The risk of acute infections in new users of antidepressants: An observational cohort study.

BACKGROUND: Preclinical studies suggested that drugs that functionally inhibit acid sphingomyelinase (FIASMA)may enhance immune cell longevity and potentially offer protection against infections. Many antidepressants have shown FIASMA activity. METHODS: We conducted a cohort study using primary-care data from the UK-based Clinical Practice Research Datalink (2000-2021). We assessed the association of composite diagnosed acute infections in new users of fluoxetine, sertraline, paroxetine, or venlafaxine aged 18-80 years compared to citalopram. We compared SARS-CoV-2 infections between groups in a secondary analysis. We estimated incidence rates (IR) and IR ratios (IRR) of acute infections in four pairwise comparisons using negative binomial regression. We applied propensity score (PS) fine stratification to control for confounding. RESULTS: In the PS-weighted cohorts, we included 353,138 fluoxetine, 222,463 sertraline, 69,963 paroxetine, 32,608 venlafaxine, and between 515,996 and 516,583 new citalopram users. PS-weighted IRs ranged between 76.8 acute infections /1000 person-years (py) (sertraline) and 98.9 infections/1000 py (citalopram). We observed PS-weighted IRRs around unity for paroxetine (0.97, 95 % CI, 0.95-1.00), fluoxetine (0.94, 95 % CI, 0.92-0.95), and venlafaxine (0.90, 95 % CI, 0.87-0.94) vs citalopram. Reduced IRR for sertraline vs citalopram (0.84, 95 % CI, 0.82-0.85), became null within subgroups by cohort entry date. In the analysis of SARS-CoV-2 infection, no statistically relevant risk reduction was seen. LIMITATIONS: Analysis not limited to patients with diagnosed depression, possible underestimation of infection incidence, and unclear FIASMA activity of citalopram. CONCLUSIONS: Fluoxetine, sertraline, paroxetine, and venlafaxine were not associated with a reduced risk of acute infection when compared with the presumably weak FIASMA citalopram.

Adverse drug events associated with nortriptyline compared with paroxetine and alternative medications in an older adult population: a retrospective cohort study in Southern California.

OBJECTIVE: Investigate risk for falls, fractures and syncope in older adult patients treated with nortriptyline compared with paroxetine and alternative medications. DESIGN: Retrospective cohort study. SETTING: The electronic medical record and prescription drug database of a large integrated healthcare system in Southern California. PARTICIPANTS: Ambulatory patients, age ≥65 years diagnosed with depression, anxiety disorder or peripheral neuropathy, dispensed one or more of ten study medications between 1 January 2008 and 31 December 2018. MAIN OUTCOME MEASURES: HR for falls, fractures and syncope with exposure to study medications adjusted for patient demographic variables and comorbidities. RESULTS: Among 195 207 subjects, 19 305 falls, 15 088 fractures and 11 313 episodes of syncope were observed during the study period. Compared with the reference medication, nortriptyline, the adjusted HRs (aHRs) for falls were statistically significantly greater for: paroxetine (aHR 1.48, 95% CI 1.39 to 1.57), amitriptyline (1.20, 95% CI 1.08 to 1.33), venlafaxine (1.44, 95% CI 1.34 to 1.56), duloxetine (1.25, 95% CI 1.12 to 1.40), fluoxetine (1.51, 95% CI 1.44 to 1.59), sertraline (1.53, 95% CI 1.44 to 1.62), citalopram (1.61, 95% CI 1.52 to 1.71) and escitalopram (1.37, 95% CI 1.21 to 1.54), but not gabapentin (0.95, 95% CI 0.89 to 1.02). For fractures, compared with nortriptyline, aHRs were significantly greater for: paroxetine, venlafaxine, duloxetine, fluoxetine, sertraline, citalopram, escitalopram and gabapentin, with aHRs ranging from 1.30 for gabapentin to 1.82 for escitalopram; risk was statistically similar for amitriptyline. For syncope, the aHRs were significantly greater for: paroxetine, venlafaxine, fluoxetine, sertraline and citalopram, with aHRs ranging from 1.19 for fluoxetine and paroxetine up to 1.30 for citalopram and sertraline; risk was similar for amitriptyline, duloxetine, escitalopram and gabapentin. CONCLUSIONS: Compared with therapeutic alternatives, nortriptyline was found to represent a lower risk for falls, fractures and syncope, versus comparator medications, except for a few instances that had equivalent risk. The risk for these adverse events from paroxetine was comparable to the alternative medications.

Efficacy and Safety of Jianpi Jieyu Decoction for Patients with Mild-to-Moderate Depression of Xin (Heart)-Pi (Spleen) Deficiency Syndrome: A Multi-centre Randomized Controlled Study / 中国结合医学杂志

OBJECTIVE@#To evaluate the efficacy and safety of Jianpi Jieyu Decoction (JJD) for treating patients with mild-to-moderate depression of Xin (Heart)-Pi (Spleen) deficiency (XPD) syndrome.@*METHODS@#In this multi-center, randomized, controlled study, 140 patients with mild-to-moderate depression of XPD syndrome were included from Xiyuan Hospital of China Academy of Chinese Medical Sciences and Botou Hospital of Traditional Chinese Medicine from December 2017 to December 2019. They were randomly divided into JJD group and paroxetine group by using a random number table, with 70 cases in each group. The patients in the JJD group were given JJD one dose per day (twice daily at morning and evening, 100 mL each time), and the patients in the paroxetine group were given paroxetine (10 mg/d in week 1; 20 mg/d in weeks 2-6), both orally administration for a total of 6 weeks. The primary outcome was the change of 17-item Hamilton Depression Rating Scale (HAMD-17) score at week 6 from baseline. The secondary outcomes included the Hamilton Anxiety Scale (HAMA) score, Traditional Chinese Medicine Symptom Scale (TCMSS), and Clinlcal Global Impression (CGI) scores at the 2nd, 4th, and 6th weekends of treatment, HAMD-17 response (defined as a reduction in score of >50%) and HAMD-17 remission (defined as a score of ⩽7) at the end of the 6th week of treatment. Adverse events (AEs) were also recorded.@*RESULTS@#From baseline to week 6, the HAMD-17 scores decreased 10.2 ± 4.0 and 9.1 ± 4.9 points in the JJD and paroxetine groups, respectively (P=0.689). The HAMD-17 response occurred in 60% of patients in the JJD group and in 50% of those in the paroxetine group (P=0.292); HAMD-17 remission occurred in 45.7% and 30% of patients, respectively (P=0.128). The differences of CGI scores at the 6th week were not statistically significant (P>0.05). There were significant differences in HAMD-17 scores between the two groups at 2nd and 4th week (P=0.001 and P=0.014). The HAMA scores declined 8.1 ± 3.0 and 6.9 ± 4.3 points from baseline to week 6 in the JJD and paroxetine groups, respectively (P=0.905 between groups). At 4th week of treatment, there was a significant difference in HAMA between the two groups (P=0.037). TCMSS decreased 11.4 ± 5.1, and 10.1 ± 6.8 points in the JJD and paroxetine groups, respectively (P=0.080 between groups). At the 6th week, the incidence of AEs in the JJD group was significantly lower than that in the paroxetine group (7.14% vs. 22.86%, P<0.05).@*CONCLUSION@#Compared with paroxetine, JJD was associated with a significantly lower incidence of AEs in patients with mild-to-moderate depression of XPD syndrome, with no difference in efficacy at 6 weeks. (Trial registration No. ChiCTR2000040922).

Anti-proliferative effects of paroxetine alone or in combination with sorafenib in HepG2 cells

Abstract Hepatocellular carcinoma (HCC) is a common cause of cancer-related death. Sorafenib is the first approved drug for the treatment of advanced HCC. Depression is frequent in cancer patients. Moreover, sorafenib might exert depression as an adverse drug reaction and paroxetine, a selective serotonin reuptake inhibitor, is a recommended pharmacotherapy. This study aimed to investigate the potential synergistic effects of paroxetine and sorafenib on HepG2 cell proliferation and death. Paroxetine and sorafenib were administered to HepG2 cells as single-agents or in combination. Cell viability was determined with XTT cell viability assay. Cellular apoptosis and DNA content were assessed by flow cytometry. The expression of anti-apoptotic Bcl-2 was examined by immunofluorescence confocal microscopy. A lower dose of sorafenib was found to be required to inhibit cell proliferation when in combination with paroxetine. Similarly, the coadministration enhanced cellular apoptosis and resulted in cell cycle arrest. Confocal imaging revealed a remarkably lower cell density and increased expression of Bcl-2 following combined treatment of paroxetine with sorafenib. To our knowledge, this is the first study demonstrating the synergistic effect of paroxetine and sorafenib in HCC and might provide a potentially promising therapeutic strategy.

La cara oculta del estudio 329 y la manipulación de la evidencia científica / Study's 329 hiddens face and scientifics evidence manipulation

El emblemático ensayo clínico 329, financiado por Smith Kline Beecham (actualmente GlaxoSmith-Kline) y publicado en2001, permitió posicionar a la paroxetina como un tratamiento efectivo y seguro para la depresión mayor en adolescentes. En la presente editorial el autor describe los sucesos ocurridos luego de su publicación, partiendo de los cuestionamientos iniciales respecto de su eficacia, hasta llegar a los resultados de su reciente reanálisis (llevando adelante por la iniciativa internacional RIAT), el cual concluyo que dicho fármaco no solo no provee un beneficio adicional al placebo para la condición y población utilizada, sino que además se asocia a efectos adversos sustanciales que no habían sido reportados en el informe original. Se exploran además las repercusiones de este suceso en la comunidad científica y se hace un señalamiento de la necesidad de permitir el acceso a las bases de datos originales que sustentan los resultados y conclusiones de las investigaciones publicadas, como mecanismo de transparencia superador a la revisión por pares. (AU)

The emblematic 329 study, funded by Smith Kline Beecham (now GlaxoSmith-Kline) and published in 2001, allowed to position paroxetine as an effective and safe treatment for major depression in adolescents. In this editorial, the author describes the events after its publication, from the initial concerns about its effectiveness, to the results of its recent reanalysis (accounted by the international RIAT initiative), which concluded that the drug not only does not provide an additional benefit than placebo, but is also associated with significant adverse effects that were not reported in the original report. It also explores the repercussions generated in the scientific community by this event, pointing out the need to allow access to original databases that support the findings and conclusions of published research, as an overcoming mechanism for transparency to the traditional peerreview. Agustín Ciapponi Study's 329 hiddens face and scientifics evidence manipulation. (AU)

Las raíces de Carpolobia lutea recuperan la excitación y el rendimiento sexual en ratas macho con disfunción sexual inducida por paroxetina / Carpolobia lutea roots restore sexual arousal and performance in paroxetine-induced sexually impaired male rats

Objective: This study aimed at investigating the aphrodisiac effects of aqueous extract of Carpolobia lutea root at the doses of 47, 94 and 141 mg/kg body weight in paroxetine-induced sexual dysfunction in male rats. Materials and methods: Thirty sexually active male rats (148.20 ± 3.22 g) were assigned into six groups (A---F) of five animals each. Rats in group A received 0.5 ml of distilled water once daily for 7 days while those in groups B, C, D, E and F which were induced with sexual dysfunction (oral administration of 10 mg/kg of paroxetine suspension, once daily for 21 days) received 0.5 ml corresponding to 7.14 mg/kg body weight of PowmaxM, 47, 94 and 141 mg/kg body weight of the extract and distilled water, respectively. Sexual behaviour parameters (frequencies of mount (ML), intromission (IF), ejaculation (EL), latencies of mount (ML), intromission (IL), ejaculation (EL) and post ejaculation interval (PEI)) were monitored 30 min post administration by pairing (1:1) with receptive female rats (114.01 ± 2.64 g) on days 1, 4 and 7. The concentrations of serum testosterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH) were determined after 7 days of administration using standard methods. Results: The study revealed that the extract contained saponins (21.02 mg/L), anthraquinones (5.11 mg/L), alkaloids (2.93 mg/L), flavonoids (1.82 mg/L), tannins (0.91 mg/L) and cardiac glycosides (0.09 mg/L) whereas terpenes, phlobatannins and steroids were not detected. Paroxetine significantly (p < 0.05) decreased mount frequency, intromission frequency, ejaculation frequency and ejaculation latency whereas it increased mount latency, intromission latency and post-ejaculatory interval for more than the baseline of 25% in each case. In contrast, all the doses of the extract significantly (p < 0.05) attenuated the parameters of sexual behaviour displayed by the sexual dysfunction animals, with the 141 mg/kg body weight comparing favourably (p > 0.05) with the sexual dysfunction animals treated with Powmax. In addition, the extract significantly (p < 0.05) elevated the levels of serum luteinizing hormone, follicle stimulating hormone and testosterone which were hitherto reduced by paroxetine.Conclusion: The study concludes that the aqueous extract of C. lutea root especially the doses of 94 and 141 mg/kg body weight restored various components of sexual arousal and performance as well as the reproductive hormones in the sexually sluggish male rats with the highest dose being the most effective. Present findings provide experimental evidence to support thefolkloric claim of the plant in the management of sexual inadequacies in males (AU)

Objetivo: el objetivo del presente estudio fue investigar el efecto afrodisíaco del extracto acuoso de la raíz de Carpolobia lutea en dosis de 47, 94 y 141mg/kg de masa corporal para casos de disfunción sexual inducida por paroxetina en ratas macho. Materiales y métodos: se distribuyeron treinta machos sexualmente activos (148,20±3,22g) en seis grupos (A-F) de 5 animales cada uno. Las ratas del grupo A recibieron 0,5ml de agua destilada al día durante 7 días, mientras que las de los grupos B, C, D, E y F—a quienes se había inducido una disfunción sexual con paroxetina (se administró una suspensión oral de paroxetina, 10mg/kg una vez al día durante 21 días)—recibieron respectivamente 0,5ml de PowmaxM en dosis de 7,14mg/kg de masa corporal, el extracto en dosis de 47, 94 y 141mg/kg de masa corporal, y agua destilada. Se observaron los parámetros de comportamiento sexual—frecuencia de cópula (ML), penetración (IF), eyaculación (EL), latencia de las cópulas (ML), penetración (IF), eyaculación (EL) e intervalo posteyaculación (PEI)—durante los 30 minutos subsiguientes a la administración comparando (1:1) con las ratas hembra (114,01±2,64g) en los días 1, 4 y 7. Las concentraciones de testosterona sérica, folitropina (FSH) y lutropina (LH) se fijaron con métodos normalizados después de 7 días de administración. Resultados: el estudio reveló que el extracto contenía saponinas (21,02mg/l), antraquinonas (5,11mg/l), alcaloides (2,93mg/l), flavonoides (1,82mg/l), taninos (0,91mg/l) y glucósidos cardiacos (0,09mg/l), si bien no se detectaron terpenos, florotaninos ni esteroides. La paroxetina redujo de manera significativa (p<0,05) la frecuencia de cópula, frecuencia de penetración, frecuencia de eyaculación y latencia de las cópulas, aunque aumentó la latencia de las cópulas, latencia de penetración y el intervalo posteyaculación en más de un 25% respecto a los valores de referencia en casa caso. Por el contrario, todas las dosis del extracto atenuaron de manera significativa (p>0,05) el comportamiento sexual de los animales con la disfunción sexual; aquellos con 141mg/kg de masa corporal arrojaron resultados favorables (p>0,05) en comparación con los que fueron tratados con Powmax. Asimismo, el extracto aumentó enormemente (p<0,05) los niveles séricos de lutropina, folitropina y testosterona que hasta el momento se veían reducidos por la paroxetina. Conclusión: el estudio llega a la conclusión de que el extracto acuoso de la raíz de C. lutea, con las dosis de 94 y 141mg/kg de masa corporal en particular, recuperaron varios componentes de la excitación y el rendimiento sexual, así como las hormonas reproductivas en las ratas macho sexualmente lentas. La dosis más alta resultó ser la más eficaz. Los presentes hallazgos suponen una demostración experimental para apoyar las reivindicaciones populares del uso de la planta en la gestión de incapacidades sexuales en varones

Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine

The objective of the present randomized, open-label, naturalistic 8-week study was to compare the efficacy and safety of treatment with clonazepam (N = 63) and paroxetine (N = 57) in patients with panic disorder with or without agoraphobia. Efficacy assessment included number of panic attacks and clinician ratings of the global severity of panic disorders with the clinical global impression (CGI) improvement (CGI-I) and CGI severity (CGI-S) scales. Most patients were females (69.8 and 68.4 percent in the clonazepam and paroxetine groups, respectively) and age (mean ± SD) was 35.9 ± 9.6 years for the clonazepam group and 33.7 ± 8.8 years for the paroxetine group. Treatment with clonazepam versus paroxetine resulted in fewer weekly panic attacks at week 4 (0.1 vs 0.5, respectively; P < 0.01), and greater clinical improvements at week 8 (CGI-I: 1.6 vs 2.9; P = 0.04). Anxiety severity was significantly reduced with clonazepam versus paroxetine at weeks 1 and 2, with no difference in panic disorder severity. Patients treated with clonazepam had fewer adverse events than patients treated with paroxetine (73 vs 95 percent; P = 0.001). The most common adverse events were drowsiness/fatigue (57 percent), memory/concentration difficulties (24 percent), and sexual dysfunction (11 percent) in the clonazepam group and drowsiness/fatigue (81 percent), sexual dysfunction (70 percent), and nausea/vomiting (61 percent) in the paroxetine group. This naturalistic study confirms the efficacy and tolerability of clonazepam and paroxetine in the acute treatment of patients with panic disorder.

Parkinsonismo farmacológico frente a demencia con cuerpos de Lewy / Pharmacological Parkinsonismo opposite to dementia with Lewy's bodies

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Síndrome serotonínico secundario al uso de paroxetina en una paciente en hemodiálisis periódica / Serotonin syndrome secondary to the use of paroxetine in a patient under systematic hemodißlisis regime

El síndrome serotonínico es una situación clínica que se caracteriza por alteraciones del estado mental, inestabilidad autonómica y anormalidades neuromusculares como tremor, hiperreflexia o mioclonías y que puede aparecer como complicación por el uso de medicamentos que incrementan los niveles de serotonina como los inhibidores de la recaptación selectiva de serotonina, o la asociación de estos con otras drogas como los inhibidores de la monoaminooxidasa. Se presenta el caso de una paciente de 78 años de edad con insuficiencia renal crónica terminal por hipertensión arterial, bajo tratamiento de hemodiálisis periódica, que desarrolla un síndrome serotonínico secundario al uso de 20 mg diarios de paroxetina que se comenzaron a administrar por un cuadro depresivo, previamente fueron descartadas enfermedades infecciosas, metabólicas, neurológicas y la sobredosis de algún medicamento. La paciente mejoró después de la suspensión de la paroxetina.

Serotonin syndrome is a clinical situation characterized by altered state of mind, autonomic instability and neuromuscular anomalies such as tremor, hyperreflexia or myoclonia, which are symptoms that may occur as a result of the use of drugs that increase serotonin levels when acting as selective serotonin reuptake inhibitors or their association with other drugs as monoaminoxidase inhibitors. This paper presented the case of a 78 years-old female patient suffering from terminal chronic renal failure caused by hypertension, low therapy of periodic hemodyalisis which gave rise to serotonin syndrome secondary to the daily use of 20 mg paroxetine prescribed for a depression condition. Infectious, metabolic, neurological diseases as well as some drug overdose were ruled out. The patient improved her condition after paroxetine treatment was suspended.

Síndrome serotonínico secundario al uso de paroxetina en una paciente en hemodiálisis periódica / Serotonin syndrome secondary to the use of paroxetine in a patient under systematic hemodißlisis regime

El síndrome serotonínico es una situación clínica que se caracteriza por alteraciones del estado mental, inestabilidad autonómica y anormalidades neuromusculares como tremor, hiperreflexia o mioclonías y que puede aparecer como complicación por el uso de medicamentos que incrementan los niveles de serotonina como los inhibidores de la recaptación selectiva de serotonina, o la asociación de estos con otras drogas como los inhibidores de la monoaminooxidasa. Se presenta el caso de una paciente de 78 años de edad con insuficiencia renal crónica terminal por hipertensión arterial, bajo tratamiento de hemodiálisis periódica, que desarrolla un síndrome serotonínico secundario al uso de 20 mg diarios de paroxetina que se comenzaron a administrar por un cuadro depresivo, previamente fueron descartadas enfermedades infecciosas, metabólicas, neurológicas y la sobredosis de algún medicamento. La paciente mejoró después de la suspensión de la paroxetina(AU)

Serotonin syndrome is a clinical situation characterized by altered state of mind, autonomic instability and neuromuscular anomalies such as tremor, hyperreflexia or myoclonia, which are symptoms that may occur as a result of the use of drugs that increase serotonin levels when acting as selective serotonin reuptake inhibitors or their association with other drugs as monoaminoxidase inhibitors. This paper presented the case of a 78 years-old female patient suffering from terminal chronic renal failure caused by hypertension, low therapy of periodic hemodyalisis which gave rise to serotonin syndrome secondary to the daily use of 20 mg paroxetine prescribed for a depression condition. Infectious, metabolic, neurological diseases as well as some drug overdose were ruled out. The patient improved her condition after paroxetine treatment was suspended(AU)

Rabdomiólisis hiponatrémica grave secundaria a paroxetina / No disponible

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Psicoterapia frente a farmacoterapia en depresión en atención ambulatoria / Psychotherapy versus drug therapy in depression in outpatient care

La depresión en Europa tiene una tasa de prevalencia del 3,9 %. Una de las principales cargas de trabajo en atención ambulatoria deriva del tratamiento de los trastornos afectivos. El objetivo del presente estudio es comparar la eficacia de la psicoterapia frente a la farmacoterapia en el tratamiento de los trastornos afectivos. En la revisión sistemática llevada a cabo se han encontrado seis ensayos clínicos aleatorizados con un grupo control de píldora-placebo relevantes para nuestra investigación. Las conclusiones obtenidas en el reanálisis de los resultados de cada estudio apuntan a una eficacia comparativamente igual de los tratamientos activos y de placebo en depresiones leves. Por otro lado no se observan diferencias significativas en relación con la eficacia de los tratamientos psicoterapéuticos frente a los tratamientos farmacológicos en depresiones moderadas y graves. En estos casos los tratamientos activos son superiores a placebo (AU)

Depression in Europe has a prevalence rate of 3,9%.One of the main work loads in out-patient care comes from treatment of affective disorders. The objective of the present study is to compare the efficacy of psychotherapy versus drug therapy in the treatment of affective disorders. The systematic review carried out has found6 randomized controlled trials with a pill-placebo control group. The conclusions obtained after re-analyzing each study point out to comparatively equal efficacy of the active treatments and placebo in mild depressions. On the other hand, no significant differences were observed in relationship to the psychotherapeutic treatment efficacy versus drug treatments in moderate and severe depressions, these out-performing placebo efficacy (AU)

Hemorragia digestiva alta asociada a tratamiento con clopidogrel y paroxetina / No disponible

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Efectos secundarios de los ISRS sin importancia para la salud que pueden contribuir al mal cumplimiento o al abandono del tratamiento / Non-serious adverse effects of selective serotonin uptake inhibitors that may contribute to poor treatment adherence or withdrawal

Introducción: Los inhibidores selectivos de la recaptación de serotonina (ISRS) son los fármacos más usados en los trastornos depresivos por su menor toxicidad, fácil dosificación y un supuesto mejor perfil de tolerabilidad. El correcto cumplimiento del tratamiento farmacológico es aún un reto importante que condiciona la probabilidad de recaída y el resultado terapéutico. Efectos secundarios sin gravedad, incluso sin ninguna trascendencia para la salud de las personas, pueden tener un peso importante a la hora de que éstas decidan abandonar el tratamiento. El objetivo principal de este estudio es valorar la frecuencia con que aparecen determinados efectos secundarios derivados del uso de los ISRS, de características leves, pero que pueden afectar a la calidad de vida de los pacientes y contribuir al abandono del tratamiento. Métodos: Estudio descriptivo, observacional y transversal, con una muestra de 116 pacientes ambulatorios que estaban en tratamiento con ISRS. Resultados: El 75% eran mujeres, con una media de edad de 47,59 años. El principio activo más prescrito fue paroxetina (25,4%). El 81% de los pacientes presentaron efectos adversos, los cuales se produjeron, en mayor o menor grado, con todos los ISRS. El fármaco mejor tolerado fue escitalopram, seguido por sertralina y citalopram, mientras que paroxetina y fluoxetina fueron los peor tolerados, según las variables analizadas en el estudio. Conclusiones: Este estudio pone de manifiesto que hay un grupo de efectos secundarios banales pero molestos producidos por los ISRS de los que hay poco publicado, pero que pueden contribuir al mal cumplimiento terapéutico (AU)

Introduction: Selective serotonin reuptake inhibitors (SSRIs) are the most widely used drugs in depressive disorders, due to their lower toxicity, easy dosage, and supposedly better tolerability profile. Proper compliance and adherence to drug treatment remains a challenge that affects the probability of relapse and therapeutic outcomes. Non-serious adverse effects, even those with no significance for the patient's health, can be a determining factor in non-compliance. The main objective of this study was to assess the frequency of certain mild adverse effects associated with SSRIs that may affect patients' quality of life and contribute to treatment withdrawal. Method: We performed a descriptive, observational and cross-sectional study in a sample of 116 outpatients treated with SSRIs. Results: Seventy-five percent of the patients were women. The mean age was 47.59 years. The most frequently prescribed drug was paroxetine (25.4%). Adverse events were found in 81% of the patients and, to a greater or lesser degree, occurred with all SSRIs. The best tolerated drug was escitalopram, followed by sertraline and citalopram, while the worst tolerated drugs were fluoxetine and paroxetine according to the variables analyzed in this study. Conclusions: This study reveals the existence of a group of trivial but annoying side effects caused by SSRIs. Little has been published in the literature on these effects, which may contribute to poor treatment adherence (AU)

Status cataplecticus secundario a la supresión brusca de paroxetina / Status cataplecticus secondary to abrupt paroxetine withdrawal

El status cataplecticus es una situación excepcional, consistente en ataques continuados de cataplejía. Presentamos un caso clínico de una mujer de 42 años diagnosticada de síndrome de narcolepsia con cataplejía, bien controlada con modafinil y paroxetina, que presentó status cataplecticus tras la auto-retirada brusca de la medicación antidepresiva (AU)

Status cataplecticus is an exceptional situation, described as continuous cataplexy attacks. We report a 42-year-old woman with narcolepsy-cataplexy syndrome, well controled with modafinil and paroxetine, who developed status cataplecticus after abrupt self-withdrawal of the antidepressant medication (AU)

Uso de antidepresivos en niños y riesgo de suicidio: una revisión / Use of antidepressants in children and risk of suicide: a review

Introducción: Los trastornos depresivos en la adolescencia tienen una incidencia del 10% y se asocian con significativa comorbilidad. Los ISRS son un tratamiento efectivo que se prescribieron ampliamente en la década de los 90. El hallazgo de una relación entre el uso de antidepresivos y un incremento del riesgo de suicidio entre la gente joven ha generado una gran controversia en los últimos años. Objetivo: Evaluar al riesgo asociado al uso de antidepresivos en la infancia en relación con la ideación suicida. Método: Revisamos la situación actual de la investigación en el campo de la terapia antidepresiva en niños y adolescentes. Se han revisado datos de estudios randomizados aparecidos en publicaciones médicas de los cinco últimos años. Se discuten aspectos metodológicos e implicaciones clínicas de los mismos. Resultados: Se han encontrado diez artículos a propósito del uso de fármacos antidepresivos en relación con el riesgo de conducta suicida. Cuatro de ellos sugieren que los antidepresivos previenen el suicidio, mientras que otros cuatro indican que el riesgo de conductas suicidas se incrementa con el uso de estos fármacos. Dos estudios no muestran resultados significativos. Conclusión: Sería necesario realizar estudios específicos acerca de este tema, ya que los existentes no muestran resultados concluyentes. No obstante, los trastornos depresivos deben ser tratados, dada su elevada prevalencia y su alta comorbilidad (AU)

Introduction: Depressive disorders during youth occur frequently (10%) and are associated with significant comorbidity. ISRS are an effective treatment that was prescribed widely across 1990´s. The finding of a relation between the use of antidepressants and an increase of suicidal risk in young people has generated a great controversy in the last years. Objective: To evaluate the risk of the antidepressant use in childhood in relation to the suicidal ideation. Method: We review the current state of research into antidepressant therapy in children and adolescents. Data from randomised controlled trials published in medical journals in the last five years were reviewed; we discuss methodologic issues and clinical implications. Results: We have found ten trials that treated about antidepressants and suicidal risk. Four of them suggest that antidepressants protect of suicide, whereas four of them indicated that the risk of suicidal behaviour is increased with antidepressant use. Two studies don´t show significant results (AU)

Antidepresivos inhibidores selectivos de la recaptación de serotonina durante el embarazo / Selective serotonin reuptake inhibitor antidepressants in pregnancy

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Probable síndrome serotoninérgico relacionado con la administración de paroxetina y tramadol / Possible serotoninergia syndrome associated with coadministration of paroxetine tramadol

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