Use of antidepressants in the treatment of chronic orofacial pain caused by temporomandibular disorders: A randomized controlled clinical trial.

BACKGROUND AND OBJECTIVE: Temporomandibular disorders (TMDs) are a common pathology, associated with pain in the facial territory and with associated psychological disorders, such as anxiety and depression. The aim of this study was to evaluate the efficacy of antidepressants in the treatment of pain associated with TMD. MATERIALS AND METHODS: Sixty four patients suffering from chronic orofacial pain, randomly distributed in 3 groups: control group treated with night splint, group treated with 10mg/day of citalopram and group treated with 25mg/day of amitriptyline. Pain intensity was assessed, randomly, by a single blinded evaluator, according to the VAS at baseline and after one, three, six and nine weeks. RESULTS: All groups showed a reduction of pain throughout the period of time evaluated, however, the group treated with amitriptyline showed the best pain reduction results 3.3±1.5, 1.5±1.4 and 0.9±1.3 at 3, 6 and 9 weeks, respectively. CONCLUSIONS: Low doses of amitriptyline appear to be a good therapeutic option in patients with TMDs suffering from chronic orofacial pain.

Effectiveness of antidepressants in improving the prognosis of COVID-19: A systematic review and meta-analysis.

OBJECTIVE, AND MATERIAL AND METHODS: A systematic review and meta-analysis was performed to evaluate the effectiveness of antidepressants in reducing the poor evolution of COVID-19 disease (a composite variable including death, hospitalization and need for mechanical ventilation), and mortality, according the guidelines for Systematic Reviews of Interventions published by the Cochrane library. SOURCE OF DATA: MEDLINE, EMBASE and COCHRANE LIBRARY were consulted up to February 25, 2022. Unpublished studies were searched on clinicaltrials.gov platform. SELECTION OF STUDIES: Seven masked and unmasked, observational and experimental studies evaluating death, hospitalization and need for mechanical ventilation were selected. A second subgroup analysis with mortality variable was performed. DATA EXTRACTION: A full risk of bias assessment was performed addressing issues such as information and confounding bias. ROB2 and Robins-I tools for randomized and no randomized studies were employed respectively. In the quantitative analysis, the risk of publication bias, heterogeneity, estimation of pooled measure and a sensitivity analysis was performed. The pooled final measure was calculated as odds ratio with its correspondent 95% confidence interval. A random effects model was used for this purpose due to the heterogeneity between included studies. Finally, a sensitivity analysis was performed to assess the robustness of final pooled measure. RESULTS: Seven studies were finally considered to calculate the final pooled measure. The effect of intervention was OR 0.73; 95% CI 0.56-0.94. CONCLUSIONS: The use of antidepressants, and specially SSRI could be effective for reducing the risk of poor progression of COVID-19 disease.

Avoidant restrictive eating disorder and panic attacks in an adult man: A case report / Trastorno evitativo restrictivo de la ingesta alimentaria y ataques de pánico en un hombre adulto: Reporte de caso

Abstract Avoidant or Restrictive Food Intake Disorder (ARFID) is an eating disorder (ED) not common in adults. In this article we present a clinical case of ARFID in a 37-year-old male patient treated in an ED center in Medellin, Colombia; displaying anxious symptoms that began a year earlier and concomitant weight loss, following a traumatic event causing an overall impairment with that patient. Several medical evaluations/examinations looking for organic causes, were excluded. Interventions were implemented by a psychiatry, a psychotherapist using cognitive-behavior therapy (CBT), and a nutritionist, all in face-to-face modality, which were carried out weekly for the first three months, then biweekly and subsequently quarterly. each lasting approximately 40-60 minutes. After the set of pharmacological interventions and psychotherapy, a great improvement in the functionality of the patient was observed. Improvement was found with respect to eating in public, food variation and panic attacks. In the absence of guidelines, it is important to use standardized and replicable treatments in this population.

Resumen El trastorno evitativo restrictivo de la ingesta (TERIA) es un trastorno alimentario (TCA) raro en adultos. Se presenta el caso de un hombre de 37 años con TERIA y trastorno de pánico atendido en un centro para TCA en Medellín, Colombia, quien presentó un año de síntomas ansiosos y pérdida de peso después de evento traumático, generando disfuncionalidad. Fue evaluada y excluida organicidad. Se realizaron intervenciones por parte de psiquiatría, psicoterapia con enfoque cognitivo conductual y nutrición, todas en modalidad presencial, las cuales se realizaron semanalmente los primeros tres meses, luego quincenalmente y posteriormente trimestralmente. Cada una con una duración de 40-60 minutos aproximadamente por sesión. Posterior al conjunto de intervenciones farmacológicas y psicoterapia, se observó una gran mejoría la funcionalidad del paciente, se encontró mejoría con respecto a comer en público, variación en los alimentos y ataques de panico. Ante la ausencia de guías de manejo de TERIA en adultos es relevante realizar tratamientos estandarizados que puedan ser replicados.

Star'd y mas allá: una mirada profunda a la eficacia de los antidepresivos / Star'd and Beyond: An In-Depth Look at the Efficacy of Antidepressants

El estudio STAR'D busco identificar las intervenciones terapéuticas más eficaces para pacientes con trastorno depresivo mayor no tratado previamente. Se trató de un ensayo clínica naturalista y a gran escala, diseñado para determinar las estrategias terapéuticas más eficiente en aquellos pacientes que no responden a un tratamiento inicial. Aunque algunos profesionales consideraron el estudio alentador al proporcionar una ruta secuencias de alternativas farmacológicas, muchos lo vieron como un recordatorio revelador de las limitaciones inherentes de los antidepresivos: estos medicamentos no son la solución definitiva para la depresión. Este artículo tiene como propósito brindar un panorama conciso del estudio STAR'D, seguido de una reflexión crítica sobre sus hallazgos e implicaciones en el ámbito clínico.

Repercusión de vortioxetina sobre la función sexual frente a otros antidepresivos / Impact of vortioxetine on sexual function compared to other antidepressants

Objetivo Analizar la repercusión del antidepresivo vortioxetina sobre la función sexual, frente a inhibidores selectivos de la recaptación de serotonina (ISRS) e inhibidores selectivos mixtos de la recaptación de serotonina y noradrenalina (IRSN o Duales) en pacientes con depresión. Material y métodos Estudio analítico, observacional, longitudinal y prospectivo en el que se incluyeron hombres y mujeres mayores de 18años con trastorno depresivo y actividad sexual en pareja, separándolos en dos grupos: 1)de estudio: inician tratamiento con vortioxetina; 2)control: mantienen tratamiento con ISRS o Duales. Se realizaron tres visitas: inclusión, seguimiento a las 4semanas y final 3meses desde la inclusión. El periodo total de seguimiento fue de 3meses. Resultados Se incluyeron 87 pacientes (edad media, 46,85años). Al final del estudio se hallaron diferencias significativas (DS) en el valor medio de la suma de las puntuaciones de los dominios evaluadores de la respuesta sexual del cuestionario de Función Sexual de la Mujer (FSM-2) entre el grupo de estudio y el de control (22,42±4,39 y 16,13±7,76, respectivamente), con menor riesgo de disfunción sexual en las mujeres tratadas con vortioxetina. También menor riesgo de disfunción sexual en estas mismas mujeres en los dominios de deseo, lubricación, orgasmo, frecuencia sexual y satisfacción sexual. Estas diferencias no se hallaron al evaluar la función sexual masculina. Conclusiones Las mujeres tratadas con vortioxetina presentaron mejor función sexual que las tratadas con ISRS o Duales y menor riesgo de disfunción sexual (AU)

Objective To analyze the impact of the antidepressant vortioxetine on sexual function, compared to selective serotonin reuptake inhibitors (SSRIs) and mixed selective serotonin and norepinephrine reuptake inhibitors (IRSN or Dual) in patients with depression. Material and methods Analytical, observational, longitudinal and prospective study, which included men and women over 18years of age, with depressive disorder and sexual activity with a partner, separating them into two groups: (i)study, starting treatment with vortioxetine; (2)control, maintaining treatment with SSRIs or Duals. Three visits were made: inclusion, follow-up at 4weeks and final 3months from inclusion. The total follow-up period was 3months. Results A total of 87 patients were included (mean age 46.85years). At the end of the study, significant differences (SD) were found in the mean value of the sum of the scores of the evaluative domains of the sexual response of the Women's Sexual Function Questionnaire (FSM-2) between the study group and the control (22.42±4.39 and 16.13±7.76, respectively), with a lower risk of sexual dysfunction in women treated with vortioxetine. Also, lower risk of sexual dysfunction in these same women in the domains of desire, lubrication, orgasm, sexual frequency and sexual satisfaction. These differences were not found when assessing male sexual function. Conclusions Women treated with vortioxetine presented better sexual function than those treated with SSRIs or Duals and a lower risk of sexual dysfunction (AU)

Ibogaína: un psicodélico atípico con potencial antiadictivo / Ibogaine: an atypical psychedelic with anti-addictive potential

El trastorno por uso de sustancias es una enfermedad crónica de graves consecuencias. Actualmente, los tratamientos farmacológicos no apuntan a corregir los cambios neurobiológicos generados en el cerebro por el uso crónico de sustancias de abuso, sino que se enfocan principalmente en la atenuación de algunos de los síntomas que padece el consumidor. La ibogaína es un psicodélico atípico que, tanto en estudios observacionales como en ensayos clínicos abiertos, ha mostrado una propiedad antiadictiva que perdura en el tiempo. Sin embargo, su delicado perfil de toxicidad cardíaca, así como su uso en entornos sin adecuadas medidas de seguridad, han limitado su progresión en las investigaciones clínicas. Los efectos antiadictivos de ibogaína han disparado diversas líneas de investigación básica, preclínica y clínica, que buscan confirmar su efectividad, entender sus mecanismos de acción y delimitar su perfil de seguridad. Dada la poca información disponible para los profesionales de salud sobre esta sustancia, esta revisión busca aportar información acerca de su potencial terapéutico, posibles mecanismos de acción y riesgos asociados a su administración.

Substance use disorder is a chronic disease with severe consequences. Currently, pharmacological treatments do not aim to correct the neurobiological changes generated in the brain by the chronic use of substances of abuse, but rather focus mainly on attenuating some of the user's symptoms. Ibogaine is an atypical psychedelic that has shown long-lasting and interesting antiaddictive properties in both observational studies and open-label clinical trials. However, its delicate profile of cardiac toxicity, as well as its use in settings without adequate safety measures, have limited its progression in clinical research. The anti-addictive effects of ibogaine have triggered diverse scientific research in basic, preclinical, and clinical areas, which seek efficacy confirmation and to fully understand ibogaine´s underlying mechanisms of action and its safety profile. Given that there is little information available to health professionals about ibogaine and its antiaddictive properties, this review aims to provide published data about its therapeutic potential in drug addiction, its mechanisms of action, and risks associated with its administration.

[Impact of vortioxetine on sexual function compared to other antidepressants]. / Repercusión de vortioxetina sobre la función sexual frente a otros antidepresivos.

OBJECTIVE: To analyze the impact of the antidepressant vortioxetine on sexual function, compared to selective serotonin reuptake inhibitors (SSRIs) and mixed selective serotonin and norepinephrine reuptake inhibitors (IRSN or Dual) in patients with depression. MATERIAL AND METHODS: Analytical, observational, longitudinal and prospective study, which included men and women over 18years of age, with depressive disorder and sexual activity with a partner, separating them into two groups: (i)study, starting treatment with vortioxetine; (2)control, maintaining treatment with SSRIs or Duals. Three visits were made: inclusion, follow-up at 4weeks and final 3months from inclusion. The total follow-up period was 3months. RESULTS: A total of 87 patients were included (mean age 46.85years). At the end of the study, significant differences (SD) were found in the mean value of the sum of the scores of the evaluative domains of the sexual response of the Women's Sexual Function Questionnaire (FSM-2) between the study group and the control (22.42±4.39 and 16.13±7.76, respectively), with a lower risk of sexual dysfunction in women treated with vortioxetine. Also, lower risk of sexual dysfunction in these same women in the domains of desire, lubrication, orgasm, sexual frequency and sexual satisfaction. These differences were not found when assessing male sexual function. CONCLUSIONS: Women treated with vortioxetine presented better sexual function than those treated with SSRIs or Duals and a lower risk of sexual dysfunction.

Rationality for the Use of Neuromodulation in Disorders of Gut-Brain Interaction (Functional Gastrointestinal Disorders)

Within the broad range of therapeutic options for managing functional gastrointestinal disorders, recently redefined as Disorders of Gut-Brain Interaction (DGBI) by the Rome Foundation in the Rome IV criteria, certain medications with antidepressant, anxiolytic, or antipsychotic effects are commonly employed. These drugs, now referred to as neuromodulators by the Rome Foundation, target the neurogastroenterological dysfunction associated with these disorders. Consequently, their clinical utility as psychiatric medications can now be leveraged to benefit patients with DGBI. This narrative review aims to provide an updated and specific overview of the indications for neuromodulators in the primary DGBI. The first section of this review focuses on the rationale and justification for their use.

En el amplio espectro de las opciones terapéuticas para el manejo de los trastornos funcionales digestivos, que se han redefinido por la Fundación Roma en los criterios Roma IV como trastornos de la interacción cerebro-intestino (TICI), algunos medicamentos con efectos antidepresivos, ansiolíticos o antipsicóticos se utilizan con mayor frecuencia. Estos medicamentos, que actúan en la disfunción neurogastroenterológica de estos trastornos, también han sido renombrados por la Fundación Roma como neuromoduladores, para que ahora puedan aprovecharse sus beneficios terapéuticos en este ámbito clínico, debido a su utilización como medicamentos psiquiátricos. Esta revisión narrativa tiene por objeto actualizar y precisar las indicaciones de los neuromoduladores en los principales TICI, y en esta primera sección se aborda la racionalidad y justificación para su utilización.

Use of anxiolytics/antidepressants among university students in the pre-vaccine period of the COVID-19 pandemic / Uso de ansiolíticos/antidepresivos por estudiantes universitarios en el periodo prevacuna en la pandemia COVID-19 / Uso de ansiolíticos/antidepressivos por estudantes universitários em período pré-vacina na pandemia da COVID-19

The present study assessed the prevalence of the use of anxiolytics/antidepressants and associated factors among university students in the pre-vaccine period of the COVID-19 pandemic. A cross-sectional study was conducted with 983 students of public and private universities in Brazil. Data were collected between September and December 2020 with the aid of a questionnaire available on the Survey Monkey® platform addressing socioeconomic data, self-rated health, the use of anxiolytics/antidepressants, history of depression, psychological/psychiatric treatment and aspects of the undergraduate course. Statistical analysis involved descriptive statistics and Poisson regression with robust variance (α= 5%). The prevalence of anxiolytics/antidepressants use was 15.7%. The use of anxiolytics/antidepressants was associated with the female sex (PR = 1.53; 95% CI: 1.03-2.26), dissatisfaction with one's overall health (PR = 1.40; 95% CI: 1.08-1.82), undergoing psychological/psychiatric treatment (PR = 2.85; 95% CI: 1.91-4.22) and a medical diagnosis of depression (PR = 3.44; 95% CI: 2.52-4.70). The female sex, dissatisfaction with one's own overall health status, undergoing psychological/psychiatric treatment and a medical diagnosis of depression exerted an influence onthe use of anxiolytics/antidepressants by undergraduate university students during the COVID-19 pandemic (AU).

El presente estudio evaluó la prevalencia del uso de ansiolíticos/antidepresivos y factores asociados entre estudiantes universitarios en el período previo a la vacunación de la pandemia COVID-19. Se realizó un estudio transversal con 983 estudiantes de universidades públicas y privadas de Brasil. Los datos fueron recolectados entre septiembre y diciembre de 2020 con la ayuda de un cuestionario disponible en la plataforma Survey Monkey® que aborda datos socioeconómicos, salud autoevaluada, uso de ansiolíticos/antidepresivos, antecedentes de depresión, tratamiento psicológico/psiquiátrico y aspectos de la carrera universitaria. curso. El análisis estadístico implicó estadística descriptiva y regresión de Poisson con varianza robusta (α= 5%). La prevalencia del uso de ansiolíticos/antidepresivos fue del 15,7%. El uso de ansiolíticos/antidepresivos se asoció con el sexo femenino (RP = 1,53; IC 95%: 1,03-2,26), insatisfacción con la salud general (RP = 1,40; IC 95%: 1,08-1,82), estar sometido a tratamiento psicológico/psiquiátrico (RP = 2,85; IC 95%: 1,91-4,22) y diagnóstico médico de depresión (RP = 3,44; IC 95%: 2,52-4,70). El sexo femenino, la insatisfacción con el propio estado de salud general, el tratamiento psicológico/psiquiátrico y el diagnóstico médico de depresión influyeron en el uso de ansiolíticos/antidepresivos por parte de estudiantes universitarios durante la pandemia de COVID-19 (AU).

O presente estudo avaliou a prevalência do uso de ansiolíticos/antidepressivos e fatores associados entre estudantes universitários no período pré-vacinal da pandemia de COVID-19. Foi realizado um estudo transversal com 983 estudantes de universidades públicas e privadas do Brasil. Os dados foram coletados entre setembro e dezembro de 2020 com auxílio de questionário disponível na plataforma Survey Monkey® abordando dados socioeconômicos, autoavaliação de saúde, uso de ansiolíticos/antidepressivos, histórico de depressão, tratamento psicológico/psiquiátrico e aspectos da graduação curso. A análise estatística envolveu estatísticadescritiva e regressão de Poisson com variância robusta (α= 5%). A prevalência de uso de ansiolíticos/antidepressivos foi de 15,7%. O uso de ansiolíticos/antidepressivos esteve associado ao sexo feminino (RP = 1,53; IC 95%: 1,03-2,26), insatisfação com asaúde geral (RP = 1,40; IC 95%: 1,08-1,82), estar em tratamento psicológico/psiquiátrico (RP = 2,85; IC 95%: 1,91-4,22) e diagnóstico médico de depressão (RP = 3,44; IC 95%: 2,52-4,70). O sexo feminino, a insatisfação com o próprio estado geral de saúde, a realização de tratamento psicológico/psiquiátrico e o diagnóstico médico de depressão exerceram influência no uso de ansiolíticos/antidepressivos por estudantes universitários de graduação durante a pandemia de COVID-19 (AU).

Intoxicación por antidepresivos tricíclicos / Tricyclic antidepressant poisoning

Introducción: el paciente intoxicado sigue siendo un desafío para el personal de salud. La intoxicación por antidepresivos tricíclicos (ATC) es un diagnóstico frecuente y una patología que puede llegar a ser muy grave. A pesar de que ha cambiado el objetivo terapéutico de estos fármacos a lo largo de los años, la alta disponibilidad de estos hace que su uso para intento de autolisis siga presentándose. Su presentación clínica es variada y dado el riesgo de mortalidad asociada, es importante que esta patología sea rápidamente reconocida por los médicos que los reciben para iniciar un manejo oportuno y eficaz. Objetivo: presentar el enfrentamiento inicial y manejo terapéutico de la intoxicación por ATC desde la perspectiva de la medicina de urgencia. Método: se realizó una revisión bibliográfica de la literatura científica sobre el manejo de un paciente intoxicado por ATC. Se presenta la evidencia actual de las intervenciones terapéuticas más utilizadas. respecto al manejo inicial y enfrentamiento de la intoxicación por antidepresivos tricíclicos, en el contexto de la atención en un servicio de urgencia. Conclusión: la intoxicación por ATC puede presentarse con síntomas leves y signos precoces, así como con síntomas graves e incluso fatales, dados principalmente por complicaciones cardiovasculres y neurológicas. Su manejo se basa en el reconocimiento precoz, medidas de soporte y terapias específicas según la clínica que presente.

Managing poisoned patients continues to be a challenge for health personnel. Tricyclic antidepressant are a frequent diagnosis, and a pathology their can be very serious. Although the therapeutic indications for these drugs have changed over the years, their high availability means that their use for suicidal attempts continues to be present. Its clinical presentation is varied and given the mortality risk, it is crucial that this entity must be rapidly recognized by the physicians who care for them to initiate timely and effective treatment. Objective: Present the initial management and therapeutic strategies for tricyclic antidepressant intoxication, from emergency medicine perspective. Method: Bibliographic review of the scientific literature on this subject. Current evidence of the most widely used therapeutic interventions is described regarding the initial management and disposition of tricyclic antidepressant intoxication in the emergency department.

Efectos de la COVID-19 en el consumo de antidepresivos en la provincia de Santa Cruz de Tenerife, Islas Canarias / Effects of COVID-19 on the consumption of antidepressants in the Province of Santa Cruz de Tenerife, Canary Islands

Fundamento: en este trabajo se analiza el impacto de la COVID-19 en el consumo de antidepresivos durante el primer año de la pandemia (2020) tomando como línea de base las tendencias de prescripción durante los 4 años anteriores (2016-2019) en la provincia de Santa Cruz de Tenerife y las cuatro islas que la conforman. Métodos: los datos de ventas en las farmacias comunitarias se tomaron como base de datos agregados. La dosis por 1000 habitantes y día se utilizó como indicador de consumo.Resultados: en las islas de El Hierro y La Gomera, el aumento de población no justifica por sí solo los incrementos relevantes observados en el consumo de antidepresivos y, posiblemente, la COVID-19 y sus consecuencias sobre la salud de la población podrían ser responsables de dichos aumentos. En la isla de Tenerife el incremento de población podría justificar, en gran medida, el ligero aumento de consumo observado. La isla de La Palma presenta un aumento de tan solo un 1,40 %, pero menor al valor esperado tomando como línea de base el periodo 2016-2019. Todas las islas presentan las mismas tendencias en el consumo de los diferentes subgrupos de antidepresivos y principios activos, aunque con ligeras variaciones, con la excepción de la isla de la Palma que presenta un comportamiento y tendencias estadísticamente diferentes.Conclusiones: las diferencias de prescripción observadas podrían estar relacionadas con las características sociosanitarias y demográficas de cada una de las islas. (AU)

Implicações neurológicas da meditação do tipo terapia cognitiva baseada em mindfulness em pacientes com transtorno de ansiedade ou transtorno depressivo: uma revisão integrativa / Neurological implications of mindfulness-based cognitive therapy in patients with anxiety or depressive disorders: an integrative review / Implicaciones neurológicas de la meditación de la terapia cognitiva basada en mindfulness en pacientes con trastorno de ansiedad o trastorno depresivo: una revisión integradora

A Terapia Cognitiva Baseada em Mindfulness (MBCT, do inglês Mindfulness-Based Cognitive Therapy) é uma técnica baseada na combinação da Terapia Cognitiva-Comportamental e da meditação mindfulness, na busca pela melhoria de sintomas psiquiátricos. O presente trabalho tem como objetivo a busca por publicações que discutam as implicações neurológicas de pacientes diagnosticados com transtorno depressivo e transtorno de ansiedade e que buscaram nessa técnica a melhoria de sua condição clínica ou qualidade de vida. Nossos resultados preliminares mostraram que os benefícios dessa prática foram colhidos na totalidade dos estudos encontrados, elucidando as áreas cerebrais modificadas e o motivo pelo qual elas foram ativadas. Procuramos abordar ainda a diferença entre essa técnica e o uso de medicamentos e tratamento usual. PALAVRAS-CHAVE: Terapia Cognitiva-Comportamental; Cérebro; Transtornos Psiquiátricos; Antidepressivos.

Mindfulness-Based Cognitive Therapy (MBCT) is a technique based on the combination of Cognitive-Behavioral Therapy and mindfulness meditation, in the search of improving psychiatric symptoms. This present work aims to search for studies and articles that discuss the neurological implications of patients diagnosed with anxiety and major depressive disorders who sought improvement in their clinical condition or life quality through this technique. The preliminary results showed that the benefits of this practice were observed in all of the studies found, elucidating the modified brain areas and the reason why they were activated. The differences between this technique and the use of medication and treatment-as-usual was also addressed.

La Terapia Cognitiva Basada en Mindfulness (MBCT) es una técnica basada en la combinación de la Terapia Cognitivo-Conductual y la meditación mindfulness, en la búsqueda de la mejora de los síntomas psiquiátricos. El presente trabajo tiene como objetivo buscar publicaciones que discutan las implicaciones neurológicas de pacientes diagnosticados con trastorno depresivo y trastorno de ansiedad y que busquen en esta técnica mejorar su condición clínica o calidad de vida. Nuestros resultados preliminares mostraron que los beneficios de esta práctica se cosecharon en todos los estudios encontrados, dilucidando las áreas cerebrales modificadas y la razón por la cual se activaron. También tratamos de abordar la diferencia entre esta técnica y el uso de medicación y tratamiento habitual.

Papel de vortioxetina en el tratamiento del dolor neuropático / Role of vortioxetine in the treatment of neuropathic pain

El dolor neuropático es un problema clínico importante e incapacitante, su manejo constituye un reto para los profesionales sanitarios. Vortioxetina es un nuevo fármaco antidepresivo con acción multimodal, lo que le confiere un perfil único. Los antidepresivos tricíclicos, en particular amitriptilina, y los inhibidores de la recaptación de serotonina y noradrenalina venlafaxina y duloxetina constituyen fármacos de primera línea en el tratamiento del dolor neuropático. La interacción entre el binomio dolor y depresión es muy frecuente, siendo la complicación psicológica más frecuente en los pacientes con dolor crónico. Esta revisión exhaustiva y descriptiva resume los datos farmacológicos más relevantes de vortioxetina, así como la bibliografía específica de vortioxetina en dolor neuropático y dolor crónico.(AU)

Neuropathic pain is an important and disabling clinical problem, its management constitutes a challenge for healthcare professionals. Vortioxetine is a new antidepressant drug with multimodal action, which gives it a unique profile. Tricyclic antidepressants, in particular amitriptyline, and serotonin and norepinephrine reuptake inhibitors venlafaxine and duloxetine are first-line drugs in the treatment of neuropathic pain. The interaction between the pain and depression binomial is very frequent, being the most frequent psychological complication in patients with chronic pain. This comprehensive and descriptive review summarizes the most relevant pharmacological data on vortioxetine, as well as the specific literature on vortioxetine in neuropathic pain and chronic pain.(AU)

Role of vortioxetine in the treatment of neuropathic pain.

Neuropathic pain is an important and disabling clinical problem, its management constitutes a challenge for healthcare professionals. Vortioxetine is a new antidepressant drug with multimodal action, which gives it a unique profile. Tricyclic antidepressants, in particular amitriptyline, and serotonin and norepinephrine reuptake inhibitors venlafaxine and duloxetine are first-line drugs in the treatment of neuropathic pain. The interaction between the pain and depression binomial is very frequent, being the most frequent psychological complication in patients with chronic pain. This comprehensive and descriptive review summarizes the most relevant pharmacological data on vortioxetine, as well as the specific literature on vortioxetine in neuropathic pain and chronic pain.

Utilización de antidepresivos y prescripción fuera de ficha técnica en atención primaria en España (2013-2018) / Antidepressant use and off-label prescribing in primary care in Spain (2013–2018)

Introducción: Estudios recientes muestran un aumento del uso de antidepresivos en menores de 18 años, aunque pocos de ellos cuentan con indicación en este grupo de edad. El objetivo de este estudio es calcular la prevalencia anual del uso de antidepresivos en niños y adolescentes y revisar la adecuación de la prescripción a las indicaciones actuales. Métodos: Estudio de prevalencia de la utilización de antidepresivos en menores de 18 años a partir de los registros de la Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP) durante el periodo 2013-2018, considerando al menos una prescripción por año para un mismo paciente. Resultados: La prevalencia de prescripción de antidepresivos entre los pacientes de la cohorte BIFAP ha aumentado de 2013 (7,97 prescripciones/1.000 pacientes) a 2018 (8,87 prescripciones/1.000 pacientes) en la mayoría de los grupos y en ambos sexos. El sexo femenino suma la mayoría de las prescripciones, superando al masculino en hasta 2,5 puntos en las tasas generales. En menores de 13 años la tendencia se invierte y los antidepresivos predominan en los chicos. La prevalencia de las prescripciones aumenta con la edad de los pacientes, igual que la proporción de tratamientos fuera de ficha técnica. El empleo de fármacos sin indicación disminuye con el transcurso del tiempo. Conclusiones: Observamos un aumento gradual en la prevalencia de prescripción de antidepresivos en menores de 18 años, preponderante en el sexo femenino. La elevada proporción de uso de estos fármacos sin indicación autorizada exige profundizar en el balance beneficio-riesgo y en alternativas de tratamiento más seguras. (AU)

Introduction: Recent studies show an increase in the use of antidepressants in minors (younger than 18 years), although few antidepressants are indicated for this age group. The aim of our study was to calculate the annual prevalence of antidepressant use in children and adolescents and to review the adherence of prescription to current indications. Methods: Study of the prevalence of antidepressant use in minors based on the records of the Electronic Database for Pharmacoepidemiologic Studies in Primary Care (BIFAP) of Spain for the 2013–2018 period, considering at least one prescription per year for each patient. Results: The prevalence of antidepressant prescription in patients from the BIFAP cohort increased between 2013 (7.97 prescriptions per 1000 patients) and 2018 (8.87 prescriptions per 1000 patients), in most groups and in both sexes. In this period, female patients received the most prescriptions, surpassing prescriptions in male patients by up to 2.5 points in the overall rates. In patients younger than 13 years, this trend was inverted and antidepressant use was higher in male patients. The prevalence of prescription rose with increasing patient age, as did the proportion of off-label prescriptions. The use of off-label medication decreased over time. Conclusions: There was a gradual increase in the prevalence of antidepressant prescription in minors younger than 18 years, with a predominance of the female sex. The high proportion of unapproved medication use in this age group calls for more thorough investigation of the risk–benefit balance of these treatments and of safer treatment alternatives. (AU)

Efficacy and safety of antipsychotics and antidepressants in the treatment of anorexia nervosa: a systematic review.

INTRODUCTION: The recommendations of the current guidelines are based on low quality evidence. Periodic updating is required, taking recent evidence into consideration. OBJECTIVE: To synthesise the best available clinical evidence on the efficacy and safety of second-generation antidepressants and antipsychotics in patients with anorexia nervosa. METHODS: Systematic review (CRD42020150577). We searched PubMed, SCOPUS, Ovid(Cochrane), EMBASE and LILACS for randomised clinical trials performed in patients with anorexia nervosa that evaluated the use of second-generation antipsychotics or oral antidepressants, at any dose and for any length of time, in outpatient and/or hospital treatment, taking weight (body mass index), psychopathological entities and safety as results. RESULTS: Five studies were included, with four assessed as having a high risk of bias. The evidence indicates that patients receiving treatment with olanzapine or fluoxetine tend to stay in treatment programmes for longer. Olanzapine showed favourable results (one study) in terms of weight gain, but did not show the same results in psychopathology, where the evidence is contradictory. CONCLUSIONS: In accordance with previous reviews, our work allows us to conclude that there is contradictory information on the efficacy of psychotropic drugs in the treatment of anorexia nervosa. Future work should focus on developing clinical trials of high methodological quality.

Vitamin D: Between the brightness of the sun and the darkness of depression.

INTRODUCTION: The scientific literature suggests a relationship between vitamin D (VitD) and the onset, treatment and prognosis of depression. However, this line of research continues to be controversial. The aim of the study was to analyse the relationship between depression and VitD values, controlling for the influence of the season. MATERIAL AND METHODS: Observational and cross-sectional study. The sample was made up of 150 adult female volunteer participants (aged between 28 and 78 years). The sample was stratified into three groups: a) depression without treatment, b) depression under treatment with antidepressants, and c) without depression (control). VitD values (ng/ml) were compared. RESULTS: Significant differences were found between the three groups surveyed. The group of participants with depression without treatment obtained the lowest VitD values (mean 18.62ng/ml; SD 8.42), compatible with severe insufficiency. The group of participants with depression in treatment obtained higher values than the previous group, although in an insufficient range (mean 23.80ng/ml; SD 11.30). The third group (control) obtained the highest values and in accordance with the desirable range (mean 30.19ng/ml; SD 10.21). There were no age differences between the groups. When controlling for possible effects of the season, the previous differences in VitD between the three groups were maintained, with an evident decrease of all the mean levels in the winter period. CONCLUSIONS: Depression is associated with insufficient VitD values. Treatment with antidepressants improves these values, although they continue to be insufficient. The findings of this study reinforce the evidence for an association between depression and VitD.

For what indications are antidepressants being used in adults in Colombia?

INTRODUCTION: Antidepressants are useful in the pharmacological treatment of different depressive and anxiety disorders, as well as being potentially useful in other indications. The aim of the study was to determine the indications for which antidepressants are being prescribed in patients over 18 years of age registered with the Colombian Health System. METHODS: Retrospective study with data from patients over 18 years old, of either sex, registered with the Colombian Health System, who are prescribed antidepressants. Medical records were reviewed, looking for indications approved and not approved by regulatory agencies. Patients were identified randomly, as well as the sociodemographic, clinical and pharmacological variables that could be associated with prescriptions for unapproved indications. RESULTS: 351 patients were evaluated, with a mean age of 60.4 ± 15.3 years, of whom 72.6% were women. They were attended in 34 cities, with prescriptions mainly by general practitioners (n = 276; 78.6%), and psychiatrists (n = 42; 12.0%). Selective serotonin reuptake inhibitors were the most widely prescribed antidepressants (n = 204; 58.1%), followed by atypicals (n = 76; 21.7%). The most frequent indications were for depression (n = 169; 48.1%), anxiety (n = 48; 13.7%), pain (n = 22; 6.3%) and sleep disorders (n = 17; 4.8%). A total of 188 prescriptions (53.6%) were made for approved indications, and the remaining 163 (46.4%) were classified as unapproved. CONCLUSIONS: Antidepressants are being prescribed for the treatment of depression, anxiety, pain and sleep disorders, especially in older adult women, but almost half of the formulations were for unapproved indications.

Antidepressant use and off-label prescribing in primary care in Spain (2013-2018).

INTRODUCTION: Recent studies show an increase in the use of antidepressants in minors (younger than 18 years), although few antidepressants are indicated for this age group. The aim of our study was to calculate the annual prevalence of antidepressant use in children and adolescents and to review the adherence of prescription to current indications. METHODS: Study of the prevalence of antidepressant use in minors based on the records of the Electronic Database for Pharmacoepidemiologic Studies in Primary Care (BIFAP) of Spain for the 2013-2018 period, considering at least one prescription per year for each patient. RESULTS: The prevalence of antidepressant prescription in patients from the BIFAP cohort increased between 2013 (7.97 prescriptions per 1000 patients) and 2018 (8.87 prescriptions per 1000 patients), in most groups and in both sexes. In this period, female patients received the most prescriptions, surpassing prescriptions in male patients by up to 2.5 points in the overall rates. In patients younger than 13 years, this trend was inverted and antidepressant use was higher in male patients. The prevalence of prescription rose with increasing patient age, as did the proportion of off-label prescriptions. The use of off-label medication decreased over time. CONCLUSIONS: There was a gradual increase in the prevalence of antidepressant prescription in minors younger than 18 years, with a predominance of the female sex. The high proportion of unapproved medication use in this age group calls for more thorough investigation of the risk-benefit balance of these treatments and of safer treatment alternatives.