Bupropion XL unapproved use in the prisons: Two cases focused on the bupropion pharmacology.

BACKGRUND: Bupropion (BUP) is a norepinephrine-dopamine reuptake inhibitor frequently used in prisons. Although its positive effects on depression treatment are often presented, there are many questions about its approved use in prisons and similar facilities. In this context, this article aims to present two case reports of BUP XL unapproved use and a review of the mechanism of action, formulations, and the clinical profile of BUP. METHODS: Two case reports. The patients' data for the case reports were obtained from their medical records. A PubMed search was conducted using the terms BUP, inmates, and efficacy to identify randomized and non-randomized controlled trials and case reports to evaluate the possible effects of BUP in prison settings. Only approved medications were included. RESULTS: The positive effects of BUP XL on major depressive disorder treatment are well-reported, but few reports are on the pharmacokinetics of BUP XL in prisons. The exact mechanism of its effect on the central nervous system is predominantly connected with its unique pharmacokinetics. CONCLUSIONS: This paper shows that BUP XL will continue to play an essential role in treating a major depressive disorder in adults in prisons and other related disorders, although a different treatment strategy should be preferred in patients with high addictive potential. Because of a similar mechanism of action, the most appropriate alternatives for BUP XL could be mirtazapine, agomelatine, aripiprazole, and quetiapine, although clinical trials are needed to confirm these alternatives.

Changes in the seasonality of suicides over time in Slovenia, 1971 to 2002. Amplitude is only positively related to suicide rates among females.

BACKGROUND: Changes in the suicide rate within one region over time had been hypothesised to correspond to changes in suicide seasonality: a recent investigation from Italy confirmed such an assumption. Data from Slovenia were investigated to further evaluate the links between suicide rates and seasonal amplitude. METHODS: A total of 14325 male suicides and 4350 female suicides occurring in Slovenia from 1971 to 2002 were investigated with harmonic spectral analysis to extract their monthly seasonal dispersion by eight-year intervals. Changes in rate over time were analysed with a test for trend based on regression analysis. RESULTS: The suicide rates of both males and females increased over time, with an evident peak in the 1987-1994 period and a decrease thereafter. Seasonality decreased across time in both sexes; however, no change of the peak was observed over time. The amplitude of the major 12-month cycle was slightly positively related to suicide rates, but the correlation was only statistically significant among females (P=0.0053; males: P=0.22). LIMITATIONS: Data could not be analysed according to age, the method of suicide, or the diagnosis attributable to the deceased, since this information was not available. CONCLUSION: The study confirmed that the seasonal effect on mortality by suicide is positively related to suicide rates, so much so that changes in suicide rates over time correspond to changes in suicide seasonality, but in Slovenia this effect was only evident among females, further pointing towards differences by sex in the mechanics leading to suicide.

Changes in the seasonality of suicides over time in Slovenia, 1971 to 2002.

BACKGROUND: Recent studies have reported changes in the time patterns of suicide, with reduced seasonality in some European and Asian countries. Anyway conflicting data were reported on the fading of suicide seasonality, and in some countries a rising trend was reported. METHODS: Harmonic spectral analysis was used to analyze all suicides in Slovenia in the years 1971 to 2002 (14,325 among males; 4350 among females). Analyses of overall changes are based on data aggregated by intervals of 8 years. RESULTS: In both sexes, seasonal variance accounts for a statistically significant proportion of total variance (36.0% among males; 13.3% among females). Anyway in both sexes the season-attributable variance in the latest interval is considerably lower than in the preceding periods. LIMITATIONS: Data could not be analyzed according to age or to mental disorder diagnosis, since this information was not available. CONCLUSION: The seasonal effect on mortality by suicide is sensitive to change, but its causes seem not to be sex-dependant.

The transformation of suicide fluctuation in Slovenia.

The fluctuating rate of suicide associated with seasonal changes is present throughout the world. An evaluation of Slovene suicide and meteorological data confirm a significant fluctuation of suicide incidence between the same months of consecutive years from 1985 to 1993. This phenomenon has been observed in all months of the year, but especially during the spring months. The research results confirm a significant correlation between suicide incidence and temperature and suicide incidence and the number of sunny hours for 1985 to 1993. The lack of significant correlation between the meteorological data and suicide incidence starting in 1994 may be interpreted as a decreasing meteorological influence on suicide incidence due to increase in antidepressant use.

Moclobemide as add-on therapy to agomelatine in a patient with treatment-resistant major depressive disorder: a psychopharmacological case.

OBJECTIVE: Treatment-resistant depression is a major depressive disorder that does not respond to adequate treatment of at least two antidepressants and is one of the major clinical challenges for clinicians and clinical pharmacists. One treatment option is to switch the patient to a different medication. Another option is to add a medication to the patient's current pharmacotherapy. This article presents an improvement of symptoms induced by a combination of moclobemide (MOC) and agomelatine (AG) treatment in a 48-year-old Caucasian woman with treatment-resistant major depressive disorder (MDD). The patient had been treated with numerous antidepressants in the last 2 years that had not been effective or had caused serious adverse effects. When MOC 300 mg daily was added to AG 25 mg daily, the patient recovered progressively without any adverse effects. Her functional status also appeared stable. No other drugs known to interact with AG were administered. The MOC dose was subsequently increased to 600 mg daily and was taken with AG 25 mg daily and zolpidem 5 mg daily. DISCUSSION: The positive effects of AG or MOC on MDD have been widely reported, but there have not been reports of a combined treatment with MOG and AG improving symptoms of treatment-resistant MDD. The exact mechanism of this effect on the central nervous system is unknown. The additive activity could have been caused by a broader spectrum activity of AG and MOC. CONCLUSION: In this report, we identified a case with positive evidence of this antidepressant combination relieving the symptoms of treatment-resistant MDD, which is otherwise difficult to manage. This case report may serve to help clinicians and clinical pharmacists as a new treatment option for treatment-resistant MDD, although further research is needed to confirm this practice.

Recognition of suicide risk according to the characteristics of the suicide process.

The suicide of a patient is a painful experience for many physicians and mental health professionals, and may contribute to the earlier and more frequent development of professional burnout. To reduce this risk in the primary care settings in which many suicidal patients are seen prior to their attempt, the authors presented concepts regarding the course of suicidal ideation and typical ways in which suicidal individuals communicate their experiences. These issues are explored through theoretical viewpoints, available records, research on suicide notes, and a review of the literature. The research findings presented can contribute to suicide prevention particularly when the risk of death is severe.