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1.
Medicine (Baltimore) ; 99(21): e20170, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481286

RESUMO

BACKGROUND: Numerous studies have reported that transcranial magnetic stimulation (TMS) and fluoxetine is used in the treatment of postpartum depression (PPD). Currently, no study has systematically investigated the efficacy and safety of TMS and fluoxetine for the treatment of patients with PPD. Thus, this study will assess the efficacy and safety of TMS and fluoxetine for treating PPD. METHODS: Relevant studies involving TMS and fluoxetine for the treatment of patients with PPD will be comprehensively searched from the electronic databases from inception to the February 1, 2020: Cochrane Library, EMBASE, MEDILINE, CINAHL, AMED, WANGFANG, VIP, and CNKI databases. No language and publication time restrictions will be applied. RevMan 5.3 software will be utilized for data pooling, data analysis, and risk of bias evaluation. If necessary, we will also assess reporting bias using funnel plot and Egger test. RESULTS: This study will comprehensively summarize the existing evidence to assess the efficacy and safety of TMS and fluoxetine for treating PPD. CONCLUSION: The findings of this study may help to establish a better approach to treat PPD using TMS and fluoxetine. DISSEMINATION AND ETHICS: This study will be disseminated through a peer-reviewed journal. This study does not need ethical approval as no primary patient data will be used. SYSTEMATIC REVIEW REGISTRATION: INPLASY202040017.


Assuntos
Depressão Pós-Parto/terapia , Fluoxetina/uso terapêutico , Inibidores de Captação de Serotonina/uso terapêutico , Estimulação Magnética Transcraniana/métodos , Adulto , Terapia Combinada/métodos , Depressão Pós-Parto/epidemiologia , Feminino , Fluoxetina/administração & dosagem , Humanos , Inibidores de Captação de Serotonina/administração & dosagem , Resultado do Tratamento
2.
AAPS PharmSciTech ; 21(5): 161, 2020 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-32488427

RESUMO

Development of generic extended-release (ER) formulations is challenging. Especially under fed conditions, the risk of failure in bioequivalence trials is high because of long gastric residence times and susceptibility to food effects. We describe the development of a generic trazodone ER formulation that was aided with a biorelevant dissolution evaluation. Trazodone hydrochloride 300-mg monolithic matrix tablets were dissolved both in USP and EMA compliant conditions and in the StressTest device that simulated both physicochemical and mechanical conditions of the gastrointestinal passage. The final formulation was tested against the originator, Trittico XR 300 mg, in a randomized cross-over bioequivalence trial with 44 healthy volunteers, in agreement with EMA guidelines. Initially developed formulations dissolved trazodone similarly to the originator under standard conditions (f2 factor above 50), but their dissolution kinetics differed significantly in the biorelevant tests. The formulation was optimized by the addition of low-viscosity hypromellose and mannitol. The final formulation was approved for the bioequivalence trial. Calculated Cmax were 1.92 ± 0.77 and 1.92 ± 0.63 [µg/mL], AUC0-t were 27.46 ± 8.39 and 29.96 ± 9.09 [µg∙h/mL], and AUC0-∞ were 28.22 ± 8.91 and 30.82 ± 9.41 [µg∙h/mL] for the originator and test formulations, respectively. The 90% confidence intervals of all primary pharmacokinetic parameters fell within the 80-125% range. In summary, biorelevant dissolution tests supported successful development of a generic trazodone ER formulation pharmaceutically equivalent with the originator under fed conditions. Employment of biorelevant dissolution tests may decrease the risk of failure in bioequivalence trials of ER formulations.


Assuntos
Desenvolvimento de Medicamentos , Inibidores de Captação de Serotonina/administração & dosagem , Trazodona/administração & dosagem , Adulto , Área Sob a Curva , Química Farmacêutica , Estudos Cross-Over , Preparações de Ação Retardada/farmacocinética , Feminino , Humanos , Masculino , Inibidores de Captação de Serotonina/farmacocinética , Solubilidade , Equivalência Terapêutica , Trazodona/farmacocinética
3.
Expert Opin Pharmacother ; 21(14): 1699-1711, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32543949

RESUMO

Introduction: A substantial number of patients with PD experience relapse after the discontinuation of effective pharmacotherapy, leading to detrimental effects on the individuals and considerable societal costs. This suggests the need to optimize pharmacotherapy to minimize relapse risk. Area covered: The present systematic review examines randomized, double-blind, placebo-controlled relapse prevention studies published over the last 20 years involving recommended medications. The authors aim to provide an overview of this topic and evaluate whether recent advances were achieved. Only seven studies were included, providing limited results. One-year maintenance pharmacotherapy with constant doses had protective effects against relapse in patients who had previously exhibited satisfactory responses to the same medication at the same doses. The duration of maintenance treatment did not influence relapse risk. No data were available concerning the use of lower doses or the predictors of relapse. Expert opinion: Relapse prevention in PD has received limited attention. Recent progress and conclusive indications are lacking. Rethinking pharmacological research in PD may be productive. Collecting a wide range of clinical and individual features/biomarkers in large-scale, multicenter long-term naturalistic studies, and implementing recent technological innovations (e.g., electronic medical records/'big data' platforms, wearable devices, and machine learning techniques) may help identify reliable predictive models.


Assuntos
Antidepressivos/uso terapêutico , Transtorno de Pânico/tratamento farmacológico , Prevenção Secundária/métodos , Inibidores de Captação de Serotonina/uso terapêutico , Antidepressivos/administração & dosagem , Esquema de Medicação , Humanos , Transtorno de Pânico/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Inibidores de Captação de Serotonina/administração & dosagem , Resultado do Tratamento
5.
Nat Commun ; 11(1): 1635, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32242018

RESUMO

It remains unclear why many patients with depression do not respond to antidepressant treatment. In three cohorts of individuals with depression and treated with serotonin-norepinephrine reuptake inhibitor (N = 424) we show that responders, but not non-responders, display an increase of GPR56 mRNA in the blood. In a small group of subjects we also show that GPR56 is downregulated in the PFC of individuals with depression that died by suicide. In mice, we show that chronic stress-induced Gpr56 downregulation in the blood and prefrontal cortex (PFC), which is accompanied by depression-like behavior, and can be reversed by antidepressant treatment. Gpr56 knockdown in mouse PFC is associated with depressive-like behaviors, executive dysfunction and poor response to antidepressant treatment. GPR56 peptide agonists have antidepressant-like effects and upregulated AKT/GSK3/EIF4 pathways. Our findings uncover a potential role of GPR56 in antidepressant response.


Assuntos
Antidepressivos/administração & dosagem , Transtorno Depressivo Maior/tratamento farmacológico , Receptores Acoplados a Proteínas-G/metabolismo , Adulto , Animais , Estudos de Coortes , Transtorno Depressivo Maior/genética , Transtorno Depressivo Maior/metabolismo , Feminino , Quinase 3 da Glicogênio Sintase/metabolismo , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Pessoa de Meia-Idade , Córtex Pré-Frontal/efeitos dos fármacos , Córtex Pré-Frontal/metabolismo , Receptores Acoplados a Proteínas-G/genética , Inibidores de Captação de Serotonina/administração & dosagem , Resultado do Tratamento
9.
Rev Paul Pediatr ; 38: e2018226, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31778417

RESUMO

OBJECTIVE: To report a case of recurrent isolated sleep paralysis (RISP), a benign parasomnia with worrisome and frightening sleep paralysis episodes. CASE: description: We describe a case of RISP in a sixteen-year-old girl who seeks medical attention for anxiety symptoms. The sleep paralysis and associated auditory and tactile hallucinations began three years before with worsening in the last year, causing fear of sleeping. The episodes were intensely frightening causing negative impact in patient's sleep, school performance and social function. Medical conditions were excluded, and she started treatment with a selective serotonin reuptake inhibitor with complete resolution of symptoms. COMMENTS: Sleep complaints are often devalued. Therefore, clinicians should actively ask their patients about their sleep during health assessment.


Assuntos
Medo/psicologia , Paralisia do Sono/complicações , Paralisia do Sono/psicologia , Transtornos do Sono-Vigília/diagnóstico , Desempenho Acadêmico/psicologia , Administração Oral , Adolescente , Ansiedade/etiologia , Ansiedade/psicologia , Diagnóstico Diferencial , Feminino , Fluvoxamina/administração & dosagem , Fluvoxamina/uso terapêutico , Alucinações/etiologia , Alucinações/psicologia , Humanos , Recidiva , Inibidores de Captação de Serotonina/administração & dosagem , Inibidores de Captação de Serotonina/uso terapêutico , Paralisia do Sono/diagnóstico , Paralisia do Sono/tratamento farmacológico , Transtornos do Sono-Vigília/etiologia , Mudança Social , Resultado do Tratamento
10.
Nat Prod Res ; 34(1): 16-25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30663358

RESUMO

This study was aimed at developing orodispersible films of citalopram using combination of natural and semisynthetic polymers for patients with swallowing problem. Okra biopolymer and moringa gum were utilized in combination with hydroxypropyl methylcellulose (HPMC) and pullulan. The disintegration time was less than 30 seconds and the drug content uniformity was 97.89-102.05% for all film formulations. Films formulated with HPMC (K15 and K4M) combination (F1) and combination of okra and HPMC K15 (F2) had superior mechanical properties as compared with F3 (okra and pullulan) and F4 (moringa gum and HPMC). Thermal analysis revealed stable formulations over the studied temperature range and the crystalline citalopram was completely or partially transformed into amorphous form as revealed by the differential thermal analysis, X-ray diffraction and scanning electron microscopy images. In conclusion, okra biopolymer could be used in combination with HPMC for the development of orodispersible films.


Assuntos
Citalopram/síntese química , Polímeros/química , Abelmoschus/química , Administração Oral , Citalopram/administração & dosagem , Humanos , Derivados da Hipromelose/química , Inibidores de Captação de Serotonina/administração & dosagem , Inibidores de Captação de Serotonina/síntese química , Solubilidade , Resistência à Tração , Difração de Raios X
11.
Arch Womens Ment Health ; 23(1): 71-79, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30762147

RESUMO

Management of mental illness in the perinatal period with antidepressants is controversial, since evidence emerged on potential harmful effects to the unborn child. However, over time, the dispensing of antidepressants in the perinatal period has increased. We examined perinatal dispensing patterns over time and the role of a recently issued guideline in this regard. We identified a 16-year cohort of 153,952 Dutch pregnancies with a delivery date between January 1999 and December 2014. Data included exposure to selective serotonin reuptake inhibitors (SSRIs) related to phases of pregnancy (preconception, pregnancy and delivery, post-delivery). The chi-square test for trends was used. With standard logistic regression, we explored the influence of patient characteristics on continuation of SSRIs during pregnancy. A persistent significant rise of dispensing rates in all phases was observed, with the largest increase during pregnancy (from 0.8% in 1999/2000 to 2.1% in 2013/2014, chi-square for trend = 141.735, p < 0.001). A substantial change of practice in terms of the SSRI used (less paroxetine) and the policy towards continuation into pregnancy (more continuation over time) was visible. Concomitant use of psycholeptics halved the probability of continuation of SSRIs (OR 0.50, 95%CI 0.43-0.55, p < 0.01). Dispensing rates of SSRIs steadily increased last 16 years, especially during pregnancy, caused by an increase in the proportion of women continuing their medication during pregnancy. In view of the demonstrated impact of uncertainty regarding effectiveness and safety of SSRIs in pregnancy, future research should involve more detailed outcome research of SSRIs as it is, and research into viable alternatives.


Assuntos
Antidepressivos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Complicações na Gravidez/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Adulto , Antidepressivos/administração & dosagem , Estudos de Coortes , Feminino , Humanos , Países Baixos , Paroxetina/administração & dosagem , Paroxetina/uso terapêutico , Período Periparto/psicologia , População , Período Pós-Parto/psicologia , Gravidez , Inibidores de Captação de Serotonina/administração & dosagem
12.
Artigo em Inglês | LILACS | ID: biblio-1092138

RESUMO

ABSTRACT Objective: To report a case of recurrent isolated sleep paralysis (RISP), a benign parasomnia with worrisome and frightening sleep paralysis episodes. Case description: We describe a case of RISP in a sixteen-year-old girl who seeks medical attention for anxiety symptoms. The sleep paralysis and associated auditory and tactile hallucinations began three years before with worsening in the last year, causing fear of sleeping. The episodes were intensely frightening causing negative impact in patient's sleep, school performance and social function. Medical conditions were excluded, and she started treatment with a selective serotonin reuptake inhibitor with complete resolution of symptoms. Comments: Sleep complaints are often devalued. Therefore, clinicians should actively ask their patients about their sleep during health assessment.


RESUMO Objetivo: Relatar um caso de paralisia do sono isolada e recorrente (PSIR), uma parassonia benigna com episódios inquietantes e assustadores de paralisia do sono. Descrição do caso: Descreve-se um caso de PSIR de uma adolescente de dezesseis anos que buscou cuidados médicos devido a sintomas de ansiedade. A paralisia do sono e as alucinações auditivas e táteis associadas haviam começado três anos antes, com agravamento no último ano, causando medo de dormir. Os episódios eram extremamente perturbadores, gerando um impacto negativo no sono, desempenho escolar e vida social da paciente. Condições médicas foram excluídas e começou um tratamento com um inibidor seletivo da recaptação de serotonina, com resolução completa dos sintomas. Comentários: Queixas relacionadas ao sono são frequentemente subvalorizadas. Portanto, os médicos devem perguntar aos seus pacientes sobre problemas relacionados com o sono durante a avaliação clínica.


Assuntos
Humanos , Feminino , Adolescente , Transtornos do Sono-Vigília/diagnóstico , Paralisia do Sono/complicações , Paralisia do Sono/psicologia , Medo/psicologia , Ansiedade/etiologia , Ansiedade/psicologia , Recidiva , Transtornos do Sono-Vigília/etiologia , Mudança Social , Administração Oral , Resultado do Tratamento , Fluvoxamina/administração & dosagem , Fluvoxamina/uso terapêutico , Inibidores de Captação de Serotonina/administração & dosagem , Inibidores de Captação de Serotonina/uso terapêutico , Paralisia do Sono/diagnóstico , Paralisia do Sono/tratamento farmacológico , Diagnóstico Diferencial , Desempenho Acadêmico/psicologia , Alucinações/etiologia , Alucinações/psicologia
13.
Artigo em Inglês | LILACS | ID: biblio-1057218

RESUMO

ABSTRACT Objective: To report a case of recurrent isolated sleep paralysis (RISP), a benign parasomnia with worrisome and frightening sleep paralysis episodes. Case description: We describe a case of RISP in a sixteen-year-old girl who seeks medical attention for anxiety symptoms. The sleep paralysis and associated auditory and tactile hallucinations began three years before with worsening in the last year, causing fear of sleeping. The episodes were intensely frightening causing negative impact in patient's sleep, school performance and social function. Medical conditions were excluded, and she started treatment with a selective serotonin reuptake inhibitor with complete resolution of symptoms. Comments: Sleep complaints are often devalued. Therefore, clinicians should actively ask their patients about their sleep during health assessment.


RESUMO Objetivo: Relatar um caso de paralisia do sono isolada e recorrente (PSIR), uma parassonia benigna com episódios inquietantes e assustadores de paralisia do sono. Descrição do caso: Descreve-se um caso de PSIR de uma adolescente de dezesseis anos que buscou cuidados médicos devido a sintomas de ansiedade. A paralisia do sono e as alucinações auditivas e táteis associadas haviam começado três anos antes, com agravamento no último ano, causando medo de dormir. Os episódios eram extremamente perturbadores, gerando um impacto negativo no sono, desempenho escolar e vida social da paciente. Condições médicas foram excluídas e começou um tratamento com um inibidor seletivo da recaptação de serotonina, com resolução completa dos sintomas. Comentários: Queixas relacionadas ao sono são frequentemente subvalorizadas. Portanto, os médicos devem perguntar aos seus pacientes sobre problemas relacionados com o sono durante a avaliação clínica.


Assuntos
Humanos , Feminino , Adolescente , Transtornos do Sono-Vigília/diagnóstico , Paralisia do Sono/complicações , Paralisia do Sono/psicologia , Medo/psicologia , Ansiedade/etiologia , Ansiedade/psicologia , Recidiva , Transtornos do Sono-Vigília/etiologia , Mudança Social , Administração Oral , Resultado do Tratamento , Fluvoxamina/administração & dosagem , Fluvoxamina/uso terapêutico , Inibidores de Captação de Serotonina/administração & dosagem , Inibidores de Captação de Serotonina/uso terapêutico , Paralisia do Sono/diagnóstico , Paralisia do Sono/tratamento farmacológico , Diagnóstico Diferencial , Desempenho Acadêmico/psicologia , Alucinações/etiologia , Alucinações/psicologia
14.
Lancet ; 394(10216): 2243-2254, 2019 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-31862249

RESUMO

BACKGROUND: Dravet syndrome is a rare, treatment-resistant developmental epileptic encephalopathy characterised by multiple types of frequent, disabling seizures. Fenfluramine has been reported to have antiseizure activity in observational studies of photosensitive epilepsy and Dravet syndrome. The aim of the present study was to assess the efficacy and safety of fenfluramine in patients with Dravet syndrome. METHODS: In this randomised, double-blind, placebo-controlled clinical trial, we enrolled children and young adults with Dravet syndrome. After a 6-week observation period to establish baseline monthly convulsive seizure frequency (MCSF; convulsive seizures were defined as hemiclonic, tonic, clonic, tonic-atonic, generalised tonic-clonic, and focal with clearly observable motor signs), patients were randomly assigned through an interactive web response system in a 1:1:1 ratio to placebo, fenfluramine 0·2 mg/kg per day, or fenfluramine 0·7 mg/kg per day, added to existing antiepileptic agents for 14 weeks. The primary outcome was the change in mean monthly frequency of convulsive seizures during the treatment period compared with baseline in the 0·7 mg/kg per day group versus placebo; 0·2 mg/kg per day versus placebo was assessed as a key secondary outcome. Analysis was by modified intention to treat. Safety analyses included all participants who received at least one dose of study medication. This trial is registered with ClinicalTrials.gov with two identical protocols NCT02682927 and NCT02826863. FINDINGS: Between Jan 15, 2016, and Aug 14, 2017, we assessed 173 patients, of whom 119 patients (mean age 9·0 years, 64 [54%] male) were randomly assigned to receive either fenfluramine 0·2 mg/kg per day (39), fenfluramine 0·7 mg/kg per day (40) or placebo (40). During treatment, the median reduction in seizure frequency was 74·9% in the fenfluramine 0·7 mg/kg group (from median 20·7 seizures per 28 days to 4·7 seizures per 28 days), 42·3% in the fenfluramine 0·2 mg/kg group (from median 17·5 seizures per 28 days to 12·6 per 28 days), and 19·2% in the placebo group (from median 27·3 per 28 days to 22·0 per 28 days). The study met its primary efficacy endpoint, with fenfluramine 0·7 mg/kg per day showing a 62·3% greater reduction in mean MCSF compared with placebo (95% CI 47·7-72·8, p<0·0001); fenfluramine 0·2 mg/kg per day showed a 32·4% reduction in mean MCSF compared with placebo (95% CI 6·2-52·3, p=0·0209). The most common adverse events (occurring in at least 10% of patients and more frequently in the fenfluramine groups) were decreased appetite, diarrhoea, fatigue, lethargy, somnolence, and decreased weight. Echocardiographic examinations revealed valve function within the normal physiological range in all patients during the trial and no signs of pulmonary arterial hypertension. INTERPRETATION: In Dravet syndrome, fenfluramine provided significantly greater reduction in convulsive seizure frequency compared with placebo and was generally well tolerated, with no observed valvular heart disease or pulmonary arterial hypertension. Fenfluramine could be an important new treatment option for patients with Dravet syndrome. FUNDING: Zogenix.


Assuntos
Epilepsias Mioclônicas/tratamento farmacológico , Fenfluramina/uso terapêutico , Convulsões/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Administração Oral , Adolescente , Anticonvulsivantes/uso terapêutico , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Fenfluramina/administração & dosagem , Fenfluramina/efeitos adversos , Humanos , Masculino , Estudos Observacionais como Assunto , Placebos , Inibidores de Captação de Serotonina/administração & dosagem , Inibidores de Captação de Serotonina/efeitos adversos , Resultado do Tratamento
16.
Drugs R D ; 19(4): 367-379, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31741176

RESUMO

PURPOSE: The aim of this study was to examine the association between selective serotonin reuptake inhibitor (SSRI) therapy and rehabilitation outcomes, specifically disability and quality of life (QOL), in a real-world setting of multi-ethnic Asian patients with first-ever stroke. METHODS: In this prospective observational pilot cohort study, we included patients with first-ever stroke admitted to two inpatient rehabilitation centres in Singapore between January and July 2018. Outcomes were measured using Functional Independence Measure (FIM)-motor scale, modified Barthel Index (MBI) and the Stroke and Aphasia Quality of Life Scale-39 generic (SAQOL-39g) questionnaire. Linear regression was used to assess the association between SSRI therapy and outcomes. Regression coefficients and 95% confidence intervals (CIs) were reported. RESULTS: Among 57 patients included for analyses, 38.6% received SSRIs. Although SSRI therapy was significantly associated with gains in MBI (coefficient 11.35; 95% CI 0.21-22.50) and SAQOL-39g overall score (coefficient 0.45; 95% CI 0.05-0.85) based on simple linear regression, no significant association between SSRI therapy and any of the investigated outcomes was found after adjustment for confounders. However, an increase in the mean number of physiotherapy and occupational therapy (PT/OT) sessions per day significantly improved FIM-motor (coefficient 16.86; 95% CI 2.64-31.07) and MBI (coefficient 22.79; 95% CI 2.35-43.23) scores. CONCLUSION: SSRI therapy did not improve disability and QOL in multi-ethnic Asian patients with first-ever stroke undergoing rehabilitation.


Assuntos
Qualidade de Vida , Inibidores de Captação de Serotonina/uso terapêutico , Reabilitação do Acidente Vascular Cerebral/métodos , Idoso , Afasia/etiologia , Afasia/psicologia , Estudos de Coortes , Avaliação da Deficiência , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Atividade Motora/efeitos dos fármacos , Projetos Piloto , Estudos Prospectivos , Recuperação de Função Fisiológica , Inibidores de Captação de Serotonina/administração & dosagem , Singapura , Inquéritos e Questionários , Resultado do Tratamento
17.
Psychiatry Res ; 282: 112613, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31669837

RESUMO

BACKGROUND: While there is sufficient evidence that Crocus Sativus L. (saffron) improves symptoms of depression in young and middle-aged adults, research on older people are missing. The purpose of the double-blind, randomized intervention study was to compare the effect of saffron and sertraline on MDD among a sample of older people. METHODS: A total of 50 older out-patients with MDD (mean age = =65 years; 70% males) were randomly assigned either to the saffron condition (60 mg/d) or to the sertraline condition (100 mg/day) for six consecutive weeks. Experts employed the Hamilton Depression Rating Scale (HDRS) to rate participants' degree of depression. Timepoints were baseline, week 2, week 4 and week 6, the end of the study. RESULTS: Symptoms of depression decreased over time, with no advantages or disadvantages for the saffron or sertraline condition. CONCLUSION: The pattern of results suggests that both saffron and sertraline have the potential to significantly decrease symptoms of depression. The results are clinically relevant, because major depressive disorders in older people is a health concern. The results are further relevant, because saffron appears to be a powerful antidepressant for older people, who might be more reluctant to the use of synthetic drugs.


Assuntos
Antidepressivos/farmacologia , Crocus , Transtorno Depressivo Maior/tratamento farmacológico , Fitoterapia , Extratos Vegetais/farmacologia , Inibidores de Captação de Serotonina/farmacologia , Sertralina/farmacologia , Idoso , Antidepressivos/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Extratos Vegetais/administração & dosagem , Inibidores de Captação de Serotonina/administração & dosagem , Sertralina/administração & dosagem , Resultado do Tratamento
18.
Proc Natl Acad Sci U S A ; 116(41): 20267-20273, 2019 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31570579

RESUMO

The ovulatory homolog model of female orgasm posits that the neuro-endocrine mechanisms underlying female orgasm evolved from and are homologous to the mechanisms mediating copulation-induced ovulation in some mammals. This model predicts that pharmacological agents that affect human orgasm, such as fluoxetine, should also affect ovulation in animals with copulation-induced ovulation, such as rabbits. We tested this prediction by treating rabbits with daily doses of fluoxetine for 2 wk and found that fluoxetine treatment reduces the number of ovulations postcopulation by 30%. In a second experiment we tested whether this result was mediated by an effect on the brain or via peripheral serotonin functions. We treated animals with fluoxetine and induced ovulation with a single injection of human chorionic gonadotropin. In this experiment ovulation rate was nominally reduced by only 8%, which is statistically not significant. We conclude that the effect of fluoxetine on copulation-induced ovulation rate supports the ovulatory homolog model of female orgasm, suggesting that female orgasm has very deep evolutionary roots among the early eutherian mammals.


Assuntos
Evolução Biológica , Gonadotropina Coriônica/farmacologia , Fluoxetina/farmacologia , Ovulação/efeitos dos fármacos , Animais , Gonadotropina Coriônica/administração & dosagem , Copulação/fisiologia , Feminino , Fluoxetina/administração & dosagem , Masculino , Ovulação/fisiologia , Coelhos , Substâncias para o Controle da Reprodução/administração & dosagem , Substâncias para o Controle da Reprodução/farmacologia , Inibidores de Captação de Serotonina/administração & dosagem , Inibidores de Captação de Serotonina/farmacologia
19.
Medicina (Kaunas) ; 55(9)2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31480427

RESUMO

Background and Objectives: Hot flushes and sleep disturbances are the most common vasomotor symptoms (VMS) reported by postmenopausal women. Hormonal treatment is to date referred to as the gold standard approach but not suitable for all the patients. Alternative treatments are needed in case of a contraindication to menopausal hormone therapy (MHT), adverse side effects, and poor compliance. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS. Nonetheless, few trials with low consensus are available about this topic. In this review, we aimed to evaluate the efficacy of low-dose paroxetine therapy in the treatment of vasomotor hot flushes and night sleep disturbances in postmenopausal women. Materials and Methods: We performed an electronic search from the beginning of all databases to July 2019. All results were then limited to a randomized trial. Restrictions for language or geographic location were not utilized. Inclusion criteria were randomized clinical trials of physiological or surgical postmenopausal women experiencing hot flushes and sleep disturbances who were randomized to either low-dose paroxetine or placebo (i.e., formulations without active ingredients). The primary outcome evaluated was the mean weekly reduction of hot flushes. Results: Five randomized clinical trials, including 1482 postmenopausal women, were analyzed. Significant heterogeneity (I2 = 90%) between studies was noted. Hot flushes episodes were significantly reduced in the treatment arm compared to placebo (mean difference (MD) -7.97 [-10.51, -5.92] episodes/week). Results on the improvement on sleep were limited by being reported in only two studies; however, no significant reduction of night-time awakenings was observed (MD, -0.40 awakenings/night [-1.38, 0.58 CI]). Conclusions: Low-dose paroxetine is an effective treatment for vasomotor menopause symptoms, including hot flushes.


Assuntos
Fogachos/tratamento farmacológico , Paroxetina/administração & dosagem , Pós-Menopausa , Inibidores de Captação de Serotonina/administração & dosagem , Transtornos do Sono-Vigília/tratamento farmacológico , Feminino , Humanos , Ovariectomia , Pós-Menopausa/efeitos dos fármacos , Pós-Menopausa/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Expert Opin Drug Saf ; 18(10): 949-963, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31430189

RESUMO

Introduction: Depression affects 300 million individuals worldwide. While selective serotonin reuptake inhibitors (SSRI) are one of the first-line pharmacological treatments of major depression in the general population, there is still uncertainty regarding their potential benefits and risks during pregnancy. Areas covered: Outcomes requisite for a proper risk/benefit assessment of SSRI in pregnancy and lactation were considered: (a) potential risks associated with untreated depression, (b) effectiveness of different treatment options of depression, (c) potential risks associated with SSRI. Expert opinion: Despite the growing amount of literature on SSRI use during pregnancy, no new trials assessing the benefits of SSRIs on maternal depression were found. In the light of new data regarding the potential risks, depressed SSRI-treated pregnant women and their children seem at increased risk for several complications (mostly of small absolute risk). The interpretation of these findings remains quite similar to our previous review as the available methodology does not allow to disentangle the potential effect of SSRIs from those of the disease itself or/and of its unmeasured associated risk factors. Thus, in pregnant or lactating women who require a pharmacological treatment, SSRIs can still be considered as appropriate when effective as the abundant data support their relative safety.


Assuntos
Transtorno Depressivo Maior/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Inibidores de Captação de Serotonina/administração & dosagem , Feminino , Humanos , Recém-Nascido , Lactação/efeitos dos fármacos , Gravidez , Medição de Risco , Inibidores de Captação de Serotonina/efeitos adversos
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