An overview of analgesics - anticonvulsants, antidepressants, and other medications (Part 3)

Pain is classified by various descriptions. Chronic pain has been described as being neuropathic (due to nervous system lesions), nociceptive (due to tissue damage), or mixed (a combination of neuropathic and nociceptive). The addition of the term nociplastic pain is used to describe patients who experience chronic pain without tissue damage or nervous system lesions. Chronic pain is often difficult to manage, particularly neuropathic pain. Evidence-based pharmacological treatment options include anticonvulsants and antidepressants. The choice of medication will depend on various factors, including patient profile, type of pain, and associated conditions. Medications with the best evidence of efficacy for first-line use in neuropathic pain are the gabapentinoids, carbamazepine, the tricyclic antidepressants, and the serotonin-noradrenaline reuptake inhibitors duloxetine and venlafaxine. The cannabinoids and ketamine are being actively investigated for use in chronic pain. Currently the cannabinoids'potential benefit is outweighed by the adverse effects, and recommendations for the use of ketamine is limited by its parenteral route of administration and low evidence of efficacy in chronic pain

Further Potential Savings Attributable to Maximum Generic Substitution of Antidepressants in South Africa: a Retrospective Analysis of Medical Claims

The main objective of the study was to calculate potential cost savings that could have been generated by maximum generic substitution of antidepressants within the private health care sector of South Africa from 2004 to 2006. Data on computerized medicine claims of patients receiving one or more antidepressants during three consecutive years (i.e. 2004; 2005 and 2006) were elicited from a South African pharmaceutical benefit management company. The total study population consisted of 292 071 items (N = 5 982 869) on 273 673 prescriptions (N = 5 213 765) at a total cost of R56 183 697.91 (N = R1 346 210 929.00). A quantitative; retrospective drug utilization review was conducted; and data were analyzed using the Statistical Analysis Systemr programme. Potential cost savings were computed for criteria-eligible substances in the study population. Generic medicine constituted 58.7(N = 292 071) of all antidepressants claimed; at a total cost of 28.2(N = R1 346 210 929.00) of all incurred costs. With total substitution of the average price of all criteria-eligible innovators; a potential saving of 9.3(N = R56 183 697.91) of the actual antidepressant cost over the study period was calculated. In developing countries with limited health care resources; generic medicines can be cost-saving treatment alternatives

Prescribing patterns of medicine classified as 'antidepressants' in South African children and adolescents

The main objective of this study was to characterise prescribing patterns of medicine classified as 'antidepressants' (hereafter simply referred to as antidepressants) in children and adolescents in the private health care sector of South Africa. A retrospective drug utilisation design was used to identify patients aged 19 years and younger from a South African pharmaceutical benefit management company's database; whom were issued at least one antidepressant between 1 January 2006 and 31 December 2006. Prescribed daily dosages (PDDs) were calculated using the Statistical Analysis Systemr program. A total of 1 013 patients received a mean number of 2.88 (SD 3.04) prescriptions per patient. Females received more prescriptions than their male counterparts; with the highest prevalence in the 15 = 19 years age group. The pharmacological groups most prescribed were the selective serotonin reuptake inhibitors (43.0) and the tricyclics (42.7); with imipramine (22.04) and amitriptyline (19) as the most commonly prescribed drugs. Approximately 30(n = 2 300) of all antidepressants in the study population were prescribed off-label. Amitriptyline and clomipramine were prescribed at daily dosages higher than recommended in children and adolescents aged 9 = 15 years. Lithium; trimipramine; trazodone and sulpiride were prescribed at sub-therapeutic dosages in adolescents. This study provided insight in the prescribing patterns of medicine classified as antidepressants in South African children and adolescents. These drugs; however; have many indications. Further research is needed to determine reasons why specific drugs are prescribed in this population

Effects of calcium channel blockers on antidepressant action of Alprazolam and Imipramine

Alprazolam is effective as an anxiolytic and in the adjunct treatment of depression. In this study; the effects of calcium channel antagonists on the antidepressant action of alprazolam and imipramine were investigated. A forced swimming maze was used to study behavioral despair in albino mice. Mice were divided into nine groups (n = 7 per group). One group received a single dose of 1Tween 80; two groups each received a single dose of the antidepressant alone (alprazolam or imipramine); two groups each received a single dose of the calcium channel blocker (nifedipine or verapamil); four groups each received a single dose of the calcium channel blocker followed by a single dose of the antidepressant (with same doses used for either in the previous four groups). Drug administration was performed concurrently on the nine groups. Our data confirmed the antidepressant action of alprazolam and imipramine. Both nifedipine and verapamil produced a significant antidepressant effect (delay the onset of immobility) when administered separately. Verapamil augmented the antidepressant effects of alprazolam and imipramine (additive antidepressant effect). This may be due to the possibility that verapamil might have antidepressant-like effect through different mechanism. Nifedipine and imipramine combined led to a delay in the onset of immobility greater than their single use but less than the sum of their independent administration. This may be due to the fact that nifedipine on its own might act as an antidepressant but blocks one imipramine mechanism that depends on L-type calcium channel activation. Combining nifedipine with alprazolam produced additional antidepressant effects; which indicates that they exert antidepressant effects through different mechanisms

Antidepressants and Antiepileptic Drugs for Chronic Non-Cancer Pain

The development of newer classes of antidepressants and second-generation antiepileptic drugs has created unprecedented opportunities for the treatment of chronic pain. These drugs modulate pain transmission by interacting with specific neurotransmitters and ion channels. The actions of antidepressants and antiepileptic drugs differ in neuropathic and non-neuropathic pain; and agents within each medication class have varying degrees of efficacy. Tricyclic antidepressants (e.g.; amitriptyline; nortriptyline; desipramine) and certain novel antidepressants (i.e.; bupropion; venlafaxine; duloxetine) are effective in the treatment of neuropathic pain. The analgesic effect of these drugs is independent of their antidepressant effect and appears strongest in agents with mixed-receptor or predominantly noradrenergic activity; rather than serotoninergic activity. First-generation antiepileptic drugs (i.e.; carbamazepine; phenytoin) and second-generation antiepileptic drugs (e.g.; gabapentin; pregabalin) are effective in the treatment of neuropathic pain. The efficacy of antidepressants and antiepileptic drugs in the treatment of neuropathic pain is comparable; tolerability also is comparable; but safety and side effect profiles differ. Tricyclic antidepressants are the most cost-effective agents; but second-generation antiepileptic drugs are associated with fewer safety concerns in elderly patients. Tricyclic antidepressants have documented (although limited) efficacy in the treatment of fibromyalgia and chronic low back pain. Recent evidence suggests that duloxetine and pregabalin have modest efficacy in patients with fibromyalgia

Analyse de la prescription des antidepresseurs au dispensaire d'Hygiene mentale de l'INSP du 1er Janvier 1999 au 31 Decembre 2001

L'analyse de la prescription des antidepresseurs au Dispensaire d'Hygiene Mentale de l'INSP. du 1er janvier 1999 au 31decembre 2001 a mis en evidence: AU NIVEAU EPIDEMIOLOGIQUE: *61;4pour cent des sujets sont de sexe feminin ; *31;1pour cent ont un age compris entre 26 et 35ans ; *25pour cent exercent dans le secteur public ; *452pour cent sont des celibataires. AU NIVEAU CLINIQUE: *25;3pour cent de cas d'insomnie sont evoques comme motif ; *61;1pour cent des symptomes observes sont somatiques ; *Les diagnostics sont domines par la depression endogene (77;1pour cent) suivi de la psychose maniaco-depressive (7;8pour cent) et des troubles anxieux (4;9pour cent). AU NIVEAU THERAPEUTIQUE: *84;9pour cent des indications sont des troubles de l'humeur. On ne note pas d'indication non psychiatrique ; *La famille des antidepresseurs tricycliques est prescrite dans 97;2pour cent des cas ; *39;9pour cent des posologies journalieres moyennes sont de 25mg ; *36;1pour cent des prescriptions sont associees a d'autres psychotropes ; *57;3pour cent des sujets ne signalent aucun effet secondaire ; *84;6pour cent des patients assidus ont une evolution favorable.Cette etude revele egalement que les antidepresseurs Inhibiteurs des Recepteurs de la Serotonine sont faiblement prescrits (2;1pour cent) dans notre contexte.Au cours du traitement; 62;4pour cent des sujets sont perdus de vue et 8;1pour cent sont irreguliers. Nous estimons qu'il serait souhaitable: *De mettre en place une politique sanitaire afin d'augmenter le nombre de centre pour l'hygiene mentale ; *De favoriser la formation des specialistes en psychiatrie ; *D'elaborer une programme de formation continue pour les praticiens des services d'hygiene mentale

Les urgences psychiatriques au Mali. Etude epidemio-clinique dans le Service de Psychiatrie de l'hopital du Point-G a Bamako

Cette etude longitudinale ayant ete conduit sur 7 mois; allant du 01/09/2004 au 31/03/2005 dans le service de psychiatrie de l'hopital du Point G. L'objectif general etait d'etudier les urgences psychiatriques. Le sexe ratio etait de 2;92 en faveur des hommes 35;6des patients se situaient entre 25-34 ans. L'agressivite (28;2) et l'agitation (12;8) etaient les motifs de prise en charge les plus evoques. Les moments feconds de schizophrenie (30;2); la Bouffee delirante (17;4) ; la depression (09;4) et confusion mentale (8;7) etaient les pathologies les plus frequentes. Plus de la moitie de nos patients (51;7);sont arrives aux heures de garde