RESUMEN
Zolpidem is a non-benzodiazepine hypnotic agent used most frequently in the treatment of insomnia, indicated for short-term use. It is not indicated for the chronic treatment of sleep disorders, despite which there is evidence in clinical practice that a large number of patients receive it for years. Although it has been described that it presents a better profile of adverse effects than benzodiazepines and that it generates a lower risk of dependence and withdrawal than these, there are significant reports of cases of dependence and withdrawal from zolpidem. A report of a case of generalized tonic-clonic seizures due to withdrawal at a dose of 300â¯mg per day of zolpidem is presented and a brief review of the literature is carried out.
Asunto(s)
Piridinas , Convulsiones , Humanos , Zolpidem/efectos adversos , Piridinas/efectos adversos , Convulsiones/inducido químicamente , Convulsiones/tratamiento farmacológico , Hipnóticos y Sedantes/efectos adversos , BenzodiazepinasRESUMEN
Introduction: Selective Serotonin Reuptake Inhibitors (SSRIs) are a group of antidepressants that have revolutionized the psychopharmacological therapeutic field since their appearance. They are in the first line of recommendation for the treatment of anxiety disorders and major depressive disorder. And although they are better tolerated and have a better side effect profile than the classic ones, they are not exempt from them. Among the adverse effects of SSRIs little considered by health professionals, are apathy or mental dullness. Restrictions of the range of emotions that are related to normal life, such as the ability to cry or feel pleasure, have been reported. This phenomenon has been called variously in the literature, such as emotional blunting, apathy, emotional indifference, or decreased sensitivity or emotional response. Objectives: The aim of this review is to analyze the emotional effects of SSRI that are described in the literature. Methods: A bibliographic review of the literature published in Pubmed from 2006 to 2021 was carried out, with the words Mesh "SSRI" and "Apathy" and "emotional blunting". Results: Literature reports indicate that the mental dullness produced by SSRIs is generated in at least 50 % of the patients who receive them, with different intensities between them. Conclusions: Although effects of emotional blunting or apathy have been reported with various groups of antidepressants, all reports agree that it occurs more frequently in patients taking SSRIs than with other antidepressants.
Introducción: Los Inhibidores Selectivos de la Recaptación de Serotonina (ISRS) son un grupo de antidepresivos que revolucionaron desde su surgimiento, el campo de la terapéutica psicofarmacológica, y se encuentran en la primera línea de recomendación para el tratamiento de los trastornos de ansiedad y del trastorno depresivo mayor. Si bien son mejor tolerados y presentan un mejor perfil de efectos adversos que los clásicos, no están exentos de ellos. Dentro de los efectos adversos de los ISRS poco considerados por los profesionales de la salud, se encuentran la apatía o el embotamiento mental. Se han reportado en la literatura restricciones del rango de las emociones que están relacionadas con la vida normal, como la capacidad de llorar o de sentir placer. Este fenómeno ha sido designado de varias maneras, como embotamiento emocional, apatía, indiferencia emocional, disminución de sensibilidad o de la respuesta emocional. Objetivos: El objetivo del trabajo es analizar los efectos a nivel emocional de los ISRS, descriptos en la literatura. Metodología: Se realizó una revisión bibliográfica de la literatura publicada en Pubmed desde 2006 hasta 2021, con las palabras Mesh "SSRI" and "Apathy" and "emotional blunting". Resultados: Según reportes de la literatura, el embotamiento emocional producido por los ISRS se genera en al menos un 50 % de los pacientes que lo reciben, con diferentes intensidades entre ellos. Conclusión: Si bien se han reportado efectos de embotamiento emocional o apatía con varios grupos de antidepresivos, todos los reportes concuerdan que se produce con más frecuencia en pacientes medicados con ISRS que con otros antidepresivos.
Asunto(s)
Apatía , Inhibidores Selectivos de la Recaptación de Serotonina , Estudios RetrospectivosRESUMEN
El zolpidem es un agente hipnótico no benzodiacepínico utilizado con suma frecuencia en el tratamiento del insomnio e indicado para emplearlo en el corto plazo. No está indicado para el tratamiento crónico de los trastornos del sueño, pese a lo cual se evidencia en la práctica clínica que gran cantidad de pacientes lo reciben por arios. Si bien se ha descrito que presenta un mejor perfil de efectos adversos que las benzodiacepinas y que genera menos riesgo de dependencia y abstinencia que estas, existen sendos reportes de casos de dependencia y abstinencia de zolpidem. Se presenta el reporte de un caso de convulsiones tónico-clónicas generalizadas por abstinencia a dosis de 300 mg/día de Zolpidem y se realiza una breve revisión de la literatura.
Zolpidem is a non-benzodiazepine hypnotic agent used most frequently in the treatment of insomnia, indicated for short-term use. It is not indicated for the chronic treatment of sleep disorders, despite which there is evidence in clinical practice that a large number of patients receive it for years. Although it has been described that it presents a better profile of adverse effects than benzodiazepines and that it generates a lower risk of dependence and withdrawal than these, there are significant reports of cases of dependence and withdrawal from zolpidem. A report of a case of generalized tonic-clonic seizures due to with drawal at a dose of 300 mg per day of zolpidem is presented and a brief review of the literature is carried out.
RESUMEN
Zolpidem is a non-benzodiazepine hypnotic agent used most frequently in the treatment of insomnia, indicated for short-term use. It is not indicated for the chronic treatment of sleep disorders, despite which there is evidence in clinical practice that a large number of patients receive it for years. Although it has been described that it presents a better profile of adverse effects than benzodiazepines and that it generates a lower risk of dependence and withdrawal than these, there are significant reports of cases of dependence and withdrawal from zolpidem. A report of a case of generalized tonic-clonic seizures due to withdrawal at a dose of 300mg per day of zolpidem is presented and a brief review of the literature is carried out.
RESUMEN
Major depression is a wide and heterogeneous concept. It is defined by DSM by the presence of 5 out of 9 different criteria. Most studies use the DSM definition of depression to screen patients who are then selected by applying strict inclusion and exclusion criteria. This process helps to unify the characteristics of the population under study and to focus more specifically on the variables that will determine safety and efficacy of the drug being studied. However, this ideal population under study is far from the real people that will be prescribed the drug once it is marketed. It is believed, theoretically at least, that most antidepressants of the same class have the same effect. However, advances in pharmacogenetics, pharmacodynamics and pharmacovigilance have shown new side effects and unexpected interactions that demand we take other precautions when prescribing an antidepressant to any given patient. Therefore, it is necessary to know the individual characteristics of each patient.
