Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 27.463
Filtrar
1.
London; National Institute for Health and Care Excellence; Apr. 7, 2021. 36 p.
Monografía en Inglés | BIGG - guías GRADE | ID: biblio-1179029

RESUMEN

This guideline covers assessing all chronic pain (chronic primary pain, chronic secondary pain, or both) and managing chronic primary pain in people aged 16 years and over. Chronic primary pain is pain with no clear underlying cause, or pain (or its impact) that is out of proportion to any observable injury or disease. This guideline should be used alongside NICE guidelines for other chronic pain conditions, including the NICE guidelines on headaches, low back pain and sciatica, rheumatoid arthritis, osteoarthritis, spondyloarthritis, endometriosis, neuropathic pain and irritable bowel syndrome.


Asunto(s)
Humanos , Adolescente , Dolor Crónico/clasificación , Dolor Crónico/prevención & control , Dolor Crónico/tratamiento farmacológico , Benzodiazepinas/uso terapéutico , Terapia por Acupuntura , Corticoesteroides/uso terapéutico , Marihuana Medicinal/uso terapéutico , Analgésicos Opioides/uso terapéutico , Anestésicos Locales/uso terapéutico , Anticonvulsivantes/uso terapéutico , Antidepresivos/uso terapéutico
2.
Adv Exp Med Biol ; 1305: 231-255, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33834403

RESUMEN

Genetic factors play a significant but complex role in antidepressant (AD) response and tolerability. During recent years, there is growing enthusiasm in the promise of pharmacogenetic/pharmacogenomic (PGx) tools for optimizing and personalizing treatment outcomes for patients with major depressive disorder (MDD). The influence of pharmacokinetic and pharmacodynamic genes on response and tolerability has been investigated, including those encoding the cytochrome P450 superfamily, P-glycoprotein, monoaminergic transporters and receptors, intracellular signal transduction pathways, and the stress hormone system. Genome-wide association studies are also identifying new genetic variants associated with AD response phenotypes, which, combined with methods such as polygenic risk scores (PRS), is opening up new avenues for novel personalized treatment approaches for MDD. This chapter describes the basic concepts in PGx of AD response, reviews the major pharmacokinetic and pharmacodynamic genes involved in AD outcome, discusses PRS as a promising approach for predicting AD efficacy and tolerability, and addresses key challenges to the development and application of PGx tests.


Asunto(s)
Trastorno Depresivo Mayor , Farmacogenética , Antidepresivos/uso terapéutico , Depresión , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Depresivo Mayor/genética , Estudio de Asociación del Genoma Completo , Humanos
3.
Adv Exp Med Biol ; 1305: 503-513, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33834415

RESUMEN

Depression is a very common disease with increasing incidence resulting from complex interactions of genetic, environmental, and immunological processes. To this day, the etiopathogenesis and treatment of depression unfortunately seem to be stuck in the synaptic gap. Despite highly potent antidepressants, the treatment rate cannot reach 100%, the treatment resistant group cannot be eliminated, and relapse cannot be prevented. These problems lead researchers to further and different research to understand and treat psychopathology. Immune dysfunction and neuroinflammation have been one of the main issues that psychiatry has focused on in recent years and helps us to understand depression. Extraneuronal components of all neuropsychiatric disorders, especially depression, have begun to be revealed in detail thanks to a better understanding of the immune system and an increase in experimental and technological possibilities. There is increasing evidence of a causal relationship between the etiopathogenesis of major depression and low-level chronic neuroinflammation. In this article, the role of neuroinflammation in the etiopathogenesis of depression and the possibilities of vaccination and immunotherapy are discussed.


Asunto(s)
Trastorno Depresivo Mayor , Antidepresivos/uso terapéutico , Depresión , Trastorno Depresivo Mayor/tratamiento farmacológico , Humanos , Inmunoterapia , Vacunación
4.
Molecules ; 26(8)2021 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-33917953

RESUMEN

It is generally assumed that selective serotonin reuptake inhibitors (SSRIs) induce antidepressant activity by inhibiting serotonin (5-HT) reuptake transporters, thus elevating synaptic 5-HT levels and, finally, ameliorates depression symptoms. New evidence indicates that SSRIs may also modulate other neurotransmitter systems by inhibiting neuronal nicotinic acetylcholine receptors (nAChRs), which are recognized as important in mood regulation. There is a clear and strong association between major depression and smoking, where depressed patients smoke twice as much as the normal population. However, SSRIs are not efficient for smoking cessation therapy. In patients with major depressive disorder, there is a lower availability of functional nAChRs, although their amount is not altered, which is possibly caused by higher endogenous ACh levels, which consequently induce nAChR desensitization. Other neurotransmitter systems have also emerged as possible targets for SSRIs. Studies on dorsal raphe nucleus serotoninergic neurons support the concept that SSRI-induced nAChR inhibition decreases the glutamatergic hyperstimulation observed in stress conditions, which compensates the excessive 5-HT overflow in these neurons and, consequently, ameliorates depression symptoms. At the molecular level, SSRIs inhibit different nAChR subtypes by noncompetitive mechanisms, including ion channel blockade and induction of receptor desensitization, whereas α9α10 nAChRs, which are peripherally expressed and not directly involved in depression, are inhibited by competitive mechanisms. According to the functional and structural results, SSRIs bind within the nAChR ion channel at high-affinity sites that are spread out between serine and valine rings. In conclusion, SSRI-induced inhibition of a variety of nAChRs expressed in different neurotransmitter systems widens the complexity by which these antidepressants may act clinically.


Asunto(s)
Antidepresivos/farmacología , Receptores Nicotínicos/metabolismo , Inhibidores de la Captación de Serotonina/farmacología , Animales , Antidepresivos/química , Antidepresivos/uso terapéutico , Depresión/tratamiento farmacológico , Humanos , Neuronas/efectos de los fármacos , Neuronas/patología , Inhibidores de la Captación de Serotonina/química , Fumar/efectos adversos
5.
Nutrients ; 13(3)2021 Mar 11.
Artículo en Inglés | MEDLINE | ID: mdl-33799507

RESUMEN

Depressive disorders represent a major public health concern and display a continuously rising prevalence. Importantly, a large proportion of patients develops aversive side effects and/or does not respond properly to conventional antidepressants. These issues highlight the need to identify further therapeutic strategies, including nutritional approaches using natural plant extracts with known beneficial impacts on health. In that context, growing evidence suggests that saffron could be a particularly promising candidate. This preclinical study aimed therefore to test its antidepressant-like properties in mice and to decipher the underlying mechanisms by focusing on monoaminergic neurotransmission, due to its strong implication in mood disorders. For this purpose, the behavioral and neurobiochemical impact of a saffron extract, Safr'Inside™ (6.5 mg/kg per os) was measured in naïve mice. Saffron extract reduced depressive-like behavior in the forced swim test. This behavioral improvement was associated with neurobiological modifications, particularly changes in serotonergic and dopaminergic neurotransmission, suggesting that Safr'Inside™ may share common targets with conventional pharmacological antidepressants. This study provides useful information on the therapeutic relevance of nutritional interventions with saffron extracts to improve management of mood disorders.


Asunto(s)
Antidepresivos/uso terapéutico , Monoaminas Biogénicas/metabolismo , Crocus , Depresión/tratamiento farmacológico , Extractos Vegetales/uso terapéutico , Transmisión Sináptica/efectos de los fármacos , Ácido 3,4-Dihidroxifenilacético/metabolismo , Administración Oral , Animales , Antidepresivos/administración & dosificación , Ansiedad/tratamiento farmacológico , Conducta Animal/efectos de los fármacos , Dopamina/metabolismo , Ácido Homovanílico/metabolismo , Ácido Hidroxiindolacético/metabolismo , Masculino , Ratones , Ratones Endogámicos C57BL , Fitoterapia , Extractos Vegetales/administración & dosificación , Serotonina/metabolismo
6.
Neurosciences (Riyadh) ; 26(2): 152-157, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33814367

RESUMEN

OBJECTIVES: To examine the prescribing patterns of antidepressants among a sample of psychiatrists working in Oman and to compare these practices to the current evidence for prescribing specific antidepressant in particular clinical situations. METHODS: This retrospective cross sectional study. Massachusetts General Hospital Psychopharmacology Questionnaire, a 10-item questionnaire listing factors that might have influenced the choice of antidepressant medication, was sent to 83 psychiatrists working in governmental health sectors in Oman. The study was done from March to July 2019. RESULTS: A total number of 78 psychiatrists responded to the questionnaire. Of these, 44 of the psychiatrists (56.4%) believed that one type of antidepressant is more efficacious than others, while 74 psychiatrists (94.9%) indicated that selective serotonin reuptake inhibitors (SSRIs) were their first-line treatment preference. Mirtazapine was chosen as the most likely antidepressant to cause weight gain by two-thirds of the participants. For the treatment of anxious depression and depression with melancholic feature, SSRIs were the first choice of treatment for 64.1% and 7% of respondents, respectively. For depression with atypical features, 42.3% indicated that a monoamine oxidase inhibitor would be their first option. CONCLUSION: There is a discrepancy between the current antidepressant prescribing practices in Oman and empirical antidepressant-prescribing evidence, and this finding is consistent with previous studies.


Asunto(s)
Antidepresivos/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Prescripciones de Medicamentos , Pautas de la Práctica en Medicina , Inhibidores de la Captación de Serotonina/uso terapéutico , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Omán , Psiquiatría , Estudios Retrospectivos
7.
J Int Med Res ; 49(4): 3000605211006633, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33827323

RESUMEN

OBJECTIVE: Major depressive disorder (MDD) is a recurrent disorder with an increasing incidence. Alterations in key signaling pathways of the nervous system, such as the Wnt and MAPK pathways, mediated through microRNAs (miRNAs) provide crucial information regarding the etiopathology of MDD. We aimed to analyze whether the heterogeneity of literature findings regarding differential expression of miRNAs in the blood could arise from their different distributions among blood compartments. METHODS: We performed a pilot study analyzing the differential expression of miR-26a, miR-494, miR-30c, miR-93, and miR-101 and investigated their levels in white blood cells, total plasma (TP), exosomes from plasma, and exosome depleted plasma (EDP) in patients with MDD before and after antidepressant treatment with escitalopram and in healthy controls. RESULTS: MiR-494 was more abundant in EDP, and miR-26a and miR-30c were predominantly more abundant in TP relative to other blood compartments. Moreover, miR-30c, miR-101, and miR-26a, were significantly downregulated in TP of patients with MDD compared with controls. After antidepressant treatment, only miR-494 was significantly differently expressed in EDP. CONCLUSIONS: This proof-of-principle study suggests that identifying the miRNA abundance in different blood compartments is crucial for biomarker development and could enrich the current knowledge regarding MDD pathophysiology.


Asunto(s)
Trastorno Depresivo Mayor , MicroARNs , Antidepresivos/uso terapéutico , Biomarcadores , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Depresivo Mayor/genética , Humanos , MicroARNs/genética , Proyectos Piloto
8.
Adv Exp Med Biol ; 1305: 333-349, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33834408

RESUMEN

Repetitive transcranial magnetic stimulation (rTMS) is an FDA-approved technique for treating medication-resistant depression. Conventional rTMS includes high frequency (HF) to left dorsolateral prefrontal cortex (DLPFC) and low frequency to right DLPFC. However, not all depressed patients could benefit from standard rTMS protocols. Meta-analytical evidence indicated that there was an average response rate of 29.3% for patients receiving the most commonly adopted HF rTMS to the left DLPFC. Hence, newer forms of rTMS paradigms are warranted to improve antidepressant response and remission rate in patients with depression, especially those who are refractory to adequate antidepressant trials. In the current chapter, we review newer forms of rTMS paradigms and the content will cover standard theta burst stimulation (TBS), prolonged iTBS (piTBS), accelerated rTMS (aTMS), deep TMS (dTMS), priming TMS (pTMS), synchronized TMS (sTMS), and magnetic seizure therapy (MST).


Asunto(s)
Trastorno Depresivo Mayor , Estimulación Magnética Transcraneal , Antidepresivos/uso terapéutico , Depresión , Trastorno Depresivo Mayor/tratamiento farmacológico , Humanos , Corteza Prefrontal , Resultado del Tratamiento
9.
Adv Exp Med Biol ; 1305: 449-461, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33834412

RESUMEN

Major depressive disorder carries a significant burden and a high risk for suicide. The need for more effective, safer, and faster-acting drugs is, therefore, compelling. The present chapter briefly assesses the most promising agents, focusing on non-monoamine-targeting compounds, namely, the glutamate antagonist ketamine and its enantiomer esketamine. A critical overview of the evidence and the pitfalls associated with current antidepressant drug development is likewise provided in the following text.


Asunto(s)
Trastorno Depresivo Mayor , Psicofarmacología , Antidepresivos/uso terapéutico , Trastorno Depresivo Mayor/tratamiento farmacológico , Antagonistas de Aminoácidos Excitadores , Humanos
11.
N Engl J Med ; 384(15): 1402-1411, 2021 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-33852780

RESUMEN

BACKGROUND: Psilocybin may have antidepressant properties, but direct comparisons between psilocybin and established treatments for depression are lacking. METHODS: In a phase 2, double-blind, randomized, controlled trial involving patients with long-standing, moderate-to-severe major depressive disorder, we compared psilocybin with escitalopram, a selective serotonin-reuptake inhibitor, over a 6-week period. Patients were assigned in a 1:1 ratio to receive two separate doses of 25 mg of psilocybin 3 weeks apart plus 6 weeks of daily placebo (psilocybin group) or two separate doses of 1 mg of psilocybin 3 weeks apart plus 6 weeks of daily oral escitalopram (escitalopram group); all the patients received psychological support. The primary outcome was the change from baseline in the score on the 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR-16; scores range from 0 to 27, with higher scores indicating greater depression) at week 6. There were 16 secondary outcomes, including QIDS-SR-16 response (defined as a reduction in score of >50%) and QIDS-SR-16 remission (defined as a score of ≤5) at week 6. RESULTS: A total of 59 patients were enrolled; 30 were assigned to the psilocybin group and 29 to the escitalopram group. The mean scores on the QIDS-SR-16 at baseline were 14.5 in the psilocybin group and 16.4 in the escitalopram group. The mean (±SE) changes in the scores from baseline to week 6 were -8.0±1.0 points in the psilocybin group and -6.0±1.0 in the escitalopram group, for a between-group difference of 2.0 points (95% confidence interval [CI], -5.0 to 0.9) (P = 0.17). A QIDS-SR-16 response occurred in 70% of the patients in the psilocybin group and in 48% of those in the escitalopram group, for a between-group difference of 22 percentage points (95% CI, -3 to 48); QIDS-SR-16 remission occurred in 57% and 28%, respectively, for a between-group difference of 28 percentage points (95% CI, 2 to 54). Other secondary outcomes generally favored psilocybin over escitalopram, but the analyses were not corrected for multiple comparisons. The incidence of adverse events was similar in the trial groups. CONCLUSIONS: On the basis of the change in depression scores on the QIDS-SR-16 at week 6, this trial did not show a significant difference in antidepressant effects between psilocybin and escitalopram in a selected group of patients. Secondary outcomes generally favored psilocybin over escitalopram, but the analyses of these outcomes lacked correction for multiple comparisons. Larger and longer trials are required to compare psilocybin with established antidepressants. (Funded by the Alexander Mosley Charitable Trust and Imperial College London's Centre for Psychedelic Research; ClinicalTrials.gov number, NCT03429075.).


Asunto(s)
Antidepresivos de Segunda Generación/uso terapéutico , Antidepresivos/uso terapéutico , Citalopram/uso terapéutico , Trastorno Depresivo Mayor/tratamiento farmacológico , Alucinógenos/uso terapéutico , Psilocibina/uso terapéutico , Adulto , Antidepresivos/efectos adversos , Antidepresivos de Segunda Generación/efectos adversos , Citalopram/efectos adversos , Trastorno Depresivo Mayor/psicología , Método Doble Ciego , Femenino , Alucinógenos/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Psilocibina/efectos adversos , Autoinforme , Encuestas y Cuestionarios , Adulto Joven
12.
Emerg Med Clin North Am ; 39(2): 307-322, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33863461

RESUMEN

Chronic brain failure, also known as dementia or major neurocognitive disorder, is a syndrome of progressive functional decline characterized by both cognitive and neuropsychiatric symptoms. It can be conceptualized like other organ failure syndromes and its impact on quality of life can be mitigated with proper treatment. Dementia is a risk factor for delirium, and their symptoms can be similar. Patients with dementia can present with agitation that can lead to injury. Logic and reason are rarely successful when attempting to redirect someone with advanced dementia. Interactions that offer a sense of choice are more likely to succeed.


Asunto(s)
Demencia/diagnóstico , Trastornos Neurocognitivos/diagnóstico , Anciano , Antidepresivos/uso terapéutico , Antipsicóticos/uso terapéutico , Benzodiazepinas/uso terapéutico , Inhibidores de la Colinesterasa/uso terapéutico , Delirio/diagnóstico , Demencia/tratamiento farmacológico , Demencia/etiología , Diagnóstico Diferencial , Medicina de Emergencia , Humanos , Incidencia , Memantina/uso terapéutico , Competencia Mental , Trastornos Neurocognitivos/tratamiento farmacológico , Trastornos Neurocognitivos/etiología , Pruebas Neuropsicológicas , Dolor/diagnóstico , Prevalencia , Agitación Psicomotora/prevención & control
14.
Nervenarzt ; 92(5): 507-514, 2021 May.
Artículo en Alemán | MEDLINE | ID: mdl-33847767

RESUMEN

There is increasing consensus on the relevance of exercise interventions for the treatment and prevention of unipolar depression. The present review article aims to provide a practitioner-friendly overview of recent insights into the underlying neurobiological mechanisms of exercise interventions in depression in order to enhance their dissemination and acceptance. Exercise has proven antidepressive efficacy in major depressive disorders. Furthermore, it has demonstrated a protective effect on the development of depressive symptoms. Neurobiological research has shown that exercise increases the volume of gray matter in the brain, improves the microstructure of white matter and leads to a higher functional connectivity in brain regions implicated in major depressive disorders. On a molecular level, preliminary findings indicate that exercise has anti-inflammatory, neuroplastic and antioxidative effects, which could represent the basis for the effects observed on a brain structural and functional level. Exercise interventions should be recommended as an adjunct therapy for all patients with major depressive disorder.


Asunto(s)
Trastorno Depresivo Mayor , Sustancia Blanca , Antidepresivos/uso terapéutico , Encéfalo , Depresión , Trastorno Depresivo Mayor/prevención & control , Ejercicio Físico , Terapia por Ejercicio , Humanos
15.
Int J Mol Sci ; 22(9)2021 Apr 22.
Artículo en Inglés | MEDLINE | ID: mdl-33922396

RESUMEN

Major depressive disorders (MDDs) are often associated with a deficiency in long-chain omega-3 polyunsaturated fatty acids (ω-3 PUFAs), as well as signs of low-grade inflammation. Epidemiological and dietary studies suggest that a high intake of fish, the major source of ω-3 PUFAs, is associated with lower rates of MDDs. Meta-analyses of randomized placebo-controlled ω-3 PUFAs intervention-trials suggest that primarily eicosapentaenoic acid (EPA), but not docosahexaenoic acid (DHA), is responsible for the proposed antidepressant effect. In this review, we dissect the current biological knowledge on EPA and DHA and their bioactive lipid metabolites to search for a pharmacological explanation of this, to date, unexplained clinical observation. Through enzymatic conversion by cyclooxygenase (COX), lipoxygenase (ALOX), and cytochrome P-450 monooxygenase (CYP), EPA and DHA are metabolized to major anti-inflammatory and pro-resolving lipid mediators. In addition, both ω-3 PUFAs are precursors for endocannabinoids, with known effects on immunomodulation, neuroinflammation, food intake and mood. Finally, both ω-3 PUFAs are crucial for the structure and organization of membranes and lipid rafts. While most biological effects are shared by these two ω-3 PUFAs, some distinct features could be identified: (1) The preferential CYP monooxygenase pathway for EPA and EPA derived eicosanoids; (2) The high CB2 receptor affinities of EPA-derived EPEA and its epoxy-metabolite 17,18-EEQ-EA, while the DHA-derived endocannabinoids lack such receptor affinities; (3) The competition of EPA but not DHA with arachidonic acid (AA) for particular glycerophospholipids. EPA and AA are preferentially incorporated into phosphatidylinositols, while DHA is mainly incorporated into phosphatidyl-ethanolamine, -serine and -choline. We propose that these distinct features may explain the superior antidepressant activity of EPA rich ω-3 PUFAs and that these are potential novel targets for future antidepressant drugs.


Asunto(s)
Antidepresivos/uso terapéutico , Trastorno Depresivo Mayor/tratamiento farmacológico , Ácidos Grasos Omega-3/uso terapéutico , Animales , Trastorno Depresivo Mayor/patología , Humanos
16.
BMC Psychiatry ; 21(1): 121, 2021 03 04.
Artículo en Inglés | MEDLINE | ID: mdl-33663440

RESUMEN

BACKGROUND: In real-world pragmatic administrative databases, patient reported remission is often missing. OBJECTIVE: We evaluate if, in administrative data, five features of antidepressant use patterns can replace patient-reported symptom remission. METHOD: We re-examined data from Sequence Treatment Alternatives to Relieve Depression (STAR*D) study. Remission was measured using 50% reduction in Hamilton index. Pattern of antidepressant use was examined through five variables: (a) number of prior ineffective antidepressants, (b) duration of taking current antidepressant, (c) receiving therapeutic dose of the medication, and (d) switching to another medication, or (e) augmenting with another antidepressant. The likelihood ratio (LR) associated with each of these predictors was assessed in 90% of data (3329 cases) and evaluated in 10% of data (350 cases) set-aside for evaluation. The accuracy of predictions was calculated using Area under the Receiver Operating Curve (AROC). RESULTS: Patients who took antidepressants for 14 weeks (LR = 2.007) were more likely to have symptom remission. Prior use of 3 antidepressants reduced the odds of remission (LR = 0.771). Patients who received antidepressants below therapeutic dose were 5 times less likely to experience remission (LR = 0.204). Antidepressant that were augment or switched, almost never led to remission (LR = 0.008, LR = 0.002 respectively). Patterns of antidepressant use accurately (AROC = 0.93) predicted symptom remission. CONCLUSION: Within the first 100 days, antidepressants use patterns could serve as a surrogate measure for patient-reported remission of symptoms.


Asunto(s)
Antidepresivos , Medición de Resultados Informados por el Paciente , Antidepresivos/uso terapéutico , Humanos
17.
BMC Psychiatry ; 21(1): 129, 2021 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-33673822

RESUMEN

BACKGROUND: Conditional power of network meta-analysis (NMA) can support the planning of randomized controlled trials (RCTs) assessing medical interventions. Conditional power is the probability that updating existing inconclusive evidence in NMA with additional trial(s) will result in conclusive evidence, given assumptions regarding trial design, anticipated effect sizes, or event probabilities. METHODS: The present work aimed to estimate conditional power for potential future trials on antidepressant treatments. Existing evidence was based on a published network of 502 RCTs conducted between 1979-2018 assessing acute antidepressant treatment in major depressive disorder (MDD). Primary outcomes were efficacy in terms of the symptom change on the Hamilton Depression Scale (HAMD) and tolerability in terms of the dropout rate due to adverse events. The network compares 21 antidepressants consisting of 231 relative treatment comparisons, 164 (efficacy) and 127 (tolerability) of which are currently assumed to have inconclusive evidence. RESULTS: Required sample sizes to achieve new conclusive evidence with at least 80% conditional power were estimated to range between N = 894 - 4190 (efficacy) and N = 521 - 1246 (tolerability). Otherwise, sample sizes ranging between N = 49 - 485 (efficacy) and N = 40 - 320 (tolerability) may require stopping for futility based on a boundary at 20% conditional power. Optimizing trial designs by considering multiple trials that contribute both direct and indirect evidence, anticipating alternative effect sizes or alternative event probabilities, may increase conditional power but required sample sizes remain high. Antidepressants having the greatest conditional power associated with smallest required sample sizes were identified as those on which current evidence is low, i.e., clomipramine, levomilnacipran, milnacipran, nefazodone, and vilazodone, with respect to both outcomes. CONCLUSIONS: The present results suggest that conditional power to achieve new conclusive evidence in ongoing or future trials on antidepressant treatments is low. Limiting the use of the presented conditional power analysis are primarily due to the estimated large sample sizes which would be required in future trials as well as due to the well-known small effect sizes in antidepressant treatments. These findings may inform researchers and decision-makers regarding the clinical relevance and justification of research in ongoing or future antidepressant RCTs in MDD.


Asunto(s)
Antidepresivos , Trastorno Depresivo Mayor , Antidepresivos/uso terapéutico , Trastorno Depresivo Mayor/tratamiento farmacológico , Humanos , Metaanálisis en Red
18.
J Affect Disord ; 286: 80-86, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33714174

RESUMEN

BACKGROUND: Major depressive disorder (MDD) is a serious and common psychiatric disorder with a high prevalence in the population. Although great advances have been made, its pathogenesis is still unclear and a validated biomarker for diagnosis or therapeutic response remains unidentified. This review aims at summarizing the functional role of miRNAs in MDD pathogenesis and their potential as biomarkers for MDD diagnosis and antidepressant response. METHODS: We performed a bibliographic research on the main databases (PubMed, Google Scholar and Web of Science) using the terms "microRNAs", "major depressive disorder", "synaptic plasticity", "biomarker", "antidepressant treatment", in order to find studies that propose the role of microRNAs in MDD pathogenesis and their potential as biomarkers for MDD diagnosis and antidepressant response. RESULTS: microRNAs (miRNAs), a class of small noncoding RNAs, act as key regulators of synaptic plasticity in MDD pathogenesis. Growing researches provide the evidence for peripheral miRNAs as potential biomarkers for MDD diagnosis and antidepressant response. These results suggest that targeting miRNAs directly could be therapeutically beneficial for MDD and miRNAs are potential biomarkers of MDD and its treatment. LIMITATIONS: The role of miRNAs in MDD pathogenesis needs further investigation. Whether miRNAs in peripheral tissues truly represent brain-derived miRNAs is still unclear at the present time. Moreover, only a few blood miRNAs alterations are consistent across studies. CONCLUSIONS: Overall, miRNAs act key regulators of synaptic plasticity in MDD pathogenesis and hold significant promise as biomarkers or therapeutic targets for MDD, but further research is still needed.


Asunto(s)
Trastorno Depresivo Mayor , MicroARNs , Antidepresivos/uso terapéutico , Biomarcadores , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Depresivo Mayor/genética , Humanos , MicroARNs/genética , Plasticidad Neuronal/genética
19.
BMC Geriatr ; 21(1): 202, 2021 03 23.
Artículo en Inglés | MEDLINE | ID: mdl-33757451

RESUMEN

BACKGROUND: Antidepressant use is more common in people with Parkinson's disease (PD), but it is unknown when this difference emerges. METHODS: We studied the incidence of antidepressant use in six-month periods from 10 years before to 15 years after PD diagnosis in the nationwide register-based Finnish Study on Parkinson's disease (FINPARK). This study included 20,456 community dwellers with clinically verified PD diagnosed during 1996-2015 and 140,291 matched comparison persons. RESULTS: Altogether 44.3% of people with PD initiated antidepressants, compared to 25.0% of people without PD. The difference was largest 6 months before PD diagnosis (incidence rate ratio 5.28, 95% CI 4.80-5.80; 9.02 and 1.68 initiations/100 person-years in people with and without PD, respectively). The difference emerged already 7 years before the diagnosis and remained above the comparison group for most of the study period. CONCLUSIONS: Persons with PD may have symptoms that require antidepressant treatment years before and after diagnosis. The symptoms needing antidepressant treatment may be clinical signs of possible PD and they should be considered as a need to assess clinical status in person diagnosed with PD.


Asunto(s)
Enfermedad de Parkinson , Antidepresivos/uso terapéutico , Estudios de Cohortes , Finlandia/epidemiología , Humanos , Incidencia , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/tratamiento farmacológico , Enfermedad de Parkinson/epidemiología
20.
J Psychiatr Pract ; 27(2): 137-144, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33656821

RESUMEN

The widespread prevalence of coronavirus disease 2019 (COVID-19) means that inpatient psychiatric units will necessarily manage patients who have COVID-19 that is comorbid with acute psychiatric symptoms. We report a case of recurrence of respiratory symptoms and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription-polymerase chain reaction (RT-PCR) testing in a patient on an inpatient psychiatric unit occurring 42 days after the initial positive SARS-CoV-2 RT-PCR test, 38 days after initial symptom resolution, and 30 days after the first of 3 negative SARS-CoV-2 RT-PCR tests. Over the course of the admission, the patient was safely initiated on clozapine. Recent literature on COVID-19's potential recurrence and neuropsychiatric effects is reviewed and implications for the management of COVID-19 on inpatient psychiatric units are discussed. In the era of COVID-19 and our still-developing understanding of this illness, psychiatrists' role as advocates and collaborators in our patients' physical health care has become even more critical.


Asunto(s)
Antidepresivos/uso terapéutico , Antipsicóticos/uso terapéutico , Trastorno Depresivo Mayor/complicaciones , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastornos Psicóticos/complicaciones , Trastornos Psicóticos/tratamiento farmacológico , Adulto , Alcoholismo/complicaciones , Alcoholismo/diagnóstico , /psicología , Clozapina , Trastorno Depresivo Mayor/diagnóstico , Hospitales Psiquiátricos , Humanos , Pacientes Internos/psicología , Masculino , Mirtazapina/uso terapéutico , Trastornos Psicóticos/diagnóstico , Recurrencia , Sertralina/uso terapéutico , Intento de Suicidio
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...