Tiaoshen Jieyu acupuncture combined with sertraline hydrochloride tablet for post-stoke depression: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical efficacy between Tiaoshen Jieyu acupuncture (acupuncture for regulating mind and relieving depression) combined with sertraline hydrochloride tablet and simple sertraline hydrochloride tablet for post-stroke depression (PSD).@*METHODS@#A total of 76 patients with PSD were randomized into an observation group (38 cases, 6 cases dropped off) and a control group (38 cases, 4 cases dropped off). Both groups were treated with conventional treatment i.e. controlling blood pressure and anti-inflammation. Sertraline hydrochloride tablet was given orally in the control group, 20 mg a time, once a day. On the basis of the treatment in the control group, Tiaoshen Jieyu acupuncture was applied at Baihui (GV 20), Yintang (GV 24+), Neiguan (PC 6), Taichong (LR 3), etc. in the observation group, Baihui (GV 20) and Yintang (GV 24+) were connected to electroacupuncture, with disperse-dense wave, 2 Hz/100 Hz in frequency, 30 min a time, once a day, 6 times a week. Treatment of 8 weeks was required in both groups. Before and after treatment, the scores of Hamilton depression scale (HAMD), National Institutes of Health stroke scale (NIHSS), Barthel index (BI) and Pittsburgh sleep quality index (PSQI) were observed respectively, the therapeutic efficacy and rate of adverse reactions were evaluated in the two groups.@*RESULTS@#After treatment, the scores of HAMD, NIHSS and PSQI were lower while BI scores were higher than those before treatment in both groups (P<0.05); the scores of HAMD, NIHSS and PSQI in the observation group were lower while BI score was higher than those in the control group (P<0.05). The total effective rate was 93.8% (30/32) in the observation group, which was higher than 70.6% (24/34) in the control group (P<0.05). The rate of adverse reactions was 9.4% (3/32) in the observation group, which was lower than 32.4% (11/34) in the control group (P<0.05).@*CONCLUSION@#Tiaoshen Jieyu acupuncture combined with sertraline hydrochloride tablet can improve the depression degree, neurological function, activity of daily living and sleep quality in patients with post-stroke depression, the clinical efficacy is superior to simple sertraline hydrochloride, and can alleviate the adverse reactions caused by medication.

Hepatotoxicidad grave inducida por sertralina / Sertraline-induced severe hepatotoxicity

We report the case of a 19-year-old patient, with a history of traumatic liver damage, but with a normal liver profile at her first discharge; 1 month after the event, with post-traumatic stress disorder, treatment with 25 mg of sertraline was started every day; one month later, she develops severe hepatotoxicity without a specific etiology. According to the Naranjo algorithm, it is attributed as a probable case of sertraline hepatotoxicity. Management is carried out with support measures and suspension of the medication, and the patient recovers until she is asymptomatic, currently has normal liver tests

Reportamos el caso de una paciente de 19 años, con antecedentes de daño hepático traumático, pero con un perfil hepático normal en su primer alta; después de 1 mes del evento, con trastorno de estrés postraumático se inició tratamiento con 25 mg diarios de sertralina; un mes después, desarrolla una hepatotoxicidad severa sin etiología determinada. De acuerdo con el algoritmo de Naranjo, se atribuye como caso probable de hepatotoxicidad por sertralina. El manejo se realiza con medidas de apoyo y suspensión del medicamento, y la paciente se recupera hasta que se encuentra asintomática, actualmente tiene pruebas hepáticas normales

La depresión: un desafío en la práctica médica general / La depresión: un desafío en la práctica médica general

Asociada o no a una enfermedad orgánica, la depresión tiene gran prevalencia en la práctica médica pero es subdiagnosticada. El trastorno del ánimo suele coexistir con variadas quejas somáticas y dolores crónicos, configurando síndromes mixtos con un diagnóstico diferencial complejo. En este artículo se describen distintas presentaciones clínicas de la depresión en medicina general, con énfasis en los estados depresivos atípicos, depresiones enmascaradas muy relevantes por su frecuencia y consecuencias: depresión posquirúrgica, cuadros dolorosos crónicos como cefaleas o lumbago, la fatiga crónica y la fibromialgia. Solo el reconocimiento y diagnóstico de la depresión subyacente posibilitará la implementación de las adecuadas intervenciones terapéuticas. Se revisan también algunas recomendaciones para el uso de antidepresivos en atención primaria y la eventual consulta psiquiátrica. (AU)

Associated or not with an organic disease, depression has a high prevalence in medical practice but is underdiagnosed. The mood disorder usually coexists with varied somatic complaints and chronic pain, forming mixed syndromes with a complex differential diagnosis. This article describes different clinical presentations of depression in general medicine, with emphasis on atypical depressive states, masked depressions very relevant for their frequency and consequences: post-surgical depression, chronic painful conditions such as headaches or lumbago, chronic fatigue and fibromyalgia. Only the recognition and diagnosis of the underlying depression will enable the implementation of appropriate therapeutic interventions. Some recommendations for the use of antidepressant drugs in primary care and the eventual psychiatric consultation are also reviewed. (AU)

Farmacovigilancia de la sertralina en pacientes cubanos con episodio de depresión mayor / Pharmaceutical surveillance of sertraline in Cuban patients affected by major depression

En la depresión predominan síntomas como: desinterés, fatiga, sentimientos de inutilidad, desconcentración, deseos de muerte e insomnio. Entre los medicamentos para tratarla se encuentra la sertralina. Con el objetivo de evaluar su seguridad, se revisaron 40 historias clínicas y cuadernos de recogida de datos de los pacientes incluidos en ensayo clínico fase III, aletatorizado, controlado y a doble ciegas: Uso de sertralina en pacientes con episodio de depresión mayor, pertenecientes al Hospital Dr Gustavo Aldereguía Lima. Se obtuvieron datos demográficos, clínicos y eventos adversos, con los cuales se realizó un estudio descriptivo, observacional y transversal que clasifica como un estudio de utilización de medicamentos sobre consecuencias prácticas. La información fue analizada mediante SPSS, versión 13, 0 para Windows. De los 40 pacientes incluidos, 24 presentaron eventos adversos para un 60 por ciento; de ellos, 16 (67 por ciento) en el grupo tratado con sertralina y 8 (33 por ciento) en los tratados con placebo. Los eventos adversos más frecuentes fueron: disminución de peso, sequedad bucal, cefalea, diarreas y náuseas. En su mayoría resultaron de intensidad ligera, causalidad probable y sin necesidad de tratamiento. El uso del fármaco se consideró seguro en el tratamiento de estos pacientes

Some predominant symptoms in depression are lack of interest, fatigue, feeling of uselessness, lack of concentration, desire of being dead and insomnia. One of the drugs to treat this illness is Sertraline. For the purpose of evaluating its safety, 40 medical histories and data collection logs with information on patients included in a double-blind, controlled, randomized phase III clinical trial Use of Sertraline in patients suffering episodes of great depression were reviewed. These patients were seen at Gustavo Aldereguía Lima hospital. Demographic, clinical and adverse event data were obtained to undertake a descriptive, observational and cross-sectional study, which was classified as a study of practical consequences of drug use. The information was analyzed by SPSS, 13, 0 version for Windows software. Of the 40 patients, 24 presented with adverse events for 60 percent; 16 (67 percent) came from the Sertraline-treated group and 8 (33 percent) from the placebo group. The most frequent adverse events were loss of weight, dry mouth, headache, diarrheas and nauseas. Most of them were mild, probable causality and treatment was not required. The use of this drug was regarded as safe in treating this type of patients

Comparison of efficacy and tolerability between sertraline and fluoxetine in patients with major depression

Aim of this study was to compare the efficacy and tolerability between Sertraline and Fluoxetine to determine suitable treatment of major depression in Pakistani population. This study was conducted in the outpatients department of psychiatry, Jinnah Postgraduate depressive disorder were selected. Two groups A1 and A2 were made of 50 patients each. Group A1 received Tab Sertraline while Group A2 received Cap Fluoxetine daily for 24 weeks after going through screening tests and diagnostic evaluation. Efficacy was evaluated by using 21 item Hamilton Depression Rating Scale [HDRS] and 20 item Self Reporting Questionnaire [SRQ]. The patients were asked to attend the OPD every 15 days. Side effects and compliance of the patients was noted at each visit. The results showed that both groups showed significant improvement in depression from week 0 to week 24 with minimal adverse effects. Compliance of the patients in both groups was good. Although HDRS and SRQ scores were significantly reduced in both groups, it was noted that Tab Sertraline improved the symptoms earlier than Cap Fluoxetine. It can be concluded that both sertraline and fluoxetine are efficacious in major depression causing few adverse effects but because sertraline improves symptoms earlier and it is cost effective it may be preferred to fluoxetine

Síndrome serotoninérgico secundario al uso de sertralina: reporte de un caso y revisión de la literatura / Serotonin syndrome secondary to the use of sertraline: case report and review

El síndrome serotoninérgico (SS) es un trastorno asociado al uso de fármacos agonistas de la serotonina, de manifestaciones clínicas variables y potencialmente letal. Su incidencia es incierta, debido a que cerca del 85 por ciento de los médicos desconoce su existencia, pero se cree que existe un aumento de ésta debido al aumento del uso de este tipo de medicamentos tanto en patologías psiquiátricas como no psiquiátricas. El SS es secundario a una estimulación excesiva de los receptores para serotonina tanto a nivel central como periférico. Sus manifestaciones incluyen alteración de conciencia variable, alteraciones neuromusculares e hiperactividad autonómica. Por lo general se resuelve de manera espontánea luego de 24 horas de suspendido el fármaco, sin embargo, puede progresar a falla multisistémica y ser letal. En el presente artículo presentamos el caso de una paciente de 80 años de edad, de sexo femenino, cursando con una depresión, que horas después de recibir la primera dosis de sertralina evolucionó con un SS. Se exponen la historia clínica, tratamiento y evolución.

Serotonin syndrome: a case report.

Serotonin syndrome is a rare but potentially fatal complication of drugs that have effects on central nervous system serotonin. It is characterized by sudden onset of altered mental status, increased neuromuscular activity and autonomic instability. The author reports a child with suprasellar region tumor who presented with depression and obsessive-compulsive disorder and received a combination of sertaline (selective serotonin reuptake inhibitor) and clomipramine (tricyclic antidepressant). Symptoms of serotonin syndrome occurred within 24 hours after increasing the dose of sertaline. The patient's symptoms resolved rapidly with discontinuation of the offending drugs and supportive care.

Sertralina e pancreatite aguda: relato de caso / Sertraline and acute pancreatitis: a case-report

A pancreatite aguda é uma patologia grave e com considerável morbidade e mortalidade. Vários fatores são apontados como possíveis causas de pancreatite aguda. Neste relato, será apresentado um caso de pancreatite aguda com possível associação causal com um inibidor seletivo de recaptura de serotonina: sertralina. Após um mês de tratamento com sertralina, uma paciente do sexo feminino, 55 anos, desenvolveu forte dor abdominal e elevação da amilase sérica. Após internação e retirada da sertralina, seus sintomas remitiram e os níveis de amilase voltaram ao normal. Pela potencial gravidade do quadro e pelo amplo uso desta medicação, tal associação deve ser lembrada em investigações de casos de pancreatite aguda.

Sertraline in hospital outpatients with major depression

One of the most prevalent medical disorders, which can adversely affect the patients, families and the society, is Major depression. The number and severity of somatic symptoms associated with depression generally are proportional to the severity of the depression. Sertraline is an antidepressant that exerts its action by specifically inhibiting the neuronal reuptake of serotonin. This was an open non-comparative study of the use of Sertraline in hospital outpatients presenting with major depression. The duration of the study was for 10 weeks. Thirty-two patients between the ages of 21 and 60 years were enrolled, and thirty-one completed the study while 1 patient was lost to follow up at baseline. The patients were initially administered Sertraline, 50mg/day, which was maintained for four weeks. Thereafter if necessary the dose was increased by 50mg/day at two-week intervals. The maximum dose administered in this study was 150 mg/day. The dose was increased only if in each case there was evidence of decreased efficacy [defined as <25 percent decrease from baseline on Hamilton Psychiatric Rating Scale [HAMD] for Depression and no change or minimal improvement on the Clinical Global Impression [CGI] scale]. The overall assessment for efficacy in the 31 patients was rated as Excellent I Good in 30 [96.8 percent] patients, and Fair in one [3.2 percent] patients. Likewise the overall assessment for toleration in 31 patients was rated as Excellent / Good in 27 [87.1 percent] and Fair in 4 [12.9 percent] patients. Five of 31 [16.1 percent] patients experienced adverse events that were mild to moderate, however none of the patients discontinued the treatment due to adverse events

Sertralina, efectos adversos por superposicion de manifestaciones de sindromes serotoninico y neuroléptico maligno / Sertraline. Adverse effects due to the superposition of serotonic and malignant neuroleptic syndrome

Se presenta un paciente de 57 años tratado con sertralina 50 mg/día, que ingresa a la sala de guardia con cuadro de confución, rigidez, convulsiones y disfunción autonómica. Fue transferido a la unidad de cuidados intensivos. El laboratorio mostró elevación de las enzimas séricas, con una creatinfosfokinasa que alcanzó su pico (35 000 Ui/I) al tercer día. El sodio sérico a su ingreso fue de 120 mEq/I, atribuido a un síndrome de secreción inapropriada de hormona antidiuérica. Fue discontinuada la sertralina y fue tratado con lorazepam y medidas de sostén. A las 60 horas de ingresado el paciente retorna a su situación basal. Se plantea la dificultad del diagnóstico diferencial entre el síndrome neuroléptico maligno y el síndrome serotonínico, por la superposición de signos y síntomas de ambos síndromes.