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1.
BMJ Open ; 11(9): e047142, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475156

RESUMO

INTRODUCTION: For over more than a decade, low-dose amitriptyline and mirtazapine are prescribed off-label for insomnia. However, placebo-controlled evidence on these antidepressants for insomnia is still lacking. Therefore, the present trial aims to assess the effectiveness of low-dose amitriptyline (10-20 mg/day) and mirtazapine (7.5-15 mg/day) in patients with insomnia disorder with difficulty maintaining sleep or early-morning awakening problems in general practice. METHODS AND ANALYSIS: The Drug REdiscovery: low-dose Amitriptyline and Mirtazapine for INsomnia disorder in General practice (DREAMING) study is a randomised, double-blind, placebo-controlled trial in about 50 general practices. Adults (18-85 years) with insomnia disorder (Diagnostic and Statistical Manual of Mental Disorders-5) who ask their general practitioner (GP) for sleep medication when non-pharmacological treatment is deemed not effective, are eligible. EXCLUSION CRITERIA: isolated sleep initiation problem, contraindications for or drug-drug interactions with either amitriptyline or mirtazapine. Participants (n=156) will be randomly assigned to three parallel treatment groups of 16-week treatment with either amitriptyline (one or two tablets of 10 mg/day) or mirtazapine (one or two tablets of 7.5 mg/day) or placebo (one or two tablets) alongside usual GP care. All participants start and end with single dose, but dose can be doubled following GP consultation in week 3. Questionnaire assessments will be conducted at baseline, week 6, 12, 20 and 52. The primary study outcome is self-reported insomnia severity at 6 weeks, measured with the Insomnia Severity Index (ISI) in an intention to treat analysis. Secondary outcomes include subjective sleep quality quantified by sleep indices, daytime functioning and symptoms, safety and treatment evaluation and other sleep care consumption. ETHICS AND DISSEMINATION: The Medical Ethics Committee of the VU Medical Centre Amsterdam approved this trial. The results of this trial will be published in peer-reviewed scientific journals and presented at relevant academic conferences and to key stakeholders. TRIAL REGISTRATION NUMBER: NTR7449.


Assuntos
Medicina Geral , Distúrbios do Início e da Manutenção do Sono , Adulto , Amitriptilina , Antidepressivos/uso terapêutico , Método Duplo-Cego , Humanos , Mirtazapina , Ensaios Clínicos Controlados Aleatórios como Assunto , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Resultado do Tratamento
2.
JAMA Netw Open ; 4(8): e2118441, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34338794

RESUMO

Importance: COVID-19 has had devastating effects on the health and well-being of older adult residents and health care professionals in nursing homes. Uncertainty about the associated consequences of these adverse effects on the use of medications common to this care setting remains. Objective: To examine the association between the COVID-19 pandemic and prescription medication changes among nursing home residents. Design, Setting, and Participants: This population-based cohort study with an interrupted time-series analysis used linked health administrative data bases for residents of all nursing homes (N = 630) in Ontario, Canada. During the observation period, residents were divided into consecutive weekly cohorts. The first observation week was March 5 to 11, 2017; the last observation week was September 20 to 26, 2020. Exposures: Onset of the COVID-19 pandemic on March 1, 2020. Main Outcomes and Measures: Weekly proportion of residents dispensed antipsychotics, benzodiazepines, antidepressants, anticonvulsants, opioids, antibiotics, angiotensin receptor blockers (ARBs), and angiotensin-converting enzyme (ACE) inhibitors. Autoregressive integrated moving average models with step and ramp intervention functions tested for level and slope changes in weekly medication use after the onset of the pandemic and were fit on prepandemic data for projected trends. Results: Across study years, the annual cohort size ranged from 75 850 to 76 549 residents (mean [SD] age, 83.4 [10.8] years; mean proportion of women, 68.9%). A significant increased slope change in the weekly proportion of residents who were dispensed antipsychotics (parameter estimate [ß] = 0.051; standard error [SE] = 0.010; P < .001), benzodiazepines (ß = 0.026; SE = 0.003; P < .001), antidepressants (ß = 0.046; SE = 0.013; P < .001), trazodone hydrochloride (ß = 0.033; SE = 0.010; P < .001), anticonvulsants (ß = 0.014; SE = 0.006; P = .03), and opioids (ß = 0.038; SE = 0.007; P < .001) was observed. The absolute difference in observed vs estimated use in the last week of the pandemic period ranged from 0.48% (for anticonvulsants) to 1.52% (for antipsychotics). No significant level or slope changes were found for antibiotics, ARBs, or ACE inhibitors. Conclusions and Relevance: In this population-based cohort study, statistically significant increases in the use of antipsychotics, benzodiazepines, antidepressants, anticonvulsants, and opioids followed the onset of the COVID-19 pandemic, although absolute differences were small. There were no significant changes for antibiotics, ARBs, or ACE inhibitors. Studies are needed to monitor whether changes in pharmacotherapy persist, regress, or accelerate during the course of the pandemic and how these changes affect resident-level outcomes.


Assuntos
COVID-19 , Prescrições de Medicamentos/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antibacterianos/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Análise de Séries Temporais Interrompida , Masculino , Ontário , SARS-CoV-2
3.
Curr Protoc ; 1(8): e208, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34406704

RESUMO

Major depression is a complex psychiatric disorder characterized by affective, cognitive, and physiological impairments that lead to maladaptive behavior. The high lifetime prevalence of this disabling condition, coupled with limitations of existing medications, make necessary the development of improved therapeutics. This requires animal models that allow investigation of key biological correlates of the disorder. Described in this article is the unpredictable chronic mild stress mouse model that can be used to screen for antidepressant drug candidates. Originally designed for rats, this model has been adapted for mice to capitalize on the advantages of this species as an experimental model, including inter-strain variability, which permits an exploration of the contribution of genetic background; the ability to create transgenic animals; and lower cost. Thus, because it combines genetic features and socio-environmental chronic stressful events, the unpredictable chronic mild stress model in mice is a relevant and valuable paradigm to gain insight into the etiological and developmental components of major depression, as well as to identify novel treatments for this condition. © 2021 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Unpredictable Chronic Mild Stress (UCMS) Test in Mice Basic Protocol 2: Assessment Of Self-Directed Activity And Anhedonia in Mice.


Assuntos
Depressão , Estresse Psicológico , Anedonia , Animais , Antidepressivos/uso terapêutico , Modelos Animais de Doenças , Camundongos , Ratos
4.
J Psychosoc Nurs Ment Health Serv ; 59(9): 7-11, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34459676

RESUMO

Approximately 30% of people treated for a major depressive episode will not achieve remission after two or more treatment trials of first-line antidepressants and are considered to have treatment-resistant depression (TRD). Because the odds of remission decrease with every subsequent medication trial, it is important for clinicians to understand the characteristics and risk factors for TRD, subtypes of major depressive disorder that are more likely to be less responsive to first-line anti-depressants, and the available treatment options. In the current article, we review the approved treatments for TRD, including esketamine, and the evidence for psilocybin and pramipexole. Although limited in specificity, guidelines to help prescribers identify person-centered treatments for TRD are available. [Journal of Psychosocial Nursing and Mental Health Services, 59(9), 7-11.].


Assuntos
Transtorno Depressivo Maior , Transtorno Depressivo Resistente a Tratamento , Antidepressivos/uso terapêutico , Depressão , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Quimioterapia Combinada , Humanos
5.
Artigo em Russo | MEDLINE | ID: mdl-34460170

RESUMO

A combination of depression and alcohol use disorder (AUD) is a typical and most common example of a dual diagnosis at the intersection of general psychiatry and addiction psychiatry. A comorbidity of depression and AUD is more common than it can be brought about by mere coincidence, which might be explained to some extent by the synergetic effect of both diseases, with each of them complicating the course and worsening the prognosis of the other. Treatment protocols for patients with depression and comorbid AUD include antidepressants, specific medications for alcohol dependence, and psychotherapy. The first-line antidepressants in the treatment of patients with a comorbid combination of depression and alcohol use disorder, as in other clinical situations implying use of antidepressants, are selective serotonin reuptake inhibitors (SSRIs). Fluvoxamine has certain advantages over the other SSRIs in the treatment of patients with a depression and comorbid AUD.


Assuntos
Alcoolismo , Alcoolismo/complicações , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Antidepressivos/uso terapêutico , Depressão/diagnóstico , Depressão/tratamento farmacológico , Depressão/epidemiologia , Fluvoxamina , Humanos , Inibidores de Captação de Serotonina/uso terapêutico
6.
Medicine (Baltimore) ; 100(31): e26678, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397800

RESUMO

BACKGROUND: Although nonpharmacological therapies are recommended as first-line treatments for insomnia, they do not widely implement in practice owing to costly or time-consuming. As a result, pharmacotherapy remains to be commonly prescribed for patients with the sleep disorder. Pharmacotherapy for insomnia consists of different types of drugs. Few studies focused on comprehensively evaluating all available drugs for insomnia. Our review aims to compare efficacy and safety of pharmacological and nonpharmacological treatments by synthesizing direct evidence and indirect evidence to help clinicians and patients make informed decisions for insomnia. METHODS: We will search the MEDLINE, EMBASE, and Cochrane Register of Controlled Trials between January 2000 and June 12, 2021. Randomized controlled trials of pharmacological and nonpharmacological interventions for insomnia will be included. Study quality will be assessed on the basis of the methodology and categories described in the Cochrane Collaboration Handbook. Eight network meta-analyses were conducted. A Bayesian network meta-analysis would be performed, and relative ranking of agents would be assessed. A node splitting method will be used to examine the inconsistency between direct and indirect comparisons when a loop connecting 3 arms exists. RESULTS: The results of this paper will be submitted to a peer-reviewed journal for publication. CONCLUSION: The conclusion of our study will provide updated evidence to rank the effectiveness and safety of pharmacological and nonpharmacological interventions for insomnia. ETHICS AND DISSEMINATION: Ethical approval is not applicable, as this study is a network meta-analysis based on published trials. INPLASY REGISTRATION NUMBER: INPLASY202160031.


Assuntos
Distúrbios do Início e da Manutenção do Sono/terapia , Antidepressivos/uso terapêutico , Benzodiazepinas/uso terapêutico , Depressores do Sistema Nervoso Central/uso terapêutico , Terapia Cognitivo-Comportamental , Terapias Complementares , Medicamentos de Ervas Chinesas/uso terapêutico , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Melatonina/uso terapêutico , Metanálise como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
7.
Medicine (Baltimore) ; 100(34): e27031, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449480

RESUMO

ABSTRACT: To determine whether exposure to antidepressants (ATDs) results in improved overall survival (OS) of patients with gastric cancer (GC) after surgery, we conducted a large cohort study and considered confounding factors that might affect the research outcomes.Patients who received a new diagnosis of GC and received surgery and chemotherapy between 1999 and 2008 were recruited and were classified into different groups based on the ATD level used. The association between the OS of patients with GC after surgery with different levels of ATD use, and the hazard ratio with comorbidities at different ATD use levels were compared.According to Kaplan-Meier method, the more of an ATD was taken, the longer the OS and a dose-dependent relationship was discovered in the OS curve; the adjusted HRs were 0.76 (95% confidence interval [CI] = 0.68-0.84) and 0.48 (95% CI = 0.41-0.57) for ATD users taking a cumulative defined daily dose (cDDD) of 28-167 and ≧168, respectively. Sensitivity analyzes were performed to investigate the effect of various comorbidities on OS with different degrees of ATD use and the results remained consistent among the varying models. Additionally, the effect of ATD use still exhibited a dose-dependent relationship in distinct stratifications for sex and age.The OS for patients with GC after surgery and chemotherapy improved with ATD use, and a dose-dependent relationship was discovered in this study. Further studies on the association between OS of GC and ATD use are required.


Assuntos
Antidepressivos/uso terapêutico , Neoplasias Gástricas/mortalidade , Adolescente , Adulto , Idoso , Quimioterapia Adjuvante , Comorbidade , Relação Dose-Resposta a Droga , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores Socioeconômicos , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia , Taiwan , Adulto Jovem
9.
Chem Biol Interact ; 347: 109603, 2021 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-34352274

RESUMO

AIMS: Major depressive disorder (MDD) affects approximately 322 million people worldwide and is a common comorbidity in patients with diabetes mellitus (DM). A possible pathophysiological mechanism correlating both diseases is the increased oxidative stress in brain regions due to hyperglycemia. Myrsine coriacea (Primulaceae) is popularly known as "capororoca" and studies have been shown that this plant exhibits several pharmacological properties attributed to myrsinoic acid A (MAA) and B (MAB). Indeed, previous results have been shown its effects on the central nervous system, leading us to explore possible psychotropic effects. MAIN METHODS: The effects of treatment with hydroalcoholic extract of the barks from Myrsine coriacea (HEBMC, 150 mg/kg, o.g.), MAA (5 mg/kg, o.g.), and MAB (3 mg/kg, o.g.) were evaluated in streptozotocin (75 mg/kg, i.p.)-induced diabetic female rats. After 28 days of treatments, rats were submitted to the forced swim test (FST) and open field test (OFT). Also, superoxide dismutase (SOD) and catalase (CAT) activities, reduced glutathione (GSH) and lipid hydroperoxides (LOOH) levels were evaluated in the hippocampus (HIP) and prefrontal cortex (PFC) of these rats. KEY FINDINGS: The treatment with MAA or MAB increased the latency of first immobility in diabetic rats, and the HEBMC administration decreased the immobility time, and increase the climbing in FST. However, only MAB treatment reduces the immobility time, increases the climbing, and swimming in FST, and increases the crossing of diabetic animals in the OFT. Besides, this behavioral improvement promoted by MAB administration was accompanied by reducing in oxidative stress in the HIP and PFC, but not reducing hyperglycemia in diabetic rats. SIGNIFICANCE: The results suggest that MAB's antioxidant effect in the HIP of diabetic animals may be essential to its antidepressant-like effect.


Assuntos
Alcenos/uso terapêutico , Antidepressivos/uso terapêutico , Benzofuranos/uso terapêutico , Depressão/prevenção & controle , Hipocampo/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Córtex Pré-Frontal/efeitos dos fármacos , Animais , Catalase/metabolismo , Depressão/etiologia , Diabetes Mellitus Experimental/induzido quimicamente , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/metabolismo , Feminino , Myrsine/química , Teste de Campo Aberto/efeitos dos fármacos , Casca de Planta/química , Extratos Vegetais/uso terapêutico , Caules de Planta/química , Ratos Wistar , Estreptozocina
10.
Zh Nevrol Psikhiatr Im S S Korsakova ; 121(5. Vyp. 2): 113-115, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34405666

RESUMO

Self-poisoning is a common method of suicide, for which various medications are used, including antidepressants. A non-systematic review of Russian-language and English-language publications, by keywords, in the databases: ELibrary.ru, PubMed, Cochrane Database of Systematic Reviews. The purpose of the review was to analyze the literature on new risk factors and methods of their reduction in suicides with self-poisoning with antidepressants. Every fifth (20%) self-poisoning performed with antidepressants. In self-poisoning attempts, one drug used in 55% of cases, and more than one drug was used in 45% of cases. Impulsive suicides account for up to half of all suicide cases. Risk factors for impulsive suicides include the presence of impulsive character traits, female gender, young age, and the use of psychostimulants. The WHO Regional Office for Europe's mhGAP-IG guidelines recommend limiting access to a patient at risk of suicide to a weekly dose of an antidepressant. Preferably, the use of antidepressants from the group of SSRIs in small forms of release.


Assuntos
Pacientes Ambulatoriais , Suicídio , Antidepressivos/uso terapêutico , Feminino , Humanos , Inibidores de Captação de Serotonina , Suicídio/prevenção & controle , Revisões Sistemáticas como Assunto
11.
Zh Nevrol Psikhiatr Im S S Korsakova ; 121(5. Vyp. 2): 116-121, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34405667

RESUMO

Based on a clinical case, the authors consider the problem of the optimal choice of an antidepressant, taking into account not only the psychopathological structure of depression, the severity and characteristics of its triad, but also the presence of somatic symptoms. This determines the need for a comprehensive analysis of the pharmacological profile of prescribed antidepressants, their psychotropic and somatotropic effects. The switch of the patient to brintellix, which has polymodal neuroreceptor activity, at a dose of 20 mg per day, made it possible to achieve remission and reduce adverse reactions caused by SSRIs.


Assuntos
Antidepressivos , Depressão , Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Humanos , Inibidores de Captação de Serotonina/uso terapêutico
12.
Neuropsychopharmacol Hung ; 23(2): 240-248, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34342416

RESUMO

The aim of this survey paper is to draw attention to the antiviral effects of the antidepressants. Recent experience with CoV-2 infection and difficulties in prevention and therapy of COVID-19 point out the lack of specific antiviral drugs, leading to the use of repurposed drugs. A number of drugs, registered for various disorders for decades including antidepressants were considered in the prevention and treatment of COVID. Preclinical studies verified the antiviral effects of some antidepressants, first of all fluoxetine and fluvoxamine. These drugs inhibit the entry of viruses into the cell, arrest their intracellular pathway, and block their replication if used in the dose of usual human therapy, according to most of the studies. However, there are only a few in vivo studies available on the antiviral effects of antidepressants. According to observation of French clinicians in the course of the pandemia in COVID-19 therapy, epidemiological studies of the morbidity and mortality of patients on antidepressants, the association of SSRI use and reduced intubation and mortality confirm the results of in vitro trials in clinical practice. However, antidepressants are not yet registered for infectious diseases, their beneficial effects can be exploited in case of comorbidity or post-COVID syndrome. (Neuropsychopharmacol Hung 2021; 23(2): 240-248).


Assuntos
Antivirais , COVID-19 , Antidepressivos/farmacologia , Antidepressivos/uso terapêutico , Antivirais/farmacologia , Antivirais/uso terapêutico , Humanos , Pandemias , SARS-CoV-2
13.
Curr Opin Anaesthesiol ; 34(5): 556-562, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34435599

RESUMO

PURPOSE OF REVIEW: The antidepressant effect of subanesthetic doses of ketamine was recognized 20 years ago. This review briefly summarizes the current understanding of the antidepressant mechanisms and the available clinical research on the use of racemic ketamine and enantiomer esketamine for depression. RECENT FINDINGS: The antidepressant effect of subanesthetic doses of ketamine is currently considered to be predominantly mediated by improved neuroplasticity in cortico-limbic areas in the brain. Single dose of 0.5 mg/kg of ketamine infused intravenously over 40 min, or single intranasal dose of esketamine cause rapid antidepressant and antisuicidal effects within hours of administration, and the antidepressant effect may last up to a week. Repeated administration of nasal spray esketamine is considered to prevent relapse of depression. Longitudinal studies are currently insufficient. When used in various doses for anesthetic induction for electroconvulsive therapy, ketamine improves seizure quality and may possibly diminish posttherapy cognitive impairment. SUMMARY: A rapid onset antidepressive effect of ketamine and esketamine has been proven conclusively. The results of extensive basic science research of the mechanism of action of low-dose ketamine doses has led to an alternative hypothesis of the pathophysiology of depression and the development of a novel neurotrophic concept of depression. Further longitudinal studies are warranted to determine the safety and efficacy of repeated administration of ketamine and its analogs to prevent relapse and recurrence of depression.


Assuntos
Eletroconvulsoterapia , Ketamina , Administração Intranasal , Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Humanos
14.
Lancet Psychiatry ; 8(9): 824-835, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34419187

RESUMO

The use of SSRIs for the treatment of depression and anxiety in young people is increasing. However, the effects of SSRIs in adolescence, a time when there are substantial changes in neural, cognitive, and social functioning, are not well understood. Here, we review evidence from clinical trials about the benefits and risks of SSRIs in young people and consider their mechanisms of action, as shown through human experimental work and animal models. We emphasise key outstanding questions about the effects of SSRIs in youth, identified through gaps in the literature and in consultation with young people with lived experience. It is crucial to characterise the mechanisms underpinning risks and benefits of SSRIs in this age group to progress the field, and to narrow the chasm between the widespread use of SSRIs in youth and the science on which this use is based.


Assuntos
Ansiolíticos/uso terapêutico , Antidepressivos/uso terapêutico , Ansiedade/tratamento farmacológico , Depressão/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Adolescente , Animais , Ansiolíticos/farmacologia , Antidepressivos/farmacologia , Humanos , Inibidores de Captação de Serotonina/farmacologia , Resultado do Tratamento
15.
Transl Psychiatry ; 11(1): 381, 2021 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-34238923

RESUMO

Major depressive disorder (MDD) is complex and multifactorial, posing a major challenge of tailoring the optimal medication for each patient. Current practice for MDD treatment mainly relies on trial and error, with an estimated 42-53% response rates for antidepressant use. Here, we sought to generate an accurate predictor of response to a panel of antidepressants and optimize treatment selection using a data-driven approach analyzing combinations of genetic, clinical, and demographic factors. We analyzed the response patterns of patients to three antidepressant medications in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, and employed state-of-the-art machine learning (ML) tools to generate a predictive algorithm. To validate our results, we assessed the algorithm's capacity to predict individualized antidepressant responses on a separate set of 530 patients in STAR*D, consisting of 271 patients in a validation set and 259 patients in the final test set. This assessment yielded an average balanced accuracy rate of 72.3% (SD 8.1) and 70.1% (SD 6.8) across the different medications in the validation and test set, respectively (p < 0.01 for all models). To further validate our design scheme, we obtained data from the Pharmacogenomic Research Network Antidepressant Medication Pharmacogenomic Study (PGRN-AMPS) of patients treated with citalopram, and applied the algorithm's citalopram model. This external validation yielded highly similar results for STAR*D and PGRN-AMPS test sets, with a balanced accuracy of 60.5% and 61.3%, respectively (both p's < 0.01). These findings support the feasibility of using ML algorithms applied to large datasets with genetic, clinical, and demographic features to improve accuracy in antidepressant prescription.


Assuntos
Transtorno Depressivo Maior , Antidepressivos/uso terapêutico , Citalopram/uso terapêutico , Demografia , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/genética , Humanos , Aprendizado de Máquina , Resultado do Tratamento
16.
J Affect Disord ; 293: 285-294, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34225208

RESUMO

BACKGROUND: In recent years, ketamine and esketamine treatment have demonstrated rapid antidepressant effects in adults with treatment-resistant depression (TRD). Hitherto, relatively few studies have reported the effect of ketamine/esketamine treatment on functional outcomes (e.g., psychosocial functioning, workplace functioning). Herein, we review and synthesize extant literature reporting functional outcomes with ketamine/esketamine treatment in adults with TRD. METHODS: A systematic review of clinical studies reporting subjective or objective ratings of general functioning as primary or secondary outcomes was performed. RESULTS: Four randomized-controlled trials, one open-label clinical study and one case series reported on the efficacy of ketamine/esketamine on subjective measures of general functioning. Overall, mixed results were reported with respect to the effect across disparate functional measures (e.g., Sheehan Disability Scale [SDS]) using ketamine/esketamine. A single study demonstrated a significant decrease (i.e., improvement) in SDS total scores in TRD with esketamine treatment; most studies, however, did not report on functional outcomes and have functional outcomes as a (co)-primary outcome measure. LIMITATIONS: Clinical studies that were included evaluated work- or social-related disability as a secondary outcome using subjective rating scales. CONCLUSION: Functional outcomes in adults with TRD receiving ketamine/esketamine was insufficiently characterized. Available evidence indicates that improvements in general psychosocial functioning is apparent. The association, if any, between symptomatic improvement and functional improvement in TRD, as well as the temporality to improve functioning, are future research vistas.


Assuntos
Transtorno Depressivo Resistente a Tratamento , Ketamina , Adulto , Antidepressivos/uso terapêutico , Depressão , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Humanos , Ketamina/uso terapêutico
17.
Curr Opin Psychiatry ; 34(5): 448-459, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34224469

RESUMO

PURPOSE OF REVIEW: Depression is a prevalent comorbidity in cancer that significantly increases the risk for numerous negative health outcomes. This review updates the current evidence base for management of depression in cancer, highlighting new research directions based on the inflammatory hypothesis of depression. RECENT FINDINGS: Research on pharmacotherapy and psychotherapy for depression in cancer has shown mixed efficacy partly because of methodological issues arising from the phenomenology of depression in cancer. After decades of stagnancy, more recent high-quality clinical trials are beginning to provide an evidence base to guide treatment. Inflammatory cytokine-associated depression is a subtype of depression that may have particular relevance in cancer, opening new avenues to explore therapeutic targets and biobehavioral impacts of interventions, which may improve cancer outcomes. SUMMARY: The continuum of severity in cancer-related depression is important to consider in management approaches. Choice of treatment should be personalized to the patient and their symptom profile as there is currently insufficient evidence to recommend any particular medication or psychotherapy over another. Psychological interventions should be considered first line for mild-to-moderate depression, and pharmacological treatment added for more severe depression, which can be optimally delivered within a collaborative care model. VIDEO ABSTRACT: http://links.lww.com/YCO/A62.


Assuntos
Antidepressivos/uso terapêutico , Depressão/terapia , Neoplasias , Psicoterapia/métodos , Antineoplásicos/uso terapêutico , Terapia Combinada , Comorbidade , Depressão/etiologia , Transtorno Depressivo/etiologia , Transtorno Depressivo/terapia , Humanos , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neoplasias/psicologia
20.
Clin Geriatr Med ; 37(3): 401-415, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34210446

RESUMO

Insomnia afflicts many geriatric patients worldwide and results in both clinical and economic consequences. Prescribing hypnotics to the elderly is particularly challenging due to multitudes of adverse effects and drug interactions. Although benzodiazepines and "Z" drugs such as zolpidem have been popular in the past, they carry a high risk of adverse effects in the elderly, such as devastating falls and injuries as well as potentially an increase in mortality. Newer classes of hypnotics such as dual orexin receptor antagonists are much better tolerated and can be explored as a potential treatment for insomnia in the elderly.


Assuntos
Hipnóticos e Sedativos/uso terapêutico , Medicamentos Indutores do Sono/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Sono/efeitos dos fármacos , Idoso , Envelhecimento , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , Benzodiazepinas/efeitos adversos , Benzodiazepinas/uso terapêutico , Humanos , Hipnóticos e Sedativos/efeitos adversos , Melatonina/efeitos adversos , Melatonina/uso terapêutico , Antagonistas dos Receptores de Orexina/efeitos adversos , Antagonistas dos Receptores de Orexina/uso terapêutico , Medicamentos Indutores do Sono/efeitos adversos
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