscience and Psychiatry Unit, Room G809, Stopford Building, University of Manchester, Oxford Road, Manchester, UK.
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32
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Abstract
Patients with neurologic illness frequently develop secondary mood disorders that are broadly categorized as unipolar or bipolar. Accurate diagnosis is essential because the treatment of unipolar disorders is markedly different from that of bipolar disorders. Aggressive treatment of mood disorders improves quality of life, reduces morbidity and mortality, and may prevent worsening of both psychiatric and neurologic disease. Antidepressants and psychotherapy are both effective for patients suffering from depressive disorders. Choice of antidepressant depends on the patient's particular symptom complex; medication side effects, which may exacerbate the underlying neurologic condition; potential interactions with other drugs; and costs. Bipolar disorder associated with neurologic illness typically requires treatment with mood stabilizers such as lithium, divalproex sodium, carbamazepine, or verapamil. Although psychotherapy in combination with pharmacologic therapy improves the outcome in bipolar illness, psychotherapy alone is not effective for this condition. Electroconvulsive therapy is an effective treatment for both depression and mania. It may have particular usefulness in Parkinson's disease, for which it has been shown to improve the movement disorder itself. Treatment of bipolar disorder, psychotic depression, or refractory depression is complicated and should be referred to a psychiatrist.
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Affiliation(s)
- CD Schneck
- University of Colorado Health Sciences Center, Department of Psychiatry, Campus Box A011-07, 4455 East 12th Avenue, Denver, CO 80220, USA.
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33
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Block SD. Assessing and managing depression in the terminally ill patient. ACP-ASIM End-of-Life Care Consensus Panel. American College of Physicians - American Society of Internal Medicine. Ann Intern Med 2000; 132:209-18. [PMID: 10651602 DOI: 10.7326/0003-4819-132-3-200002010-00007] [Citation(s) in RCA: 212] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Psychological distress often causes suffering in terminally ill patients and their families and poses challenges in diagnosis and treatment. Increased attention to diagnosis and treatment of depression can improve the coping mechanisms of patients and families. This paper reviews the clinical characteristics of normal grief and clinical depression and explains strategies for differential diagnosis. Although some literature discusses the psychological issues facing elderly patients and terminally ill patients with cancer, less is known about patients with end-stage pulmonary, cardiac, renal, and neurologic disease. Data on the effectiveness of interventions in terminally ill patients are lacking. Treatment recommendations in this paper represent extrapolations from existing literature and expert opinion. Diagnosing and treating depression in terminally ill patients involve unique challenges. Evidence of hopelessness, helplessness, worthlessness, guilt, and suicidal ideation are better indicators of depression in this context than neurovegetative symptoms. Although terminally ill patients often have suicidal thoughts, they are usually fleeting. Sustained suicidal ideation should prompt a comprehensive evaluation. Clinicians should have a low threshold for treating depression in terminally ill patients. Psychostimulants, because of their rapid onset of action, are useful agents and are generally well tolerated. Selective serotonin reuptake inhibitors and tricyclic antidepressants may also be used. Psychological interventions-including eliciting concerns and conveying the potential for connection, meaning, reconciliation, and closure in the dying process-can also facilitate coping.
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Affiliation(s)
- S D Block
- Dana-Farber Cancer Institute, Boston, MA 02115, USA
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34
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Abstract
A history of depression or depressive symptomatology has been reported in up to two-thirds of patients with medically intractable epilepsy, whereas community studies have demonstrated affective disorder only in a quarter of these patients. Depression has been reported peri- and interictally. However, differentiation may be difficult in patients with frequent seizures. Most authors have found no correlation between depression and epilepsy variables. However, complex partial seizures, especially of temporal lobe origin, appear to be etiologic factors, particularly in men with left-sided foci. Depression is also more common in patients treated with polytherapy especially with barbiturates, phenytoin, and vigabatrin. Depression has also been described de novo after temporal lobectomy. Psychosocial factors also play a part, but underlying risk factors (e.g., genetic, endocrine and metabolic) may explain the increased rates of depression in people with epilepsy compared to those with other neurologic and chronic medical conditions. The depression appears to be endogenous. Patients tend to exhibit fewer neurotic traits and more psychotic symptoms such as paranoia, delusions, and persecutory auditory hallucinations. Treatment approaches include psychotherapy, rationalization of antiepileptic drug medication, antidepressant treatment, and ECT. The tricyclic and related antidepressants appear to be epileptogenic, especially in people at high risk (personal or family history of seizures, abnormal pretreatment EEG, brain damage, alcohol or substance abuse/withdrawal and concurrent use of CNS-active medication). Seizures tend to occur early in treatment or after dose increments, especially if rapidly titrated. There is little evidence that the newer antidepressants, e.g., selective serotonin reuptake inhibitors, moclobemide, venlafaxine, or nefazodone are more epileptogenic than placebo.
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Affiliation(s)
- M V Lambert
- Department of Psychological Medicine (Neuropsychiatry), Institute of Psychiatry and GKT School of Medicine, London, United Kingdom
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35
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Abstract
Depression is commonly seen in patients with chronic disease, including rheumatologic disease. Because of ongoing contact with their patients, rheumatologists are uniquely poised to recognize depressive disorders and formulate a treatment plan. Recent advances in pharmacotherapy have simplified management and increased the likelihood of successful treatment. Through heightened awareness, rheumatologists can feel more comfortable in diagnosing and initiating therapy for depression.
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Affiliation(s)
- C M Stoltz
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA
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36
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Fatemi SH, Emamian ES, Kist DA. Venlafaxine and bupropion combination therapy in a case of treatment-resistant depression. Ann Pharmacother 1999; 33:701-3. [PMID: 10410184 DOI: 10.1345/aph.18249] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To report the therapeutic efficacy of venlafaxine and bupropion in a patient with treatment-refractory major depression. CASE SUMMARY A 21-year-old white woman with chronic and recurrent major depression presented with lack of response to several antidepressants. On examination, the patient exhibited neurovegetative signs of depression, guilt feelings, and suicidal ideation. The patient was administered venlafaxine 75 mg three times daily. The dose was titrated to 150 mg three times daily over the next month. Later bupropion was instituted up to 100 mg three times daily over a four-month period. The patient responded favorably to combination therapy and has remained free of depression for approximately 23 months. DISCUSSION Venlafaxine and bupropion are antidepressant agents with unique pharmacologic profiles, each effective in the treatment of depression. Recent data indicate that combinations of selective serotonin-reuptake inhibitors and bupropion can convert partial response to full response in patients with treatment-resistant depression. We considered whether a combination of venlafaxine and bupropion would reduce the depressive symptoms of a patient who was unresponsive to various classes of psychotropic agents. Gradual administration of venlafaxine and bupropion acted synergistically to significantly reduce depressive symptoms (p < 0.002) and significantly increase social function (p < 0.002) over a period of eight months. CONCLUSIONS To our knowledge this is the first report of successful combination therapy with venlafaxine and bupropion in treatment of chronic recurrent and refractory major depression.
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Affiliation(s)
- S H Fatemi
- Department of Psychiatry, School of Medicine, University of Minnesota, Minneapolis 55455, USA
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37
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Abstract
A meta-analysis of 20 short term comparative studies of 5 selective serotonin reuptake inhibitors (SSRIs; citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline) has shown no difference in efficacy between individual compounds but a slower onset of action of fluoxetine. There were suggestions that fluoxetine caused more agitation, weight loss and dermatological reactions than the other SSRIs. More patients discontinued fluvoxamine and fewer patients stopped sertraline because of adverse effects than their comparator SSRIs. The most common adverse reactions to the SSRIs were gastrointestinal (especially nausea) and neuropsychiatric (particularly headache and tremor). Data from the Committee on Safety of Medicines showed more reports of suspected reactions (including discontinuation reactions) to paroxetine, and of gastrointestinal reactions to fluvoxamine and paroxetine, than the other SSRIs during their first 2 years of marketing. Prescription-event monitoring revealed a higher incidence of adverse events related to fluvoxamine than its comparators. There were higher incidences of gastrointestinal symptoms, malaise, sedation and tremor during treatment with fluvoxamine and of sedation, tremor, sweating, sexual dysfunction and discontinuation reactions with paroxetine. Fluoxetine was not associated with a higher incidence of suicidal, aggressive and related events than the other SSRIs. Patients have survived large overdoses of each of the compounds, but concern has been expressed over 6 fatalities following overdoses of citalopram. Drug interactions mediated by cytochrome P450 enzymes are theoretically less likely to occur during treatment with citalopram and sertraline, but there is a sparsity of clinical data to support this. Methodological difficulties and price changes do not allow choice for recommendations on the choice of SSRI based on pharmacoeconomic data. Taking into account the strengths and weaknesses of the methods used to compare drugs, guidelines to the selection of individual SSRIs in clinical practice are proposed. Citalopram should be avoided in patients likely to take overdoses. Fluoxetine may not be the drug of first choice for patients in whom a rapid antidepressant effect is important or for those who are agitated, but it may have advantages over other SSRIs in patients who are poorly compliant with treatment and those who have previously had troublesome discontinuation symptoms. Fluvoxamine, and possibly paroxetine, should not be used as first choice in patients especially prone to SSRI-related adverse reactions, while paroxetine should be avoided if previous discontinuation of treatment was troublesome. When in doubt about the risks of drug interactions, citalopram or sertraline should be considered given the lower theoretical risk of interactions.
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Affiliation(s)
- J G Edwards
- University of Southampton, Faculty of Medicine, Health and Biological Sciences, Department of Psychiatry, Royal South Hants Hospital, England
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38
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Hylan TR, Crown WH, Meneades L, Heiligenstein JH, Melfi CA, Croghan TW, Buesching DP. SSRI antidepressant drug use patterns in the naturalistic setting: a multivariate analysis. Med Care 1999; 37:AS36-44. [PMID: 10217392 DOI: 10.1097/00005650-199904001-00007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The study of the duration and pattern of antidepressant use in actual clinical practice can provide important insights into how antidepressant prescribing patterns compare with recommended depression treatment guidelines. OBJECTIVE The purpose of this study, using data available from depressed outpatients in the United States, is to assess the effects of initial SSRI antidepressant selection on the subsequent pattern and duration of antidepressant use. RESEARCH DESIGN Multiple logistic regression analysis of data from a large prescription and medical claims database (MarketScan) for the years 1993 and 1994 were used to estimate the determinants of antidepressant drug use patterns for 1,034 patients with a "new" episode of antidepressant therapy who were prescribed one of three most often prescribed selective serotonin reuptake inhibitors (SSRIs), paroxetine, sertraline, or fluoxetine. RESULTS Patients initiating therapy on sertraline or paroxetine were less likely than patients initiating therapy on fluoxetine to have four or more prescriptions of their initial antidepressant within the first 6 months. CONCLUSIONS The findings suggest that antidepressant selection is an important determinant of the initial duration and pattern of antidepressant use which is consistent with current recommended depression treatment guidelines.
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Affiliation(s)
- T R Hylan
- Global Health Outcomes Research, Eli Lilly and Company, Indianapolis, IN 46285-2128, USA
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Tauscher J, Pirker W, de Zwaan M, Asenbaum S, Brücke T, Kasper S. In vivo visualization of serotonin transporters in the human brain during fluoxetine treatment. Eur Neuropsychopharmacol 1999; 9:177-9. [PMID: 10082245 DOI: 10.1016/s0924-977x(98)00013-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Beta-CIT can be used as a tracer for SPECT to visualize serotonin transporters in the human brain. We present a case of bulimia nervosa and major depressive disorder, who had been treated with up to 60 mg/d fluoxetine for several weeks. Four hours after injection of the tracer more than 40% of serotonin transporters were blocked. To our knowledge, this is the first direct documentation of the pharmacodynamic action of fluoxetine in the human brain in vivo.
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Affiliation(s)
- J Tauscher
- Department of General Psychiatry, University Hospital of Vienna, Austria.
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Hylan TR, Meneades L, Crown WH, Sacristan JA, Gilaberte I, Montejo AL. SSRI antidepressant use patterns and their relation to clinical global impression scores: a naturalistic study. J Affect Disord 1999; 52:111-9. [PMID: 10357024 DOI: 10.1016/s0165-0327(98)00064-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND A cascade of events follows initial antidepressant selection which includes the subsequent antidepressant use pattern, resultant clinical outcomes, and associated health care expenditures. PURPOSE The purpose of this study using data from a clinical practice setting was to test whether the pattern of antidepressant use was correlated with patients' treatment response as measured by the score on the Clinical Global Impression-Improvement scale. DATA AND METHODS A retrospective dataset of patients who initiated therapy on fluoxetine, fluvoxamine, paroxetine, or sertraline in a primary care setting in Spain was used. A Cox proportional hazard analysis was used to predict the likelihood of treatment response based upon the pattern of initial antidepressant use, while minimizing the influence of other factors. RESULTS After controlling for other observed baseline characteristics including initial disease severity, (a) patients who remained on their initial antidepressant therapy for at least 2 months with no switching, augmentation, or upward dose titration were 1.63 times more likely to experience a treatment response than patients who had an adjustment to therapy; and (b) patients who initiated therapy on sertraline were 0.46 times as likely to experience a treatment response as patients who initiated therapy on the most common study antidepressant, fluoxetine. CONCLUSION The pattern of antidepressant use is an important determinant of treatment response among patients initiating therapy on the newer antidepressants in clinical practice.
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Affiliation(s)
- T R Hylan
- Global Health Economics Research, Eli Lilly and Company, Indianapolis, IN 46285, USA.
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Fawcett J, Barkin RL. Review of the results from clinical studies on the efficacy, safety and tolerability of mirtazapine for the treatment of patients with major depression. J Affect Disord 1998; 51:267-85. [PMID: 10333982 DOI: 10.1016/s0165-0327(98)00224-9] [Citation(s) in RCA: 154] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mirtazapine is a presynaptic alpha-2 antagonist that has dual action by increasing noradrenergic and serotonergic neurotransmission. The enhancement of serotonergic neurotransmission is specifically mediated via 5-HT1 receptors because mirtazapine is a postsynaptic serotonergic 5-HT2 and 5-HT3 antagonist. In addition, mirtazapine has only a weak affinity for 5-HT1 receptors and has very weak muscarinic anticholinergic and histamine (H1) antagonist properties. As a consequence of its unique pharmacodynamic properties, mirtazapine is an effective, safe and well-tolerated addition to the antidepressant armamentarium. Mirtazapine is well absorbed from the gastrointestinal tract following oral administration, and it is extensively metabolized in the liver to four metabolites via demethylation and hydroxylation, followed by glucuronide conjugation. The unconjugated desmethyl metabolite is pharmacologically less active than the parent compound. Mirtazapine lacks auto-induction of hepatic isoenzymes. Although mirtazapine is a substrate of P450 isoenzymes 1A2, 2D6 and 3A4, in vitro studies show that it is not a potent inhibitor or inducer of any of these enzymes. Mirtazapine has been evaluated in a worldwide clinical development program involving approximately 4500 patients. Controlled clinical trials involving almost 2800 mirtazapine-treated patients have demonstrated the compound to be effective for the treatment of moderate-to-serve major depression. Mirtazapine was consistently superior to placebo, and equivalent in efficacy to the tricyclic antidepressants amitriptyline, doxepin and clomipramine, but with an improved tolerability profile. Mirtazapine has shown a rapid onset of action in patients with predominantly severe depressive illness in a comparative study against fluoxetine. Mirtazapine has a unique tolerability profile, since the specific postsynaptic 5-HT2 and 5-HT3 receptor blockade of mirtazapine provides early antidepressant effects without causing unwanted serotonin-related side-effects. Transient somnolence, hyperphagia and weight gain are the most commonly reported adverse events, which may be attributed to the antihistaminic (H1) activity of mirtazapine at low doses. Somnolence, the most commonly reported side-effect, appears to be less frequent at higher dosages. Mirtazapine also demonstrates important anxiolytic and sleep-improving effects, which may be related to its pharmacodynamic properties. In addition, mirtazapine does not appear to be associated with sexual dysfunction. Mirtazapine has shown no significant cardiovascular adverse effects at multiples of 7 to 22 times the maximum recommended dose. Mirtazapine is a unique addition to the antidepressant armamentarium as first-line therapy in patients with major depression and symptoms of anxiety/agitation or anxiety/somatization or complaints of insomnia and as a useful alternative in depressed patients who do not adequately respond to or are intolerant of tricyclic antidepressants or serotonin-specific reuptake inhibitors.
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Affiliation(s)
- J Fawcett
- Department of Psychiatry, Rush-Presbyterian St. Luke's Medical Center, Chicago, IL 60612, USA
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Casacalenda N, Boulenger JP. Pharmacologic treatments effective in both generalized anxiety disorder and major depressive disorder: clinical and theoretical implications. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1998; 43:722-30. [PMID: 9773222 DOI: 10.1177/070674379804300707] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review the efficacy of anxiolytics (alprazolam and azapirones) in major depressive disorder (MDD) and that of antidepressants in generalized anxiety disorder (GAD), thereby exploring the possible theoretical and clinical implications of this efficacy. METHOD A Medline literature search was performed for the period January 1980 to September 1997 of randomized, double-blind comparison studies between anxiolytics and antidepressants in the acute treatment of adult patients with either MDD or GAD. RESULTS Alprazolam, at doses double those generally recommended for anxiety disorders, appears to be as effective as tricyclic antidepressants (TCAs) in the acute treatment of mild to moderate MDD. Alprazolam was also found to have a more rapid onset of action than to TCAs, particularly for the improvement of anxiety, somatization, and insomnia. Two azapirones (buspirone and gepirone) also have demonstrated a modest acute antidepressant effect in preliminary studies, albeit only in a depressed outpatient sample with considerable anxiety at baseline. Finally, various antidepressant drugs (imipramine, trazodone, paroxetine) were shown to have, at the least, comparable efficacy to benzodiazepines (BZDs) in the acute treatment of GAD. CONCLUSIONS The nonspecificity of treatment response suggests that GAD and MDD are 1) different expressions of a similar disorder with a common neurobiological substrate, 2) discrete diagnostic entities that respond to independent pharmacological effects of the same drugs, or 3) a combination of the two (heterogeneity hypothesis). The most relevant clinical finding is the efficacy of antidepressants in the acute treatment of GAD.
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Affiliation(s)
- N Casacalenda
- Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec.
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Kasper S, Zivkov M, Roes KC, Pols AG. Pharmacological treatment of severely depressed patients: a meta-analysis comparing efficacy of mirtazapine and amitriptyline. Eur Neuropsychopharmacol 1997; 7:115-24. [PMID: 9169299 DOI: 10.1016/s0924-977x(96)00394-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Efficacy data were available from 405 severely depressed patients (baseline 17-item Hamilton Rating Scale for Depression-HAMD scores > or = 25) participating in randomized, double-blind, amitriptyline-controlled studies of mirtazapine. Main efficacy variable were changes from baseline in the group mean 17-item HAMD scores and responder rates. Secondary efficacy variables were changes in depressed mood item on the HAMD and in factors derived from the 17-item HAMD scale. Treatment with either mirtazapine or amitriptyline resulted in robust reductions of baseline HAMD scores and in similar and high percentages of responders. Both drugs produced favourable effects on depressed mood and on symptoms commonly associated with depression, such as anxiety, sleep and vegetative disturbances. There were neither statistically significant nor clinically relevant differences between mirtazapine and amitriptyline at any assessment point nor at endpoint. The results demonstrate that the new antidepressant mirtazapine and the tricyclic antidepressant amitriptyline are equally effective in the treatment of severely depressed patients.
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Affiliation(s)
- S Kasper
- Department of General Psychiatry, University of Vienna, Austria
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Abstract
BACKGROUND Major depression is a common disorder but the pathophysiology is poorly understood. Current hypotheses implicate deficient function of brain serotonin pathways because drugs that selectively increase brain serotonin activity are effective antidepressants. However, there is no direct evidence that lowered serotonin function causes major depression. We aimed to assess whether lowering of brain serotonin activity by depletion of its amino acid precursor, tryptophan, could provoke a short-term relapse of clinically significant symptoms in women vulnerable to major depressive disorder. METHODS We studied 15 women who had suffered recurrent episodes of major depression but had recovered and were no longer on drug treatment. Patients received two amino acid mixtures in a double-blind crossover design. One of the mixtures was nutritionally balanced and contained tryptophan and the other was identical except it contained no tryptophan. Participants were scored on the Hamilton rating scale for depression (HAMD) before and 7 h after drinking each mixture. They also completed hourly self-rated measures of mood during this period. Blood samples were also taken at baseline and 7 h for measurement of plasma tryptophan. FINDINGS The tryptophan-free mixture produced a 75% reduction in plasma tryptophan concentration. After drinking the tryptophan-free mixture, ten of the 15 women experienced temporary but clinically significant depressive symptoms. The mean difference in total HAMD scores (7 h minus baseline) were significantly higher after the tryptophan-free mixture than after the nutritionally balanced mixture (7.3 vs 0.15 [95% CI 4.5-9.9]; p < 0.001). No changes in mood were seen after taking the nutritionally balanced mixture. INTERPRETATION We conclude that rapid lowering of brain serotonin function can precipitate clinical depressive symptoms in well, untreated individuals who are vulnerable to major depressive disorder. The findings support a key role for deficient serotonin function in the aetiology of depression.
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Affiliation(s)
- K A Smith
- University Department of Psychiatry, Littlemore Hospital, Oxford, UK
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Joffe R, Sokolov S, Streiner D. Antidepressant treatment of depression: a metaanalysis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1996; 41:613-6. [PMID: 8978938 DOI: 10.1177/070674379604101002] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To carry out a metaanalysis of antidepressant studies to calculate the effect sizes for antidepressant effect in depressive disorder. METHOD A metaanalysis of all antidepressant studies that included an active comparison drug as well as placebo was used to calculate the effect size. Articles were selected from a MEDLINE search for the period January 1966 to June 1995. Forty-nine studies were included in the metaanalysis. RESULTS The effect sizes for antidepressant treatment are moderately larger than for placebo. A larger effect size was observed in studies where objective diagnostic criteria for depression were used. CONCLUSIONS We conclude that the superior efficacy of antidepressants over placebo can be demonstrated.
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Affiliation(s)
- R Joffe
- Department of Psychiatry, McMaster University, Hamilton, Ontario
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Schnyder U, Koller-Leiser A. A double-blind, multicentre study of paroxetine and maprotiline in major depression. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1996; 41:239-44. [PMID: 8726790 DOI: 10.1177/070674379604100409] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study was performed to compare the clinical efficacy, side effects, and safety of paroxetine and maprotiline, the latter being the most frequently prescribed antidepressant in Switzerland. METHOD Seventy-one patients (in and outpatients) with major depression were randomly allocated to treatment with paroxetine (20 to 40 mg daily) or with maprotiline (50 to 150 mg daily). Efficacy was measured by means of the Hamilton Psychiatric Rating Scale for Depression, the Montgomery-Asberg Depression Rating Scale, the Clinical Global Impression, and the Hopkins Symptom Checklist. RESULTS The 2 components showed a similar efficacy. The adverse effect profile was comparable in the 2 treatment groups, although the findings showed a nonsignificant trend pointing in the direction of lower side effects with paroxetine. CONCLUSION In the moderate dose regimens tested, the 2 components seemed to be of similar efficacy, with comparable profiles of side effects and safety.
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Affiliation(s)
- U Schnyder
- Psychiatrische Poliklinik, Universitätsspital, Zürich, Switzerland
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Maremmani I, Marini G, Castrogiovanni P, Deltito J. The effectiveness of the combination fluoxetine-naltrexone in bulimia nervosa. Eur Psychiatry 1996; 11:322-4. [DOI: 10.1016/s0924-9338(96)89902-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/1995] [Accepted: 01/22/1996] [Indexed: 10/18/2022] Open
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Burns RA, Lock T, Edwards DR, Katona CL, Harrison DA, Robertson MM, Nairac B, Abou-Saleh MT. Predictors of response to amine-specific antidepressants. J Affect Disord 1995; 35:97-106. [PMID: 8749837 DOI: 10.1016/0165-0327(95)00039-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Discriminant function analysis of data from a double-blind comparative trial of lofepramine (a noradrenaline-specific reuptake inhibitor) and fluoxetine (a serotonin-specific reuptake inhibitor), involving 183 patients was used to identify predictors of response. Psychic anxiety significantly predicted a positive response to antidepressant medication, whereas psychomotor retardation, observed sadness, subjective lassitude and somatic complaints were significant predictors of nonresponse. Age, gender, endogenicity, duration of illness and number of previous episodes were not predictive of response. Significant differences were found between predictors of response to fluoxetine and lofepramine (P < 0.001 all groups). Predictors of response to lofepramine were similar to overall predictors, i.e., psychic anxiety predicted responders whilst observed sadness, psychomotor retardation, lassitude, inability to feel and somatic complaints predicted nonresponders. In contrast, baseline weight loss predicted response to fluoxetine, whereas anxiety, reduced insight and a tendency to blame others significantly predicted nonresponse. Such findings have practical implications for the management of depressive illness.
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Affiliation(s)
- R A Burns
- Department of Psychiatry, Royal Liverpool Hospital, UK
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Abstract
Among drugs which cause weight gain, the tricyclic antidepressant medications are a drug class producing persistent and problematic body weight gain in many treated patients. Major depressive illness is often associated with reductions in appetite and body weight, and treatment with antidepressants effectively restores mood, appetite and weight. However, a frequent complaint of patients treated with tricyclic drugs is of excessive and unwanted weight gain, often times resulting in medication noncompliance. The incidence of weight gain during acute and chronic treatment with different, frequently prescribed antidepressant drugs will be reviewed, as will the possible mechanisms by which such drugs alter caloric intake and expenditure, contributing to drug-induced weight gain.
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Affiliation(s)
- M H Fernstrom
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
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Pirker W, Asenbaum S, Kasper S, Walter H, Angelberger P, Koch G, Pozzera A, Deecke L, Podreka I, Brücke T. beta-CIT SPECT demonstrates blockade of 5HT-uptake sites by citalopram in the human brain in vivo. J Neural Transm (Vienna) 1995; 100:247-56. [PMID: 8748670 DOI: 10.1007/bf01276462] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The cocaine analogue 2-beta-carbomethoxy-3-beta-(4-iodophenyl)-tropane (beta-CIT) is a potent ligand for both dopamine- and serotonin uptake sites which in its 123I labeled form can be used for single photon emission computerized tomography (SPECT). It was demonstrated previously by SPECT-studies in non-human primates that 123I-beta-CIT binds to dopamine transporters in the striatum and to serotonin transporters in hypothalamus and midbrain. The aim of the present study was to compare 123I-beta-CIT binding in the brain stem of normal controls and a group of subjects under treatment with the selective serotonin reuptake inhibitor (SSRI) citalopram. 123I-beta-CIT-SPECT was performed in 12 depressed patients under 20 mg (n = 5), 40 mg (n = 6) and 60 mg (n = 1) citalopram daily, in one untreated depressed patient and in 11 controls at regular time intervals up till 24 hours p.inj. A highly significant reduction of beta-CIT binding was found in an area including mesial thalamus, hypothalamus, midbrain and pons in patients under citalopram compared to controls (44.1 +/- 14.4 vs. 82.3 +/- 18.6cpm's/mCi x kg body weight; specific binding 4 hrs p.inj.; p = 0.0001). No differences were seen between the high and low dose group and no changes were found in the striatum. 123I-beta-CIT binding in the brain stem and striatum in one untreated depressed patient fell within the range of control values. To our knowledge this is the first report directly demonstrating the effect of a selective serotonin uptake inhibitor in the brain in humans in vivo. SPECT measurements of serotonin uptake sites in patients with depression and other psychiatric disorders might provide better insights into the pathophysiology of these disorders and into mechanisms of drug action.
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Affiliation(s)
- W Pirker
- Neurological University Clinic, Vienna, Austria
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