[Serotonin syndrome: review and case series from the Swiss pharmacovigilance system]. / Syndrome sérotoninergique: mise au point et revue des cas annoncés en Suisse.

Serotonin syndrome is a potential adverse reaction to drugs increasing serotoninergic activity in the nervous system, some of them being frequently prescribed, such as antidepressant drugs. As clinical presentation is variable and often aspecific, diagnosing serotonin syndrome can be a challenge, particularly in mild cases. Serious forms can be lethal. The aim of this article is to increase practitioners awareness of this syndrome by reviewing current knowledge on physiopathology, clinical presentation and therapy. We also analyzed the 102 cases notified to Swissmedic from 1998 to 2009, focusing on patients profile and suspected drugs.

Non-pharmacological treatment of psychiatrists in addition to the prescribing of an antidepressant drug.

BACKGROUND: Guidelines for the treatment of depression regularly emphasize that pharmacotherapy of depression should be accompanied by supportive counseling and other psychotherapeutic interventions. It is unknown which role psychiatrists in routine care give to such verbal therapies. METHODS: In a drug utilization study of venlafaxine, psychiatrists in private practice and in hospitals were asked to tell what non-pharmacological therapies they saw as an important part of the treatment of the present depressive episode. Additionally patient characteristics, treatment variables, setting characteristics and physician characteristics were assessed. RESULTS: Psychiatrists reported some kind of verbal therapies in 19.0% of outpatients and 36.8% of inpatients. Verbal therapies were reported more often for younger patients, who got more double diagnoses and were more severely ill. Patients with verbal therapies got more psychotropic medication. In the inpatient setting verbal therapies were related to generally more treatment overall and a higher rate of treatment response. In both treatment settings verbal therapies were related to lower rates of discontinuation of the antidepressant. CONCLUSION: Verbal interactions are part of any patient-physician encounter and should be theory guided as part of the therapeutic process in the treatment of depressive disorders. Under this assumption the rate of patients for which psychiatrists reported some kind of verbal therapy as explicit part of their treatment could be higher. More research is needed on patient guidance, counseling and supportive psychotherapy in psychiatry.

Dosage finding and outcome of venlafaxine treatment in psychiatric outpatients and inpatients: results of a drug utilization observation study.

BACKGROUND: Venlafaxine is an antidepressive drug with the special characteristic of inhibiting both synaptic serotonin and norepinephrine reuptake. This double action is dosage dependent, with the relatively weaker inhibition of norepinephrine becoming clinically relevant only at higher dosages. This allows treatment to be tailored towards the needs of individual patients through differential dosing. It is unknown, however, how physicians use this unique feature in prescribing venlafaxine in routine treatment. METHOD: Data from a drug utilization observation (DUO) study, including 6706 patients, are used to investigate which patient and setting variables predict dosage of venlafaxine as prescribed by psychiatrists in inpatient and outpatient settings. Treatment outcome and adverse drug reactions (ADR) were analyzed for different dosage groups. RESULTS: Treatment setting is the most important factor in predicting high (> 75 mg/day) or low (up to 75 mg/day) dosage of venlafaxine, with inpatients receiving higher dosages. Severity of illness and a history of previous treatment with major antidepressives are also related to higher dosages. Although the total rate of ADR did not increase with increased dosage, the profile of drug reactions changed. Response to therapy was better in cases of non-chronic, major depression with no treatment history of antidepressives. Additionally, increased dosage increased the likelihood of response in outpatients. In both settings, very high dosages predicted better response to venlafaxine among severely ill patients. CONCLUSION: Venlafaxine at a dosage of 75 mg/day is sufficient for the majority of cases. In extremely ill patients, higher dosages are associated with additional benefits. Therefore, a stepwise dosage regimen is suggested, with an increase of dosage to upper limits in cases of non-response before discontinuation of treatment with venlafaxine.

[Depressive disorders and antidepressive therapy. A comparison of neurology practice and psychiatric clinic]. / Depressive Erkrankungen und antidepressive Therapie. Ein Vergleich von Nervenarztpraxis und psychiatrischer Klinik.

It is a question of great importance when psychiatric patients should be treated as inpatients or as outpatients. This decision depends on therapeutic as well as economic considerations. However in depression, as in other mental illnesses, many cases could reasonably be treated as in- or outpatients alike. Despite the importance of this question, there is to our knowledge no epidemiological study which compares patients in inpatient and outpatient settings within the current German medical system. 1300 inpatients and 5376 outpatients were investigated using identical methodologies within a drug utilization study of the antidepressant venlafaxine. Inpatients were found to be more severely ill and have a recurrent course of illness and higher rates of comorbidity. Outpatients more often had a chronic course. Inpatients were treated more often and with a wider variety of medication than outpatients, with the exception of phytopharmaceuticals. Venlafaxine was given in higher doses in the inpatient setting and combined more often with other psychotropic medications. Complaints of adverse drug reactions were comparable in both groups. Nausea was the most frequent, reported by 9.7% of inpatients and 15.2% of outpatients. The data show that the distribution of patients in outpatient and inpatient settings corresponds to the stepwise structure of the German health care system.

Influence of clenbuterol, a beta-adrenergic agonist, on desipramine induced growth hormone, prolactin and cortisol stimulation.

We report herein the effects of the beta-adrenergic agonist clenbuterol on desipramine (DMI)-induced growth hormone (GH), prolactin (PRL) and cortisol secretion in healthy male subjects. In the first study, nine subjects were treated with either clenbuterol (0.04 mg, p.o.) or placebo. In the second study, 12 subjects received either DMI (50 mg, i.v.) alone or in combination with clenbuterol (0.04 mg, p.o.) given 60 min prior to DMI administration. Clenbuterol alone had no influence on GH, PRL, or cortisol concentrations, compared to placebo. DMI alone caused GH stimulation (mean maximum = 15.7 +/- 3.4 ng/ml), which was significantly lower after combined administration of DMI and clenbuterol (mean maximum = 7.7 +/- 1.6 ng/ml) (p less than or equal to 0.01). DMI-induced PRL and cortisol stimulation was not influenced by clenbuterol pretreatment. These results indicate the inhibiting influence of noradrenergic beta-receptors on GH stimulation.