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Taylor RW, Marwood L, Oprea E, DeAngel V, Mather S, Valentini B, Zahn R, Young AH, Cleare AJ. Pharmacological Augmentation in Unipolar Depression: A Guide to the Guidelines. Int J Neuropsychopharmacol 2020; 23:587-625. [PMID: 32402075 PMCID: PMC7710919 DOI: 10.1093/ijnp/pyaa033] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/27/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pharmacological augmentation is a recommended strategy for patients with treatment-resistant depression. A range of guidelines provide advice on treatment selection, prescription, monitoring and discontinuation, but variation in the content and quality of guidelines may limit the provision of objective, evidence-based care. This is of importance given the side effect burden and poorer long-term outcomes associated with polypharmacy and treatment-resistant depression. This review provides a definitive overview of pharmacological augmentation recommendations by assessing the quality of guidelines for depression and comparing the recommendations made. METHODS A systematic literature search identified current treatment guidelines for depression published in English. Guidelines were quality assessed using the Appraisal of Guidelines for Research and Evaluation II tool. Data relating to the prescription of pharmacological augmenters were extracted from those developed with sufficient rigor, and the included recommendations compared. RESULTS Total of 1696 records were identified, 19 guidelines were assessed for quality, and 10 were included. Guidelines differed in their quality, the stage at which augmentation was recommended, the agents included, and the evidence base cited. Lithium and atypical antipsychotics were recommended by all 10, though the specific advice was not consistent. Of the 15 augmenters identified, no others were universally recommended. CONCLUSIONS This review provides a comprehensive overview of current pharmacological augmentation recommendations for major depression and will support clinicians in selecting appropriate treatment guidance. Although some variation can be accounted for by date of guideline publication, and limited evidence from clinical trials, there is a clear need for greater consistency across guidelines to ensure patients receive consistent evidence-based care.
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Affiliation(s)
- Rachael W Taylor
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Lindsey Marwood
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
| | - Emanuella Oprea
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Valeria DeAngel
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sarah Mather
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Beatrice Valentini
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- Department of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Roland Zahn
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Allan H Young
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anthony J Cleare
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom
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Kirino S, Sakuma M, Misawa F, Fujii Y, Uchida H, Mimura M, Takeuchi H. Relationship between polydipsia and antipsychotics: A systematic review of clinical studies and case reports. Prog Neuropsychopharmacol Biol Psychiatry 2020; 96:109756. [PMID: 31472167 DOI: 10.1016/j.pnpbp.2019.109756] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This systematic review aimed to elucidate the relationship between polydipsia and antipsychotics. METHODS We systematically searched MEDLINE, Embase, and PsycINFO, and included clinical studies and case reports on polydipsia induced or improved by antipsychotics. RESULTS We identified 61 articles: 1 double-blind randomized controlled trial (RCT), 4 single-arm trials, 1 cross-sectional study, 3 case series, and 52 case reports. The double-blind RCT demonstrated no significant difference in improvement in polydipsia between olanzapine and haloperidol. Two single-arm trials showed that polydipsia improved during clozapine treatment, whereas the other 2 showed that risperidone did not improve polydipsia. The cross-sectional study showed the prevalence of hyponatremia with first-generation antipsychotics (FGAs: 26.1%) and second-generation antipsychotics (SGAs: 4.9%). Two case series reported that clozapine improved polydipsia; the other one indicated that patients with polydipsia who were treated with FGAs had schizophrenia (70.4%) and mental retardation (25.9%). Of 90 cases in the case reports, 67 (75.3%) were diagnosed with schizophrenia. Of 83 cases in which antipsychotic treatment started before the onset of polydipsia, 75 (90.3%) received FGAs, particularly haloperidol (n = 24, 28.9%), and 11 (13.3%) received risperidone. Among 40 cases in which polydipsia was improved following antipsychotic treatment, 36 (90.0%) received SGAs, primarily clozapine (n = 14, 35.0%). CONCLUSIONS Although the causal relationship between polydipsia and antipsychotics remains unclear because of the paucity of high-quality studies, antipsychotics with high affinity to dopamine D2 receptors may be associated with an increased risk of polydipsia while clozapine may be effective for treating polydipsia.
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Affiliation(s)
- So Kirino
- Yamanashi Prefectural Kita Hospital, Yamanashi, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Mutsuki Sakuma
- Yamanashi Prefectural Kita Hospital, Yamanashi, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | | | - Yasuo Fujii
- Yamanashi Prefectural Kita Hospital, Yamanashi, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyoshi Takeuchi
- Yamanashi Prefectural Kita Hospital, Yamanashi, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
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Abstract
Olanzapine is an atypical antipsychotic that has a pharmacological profile similar that of clozapine. It is biotransformed by hepatic enzymes and can be dosed on a once-daily basis. In large, double-blind, placebo-controlled trials, olanzapine was shown to be efficacious in the treatment of schizophrenia relative to placebo. Many trials showed superior efficacy to haloperidol, especially against negative symptoms. Olanzapine is FDA-approved for the treatment of psychotic disorders, though data suggest possible use in depression, bipolar disorder, psychogenic polydipsia, and developmental disabilities. Olanzap-ine appears to be well-tolerated. Commonly reported adverse effects include orthostatic hypotension, sedation, hepatic transaminase elevations, weight gain, headache, agitation, dizziness, and constipation. The incidence of extrapyramidal symptoms and tardive dyskinesia is low. Few drug interactions have been reported. The recommended starting dose is 10 mg once daily. One trial indicated that the higher cost of this agent might be offset by a reduction in overall hospitalization costs.
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Affiliation(s)
- Andrew E. Falsetti
- Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University; and Clinical Pharmacy Specialist in Psychiatry, Veterans Affairs Medical Center, Bronx, NY
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Anil SS, Ratnakaran B, Suresh N. A case report of rapid-onset hyponatremia induced by low-dose olanzapine. J Family Med Prim Care 2017; 6:878-880. [PMID: 29564285 PMCID: PMC5848420 DOI: 10.4103/jfmpc.jfmpc_205_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hyponatremia has been reported with the use of psychotropic drugs. Olanzapine does not find much mention as a cause of hyponatremia in literature; however, it has been found to be the second most frequently reported atypical antipsychotic to cause it. We report a case of hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion which occurred at a rapid onset following the administration of low-dose olanzapine during inpatient treatment of a patient with bipolar disorder. We would like to highlight our case for the need to be vigil about such fatal side complications apart from metabolic side effects of atypical antipsychotics.
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Affiliation(s)
| | - Badr Ratnakaran
- Department of Psychiatry, Dr. Kunhalu's Nursing Home, Ernakulam, Kerala, India
| | - Nisha Suresh
- Department of Psychiatry, General Hospital, Ernakulam, Kerala, India
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Chiang CL, Lin YH, Hsieh MH. Olanzapine-induced hyponatremia in a patient with autism. J Child Adolesc Psychopharmacol 2013; 23:699-700. [PMID: 24261660 DOI: 10.1089/cap.2013.0055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Chih-lin Chiang
- 1 Department of Psychiatry, Shin Kong Wu Ho-Su Memorial Hospital , Taipei, Taiwan
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Mannesse CK, van Puijenbroek EP, Jansen PA, van Marum RJ, Souverein PC, Egberts TC. Hyponatraemia as an Adverse Drug Reaction of Antipsychotic Drugs. Drug Saf 2010; 33:569-78. [DOI: 10.2165/11532560-000000000-00000] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Meulendijks D, Mannesse CK, Jansen PA, van Marum RJ, Egberts TC. Antipsychotic-Induced Hyponatraemia. Drug Saf 2010; 33:101-14. [DOI: 10.2165/11319070-000000000-00000] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Bersani G, Pesaresi L, Orlandi V, Gherardelli S, Pancheri P. Atypical antipsychotics and polydipsia: a cause or a treatment? Hum Psychopharmacol 2007; 22:103-7. [PMID: 17335101 DOI: 10.1002/hup.825] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary polydipsia (PP) is a frequent complication that affects many chronic schizophrenic inpatients. Due to possible lethal consequences, for example, hyponatremia, coma and death, it's fundamental for the physician achieving early diagnosis and treating this condition. The first step is identifying polydipsia by clinical, biochemical and pharmacological means. Nowadays, the pathophysiology of PP remains unclear, and this limits the possibility of detecting an appropriate drug treatment. Typical antipsychotics have been associated to a worsening of polydipsic behavior, while more recently atypical antipsychotics have been reported as being useful. However results are still mixed and controversial. It appears that risperidone and olanzapine are not clearly effective; clozapine may improve symptoms, although it is difficult to manage from a therapeutic point of view; quetiapine has been poorly studied so far, nonetheless it has given interesting results. Through a case study analysis, this report presents a brief, yet selective, overview of the current state of psychopharmacology in the treatment of PP with atypical antipsychotics in schizophrenia.
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Affiliation(s)
- Giuseppe Bersani
- University of Rome, La Sapienza, III Psychiatric Clinic, Department of Psychiatric Sciences and Psychological Medicine, Italy.
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Meerabux J, Iwayama Y, Sakurai T, Ohba H, Toyota T, Yamada K, Nagata R, Irukayama-Tomobe Y, Shimizu H, Yoshitsugu K, Ohta K, Yoshikawa T. Association of an orexin 1 receptor 408Val variant with polydipsia-hyponatremia in schizophrenic subjects. Biol Psychiatry 2005; 58:401-7. [PMID: 15978554 DOI: 10.1016/j.biopsych.2005.04.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2004] [Revised: 03/16/2005] [Accepted: 04/05/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Primary polydipsia is a common complication in patients with chronic psychoses, particularly schizophrenia. Disease pathogenesis is poorly understood, but one contributory factor is thought to be dopamine dysregulation caused by prolonged treatment with neuroleptics. Both angiotensin-converting enzyme (ACE) and orexin (hypocretin) signaling can modulate drinking behavior through interactions with the dopaminergic system. METHODS We performed association studies on the insertion/deletion (I/D) sequence polymorphism of ACE and single nucleotide polymorphisms within the prepro-orexin (HCRT), orexin receptor 1 (HCRTR1), and orexin receptor 2 (HCRTR2) genes. Genotypes were determined by polymerase chain reaction amplification, followed by either electrophoretic separation or direct sequencing. RESULTS The ACE I/D polymorphism showed no association with polydipsic schizophrenia. Screening of the orexin signaling system detected a 408 isoleucine to valine mutation in HCRTR1 that showed significant genotypic association with polydipsic-hyponatremic schizophrenia (p = .012). The accumulation of this mutation was most pronounced in polydipsic versus nonpolydipsic schizophrenia (p = .0002 and p = .008, for the respective genotypic and allelic associations). The calcium mobilization properties and the protein localization of mutant HCRTR1 seem to be unaltered. CONCLUSION Our preliminary data suggest that mutation carriers might have an increased susceptibility to polydipsia through an undetermined mechanism.
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Affiliation(s)
- Joanne Meerabux
- Laboratory for Molecular Psychiatry, RIKEN Brain Science Institute, 2-1 Hirosawa, Wako-city, Saitama 351-0198, Japan
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Goldman MB, Hussain N. Absence of effect of olanzapine on primary polydipsia: results of a double-blind, randomized study. J Clin Psychopharmacol 2004; 24:678-80. [PMID: 15538138 DOI: 10.1097/01.jcp.0000145337.07676.2f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kruse D, Pantelis C, Rudd R, Quek J, Herbert P, McKinley M. Treatment of psychogenic polydipsia: comparison of risperidone and olanzapine, and the effects of an adjunctive angiotensin-II receptor blocking drug (irbesartan). Aust N Z J Psychiatry 2001; 35:65-8. [PMID: 11270459 DOI: 10.1046/j.1440-1614.2001.00847.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Our objective was to determine the outcome of novel strategies in managing a case of severe polydipsia. CLINICAL PICTURE The patient was a 39-year-old male with a 20-year history of paranoid schizophrenia who, despite only mild residual psychotic symptoms, had been hospitalized for the previous 10 years because of severe polydipsic behaviour complicated by water intoxication. TREATMENT Novel antipsychotic agents, risperidone and olanzapine, as well as the specific angiotensin-II receptor blocking drug, irbesartan were employed at selected intervals in a study lasting nearly 3 years. A strict behavioural management programme was ongoing, in which diurnal weight change and the number of breaches of weight limits, requiring management in a low-stimulus environment, were documented on a daily basis. Summary measures of diurnal weight change and behavioural intervention were charted against changes in treatment. OUTCOME Polydipsic behaviour improved on risperidone up to 4 mg daily, but was not sustained. Olanzapine was similarly successful in stabilizing polydipsia, and improvement was achieved with the addition of irbesartan. CONCLUSION We suggest that the D2-sparing profiles of receptor binding achieved with low-dose risperidone and olanzapine may account for this beneficial effect. The benefit derived with irbesartan implicates the involvement of brain angiotensin systems centrally in helping to regulate drinking behaviour.
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Affiliation(s)
- D Kruse
- Austin and Repatriation Medical Centre, Department of Psychiatry and Psychology, Melbourne, Australia
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