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Journal of Integrative Medicine ; (12): 305-320, 2022.
Article in English | WPRIM | ID: wpr-939895


BACKGROUND@#Some depressed patients receive acupuncture as an adjunct to their conventional medications.@*OBJECTIVE@#This review aims to provide evidence on whether acupuncture can enhance the therapeutic effectiveness of antidepressants for treating depression, and explore whether acupuncture can reduce the adverse reactions associated with antidepressants.@*SEARCH STRATEGY@#English and Chinese databases were searched for randomized controlled trials (RCTs) published until December 1, 2021.@*INCLUSION CRITERIA@#RCTs with a modified Jadad scale score ≥ 4 were included if they compared a group of participants with depression that received acupuncture combined with antidepressants with a control group that received antidepressants alone.@*DATA EXTRACTION AND ANALYSIS@#Meta-analysis was performed, and statistical heterogeneity was assessed based on Cochran's Q statistic and its related P-value. Primary outcomes were the reduction in the severity of depression and adverse reactions associated with antidepressants, while secondary outcomes included remission rate, treatment response, social functioning, and change in antidepressant dose. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to evaluate the overall quality of evidence in the included studies.@*RESULTS@#This review included 16 studies (with a total of 1958 participants). Most studies were at high risk of performance bias and at low or unclear risk of selection bias, detection bias, attrition bias, reporting bias, and other bias. Analysis of the 16 RCTs showed that, compared with antidepressants alone, acupuncture along with antidepressants reduced the Hamilton Depression Rating Scale-17 (HAMD-17) scores (standard mean difference [SMD] -0.44, 95% confidence interval [CI] -0.55 to -0.33, P < 0.01; I2 = 14%), Self-rating Depression Scale (SDS) scores (SMD -0.53, 95% CI -0.84 to -0.23, P < 0.01; I2 = 79%), and the Side Effect Rating Scale (SERS) scores (SMD -1.11, 95% CI -1.56 to -0.66, P < 0.01; I2 = 89%). Compared with antidepressants alone, acupuncture along with antidepressants improved World Health Organization Quality of Life-BREF scores (SMD 0.31, 95% CI 0.18 to 0.44, P < 0.01; I2 = 15%), decreased the number of participants who increased their antidepressant dosages (relative risk [RR] 0.32, 95% CI 0.22 to 0.48, P < 0.01; I2 = 0%), and resulted in significantly higher remission rates (RR 1.52, 95% CI 1.26 to 1.83, P < 0.01; I2 = 0%) and treatment responses (RR 1.35, 95% CI 1.24 to 1.47, P < 0.01; I2 = 19%) in terms of HAMD-17 scores. The HAMD-17, SDS and SERS scores were assessed as low quality by GRADE and the other indices as being of moderate quality.@*CONCLUSION@#Acupuncture as an adjunct to antidepressants may enhance the therapeutic effectiveness and reduce the adverse drug reactions in patients receiving antidepressants. These findings must be interpreted with caution, as the evidence was of low or moderate quality and there was a lack of comparative data with a placebo control.@*SYSTEMATIC REVIEW REGISTRATION@#INPLASY202150008.

Acupuncture Therapy/methods , Antidepressive Agents/adverse effects , Depression/drug therapy , Drug-Related Side Effects and Adverse Reactions/drug therapy , Humans
Braz. J. Pharm. Sci. (Online) ; 58: e19847, 2022. tab, graf
Article in English | LILACS | ID: biblio-1384020


The objective of this study is to examine the antidepressant and antioxidant effects of thymoquinone (TQ) on reserpine-induced depression, and to investigate the antidepressant and antioxidant activity of combined treatment of TQ+citalopram. In total, 36 male Wistar rats were randomly divided into 6 groups: 1)control1, 2)control2, 3)reserpine, 4)reserpine+TQ 5)reserpine+citalopram and 6)reserpine+TQ+citalopram. Depression was induced by administering intraperitoneal reserpine of 0.2mg/kg/14days. For antidepressant effects, 10 mg/kg TQ and/or 10 mg/kg citalopram was administered intragastrically 30 minutes prior to the administration of reserpine. Rat behavior was examined using the Behavioral Test following the completion of treatment protocol. Total nitric oxide (NOx) levels, malondialdehyde (MDA) levels, total oxidants status (TOS), total antioxidant status (TAS) in brain cortex, plasma as well as brain cortex glutathione (GSH) and levels of plasma total sulfhydryl groups (RSH) were examined. Treatment with TQ ameliorated the reserpine-induced changes in the Behavioral Test (p<0.05). TQ treatment significantly increased dopamine (DA) and noradrenaline (NA) expressions when compared to the R group (p<0.01). Serotonin (5-HT) expression also increased significantly (p<0.05). Brain cortex and plasma TOS, MDA and NOx levels decreased, whereas TAS, GSH and RSH levels increased (p< 0.05). TQ has the ability to prevent depression induced by reserpine. The combination of TQ+citalopram can be used in the treatment of depression with a stronger antioxidant effect

Animals , Male , Rats , Nigella sativa/classification , Rats, Wistar , Phytochemicals/analysis , Antidepressive Agents/adverse effects , Antioxidants/adverse effects , Oxidative Stress , Depression
Braz. J. Pharm. Sci. (Online) ; 58: e20023, 2022. graf
Article in English | LILACS | ID: biblio-1403706


Abstract Caffeic acid is a phenolic compound widely distributed in plants and beverages such as coffee. Although its mechanism of action is poorly understood, caffeic acid reportedly induces antidepressant-like and neuroprotective effects. This study aimed to investigate the involvement of cellular signaling pathways in acute antidepressant-like effect induced by caffeic acid in mice. All procedures were approved by the Institutional Animal Ethics Committee of the UNIVALI n. 021/2013. Female Swiss mice were administered with vehicle, caffeic acid (5 mg/ kg, p.o.), inhibitor (H-89, U0126, chelerythrine, or PD9859, i.c.v.) or caffeic acid plus inhibitor. The behavioral effects were evaluated 1h after the administration of compounds to mice using tail suspension test (TST) and open field test (OFT). The results showed that the antidepressant- like effect of caffeic acid in mice was possibly mediated by the activation of PKA, MEK 1/2, PKC and MAPK (as assessed using TST), without compromising their locomotor activity (as assessed using OFT). Our results demonstrated, at least in part, the pathways involved in the neuroprotective and behavioral effects of caffeic acid.

Animals , Female , Mice , Caffeic Acids/analysis , Coffee/adverse effects , Neuroprotective Agents/administration & dosage , Antidepressive Agents/adverse effects , Plants , Signal Transduction , Mitogen-Activated Protein Kinase Kinases , Animal Care Committees/classification , Open Field Test
Braz. J. Pharm. Sci. (Online) ; 58: e19739, 2022. tab, graf
Article in English | LILACS | ID: biblio-1383981


Abstract The purpose of this study is to estimate the prevalence of and characterize the use of psychoactive drugs among drug users in a Brazilian municipality, relating the findings to factors associated with the consumption of these substances. Through a cross-sectional design, 1,355 drug users from the public health systems community pharmacies were interviewed. Sociodemographic and health-related data were collected, as well as any other prescribed drugs. The prevalence of psychoactive drug use within the last month was 31.0%, with antidepressants and benzodiazepines being the most prescribed (53.5% and 24.6% respectively). Most psychoactive drug users were female (81.9%), lived with a partner (52.6%), had private health insurance (69.2%) and a monthly per-capita income up to one minimum wage (54.0%). The adjusted Odds Ratio (OR) confirmed the following factors to be positively associated with the use of psychoactive drugs: female gender (OR=2.06; 95% CI 1.44; 2.95), age ≥60 years old (OR=1.77; 95% CI 1.26; 2.48), follow-up with a psychologist (OR=4.12; 95% CI 1.84; 5.25), absence of regular physical activity (OR=1.59; 95% CI 1.13; 2.23), and smokers (OR=1.94; 95% CI 1.26; 2.97). Approximately one out of three individuals used at least one psychoactive drug. Health managers should focus the planning and actions aimed at their rational use for these groups, leading to increased overall treatment success

Humans , Male , Female , Adolescent , Adult , Middle Aged , Psychotropic Drugs/analysis , Unified Health System , Pharmacies/classification , Pharmacoepidemiology/classification , Drug Users/statistics & numerical data , Antidepressive Agents/adverse effects
Rev. Ateneo Argent. Odontol ; 66(1): 34-46, 2022. ilus, tab
Article in Spanish | LILACS | ID: biblio-1380253


La población mayor de 60 años es el grupo etario de mayor crecimiento en el mundo. Debido a que la depresión es una patología frecuente en la persona adulta mayor y anciana, los inhibidores de la recap- tación de la serotonina (ISRS) son el tratamiento de primera línea de elección. Este trabajo referencia la asociación del consumo de estos fármacos con la disminución de la densidad ósea mineral (DMO), el riesgo de fracturas y su repercusión en la atención odontológica. Además, incluye una breve descripción de la homeostasis ósea y la relación depresión-carga alostática. El trabajo interdisciplinario y una correcta anamnesis pueden detectar posibles complicaciones y riesgos vinculados con este tipo de medicamen- tos. Ello facilitaría un mejor manejo, más aún en el adulto mayor, donde una pequeña variable puede repercutir en su integridad (AU)

The population over 60 is the fastest growing age group in the world. Depression is a frequent pathology in the elderly and the elderly, with serotonin reuptake inhibitors (SSRI) being the 1st line treatment of choice. The association of the consumption of this drug with a decrease in bone mineral density (BMD), risk of fractures and its impact on dental care are referenced in this work. In addition, it includes a brief description of bone homeostasis and the depression-allostatic load relationship. Interdisciplinary work and a correct anamnesis can detect possible complications and risks linked to this type of medication, facilitating better management and even more so in the elderly, where a small variable can affect their integrity (AU)

Humans , Male , Female , Aged , Aged, 80 and over , Dental Care for Aged/methods , Selective Serotonin Reuptake Inhibitors/adverse effects , Depression/complications , Antidepressive Agents/adverse effects , Bone Density/drug effects , Dental Implants/adverse effects , Risk Factors , Age Factors , Bone Remodeling/physiology , Selective Serotonin Reuptake Inhibitors/therapeutic use , Dental Restoration Failure , Fractures, Bone/prevention & control , Allostasis , Homeostasis
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 43(3): 306-313, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1249200


Objective: To evaluate the efficacy and safety of Morinda officinalis oligosaccharide (MOO) capsules for depressive disorder. Methods: Eight electronic databases were searched for relevant studies from inception to April 19, 2020. Randomized controlled trials comparing MOO capsules with antidepressants were included. Data analysis was conducted using Review Manager 5.3 software. The risk of bias was assessed using the Cochrane Risk of Bias Tool, and the quality of the studies was evaluated by two researchers using the Grading of Recommendation, Assessment, Development and Evaluations (GRADE) software. Results: Seven studies involving 1,384 participants were included in this study. The effect of MOO capsules for moderate depressive disorder was not different from that of antidepressants (risk ratio [RR] = 0.99, 95%CI 0.92-1.06). Regarding adverse events, no significant difference was found between MOO capsules and antidepressants (RR = 0.84, 95%CI 0.65-1.07). In addition, the quality of evidence related to these adverse events was rated as low. Conclusion: This systematic review suggests that the efficacy of MOO capsules in the treatment of mild to moderate depression is not inferior to that of conventional antidepressants, which may provide a new direction for clinical alternative selection of antidepressants. However, more high-quality research and detailed assessments are needed.

Humans , Morinda , Depressive Disorder/drug therapy , Oligosaccharides/adverse effects , Capsules/therapeutic use , Antidepressive Agents/adverse effects
Rev. chil. neuro-psiquiatr ; 59(1): 66-71, mar. 2021. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388379


Resumen La mirtazapina es un antidepresivo atípico con características complejas, que incluye actividad agonista/antagonista en una amplia variedad de receptores que produce efectos terapéuticos en la ansiedad, depresión y el sueño. Sin embargo, se han reportado casos de lesión hepática inducida por antidepresivos con ausencia de sintomatología, bajo la forma de variantes hepatocelular, colestásica y mixta. Este es el caso de una paciente que de carácter incidental presenta cambios en la analítica hepática tras el uso de mirtazapina a partir del cual se hace una breve revisión de la evidencia encontrada hasta el momento.

Mirtazapine is an atypical antidepressant with complex characteristics, including agonist/antagonist activity at a wide variety of receptors that produces therapeutic effects on anxiety, depression and sleep disorder. However, cases of antidepressant-induced liver injury with no symptoms have been reported, in the form of hepatocellular, cholestatic, and mixed variants. This is the case of a patient who incidentally presents changes in liver analysis after the use of mirtazapine, from which a brief review of the evidence found so far is made.

Humans , Female , Middle Aged , Chemical and Drug Induced Liver Injury , Mirtazapine/adverse effects , Antidepressive Agents/adverse effects , Anxiety/drug therapy , Depression/drug therapy , Asymptomatic Diseases
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 43(1): 70-74, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1153286


Objective: To investigate whether poor antidepressant tolerability is associated with functional brain changes in children and adolescents of parents with bipolar I disorder (at-risk youth). Methods: Seventy-three at-risk youth (ages 9-20 years old) who participated in a prospective study and had an available baseline functional magnetic resonance imaging (fMRI) scan were included. Research records were reviewed for the incidence of adverse reactions related to antidepressant exposure during follow-up. The sample was divided among at-risk youth without antidepressant exposure (n=21), at-risk youth with antidepressant exposure and no adverse reaction (n=12), at-risk youth with antidepressant-related adverse reaction (n=21), and healthy controls (n=20). The fMRI task was a continuous performance test with emotional distracters. Region-of-interest mean activation in brain areas of the fronto-limbic emotional circuit was compared among groups. Results: Right amygdala activation in response to emotional distracters significantly differed among groups (F3,66 = 3.1, p = 0.03). At-risk youth with an antidepressant-related adverse reaction had the lowest amygdala activation, while at-risk youth without antidepressant exposure had the highest activation (p = 0.004). Conclusions: Decreased right amygdala activation in response to emotional distracters is associated with experiencing an antidepressant-related adverse reaction in at-risk youth. Further studies to determine whether amygdala activation is a useful biomarker for antidepressant-related adverse events are needed.

Humans , Child , Adolescent , Adult , Young Adult , Bipolar Disorder/drug therapy , Brain/diagnostic imaging , Magnetic Resonance Imaging , Prospective Studies , Emotions , Amygdala , Antidepressive Agents/adverse effects
Rev. chil. neuro-psiquiatr ; 58(4): 400-412, dic. 2020. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388359


Resumen A través de una revisión comprensiva, este trabajo pretende entregar al clínico un abordaje de los factores que están involucrados en la práctica clínica cotidiana cuando cruzamos la sexualidad y el episodio depresivo mayor en pacientes monopolares. A nuestro juicio lograr la recuperación funcional en pacientes con trastorno depresivo monopolar incluye a una sexualidad saludable. Para ello se requiere que el clínico tenga el tema en mente, lo aborde en su evaluación, conozca estas relaciones bidireccionales e involucre estas variables en la elección de su tratamiento farmacológico. Incluir a la sexualidad en el proceso de perfilamiento para la elección del tratamiento antidepresivo más eficaz es también nuestro objetivo. Se analizan las estrategias antidepresivas más frecuentes y los grupos farmacológicos más usados en esta área, en concordancia con lo que sabemos hoy de esta diada y sus relaciones con los mecanismos de acción antidepresiva.

The object of this comprehensive review is to provide the clinician with an overview of the factors involved in everyday clinical practice when sexuality is an element of a major depressive episode in monopolar patients. In our opinion, functional recovery in patients with monopolar depressive disorder includes achieving healthy sexuality. This requires the clinician to bear this issue in mind, consider it in his/her assessment, be familiar with these bidirectional relations and involve these variables in his choice of pharmacological treatment. We also consider it important to include sexuality in the profiling process in order to select the most effective antidepressant treatment. We analyse the most frequent antidepressant strategies and the pharmacological groups most used in this area, consistent with what is known today about this diad and how it relates with antidepressant action mechanisms.

Humans , Sexual Dysfunction, Physiological , Depressive Disorder, Major/drug therapy , Antidepressive Agents/adverse effects , Sexuality
Article in English | WPRIM | ID: wpr-880590


Depression has a high incidence in patients with cardiovascular diseases (CVD) and shows adverse effects on their life quality and prognosis. With the advent of new antidepressant drugs, oral antidepressant drugs are increasingly used in CVD patients with depression, and their efficacy and safety have attracted attention. Commonly used antidepressant drugs have many adverse reactions. When applying antidepressant drugs in CVD patients, we should pay special attention to their cardiovascular adverse reactions and their interaction drugs with commonly used CVD drugs. Clinicians should comprehensively evaluate and select appropriate antidepressant drugs for patients.

Antidepressive Agents/adverse effects , Cardiovascular Diseases/chemically induced , Cardiovascular System , Humans , Incidence , Patients
Cad. Saúde Pública (Online) ; 36(2): e00026619, 2020. tab, graf
Article in English | LILACS | ID: biblio-1055634


Abstract: This study investigated whether antenatal exposure to antidepressants (ADs) increases the risks of autism spectrum disorders (ASD), attention deficit/hyperactivity disorders (ADHD), schizophrenia and other mental illnesses, and cognitive and developmental deficits in infants or preschool children. PubMed, EMBASE, BIREME/BVS databases were searched to identify studies examining associations of ADs in pregnancy with neurodevelopmental and psychiatric disorders. Twenty studies addressed ASD and/or ADHD risks while 30 focused on developmental and cognitive deficits in infants or preschool children. Most studies detected no association of antenatal AD with ASD after adjustment of risk ratios for maternal depression or psychiatric disorders. Some studies showed that maternal depression, regardless of whether it is treated or untreated, increased ASD risks. Seven out of 8 studies found no increase in ADHD risk associated with antenatal exposure to selective serotonin reuptake inhibitors, the most commonly used AD. No consistent evidence was found linking AD in pregnancy to neurocognitive developmental deficits in infants or preschool children. A residual confounding by indication (depression severity) remained in almost all studies. This systematic review found no consistent evidence suggesting that ADs in pregnancy increase risks of ASD, ADHD, and neurocognitive development deficits. Some studies, however, found evidence that maternal depression increases ASD risks.

Resumo: O estudo teve como objetivo investigar se a exposição intrauterina a antidepressivos (ADs) aumenta o risco de transtornos do espectro autista (TEA), transtorno de déficit de atenção e hiperatividade (TDAH), esquizofrenia e outros transtornos mentais e déficits cognitivos e de desenvolvimento em lactentes e pré-escolares. Foram realizadas buscas nas bases PubMed, EMBASE e BIREME/BVS para identificar estudos sobre associações entre o uso de ADs durante a gestação e transtornos de neurodesenvolvimento e psiquiátricos. Vinte estudos trataram de riscos de TEA e/ou TDAH, enquanto 30 focaram em déficits cognitivos e de desenvolvimento em lactentes ou pré-escolares. A maioria dos estudos não detectou associação entre AD na gestação e TEA, depois de ajustar as razões de risco para depressão ou outros transtornos psiquiátricos maternos. Alguns estudos mostraram que a depressão materna, quer tratada ou não, aumenta o risco de TEA. Sete entre oito estudos não detectaram aumento de risco de TDAH associado à exposição intrauterina a inibidores seletivos da recaptação da serotonina, o AD mais comumente utilizado. Não foram encontradas evidências consistentes entre o uso de AD na gestação e déficits de desenvolvimento neurocognitivo em lactentes ou pré-escolares. Em quase todos os estudos, permaneceu um confundimento residual por indicação (gravidade da depressão). A revisão sistemática não encontrou evidências consistentes de que os ADs na gestação aumentassem o risco de TEA, TDAH ou déficits de desenvolvimento neurocognitivo. Entretanto, alguns estudos evidenciaram que a depressão materna aumenta o risco de TEA.

Resumen: Este estudio investigó si la exposición prenatal a antidepresivos (ADs) incrementa los riesgos de trastornos del espectro autista (TEA), trastornos de déficit de atención/hiperactividad (TDAH), esquizofrenia, así como otras enfermedades mentales, cognitivas, y déficits en el desarrollo de niños de primaria o preescolares. Se consultaron las bases de datos PubMed, EMBASE, BIREME/BVS para identificar estudios de asociaciones de ADs durante el embarazo con trastornos de desarrollo neurológico y psiquiátricos. Veinte estudios estaban centrados en riesgos de TEA y/o TDAH, mientras que 30 se centraron en déficits de desarrollo y cognitivos en niños de primaria o preescolares. La mayor parte de los estudios no detectaron asociación de AD, durante la etapa prenatal, con TDA tras el ajuste de las ratios de riesgo para depresión materna o trastornos psiquiátricos. Algunos estudios mostraron que la depresión materna, independientemente de si es tratada o no, incrementó los riesgos de TEA. Siete de los 8 estudios no encontraron un incremento en el riesgo de TDAH, asociado con la exposición prenatal a inhibidores selectivos de la recaptación de serotonina, el antidepresivo más usado habitualmente durante el período prenatal. No se encontraron evidencias consistentes relacionando AD durante el embarazo y déficits en el desarrollo neurocognitivo de niños de primaria o preescolares. En casi todos los estudios hubo una desviación residual señalada como gravedad de la depresión. Esta revisión sistemática no halló evidencias consistentes, sugiriendo que el consumo de ADs durante el embarazo incremente el riesgo de TEA, TDAH, y déficits en el desarrollo neurocognitivo. Algunos estudios, no obstante, encontraron evidencias de que la depresión materna incrementa riesgos de TEA.

Humans , Female , Pregnancy , Infant , Child, Preschool , Prenatal Exposure Delayed Effects , Schizophrenia/epidemiology , Attention Deficit Disorder with Hyperactivity/epidemiology , Autism Spectrum Disorder/epidemiology , Antidepressive Agents/adverse effects , Schizophrenia/chemically induced , Attention Deficit Disorder with Hyperactivity/chemically induced , Brazil/epidemiology , Risk Factors , Autism Spectrum Disorder/chemically induced
J. bras. nefrol ; 41(4): 518-525, Out.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056611


ABSTRACT Introduction: Proximal femur fractures affect the mortality and morbidity of elderly individuals. Recent studies have shown an association between fragility fractures and hyponatremia, a common fluid and electrolyte balance disorder. Objectives: This study aimed to investigate the occurrence of hyponatremia in patients with fragility fractures of the proximal femur. Methods: The authors looked into the data from the medical records of patients admitted to the emergency unit of the Real Hospital Português for fragility fractures of the proximal femur from 2014 to 2017. The study included patients with serum sodium levels recorded in their charts. Results: Fourteen of 69 (20.3%) patients with proximal femur fractures had hyponatremia. The main factors linked to hyponatremia were lung disease, and prescription of amiodarone and/or antidepressants. Conclusion: In elderly individuals, fragility fractures of the proximal femur may correlate with hyponatremia, particularly among patients on amiodarone or antidepressants.

RESUMO Introdução: Fratura de fêmur proximal tem impacto na mortalidade e morbidade de idosos. Estudos recentes vêm demonstrando associação entre fratura por fragilidade e hiponatremia, um distúrbio hidroeletrolítico comum na prática médica. Objetivos: Investigar a ocorrência de hiponatremia em pacientes com fratura proximal de fêmur por fragilidade. Metodologia: Foram coletados dados a partir de prontuários de pacientes admitidos na emergência do Real Hospital Português devido à fratura proximal de fêmur por fragilidade, entre 2014 e 2017, e aqueles com natremia disponível no prontuário eletrônico foram incluídos no estudo. Resultado: Dentre os 69 pacientes com fratura de fêmur proximal, houve uma ocorrência de 14 pacientes com hiponatremia, o que corresponde a 20,3%. Os principais fatores associados à hiponatremia no estudo foram doença pulmonar, uso de amiodarona e antidepressivos. Conclusão: Em idosos, a fratura de fêmur proximal por fragilidade pode estar correlacionada com hiponatremia, principalmente quando estão sob uso de amiodarona ou antidepressivos.

Humans , Male , Female , Aged , Aged, 80 and over , Fractures, Bone/blood , Femoral Fractures/blood , Hyponatremia/complications , Water-Electrolyte Balance/physiology , Brazil/epidemiology , Comorbidity , Cross-Sectional Studies , Fractures, Bone/epidemiology , Femoral Fractures/epidemiology , Amiodarone/adverse effects , Hyponatremia/diagnosis , Hyponatremia/etiology , Lung Diseases/complications , Anti-Arrhythmia Agents/adverse effects , Antidepressive Agents/adverse effects
Int. j. morphol ; 37(2): 576-583, June 2019. graf
Article in English | LILACS | ID: biblio-1002261


Antidepressants use during pregnancy was associated with an increased risk of autism spectrum disorders. Animal models based on early life alterations in serotonin availability replicate some of the anatomical and behavioral abnormalities observed in autistic individuals. In recent years there has been a growing interest in the possible role of the hippocampus in autism. The aim of study is to examine the effects of neonatal antidepressant (CTM) exposure during a sensitive period of brain development on pyramidal and granule cells density of hippocampal formation. We examined the pyramidal and granular cells density of dorsal hippocampus using Nissl stained sections obtained from neonatal citalopram (CTM) exposed rats (5 mg/kg, twice daily, s.c.), from postnatal day 8 to 21 (PN8-21), saline and non-exposed rats. The density of pyramidal cells was significantly increased by 10.2 % in CA1, 10.6 % in CA3 and 13.2 % in CA4 in CTM treated compared with non-treated or saline treated animals (p<0.0001). The density of granule cells in the dentate gyrus was significantly increased by 12.0 % in CTM treated compared with non-treated or saline treated animals (p<0.0001). These findings were obtained only from male rats, suggesting a sexual dimorphism in neural development after SSRI exposure. These data suggest that the neonatal exposure to CTM may induce long-lasting changes in the hippcampal formation in adults, and such effects appear to preferentially target males.

El uso de antidepresivos durante el embarazo se asoció con un mayor riesgo de trastornos del espectro autista. Los modelos animales basados en alteraciones tempranas de la vida en la disponibilidad de serotonina replican algunas de las anomalías anatómicas y de comportamiento observadas en individuos autistas. En los últimos años ha habido un interés creciente en el posible papel del hipocampo en el autismo. El objetivo del estudio fue examinar los efectos de la exposición al antidepresivo neonatal (CTM) durante un período sensible del desarrollo cerebral en la densidad de las células piramidales y granulares de la formación del hipocampo. Examinamos la densidad de las células piramidales y granulares del hipocampo dorsal utilizando secciones teñidas con Nissl obtenidas de ratas expuestas al citalopram neonatal (CTM) (5 mg / kg, dos veces al día, sc), desde el día postnatal 8 a 21 (PN8-21), solución salina y ratas no expuestas. La densidad de células piramidales se incrementó significativamente en un 10,2 % en CA1, 10,6 % en CA3 y 13,2 % en CA4 en CTM tratados en comparación con animales no tratados o tratados con solución salina (p <0,0001). La densidad de células granulares en el giro dentado aumentó significativamente en un 12,0 % en los animales tratados con CTM en comparación con los animales no tratados o tratados con solución salina (p <0,0001). Estos hallazgos se obtuvieron solo en ratas macho, lo que sugiere un dimorfismo sexual en el desarrollo neural después de la exposición a ISRS. Estos datos sugieren que la exposición neonatal a la CTM puede inducir cambios de larga duración en la formación del hipocampo en adultos, y estos efectos parecen dirigirse preferentemente a los machos.

Animals , Male , Female , Pregnancy , Rats , Prenatal Exposure Delayed Effects , Citalopram/pharmacology , Hippocampus/drug effects , Antidepressive Agents/pharmacology , Autistic Disorder/chemically induced , Behavior, Animal/drug effects , Citalopram/adverse effects , Cell Count , Sex Factors , Rats, Sprague-Dawley , Pyramidal Cells/drug effects , Hippocampus/cytology , Hippocampus/growth & development , Animals, Newborn , Antidepressive Agents/adverse effects
Cad. Saúde Pública (Online) ; 35(2): e00041018, 2019. tab
Article in Portuguese | LILACS | ID: biblio-1039414


O objetivo deste artigo foi avaliar a conformidade entre as recomendações de uso de medicamentos antidepressivos durante a amamentação, presentes em bulas, e as recomendações de fontes bibliográficas baseadas em evidências científicas. Foram avaliadas as bulas padrão de 23 antidepressivos com registro ativo no Brasil. A presença de contraindicação do uso do antidepressivo durante a amamentação foi comparada com as informações presentes no manual técnico do Ministério da Saúde, no livro Medications and Mothers' Milk e nas bases de dados LactMed, Micromedex e UpToDate. Na maioria das bulas (62,5%), o antidepressivo é contraindicado na amamentação. Entre as fontes bibliográficas, esse percentual variou de 0% a 25%. O estudo aponta para baixa conformidade entre bulas e fontes bibliográficas, alertando sobre a necessidade de revisão do conteúdo e forma de apresentação das informações presentes nas bulas dos antidepressivos no Brasil.

This article sought to evaluate the conformity between recommendations regarding antidepressant use during breastfeeding found in drug package inserts with recommendations from science-based bibliographic sources. We evaluated the standard drug package inserts of 23 antidepressants with active registration in Brazil. The presence of contraindications of antidepressant use during breastfeeding was compared with information present in the Brazilian Ministry of Health technical manual, the book Medications and Mothers' Milk and on the databases LactMed, Micromedex and UpToDate. In most drug package inserts (62.5%), antidepressants are contraindicated during breastfeeding. Among bibliographical sources, that percentage varied between 0% and 25%. The study shows a low conformity between drug package inserts and bibliographical sources, alerting to the need for revising the content and presentation of information present in antidepressant drug package inserts in Brazil.

El objetivo de este artículo fue evaluar la conformidad entre las recomendaciones de uso de medicamentos antidepresivos durante la lactancia, presentes en prospectos, y las recomendaciones de fuentes bibliográficas, basadas en evidencias científicas. Se evaluaron los prospectos estándar de 23 antidepresivos con registro activo en Brasil. La presencia de contraindicaciones en el consumo de antidepresivos durante la lactancia se comparó con la información presente en el manual técnico del Ministerio de la Salud, en el libro Medications and Mothers' Milk, y en las bases de datos LactMed, Micromedex y UpToDate. En la mayoría de los prospectos (62,5%), el antidepresivo está contraindicado durante la lactancia. Entre las fuentes bibliográficas el porcentaje varió de 0% a 25%. El estudio señala la escasa conformidad entre prospectos y fuentes bibliográficas, alertando sobre la necesidad de revisión del contenido, así como de la forma de presentación de la información que aparece en los prospectos de los antidepresivos en Brasil.

Humans , Female , Breast Feeding/adverse effects , Evidence-Based Medicine , Drug Industry/standards , Drug Labeling/standards , Antidepressive Agents/adverse effects , Brazil , Lactation/metabolism , Risk Factors , Drug Monitoring , Maternal Exposure/adverse effects , Drug Information Services/standards , Antidepressive Agents/administration & dosage
Trends psychiatry psychother. (Impr.) ; 40(3): 241-243, July-Sept. 2018.
Article in English | LILACS | ID: biblio-1043517


Abstract Introduction Psychopharmaceutical medications are noted for being one of the most commonly prescribed drugs worldwide, which makes the issue of overprescribing them such a heated topic in medicine and psychiatry today. Method A literature review was made to investigate the topic of psychotropic medication prescriptions. The scope intended here is specific to antidepressant use, or rather overuse, in Australia, but it can be compared to the use of other psychotropic drugs in most western countries. The focus is directed towards the most vulnerable group of patients: the elderly. Results The past few decades have witnessed a surge in the use of psychotropic drugs, most notably antidepressants, in Australia and worldwide. This has numerous reasons as well as consequences, especially on vulnerable members of society. Conclusion It has been suggested that overprescription of antidepressants is fueled by the increase in the incidence of depression, stress and anxiety, or due to the way psychotropic medications are marketed. However, regardless of the validity of the said reasons, another explanation could be suggested: psychiatric disorders, namely depression, are being overdiagnosed on a considerable scale, probably leading to a list of significant adverse consequences that mostly affect the most vulnerable groups of patients. At the end, further rigorous research should certainly be undertaken to examine the extent and cost of overprescription of psychotropic drugs in society.

Resumo Introdução Os psicofármacos estão entre as medicações mais frequentemente prescritas no mundo todo, tornando o assunto da prescrição excessiva um assunto polêmico na medicina e na psiquiatria nos dias atuais. Método Foi feita uma revisão da literatura para investigar o tópico das prescrições dos medicamentos psicotrópicos. O escopo pretendido aqui é especificamente o uso de antidepressivos, ou melhor, seu uso excessivo, na Austrália, mas ele pode ser comparado ao uso de outros medicamentos psicotrópicos na maioria dos países ocidentais. O foco é direcionado ao grupo mais vulnerável de pacientes: os idosos. Resultados As últimas décadas testemunharam um aumento no uso de drogas psicotrópicas, principalmente antidepressivos, na Austrália e no mundo todo. Isso tem várias razões e também consequências, especialmente nos membros vulneráveis da sociedade. Conclusão Tem sido sugerido que a prescrição excessiva de antidepressivos é motivada pelo aumento na incidência de depressão, stress e ansiedade, ou devido à forma como as medicações psicotrópicas são comercializadas. No entanto, independentemente da validade das razões apontadas, outra explicações poderia ser sugerida: transtornos psiquiátricos, especialmente depressão, têm sido sobrediagnosticados em uma escala considerável, provavelmente levando a uma lista de consequências adversas significativas que afetam principalmente os grupos mais vulneráveis de pacientes. Afinal, pesquisas rigorosas deveriam ser conduzidas para examinar a extensão e o custo da prescrição excessiva de medicamentos psicotrópicos na sociedade.

Humans , Aged , Practice Patterns, Physicians' , Depressive Disorder/drug therapy , Antidepressive Agents/adverse effects , Antidepressive Agents/therapeutic use , Drug Prescriptions , Australia
Rev. medica electron ; 40(2): 420-432, mar.-abr. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-902309


RESUMEN Las reacciones adversas a los medicamentos, son una reacción nociva o no intencionada. Ocurre con las dosis habituales empleadas en el ser humano para la profilaxis, diagnóstico o tratamiento de enfermedades y también para modificar las funciones fisiológicas. Con esta revisión se pretendió proporcionar una actualización de las reacciones de los fármacos antidepresivos. Se tuvo en cuenta cuestiones importantes, tales como: la selección, forma de uso, duración de la terapia y consideraciones relacionadas con situaciones patológicas particulares (AU).

ABSTRACT Adverse reactions to drugs are a noxious and non-intended reaction. It occurs with the doses usually used for prophylaxis, diagnosis and disease treatment in the human being, and also for modifying the physiologic functions. The aim of this review was giving an update of the reactions to anti-depressant drugs. Important questions were taken into account like drug choose, form of use, therapy lasting and considerations related to particular pathologic situations (AU).

Humans , Depression/epidemiology , Drug-Related Side Effects and Adverse Reactions/epidemiology , Antidepressive Agents/adverse effects , Antidepressive Agents/therapeutic use , Bibliography of Medicine , Antidepressive Agents, Second-Generation/adverse effects , Antidepressive Agents, Tricyclic/therapeutic use , Antidepressive Agents, Tricyclic/pharmacology
Rev. chil. cir ; 69(4): 345-351, ago. 2017. tab
Article in Spanish | LILACS | ID: biblio-899614


El uso de antidepresivos en el perioperatorio es muy frecuente, y la práctica clínica indica que los pacientes usuarios de antidepresivos que son sometidos a cirugía tienen un riesgo perioperatorio aumentado. No existen en la actualidad guías clínicas basadas en la evidencia que orienten el manejo de este tipo de pacientes, por lo que las recomendaciones se basan en las escasas revisiones sistemáticas y metaanálisis disponibles, reportes de casos y opinión de expertos, que en muchos casos resultan controversiales. La decisión de mantener o suspender la medicación antidepresiva implica considerar los riesgos tanto desde el punto de vista fisiológico (características generales del paciente, riesgos asociados al antidepresivo utilizado, la cirugía propiamente como tal, la interacción con fármacos frecuentemente utilizados en el perioperatorio, entre otros) como desde el punto de vista psiquiátrico (riesgo de síndrome de retirada, recaída de la enfermedad psiquiátrica, intentos suicidas), por lo que la decisión debe ser tomada idealmente de forma multidisciplinaria entre cirujanos, anestesiólogos y psiquiatras, con la idea de confeccionar un plan quirúrgico, anestésico y de manejo perioperatorio seguro para el paciente.

Antidepressant use in the perioperative is a common practice, and clinical evidence shows that surgical patients using antidepressants have an increased perioperative risk. There are not evidence-based guidelines for the perioperative management of these patients, and recommendations are based on few systematic reviews and meta-analysis, case reports and expert opinion, which in many cases are controversial. The decision to continue or discontinue the medication involves considering general patient characteristics, risks associated with the antidepressant used, type of surgery, interaction with drugs commonly used in the perioperative, risk of withdrawal symptoms, relapse of psychiatric disease and suicide risk, so decision should be made between surgeons, anesthesiologists and psychiatrists, in order to design a safe management plan for the patient who undergo surgery.

Humans , Depressive Disorder/drug therapy , Perioperative Period , Antidepressive Agents/adverse effects , Selective Serotonin Reuptake Inhibitors/adverse effects , Monoamine Oxidase Inhibitors/adverse effects , Antidepressive Agents, Tricyclic/adverse effects