Sedative antidepressants and insomnia / Antidepressivos sedativos e insônia

OBJECTIVE: The present review addresses the relationship between sleep and depression and how serotonergic transmission is implicated in both conditions. METHOD: Literature searches were performed in the PubMed and MedLine databases up to March 2010. The terms searched were "insomnia", "depression", "sedative antidepressants" and "serotonin". In order to pinpoint the sedative antidepressants most used to treat insomnia, 34 ISI articles, mainly reviews and placebo-controlled clinical trials, were selected from 317 articles found in our primary search. RESULTS: Sleep problems may appear months before the diagnosis of clinical depression and persist after the resolution of depression. Treatment of insomnia symptoms may improve this comorbid disease. Some antidepressant drugs can also result in insomnia or daytime sleepiness. Serotonin (5-HT) demonstrates a complex pattern with respect to sleep and wakefulness that is related to the array of 5-HT receptor subtypes involved in different physiological functions. It is now believed that 5HT2 receptor stimulation is subjacent to insomnia and changes in sleep organization related to the use of some antidepressants. CONCLUSION: Some drugs commonly prescribed for the treatment of depression may worsen insomnia and impair full recovery from depression. 5-HT2 receptor antagonists are promising drugs for treatment strategies since they can improve comorbid insomnia and depression.

OBJETIVO: Esta atualização aborda a relação entre sono e depressão e como a transmissão serotoninérgica está envolvida em ambas condições. MÉTODO: Foi realizada uma busca na literatura no PubMed e MedLine até março de 2010 com os termos "insônia", "depressão", "antidepressivos sedativos" e "serotonina". A fim de contemplar os antidepressivos sedativos mais utilizados no tratamento da insônia, 34 artigos ISI, principalmente revisões e estudos clínicos placebo-controlados, foram selecionados entre 317 artigos encontrados na busca inicial. RESULTADOS: Alterações de sono podem aparecer meses antes do diagnóstico clínico de depressão e persistir após a resolução da depressão. O tratamento dos sintomas de insônia pode melhorar essa doença associada. Alguns antidepressivos também podem levar à insônia ou sonolência diurna. A serotonina (5-HT) demonstra um padrão complexo no que diz respeito ao sono e vigília, o que está relacionado com a variedade de subtipos do receptor 5-HT envolvidos em diferentes funções fisiológicas. Acredita-se, atualmente, que a estimulação do receptor 5-HT2 esteja envolvida nas alterações da organização do sono e insônia relacionada a alguns antidepressivos. CONCLUSÃO: Alguns medicamentos normalmente prescritos para o tratamento de depressão podem piorar a insônia e dificultar a completa recuperação da depressão. Os antagonistas do receptor 5-HT2 são drogas promissoras para o tratamento, pois podem melhorar a insônia e depressão associadas.

Morphological aspects of the distal medial striated artery (artery of Heubner)

The distal medial striated artery, one of the branches of the anterior complex of the circle of Willis, is important because it supplies the caudate nucleus and adjoining putamen, part of the septal nucleus and fibers of the anterior part of the internal capsule. This vessel situated in a region often dealt with in neurological surgeries and can be injured because of its anatomical relationship with important structures in this region. In this study, we examined the anatomical arrangement in 50 human brains fixed in 20 per cent formaldehyde solution. The origin of this vessel was assessed relative to the pre-, post- and communicating segments of the anterior cerebral artery. Of the 121 arteries found, 49.6 per cent arose from the post-communicating segment and were duplicated in 50.4 per cent of the cases, single in 49.6 per cent and symmetrical in 44.5 per cent. The distal medial striated artery was absent in only one specimen. In relation to the pre-communicating segment, the course of this artery was anterior in 77 per cent of the cases, superior in 20 per cent and posterior in 3 per cent. A division of the anterior perforated substance into anterior, lateral and medial regions served to locate the terminal branches of the artery. The terminal branches penetrated the anterior, lateral and medial regions in 48.8 per cent, 47 per cent and 4.3 per cent of the cases respectively.