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2.
J Clin Psychiatry ; 81(4)2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32558407

RESUMO

OBJECTIVE: Differential predictors of response to alternative treatment options are needed to improve the outcomes in major depressive disorder. The symptom dimension comprising loss of interest and reduced activity has been reported as a predictor of poor outcome of treatment with antidepressants. We hypothesized that augmentation with partial dopamine agonist aripiprazole will be effective for individuals with pronounced interest-activity symptoms. METHODS: We tested the hypothesis in the 2-phase Canadian Biomarker Integration Network in Depression trial 1 (CAN-BIND-1). All participants had a primary diagnosis of major depressive disorder confirmed with the Mini-International Neuropsychiatric Interview. In phase 1, 188 individuals received escitalopram monotherapy 10-20 mg daily for 8 weeks. In phase 2, nonresponders received augmentation with aripiprazole 2-10 mg daily while responders continued escitalopram monotherapy for another 8 weeks. Outcomes were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS) every 2 weeks. Effects of baseline interest-activity symptoms on outcomes were tested in repeated-measures mixed-effects models. RESULTS: Higher baseline interest-activity score (indicative of more severe loss of interest and reduction in activity) predicted worse outcome of escitalopram monotherapy in phase 1 (b = 1.75; 95% CI, 0.45 to 3.05; P = .009), but the association disappeared with the augmentation option in phase 2 (b = -0.19; 95% CI, -1.30 to 0.92; P = .739). A significant interaction between the baseline interest-activity score and aripiprazole reflected the opposite direction of the relationship between baseline interest-activity score and degree of improvement with escitalopram monotherapy versus aripiprazole augmentation (b = -1.60; 95% CI, -2.35 to -0.84; P < .001). CONCLUSIONS: Individuals with prominent loss of interest and reduction in activity benefit less from escitalopram monotherapy and more from aripiprazole augmentation. Future trials may test the benefits of early prodopaminergic augmentation guided by interest-activity symptoms. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01655706.


Assuntos
Aripiprazol/uso terapêutico , Citalopram/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Letargia/tratamento farmacológico , Adolescente , Adulto , Antidepressivos de Segunda Geração/uso terapêutico , Transtorno Depressivo Maior/complicações , Agonistas de Dopamina/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Letargia/complicações , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
Medicine (Baltimore) ; 99(26): e20608, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590736

RESUMO

BACKGROUND: This study aims to assess the efficacy and safety of citalopram for the treatment of patients with post-stroke depression (PSD). METHODS: We will comprehensively search Cochrane Library, PUBEMD, EMBASE, WorldSciNet, Web of Science, VIP Database, CBM database, and China National Knowledge Infrastructure. The search period is limited from the construction of each database to the February 1, 2020. No language and publication status are limited. Two investigators will independently carry out study choosing, data extraction, study methodological quality assessment, and quality of evidence. A third investigator will help to resolve any disagreements between 2 investigators. RevMan 5.3 software will be employed for statistical analysis. RESULTS: This study will summarize the up-to-date evidence and synthesize the data to explore the efficacy and safety of citalopram for patients with PSD. CONCLUSIONS: The results of this study may present helpful evidence to determine whether citalopram is an effective management for patients with PSD. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020171015.


Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Citalopram/uso terapêutico , Depressão/tratamento farmacológico , Acidente Vascular Cerebral/psicologia , Humanos , Metanálise como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
4.
PLoS One ; 15(4): e0232226, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353006

RESUMO

OBJECTIVES: To examine patterns of generic escitalopram initiation and substitution among Medicare beneficiaries. METHODS: This retrospective new user cohort used a 5% random sample of 2013-2015 Medicare administrative claims data. Fee-for-service Medicare beneficiaries continuously enrolled in Parts A, B, and D during a 6-month washout period prior to their initial generic or brand oral escitalopram prescriptions were included (n = 12,351). The primary outcomes were generic escitalopram treatment initiation, and among brand escitalopram initiators, generic substitution within 12 months. Patient demographics, health service utilization, and prescription level factors were measured and assessed. RESULTS: Among all escitalopram initiators, about 88.2% Medicare beneficiaries initiated generic escitalopram. Beneficiaries who were younger age, male, residing in non-Northeast regions or urban area, in the Part D plan deductible benefit phase, and filling prescriptions at community/retail pharmacies were more likely to initiate generic treatment. Among brand escitalopram initiators (n = 1,464), about 20.7% switched to generic escitalopram, 31.2% switched to another alternative antidepressant, 25.1% discontinued treatment, and 8.7% were lost to follow up or passed away within 12 months after brand initiation. Factors associated with generic escitalopram substitution included region (Midwest vs. Northeast, adjusted hazard ratio (HR) = 1.46, 95% CI = 1.04-2.05), pre-index hospitalization (HR = 1.31; 95% CI = 1.16-1.48) and lower escitalopram average daily dosage (HR = 0.97; 95% CI = 0.95-0.99). CONCLUSIONS: In 2013-2015, almost 90% Medicare beneficiaries initiated generic escitalopram treatment. Among brand escitalopram initiators, about 1 in 5 patients switched to generic escitalopram within 1 year, as compared to 1 in 4 or 1 in 3 who discontinued current or switched to alternative treatment, respectively. Medicare beneficiary's geographic region was independently associated with generic escitalopram initiation and substitution. Findings from this study not only provide up-to-date evidence in generic escitalopram use patterns among Medicare population, but also can guide educational and practice interventions to further increase generic escitalopram use.


Assuntos
Citalopram/economia , Citalopram/uso terapêutico , Substituição de Medicamentos/economia , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Custos de Medicamentos , Feminino , Humanos , Masculino , Medicare/economia , Farmácias/economia , Estudos Retrospectivos , Estados Unidos
5.
Epidemiol Psychiatr Sci ; 29: e125, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32370818

RESUMO

AIMS: More than one-half of betel-quid (BQ) chewers have betel-quid use disorder (BUD). However, no medication has been approved. We performed a randomised clinical trial to test the efficacy of taking escitalopram and moclobemide antidepressants on betel-quid chewing cessation (BQ-CC) treatment. METHODS: We enrolled 111 eligible male BUD patients. They were double-blinded, placebo-controlled and randomised into three treatment groups: escitalopram 10 mg/tab daily, moclobemide 150 mg/tab daily and placebo. Patients were followed-up every 2 weeks and the length of the trial was 8 weeks. The primary outcome was BQ-CC, defined as BUD patients who continuously stopped BQ use for ⩾6 weeks. The secondary outcomes were the frequency and amount of BQ intake, and two psychological rating scales. Several clinical adverse effects were measured during the 8-week treatment. RESULTS: Intention-to-treat analysis shows that after 8 weeks, two (5.4%), 13 (34.2%) and 12 (33.3%) of BUD patients continuously quit BQ chewing for ⩾6 weeks among placebo, escitalopram, moclobemide groups, respectively. The adjusted proportion ratio of BQ-CC was 6.3 (95% CI 1.5-26.1) and 6.8 (95% CI 1.6-28.0) for BUD patients who used escitalopram and moclobemide, respectively, as compared with those who used placebo. BUD patients with escitalopram and moclobemide treatments both exhibited a significantly lower frequency and amount of BQ intake at the 8th week than those with placebo. CONCLUSIONS: Prescribing a fixed dose of moclobemide and escitalopram to BUD patients over 8 weeks demonstrated treatment benefits to BQ-CC. Given a relatively small sample, this study provides preliminary evidence and requires replication in larger trials.


Assuntos
Antidepressivos/uso terapêutico , Areca , Citalopram/uso terapêutico , Mastigação , Moclobemida/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Adolescente , Adulto , Idoso , Areca/efeitos adversos , Grupo com Ancestrais do Continente Asiático , Método Duplo-Cego , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do Tratamento
6.
Neuropsychopharmacol Hung ; 22(1): 4-15, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32329748

RESUMO

Discovery and development of the selective serotonin reuptake inhibitors mark a milestone in neuropharmacology. Drugs from this class alter the functioning of the serotonin system by the potentiation of serotonin through the negative allosteric modulation of its neuronal uptake by the human serotonin transporter. Selective serotonin reuptake inhibitors show few side effects compared to those caused by traditional antidepressants and they vary in the binding interactions formed during binding. Generally, their binding involves three specific regions of the drug structures, each participating in vital interactions, such as salt bridge formation and additional hydrophobic interactions with conserved residues in the central binding site of the target protein. Side effects, however, such as the initial lack of response to treatment, or drowsiness, nausea, and sexual dysfunction occasionally may arise. Additional binding studies, furthermore, highlighted the importance of enantioselectivity in the binding of these compounds, raising concerns about the beneficial application of racemate mixtures of some of these compounds. Therefore, additional characterisation of binding and further structural improvement of this class of drugs is necessary. The recently synthesized sertraline salts, and functional derivatives of fluoxetine and citalopram show promising results in delivering antidepressant activity as well as in effectively overcoming anorexigenic side-effects in rodent models. Hence, despite certain non-desired effects associated with selective serotonin reuptake inhibitor applications, this class of drugs is considered as first-line medication in the management of major depression, and is carrying an excellent potential for the development and refinement of the currently available and novel antidepressant therapies.


Assuntos
Citalopram/uso terapêutico , Depressão/tratamento farmacológico , Fluoxetina/uso terapêutico , Sertralina/uso terapêutico , Humanos , Proteínas da Membrana Plasmática de Transporte de Serotonina , Inibidores de Captação de Serotonina
7.
BMC Psychiatry ; 20(1): 124, 2020 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-32171290

RESUMO

BACKGROUND: Previous studies have shown escitalopram is related to sleep quality. However, effects of escitalopram on dynamics of electroencephalogram (EEG) features especially during different sleep stages have not been reported. This study may help to reveal pharmacological mechanism underlying escitalopram treatment. METHODS: The spatial and temporal responses of patients with major depressive disorder (MDD) to escitalopram treatment were analyzed in this study. Eleven MDD patients and eleven healthy control subjects who completed eight weeks' treatment of escitalopram were included in the final statistics. Six-channel sleep EEG signals were acquired during sleep. Power spectrum and nonlinear dynamics were used to analyze the spatio-temporal dynamics features of the sleep EEG after escitalopram treatment. RESULTS: For temporal dynamics: after treatment, there was a significant increase in the relative energy (RE) of Î´1 band (0.5 - 2 Hz), accompanied by a significant decrease in the RE of ß2 band (20 - 30 Hz). Lempel-Ziv complexity and Co - complexity values were significantly lower. EEG changes at different sleep stages also showed the same regulation as throughout the night sleep. For spatio dynamics: after treatment, the EEG response of the left and right hemisphere showed asymmetry. Regarding band-specific EEG complexity estimations, δ1 and ß2 in stage-1 and δ1 in stage-2 sleep stage in frontal cortex is found to be much more sensitive to escitalopram treatment in comparison to central and occipital cortices. CONCLUSIONS: The sleep quality of MDD patients improved, EEG response occurred asymmetry in left and right hemispheres due to escitalopram treatment, and frontal cortex is found to be much more sensitive to escitalopram treatment. These findings may contribute to a comprehensive understanding of the pharmacological mechanism of escitalopram in the treatment of depression.


Assuntos
Antidepressivos de Segunda Geração , Citalopram , Transtorno Depressivo Maior , Eletroencefalografia , Adulto , Antidepressivos de Segunda Geração/farmacologia , Antidepressivos de Segunda Geração/uso terapêutico , Citalopram/farmacologia , Citalopram/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/fisiopatologia , Humanos , Masculino , Projetos Piloto , Sono , Adulto Jovem
8.
Cerebrovasc Dis ; 49(1): 19-25, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32023608

RESUMO

BACKGROUND: We aimed to examine sex differences in symptom characteristics and pharmacological responses in post-stroke depressive (PSD) symptoms. METHODS: This is a post hoc analysis of EMOTION (ClinicalTrials.gov, NCT01278498), a randomized, placebo-controlled, double-blind trial that examined the efficacy of escitalopram for 3 months on depression in patients with acute stroke. Depressive symptoms were evaluated using the 10-item Montgomery-Åsberg Depression Rating Scale (MADRS). Baseline characteristics, clinical variables, and treatment responses to escitalopram were compared between male and female patients. Treatment responses were defined as changes in MADRS (total score and its components) between baseline and 3 months and were compared between the escitalopram and placebo groups within each sex group. The least square mean was calculated to determine the independent effect of escitalopram, of which interaction was evaluated with patient sex. RESULTS: Of the 478 patients (intention-to-treat population), 187 (39%) were female. Female patients were significantly older than male patients and demonstrated more severe depressive symptoms at baseline (male vs. female, MADRS score, mean [SD]: 9.7 ± 8.0 vs. 12.2 ± 8.4, p = 0.001), especially in apparent sadness, reported sadness, and reduced appetite items. These differences were significant after adjustment for age and the severity of neurologic deficits. The female escitalopram group showed a significant 3-month improvement in MADRS scores (placebo [n = 86] vs. escitalopram [n = 101], least square mean [95% CI] -2.7 [-4.1 to -1.2] vs. -5.0 [-6.4 to -3.6], p = 0.007), and this efficacy was prominent in apparent sadness, reported sadness, and pessimistic thoughts items. However, there was no significant effect of escitalopram on depressive symptoms in the male group. The treatment responses of escitalopram tended to be more pronounced in the female group, particularly in alleviating a subset of depressive symptoms such as apparent sadness (p for interaction = 0.009). CONCLUSION: PSD may differ according to sex in its symptom characteristics and treatment responses to escitalopram, and tailored treatment strategies for PSD may therefore be needed.


Assuntos
Afeto/efeitos dos fármacos , Antidepressivos de Segunda Geração/uso terapêutico , Citalopram/uso terapêutico , Depressão/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Depressão/diagnóstico , Depressão/etiologia , Depressão/psicologia , Método Duplo-Cego , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Resultado do Tratamento
9.
JAMA Netw Open ; 3(1): e1918377, 2020 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-31899530

RESUMO

Importance: Social and economic costs of depression are exacerbated by prolonged periods spent identifying treatments that would be effective for a particular patient. Thus, a tool that reliably predicts an individual patient's response to treatment could significantly reduce the burden of depression. Objective: To estimate how accurately an outcome of escitalopram treatment can be predicted from electroencephalographic (EEG) data on patients with depression. Design, Setting, and Participants: This prognostic study used a support vector machine classifier to predict treatment outcome using data from the first Canadian Biomarker Integration Network in Depression (CAN-BIND-1) study. The CAN-BIND-1 study comprised 180 patients (aged 18-60 years) diagnosed with major depressive disorder who had completed 8 weeks of treatment. Of this group, 122 patients had EEG data recorded before the treatment; 115 also had EEG data recorded after the first 2 weeks of treatment. Interventions: All participants completed 8 weeks of open-label escitalopram (10-20 mg) treatment. Main Outcomes and Measures: The ability of EEG data to predict treatment outcome, measured as accuracy, specificity, and sensitivity of the classifier at baseline and after the first 2 weeks of treatment. The treatment outcome was defined in terms of change in symptom severity, measured by the Montgomery-Åsberg Depression Rating Scale, before and after 8 weeks of treatment. A patient was designated as a responder if the Montgomery-Åsberg Depression Rating Scale score decreased by at least 50% during the 8 weeks and as a nonresponder if the score decrease was less than 50%. Results: Of the 122 participants who completed a baseline EEG recording (mean [SD] age, 36.3 [12.7] years; 76 [62.3%] female), the classifier was able to identify responders with an estimated accuracy of 79.2% (sensitivity, 67.3%; specificity, 91.0%) when using only the baseline EEG data. For a subset of 115 participants who had additional EEG data recorded after the first 2 weeks of treatment, use of these data increased the accuracy to 82.4% (sensitivity, 79.2%; specificity, 85.5%). Conclusions and Relevance: These findings demonstrate the potential utility of EEG as a treatment planning tool for escitalopram therapy. Further development of the classification tools presented in this study holds the promise of expediting the search for optimal treatment for each patient.


Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Citalopram/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Eletroencefalografia/estatística & dados numéricos , Aprendizado de Máquina , Adulto , Biomarcadores/análise , Canadá , Transtorno Depressivo Maior/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Máquina de Vetores de Suporte , Resultado do Tratamento
10.
Psychiatry Res ; 284: 112750, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31958711

RESUMO

Glutamatergic modulators may have therapeutic potential in the treatment of depressive disorder (DD), riluzole, as a modulating drug of the glutamatergic system, its antidepressant efficacy and safety of riluzole for DD are inconsistent. This meta-analysis was performed to determine the efficacy and safety of riluzole used for DD. A systematic literature search was performed using PubMed, Embase, Cochrane Library, Web of Science, VIP and other databases from 1980 to 2019. The primary outcome was change in depression severity and meta-analysis was performed using comprehensive meta-analysis software. Seven randomized controlled trials (RCTs) were included. There was some difference in depression severity change in riluzole-citalopram therapy. No significant differences were observed in response rate, remission rate, relapse rate and adverse events, while, the relapse time in riluzole group was longer than placebo group. In this meta-analysis riluzole showed no antidepressant efficacy compared to placebo in monotherapy or riluzole-ketamine combined therapy, while it might relieve depression severity to some extent in riluzole-citalopram therapy. Furthermore, riluzole showed favorable safety for DD. The longer relapse time of riluzole group might have clinical significance to some extent, although this had no statistical difference. More studies are needed to clarify the potential association between riluzole and DD.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Riluzol/uso terapêutico , Adulto , Citalopram/uso terapêutico , Feminino , Humanos , Ketamina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
11.
Psychiatry Res ; 284: 112781, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31986357

RESUMO

BACKGROUND: Vascular Endothelial Growth Factor (VEGF) has been implicated in the neurotrophic model of depression. We explored the potential role of VEGF in the pathophysiology of bipolar depression and potential utility as a diagnostic or outcome predictive biomarker. METHODS: In a double-blind study, treatment-resistant bipolar depressed patients received Escitalopram and were randomized to receive add-on Celecoxib (26 participants) or Placebo (21 participants). There were 32 healthy controls. Plasma levels of VEGF were determined at three timepoints over eight weeks. RESULTS: Bipolar patients had significantly higher VEGF levels at baseline compared to healthy controls. Logistic regression analysis revealed that the AUC is 0.67 and the VEGF cut point is 8.21. At all timepoints, patients receiving Celecoxib had comparable VEGF levels to those receiving Placebo. VEGF levels did not change significantly over time. Baseline VEGF was a poor predictor of treatment response with an AUC of 0.53. CONCLUSIONS: The increased VEGF in bipolar depression agrees with similar findings in major depressive disorder. A high VEGF level tended to accurately predict bipolar disorder, with apparent differential VEGF expression. Baseline VEGF did not predict treatment response, and levels did not change with treatment. Plasma VEGF may have diagnostic utility and guide personalized treatment.


Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Transtorno Bipolar/sangue , Transtorno Bipolar/tratamento farmacológico , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Fator A de Crescimento do Endotélio Vascular/sangue , Adulto , Idoso , Biomarcadores/sangue , Transtorno Bipolar/diagnóstico , Celecoxib/uso terapêutico , Citalopram/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Resultado do Tratamento , Adulto Jovem
12.
Depress Anxiety ; 37(1): 73-80, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31916662

RESUMO

BACKGROUND: Complicated grief (CG) is characterized by persistent, impairing grief after losing a loved one. Little is known about sleep disturbance in CG. Baseline prevalence of subjective sleep disturbance, impact of treatment on sleep, and impact of mid-treatment sleep on CG and quality of life outcomes were examined in adults with CG in secondary analyses of a clinical trial. METHODS: Patients with CG (n = 395, mean age =53.0; 78% female) were randomized to CGT+placebo, CGT+citalopram (CIT), CIT, or placebo. Subjective sleep disturbance was assessed by a grief-anchored sleep item (Pittsburgh Sleep Quality Index: PSQI-1) and a four-item sleep subscale of the Quick Inventory of Depressive Symptomatology (QIDS-4). Sleep disturbance was quantified as at least one QIDS-4 item with severity ≥2 or grief-related sleep disturbance ≥3 days a week for PSQI-1. Outcomes included the Inventory of Complicated Grief (ICG), Work and Social Adjustment Scale (WSAS), and Clinical Global Impressions Scale. RESULTS: Baseline sleep disturbance prevalence was 91% on the QIDS-4 and 46% for the grief-anchored PSQI-1. Baseline CG severity was significantly associated with sleep disturbance (QIDS-4: p = .015; PSQI-1: p = .001) after controlling for comorbid depression and PTSD. Sleep improved with treatment; those receiving CGT+CIT versus CIT evidenced better endpoint sleep (p = .027). Mid-treatment QIDS-4 significantly predicted improvement on outcome measures (all p < .01), though only WSAS remained significant after adjustment for mid-treatment ICG (p = .02). CONCLUSIONS: Greater CG severity is associated with poorer sleep beyond PTSD and depression comorbidity. Additional research including objective sleep measurement is needed to optimally elucidate and address sleep impairment associated with CG.


Assuntos
Luto , Pesar , Transtornos do Sono-Vigília/fisiopatologia , Citalopram/uso terapêutico , Comorbidade , Depressão/complicações , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Sono/efeitos dos fármacos , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/tratamento farmacológico , Transtornos do Sono-Vigília/psicologia , Resultado do Tratamento
13.
J Psychosoc Nurs Ment Health Serv ; 58(1): 23-28, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31895967

RESUMO

Benzodiazepines are a class of medications that tend to fly "under the radar" within the general population but nonetheless post a significant risk to older adults when not used appropriately. The current article aims to shine a spotlight on this medication class along with a framework for a team-based approach to successfully de-escalate use when clinically appropriate. [Journal of Psychosocial Nursing and Mental Health Services, 58(1), 23-28.].


Assuntos
Alprazolam/uso terapêutico , Benzodiazepinas , Desprescrições , Hipnóticos e Sedativos/uso terapêutico , Acetaminofen/uso terapêutico , Idoso , Benzodiazepinas/administração & dosagem , Benzodiazepinas/envenenamento , Citalopram/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Masculino , Oxicodona/uso terapêutico , Inibidores de Captação de Serotonina/uso terapêutico
14.
Trials ; 21(1): 10, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900198

RESUMO

BACKGROUND: Threshold regression, in which time to remission is modelled as a stochastic drift towards a boundary, is an alternative to the proportional hazards survival model and has a clear conceptual mechanism for examining the effects of drug dose. However, for both threshold regression and proportional hazard models, when dose titration occurs during treatment, the estimated causal effect of dose can be biased by confounding. An instrumental variable analysis can be used to minimise such bias. METHOD: Weekly antidepressant dose was measured in 380 men and women with major depression treated with escitalopram or nortriptyline for 12 weeks as part of the Genome Based Therapeutic Drugs for Depression (GENDEP) study. The averaged dose relative to maximum prescribing dose was calculated from the 12 trial weeks and tested for association with time to depression remission. We combined the instrumental variable approach, utilising randomised treatment as an instrument, with threshold regression and proportional hazard survival models. RESULTS: The threshold model was constructed with two linear predictors. In the naïve models, averaged daily dose was not associated with reduced time to remission. By contrast, the instrumental variable analyses showed a clear and significant relationship between increased dose and faster time to remission, threshold regression (velocity estimate: 0.878, 95% confidence interval [CI]: 0.152-1.603) and proportional hazards (log hazards ratio: 3.012, 95% CI: 0.086-5.938). CONCLUSIONS: We demonstrate, using the GENDEP trial, the benefits of these analyses to estimate causal parameters rather than those that estimate associations. The results for the trial dataset show the link between antidepressant dose and time to depression remission. The threshold regression model more clearly distinguishes the factors associated with initial severity from those influencing treatment effect. Additionally, applying the instrumental variable estimator provides a more plausible causal estimate of drug dose on treatment effect. This validity of these results is subject to meeting the assumptions of instrumental variable analyses. TRIAL REGISTRATION: EudraCT, 2004-001723-38; ISRCTN, 03693000. Registered on 27 September 2007.


Assuntos
Citalopram/uso terapêutico , Depressão/tratamento farmacológico , Nortriptilina/uso terapêutico , Indução de Remissão/métodos , Adulto , Antidepressivos/uso terapêutico , Antidepressivos de Segunda Geração/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Depressão/diagnóstico , Feminino , Humanos , Masculino , Índice de Gravidade de Doença , Resultado do Tratamento
15.
World Neurosurg ; 135: 217-221, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31698125

RESUMO

BACKGROUND: Meningiomas are the most common benign intracranial tumor. Although meningiomas are slow growing and potentially highly vascularized, hemorrhage of these tumors is rare. We propose 2 novel modifiable risk factors that may provoke intratumoral hemorrhage of a World Health Organization grade I meningioma. CASE DESCRIPTION: We outline the clinical presentation of a 56-year-old female with spontaneous subarachnoid hemorrhage with intraventricular extension in a coma from a petroclival meningioma taking escitalopram for depression and high-dose estrogen replacement therapy for menopause. Pathology confirmed the diagnosis of World Health Organization grade I meningioma. Postoperatively, the patient declined neurologically and developed vasospasm of the basilar artery, as well as seizures, fever, and new-onset atrial fibrillation. CONCLUSIONS: Spontaneous hemorrhage of meningiomas is a rare event. Known risk factors are age older than 70 or younger than 30; intraventricular or convexity location; malignant, fibrous, or angioblastic histopathology; and presence of hypertension, anticoagulation therapy, and traumatic brain injury. We propose 2 new risk factors to be considered that may predispose to hemorrhage of a meningioma: serotonin-modulating therapy and high-dose estrogen-replacement.


Assuntos
Hemorragia Cerebral Intraventricular/etiologia , Citalopram/uso terapêutico , Terapia de Reposição de Estrogênios , Neoplasias Meníngeas/complicações , Meningioma/complicações , Inibidores de Captação de Serotonina/uso terapêutico , Hemorragia Subaracnóidea/etiologia , Artéria Basilar/diagnóstico por imagem , Hemorragia Cerebral Intraventricular/diagnóstico por imagem , Hemorragia Cerebral Intraventricular/cirurgia , Coma/etiologia , Angiografia por Tomografia Computadorizada , Descompressão Cirúrgica , Estrogênios/administração & dosagem , Feminino , Humanos , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Fatores de Risco , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/cirurgia , Vasodilatadores/uso terapêutico , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/tratamento farmacológico , Vasoespasmo Intracraniano/etiologia , Verapamil/uso terapêutico
16.
Int Braz J Urol ; 45(6): 1209-1215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808410

RESUMO

PURPOSE: To compare the efficacy and safety of available selective serotonin reuptake inhibi-tors (SSRIs) in order to find the most effective drug with the least number of side effects in treatment of premature ejaculation (PE). MATERIALS AND METHODS: This study was a randomized clinical trial. Four hundred and eighty pati-ents with PE in the 4 groups referred to Imam Reza hospital Tehran, Iran from July 2018 to Fe-bruary 2019 were enrolled in the study. The patients received sertraline 50mg, fluoxetine 20mg, paroxetine 20mg and citalopram 20mg, every 12 hours daily. The intravaginal ejaculatory laten-cy time (IELT) before treatment, fourth and eighth weeks after treatment was recorded by the patient's wife with a stopwatch. RESULTS: Mean IELT before, 4 and 8 weeks after treatment in four groups were: sertraline 69.4±54.3, 353.5±190.4, 376.3±143.5; fluoxetine 75.5±64.3, 255.4±168.2, 314.8±190.4; paroxeti-ne 71.5±69.1, 320.7±198.3, 379.9±154.3; citalopram 90.39±79.3, 279.9±192.1, 282.5±171.1 seconds, respectively. The ejaculation time significantly increased in all groups (p <0.05), but there was no significant difference between the groups (P=0.75). Also, there was no significant difference in drugs side effects between groups (p >0.05). The most common side effects were drowsiness and dyspepsia, which were not severe enough to cause discontinuation of the drug. CONCLUSIONS: All available SSRIs were effective and usually had no serious complications. In patients who did not respond to any of these drugs, other SSRI drugs could be used as a salvage therapy.


Assuntos
Citalopram/uso terapêutico , Fluoxetina/uso terapêutico , Paroxetina/uso terapêutico , Ejaculação Precoce/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Sertralina/uso terapêutico , Adulto , Idoso , Ejaculação/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Reação/efeitos dos fármacos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
17.
Rev. Hosp. Ital. B. Aires (2004) ; 39(4): 128-134, dic. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1099754

RESUMO

Asociada o no a una enfermedad orgánica, la depresión tiene gran prevalencia en la práctica médica pero es subdiagnosticada. El trastorno del ánimo suele coexistir con variadas quejas somáticas y dolores crónicos, configurando síndromes mixtos con un diagnóstico diferencial complejo. En este artículo se describen distintas presentaciones clínicas de la depresión en medicina general, con énfasis en los estados depresivos atípicos, depresiones enmascaradas muy relevantes por su frecuencia y consecuencias: depresión posquirúrgica, cuadros dolorosos crónicos como cefaleas o lumbago, la fatiga crónica y la fibromialgia. Solo el reconocimiento y diagnóstico de la depresión subyacente posibilitará la implementación de las adecuadas intervenciones terapéuticas. Se revisan también algunas recomendaciones para el uso de antidepresivos en atención primaria y la eventual consulta psiquiátrica. (AU)


Associated or not with an organic disease, depression has a high prevalence in medical practice but is underdiagnosed. The mood disorder usually coexists with varied somatic complaints and chronic pain, forming mixed syndromes with a complex differential diagnosis. This article describes different clinical presentations of depression in general medicine, with emphasis on atypical depressive states, masked depressions very relevant for their frequency and consequences: post-surgical depression, chronic painful conditions such as headaches or lumbago, chronic fatigue and fibromyalgia. Only the recognition and diagnosis of the underlying depression will enable the implementation of appropriate therapeutic interventions. Some recommendations for the use of antidepressant drugs in primary care and the eventual psychiatric consultation are also reviewed. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Atenção Primária à Saúde/tendências , Depressão/diagnóstico , Psiquiatria/tendências , Sinais e Sintomas , Transtornos Somatoformes/diagnóstico , Citalopram/efeitos adversos , Citalopram/uso terapêutico , Fibromialgia/complicações , Síndrome de Fadiga Crônica/complicações , Fluoxetina/efeitos adversos , Fluoxetina/uso terapêutico , Inibidores de Captação de Serotonina/efeitos adversos , Dor Lombar/complicações , Antagonistas Colinérgicos/efeitos adversos , Erros Médicos , Sertralina/efeitos adversos , Sertralina/uso terapêutico , Depressão/classificação , Depressão/complicações , Depressão/terapia , Depressão/epidemiologia , Medicina Geral , Dor Crônica/complicações , Cloridrato de Venlafaxina/efeitos adversos , Cloridrato de Venlafaxina/uso terapêutico , Cloridrato de Duloxetina/efeitos adversos , Cloridrato de Duloxetina/uso terapêutico , Inibidores da Recaptação de Serotonina e Norepinefrina/efeitos adversos , Cefaleia/complicações , Amitriptilina/efeitos adversos , Amitriptilina/uso terapêutico , Antidepressivos/administração & dosagem
19.
Medicine (Baltimore) ; 98(41): e17501, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593119

RESUMO

BACKGROUND: Traditional treatment of functional dyspepsia (FD) is unsatisfactory in a subgroup of patients with FD, and the potential role of antidepressant medications also has not been definitely clarified. To provide more evidence for future optimal practice recommendations, we reviewed a 1-year clinical database of antidepressant agents applied in outpatients with FD. METHODS: Clinical presentations, treatment course, and outcomes were determined by chart review of patients referring to the functional gastrointestinal disorders specialist clinic. One hundred thirty patients with FD were included for further analysis. RESULTS: Patients were treated with different antidepressant drugs according to individual symptoms. The most commonly used drugs were flupenthixol melitracen and fluoxetine. Improvement and complete remission occurred in 93.8% and 54.6% of patients, respectively. There was a trend toward superior outcome for citalopram compared to sulpiride and mirtazapine in overall analysis. Meanwhile, regimens containing fluoxetine had significant increased remission rate compared to any other antidepressant regimens in postprandial distress syndrome subgroup analysis. Furthermore, older patients were more likely to achieve remission. However, sex and symptom duration were not associated with symptom remission. Finally, 11.5% of patients experienced adverse events. CONCLUSIONS: This retrospective cohort study indicated that small dose antidepressant therapy, especially citalopram and fluoxetine, is an effective and well tolerated treatment option for refractory FD.


Assuntos
Antracenos/uso terapêutico , Dispepsia/tratamento farmacológico , Fluoxetina/uso terapêutico , Flupentixol/uso terapêutico , Antracenos/efeitos adversos , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , China/epidemiologia , Citalopram/uso terapêutico , Combinação de Medicamentos , Dispepsia/diagnóstico , Feminino , Fluoxetina/efeitos adversos , Flupentixol/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Mirtazapina/uso terapêutico , Período Pós-Prandial , Indução de Remissão , Estudos Retrospectivos , Resultado do Tratamento
20.
Psychiatr Danub ; 31(Suppl 3): 411-415, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488762

RESUMO

BACKGROUND: Based on our 2012 study and a review of the literature on the therapeutic alliance we asked ourselves different questions: does the alliance exert a real influence on the evolution of depressive affects, the rate of remission and the physical and global health? SUBJECTS AND METHODS: In a two-year study, forty people with major depressive disorder are randomly assigned to groups that receive a SSRI (escitalopram) or a SNRI (duloxetine), each group receive concomitant ASA (100 mg) or a placebo. Sociodemographic data are recorded and patients under went regular assessments with the Hamilton depression scale (HDS) and Clinical Global Impression (CGI) scale, the Helping Alliance Questionnaire (HAQ) and the Short Form Health Survey (SF-12). RESULTS: There is no significant difference in efficacy between the two antidepressants or between antidepressant treatment with and without ASA. However, subgroup comparisons reveal that the duloxetine + ASA (DASA) subgroup showed a more rapid improvement in HDS score as early as 2 months (t=-3.114, p=0.01), in CGI score at 5 months (t=-2.119, p 0.05) than the escitalopram + placebo (EP) subgroup. Regardless of the treatment arm, the remission rate at 2 years is 50%. Among patients in remission a majority, 65%, have a high level of alliance in opposition to nonresponders who have found mostly a low level of alliance (χ2=6.296, p 0.012). HAQ scores are not correlated with HAD scores, but a correlation is found with remission rates (r=0.316*). At all times, HAQ scores are correlated with physical health. CONCLUSION: Our findings suggest that a noradrenergic agent combined with ASA is more effective in treating depression than a serotonergic agent alone. A good alliance improves effectiveness of anti-depressant treatment of 1.85 and leads to an improvement of the physical health rather than directly on the depressive feelings.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/terapia , Nível de Saúde , Inibidores de Captação de Serotonina/uso terapêutico , Inibidores da Recaptação de Serotonina e Norepinefrina/uso terapêutico , Aliança Terapêutica , Citalopram/uso terapêutico , Método Duplo-Cego , Cloridrato de Duloxetina/uso terapêutico , Humanos
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