Interaction between antidepressants and alcohol: signal amplification by multiple case reports.

BACKGROUND: Alcohol use and antidepressant prescription are prevalent in many countries, but little is known about their combined effects. OBJECTIVE: Having been surprised by selective serotonin reuptake inhibitor (SSRI) antidepressant-treated patients who became prone to pathological intoxication, we examined this association, searching for relevant literature and cases. METHODS: A detailed literature search showed little or no interaction between SSRIs and alcohol in laboratory studies, and inconsistent effects of these drugs in problem drinkers. We collected cases to study from our own and colleagues' practices, regulatory agencies and web-based discussion fora, and considered evidence for interactions according to standard criteria. RESULTS: Pathological intoxication, characterized by unexpected and often gross disinhibition, was identified in 100 of 201 reports that provided enough detail to be evaluated. Memory impairment was prominent in just over half (53/100) of these. Outcomes included serious violence; homicide occurred in 8 cases, including two double and one triple homicide (12 deaths). CONCLUSIONS: Multiple lines of evidence amplify a thus far barely recognized signal of interactions of SSRI and related antidepressants with alcohol. Systematic collection of further data is required to further characterize this syndrome, but in the meantime effective warnings must be introduced to alert prescribers and patients to the serious risk of pathological intoxication during antidepressant treatment.

Jet lag.

INTRODUCTION: Jet lag is a syndrome caused by disruption of the 'body clock', and affects most air travellers crossing five or more time zones; it is worse on eastward than on westward flights. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions to prevent or minimise jet lag? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found five studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: hypnotics, lifestyle and environmental adaptations, and melatonin.

Case histories as evidence.

In courts case histories play a central part when a crime may have resulted from an effect of a prescribed drug; in civil cases where a person may have suffered damage from a drug; and in coroners' enquiries into the cause of unexplained deaths. The court must decide two important questions: 1. Can the suspected medication(s) cause this kind of effect? 2. Did it (or they) do so in this particular case? Many judges and coroners have not addressed these questions clearly and have not used expert witnesses consistently, on occasion disregarding scientific evidence. Courts need to appoint experts to explain and interpret the scientific evidence. Few judges are equipped to resolve contradictions between different experts. Brief accounts of five cases from four countries illustrate these points. The reluctance of legal processes to implicate drugs as a possible cause of violent behaviour leads to injustice. Courts must be required to obtain appropriate expert evidence, and be given independent data on which drugs can cause such behaviour.

Public understanding of drug therapy.

Knowing some basic principles about medicines would help patients to understand drug therapy and to help and encourage them to use it well. These principles relate to the categories and names of drugs, their different uses, how they reach the site of action (absorption, distribution, fate), how they produce their effects, both beneficial and harmful, the time courses of drug actions, how the pattern and intensity of the effects of a drug depend on dose and timing, drug interactions, how drug effects are demonstrated and investigated and sources of information and their trustworthiness. These basic principles are an essential part of health literacy and understanding them would enable individuals to comprehend better the information that they are likely to receive about medicines that they will take. Different populations need different types of education. For schoolchildren, the principles could fit into biology and domestic science teaching, starting in the later years of primary school or early in secondary school. A teaching package would also be needed for their teachers. For adults, web-based learning seems the most practical option. Web-based programmes could be supported by the NHS and professional bodies and through public libraries and local community health services. Specific groups for targeting could include young mothers and carers of chronically ill people. For retired people, one could envisage special programmes, perhaps in collaboration with the University of the Third Age. Conversations between patients and professionals would then become more effective and help shared decision making.

Unexpected aggressive behaviour: interaction of bupropion and alcohol.

A healthy policeman was prescribed bupropion in 2002 to help him stop smoking. It worked but after 18 months he relapsed. Though it had given him headaches and insomnia he tried using it again in 2009, [corrected] taking 150 mg/day. Three days after starting the tablets he took his wife out for dinner. They shared a bottle of wine and he also had other drinks. After walking home they quarrelled, he slapped her, she slapped him. He threw the phone at her saying 'call the police!'. They came and charged him with assault; he was suspended. An expert report attributed the aggressive outburst to an interaction between bupropion and alcohol; the accused was a social drinker and had never been violent. An expert advising the police agreed, and 14 months after the event the court dismissed the case.

Quality information for quality use of medicines; 2nd International Conference, Kazan, 15-16 October 2010.

Kazan hosted Russia's first international conference on medicines that was entirely independent of the pharmaceutical industry, attracting 414 participants from 9 countries and 20 regions of the Russian Federation. The meeting was greeted and endorsed by world leaders in pharmaceutical information, policy and regulation. Delegates discussed the professional and social problems arising from unethical drug promotion, including compromised evidence from clinical trials and consequent impairments in health service delivery. The Conference adopted a resolution prioritizing policy development and health system needs, notably including the development of clinical pharmacology. A website documents conference materials and provides an interface for future collaboration: http://evidenceupdate-tatarstan.ru/confer.

[Patients reported adverse drug reactions: what's happening in Europe]. / Adverse drug reactions riportate direttamente dai pazienti: cosa succede in Europa.

This contribution in based on a report that describes the European situation regarding patient reported Adverse Drug reactions (DPR) and analyzes the literature on the topic. In 7 European countries DPRs are accepted, and used for decision making. Patients reports in general are more vivid that those of health care workers and report information that professional reporters can never be expected to provide. Moreover, DPRs are reliable and comparable to those of professional reporters.