RESUMO
Dental Caries are an uncommon, but significant side effect of the tricyclic antidepressants and other anticholinergic psychoactive drugs. The authors trace the etiological aspects of this syndrome including the effects of depression and antidepressant medication on salivary properties. A typical clinical presentation of the syndrome is described and the side effect profiles of the various tricyclic antidepressants are compared. With this clinical background guidelines for the management of dry mouth are presented, emphasizing the importance of technical skill, safety and continuity of care.
Assuntos
Antidepressivos Tricíclicos/efeitos adversos , Cárie Dentária/induzido quimicamente , Depressão/tratamento farmacológico , Adulto , Amitriptilina/efeitos adversos , Combinação de Medicamentos , Feminino , Humanos , Imipramina/efeitos adversos , Perfenazina/efeitos adversos , Pilocarpina/uso terapêutico , Xerostomia/induzido quimicamente , Xerostomia/tratamento farmacológicoRESUMO
BACKGROUND: The aim of this study was to examine the efficacy of the combination of fluoxetine plus perphenazine in the treatment of psychotic depression. METHOD: Thirty patients who met DSM-III-R criteria for major depression with psychotic features were treated with fluoxetine plus perphenazine for 5 weeks. Patients were assessed at baseline and weekly using the Hamilton Rating Scale for Depression (HAM-D), Brief Psychiatric Rating Scale (BPRS), and a side-effect checklist that included specific extrapyramidal and anticholinergic side effects. RESULTS: Twenty-two (73%) of the 30 patients had a 50% or greater reduction in total HAM-D by Week 5. There was a significant improvement in HAM-D and BPRS scores at each week compared with baseline scores. Side effects reported by the patients included dry mouth (40%), blurry vision (40%), constipation (40%), tremor or rigidity (40%), and orthostatic hypotension or dizziness (27%). CONCLUSION: Fluoxetine when used in combination with perphenazine for the treatment of patients with psychotic depression has a response rate similar to the reported rates of response for tricyclic antidepressants (TCAs) plus antipsychotics, amoxapine, and electroconvulsive therapy. The side effects produced by the fluoxetine plus perphenazine combination were less than what has been reported for TCA plus antipsychotic treatment of psychotic depression and similar to the side effects reported with amoxapine. These data suggest that the combination of fluoxetine and perphenazine is effective for the treatment of psychotic depression and may be easier for patients to tolerate than a TCA plus antipsychotic.
Assuntos
Transtorno Depressivo/tratamento farmacológico , Fluoxetina/uso terapêutico , Perfenazina/uso terapêutico , Adulto , Amoxapina/efeitos adversos , Amoxapina/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/psicologia , Transtorno Depressivo/psicologia , Quimioterapia Combinada , Eletroconvulsoterapia , Feminino , Fluoxetina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Perfenazina/efeitos adversos , Escalas de Graduação PsiquiátricaAssuntos
Adulto , Luxações Articulares/etiologia , Mandíbula , Músculos da Mastigação/efeitos dos fármacos , Doenças Musculares/induzido quimicamente , Parassimpatolíticos/uso terapêutico , Perfenazina/efeitos adversos , Perfenazina/uso terapêutico , Articulação Temporomandibular/efeitos dos fármacos , Vômito/tratamento farmacológico , Feminino , HumanosRESUMO
Tardive dyskinesia has not previously been discussed in the dental literature. It is a drug-induced movement disorder commonly involving the perioral and masticatory muscles. It can sometimes be a cause of orofacial pain. Two brief cases reports are provided as examples. Clinical features of tardive dyskinesia are presented to assist the dental practitioner in recognizing the syndrome. Suggestions for management are included.