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At present， many antidepressant drug categories have been marketed in China， but still lack a scientific and standardized system for drug comprehensive clinical evaluation. To guide and promote medical institutions to standardize the comprehensive clinical evaluation of antidepressant drugs， 19 clinical， pharmacy and evidence-based medicine experts from China were organized by the China Population Welfare Foundation to evaluate 11 drugs in 5 categories， including sertraline/escitalopram/ paroxetine/fluvoxamine/citalopram/fluoxetine/venlafaxine/duloxetine/vortioxetine/agomelatine/mirtazapine， through seminars and interviews， concerning clinical real-world data and evidence-based medicine， and to form the first draft of Expert Consensus on Comprehensive Clinical Evaluation of Antidepressant drugs， which is finalized after peer review by 18 clinical and pharmacy experts. The evaluation system of this expert consensus adopts the quantitative evaluation system of percentile and carries out a systematic evaluation from 6 dimensions of effectiveness， safety， economy， suitability， accessibility and innovativeness， while the evaluation dimensions are more detailed， with the operability of the drug evaluation system and the characteristics of drugs in the field of antidepressants. It aims to provide a theoretical basis for the rational use of drugs in the field of psychiatric disorders in medical institutions and help improve the quality of pharmacy services to better meet the needs of the people for medication.
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Abstract: This study investigated whether antenatal exposure to antidepressants (ADs) increases the risks of autism spectrum disorders (ASD), attention deficit/hyperactivity disorders (ADHD), schizophrenia and other mental illnesses, and cognitive and developmental deficits in infants or preschool children. PubMed, EMBASE, BIREME/BVS databases were searched to identify studies examining associations of ADs in pregnancy with neurodevelopmental and psychiatric disorders. Twenty studies addressed ASD and/or ADHD risks while 30 focused on developmental and cognitive deficits in infants or preschool children. Most studies detected no association of antenatal AD with ASD after adjustment of risk ratios for maternal depression or psychiatric disorders. Some studies showed that maternal depression, regardless of whether it is treated or untreated, increased ASD risks. Seven out of 8 studies found no increase in ADHD risk associated with antenatal exposure to selective serotonin reuptake inhibitors, the most commonly used AD. No consistent evidence was found linking AD in pregnancy to neurocognitive developmental deficits in infants or preschool children. A residual confounding by indication (depression severity) remained in almost all studies. This systematic review found no consistent evidence suggesting that ADs in pregnancy increase risks of ASD, ADHD, and neurocognitive development deficits. Some studies, however, found evidence that maternal depression increases ASD risks.
Resumo: O estudo teve como objetivo investigar se a exposição intrauterina a antidepressivos (ADs) aumenta o risco de transtornos do espectro autista (TEA), transtorno de déficit de atenção e hiperatividade (TDAH), esquizofrenia e outros transtornos mentais e déficits cognitivos e de desenvolvimento em lactentes e pré-escolares. Foram realizadas buscas nas bases PubMed, EMBASE e BIREME/BVS para identificar estudos sobre associações entre o uso de ADs durante a gestação e transtornos de neurodesenvolvimento e psiquiátricos. Vinte estudos trataram de riscos de TEA e/ou TDAH, enquanto 30 focaram em déficits cognitivos e de desenvolvimento em lactentes ou pré-escolares. A maioria dos estudos não detectou associação entre AD na gestação e TEA, depois de ajustar as razões de risco para depressão ou outros transtornos psiquiátricos maternos. Alguns estudos mostraram que a depressão materna, quer tratada ou não, aumenta o risco de TEA. Sete entre oito estudos não detectaram aumento de risco de TDAH associado à exposição intrauterina a inibidores seletivos da recaptação da serotonina, o AD mais comumente utilizado. Não foram encontradas evidências consistentes entre o uso de AD na gestação e déficits de desenvolvimento neurocognitivo em lactentes ou pré-escolares. Em quase todos os estudos, permaneceu um confundimento residual por indicação (gravidade da depressão). A revisão sistemática não encontrou evidências consistentes de que os ADs na gestação aumentassem o risco de TEA, TDAH ou déficits de desenvolvimento neurocognitivo. Entretanto, alguns estudos evidenciaram que a depressão materna aumenta o risco de TEA.
Resumen: Este estudio investigó si la exposición prenatal a antidepresivos (ADs) incrementa los riesgos de trastornos del espectro autista (TEA), trastornos de déficit de atención/hiperactividad (TDAH), esquizofrenia, así como otras enfermedades mentales, cognitivas, y déficits en el desarrollo de niños de primaria o preescolares. Se consultaron las bases de datos PubMed, EMBASE, BIREME/BVS para identificar estudios de asociaciones de ADs durante el embarazo con trastornos de desarrollo neurológico y psiquiátricos. Veinte estudios estaban centrados en riesgos de TEA y/o TDAH, mientras que 30 se centraron en déficits de desarrollo y cognitivos en niños de primaria o preescolares. La mayor parte de los estudios no detectaron asociación de AD, durante la etapa prenatal, con TDA tras el ajuste de las ratios de riesgo para depresión materna o trastornos psiquiátricos. Algunos estudios mostraron que la depresión materna, independientemente de si es tratada o no, incrementó los riesgos de TEA. Siete de los 8 estudios no encontraron un incremento en el riesgo de TDAH, asociado con la exposición prenatal a inhibidores selectivos de la recaptación de serotonina, el antidepresivo más usado habitualmente durante el período prenatal. No se encontraron evidencias consistentes relacionando AD durante el embarazo y déficits en el desarrollo neurocognitivo de niños de primaria o preescolares. En casi todos los estudios hubo una desviación residual señalada como gravedad de la depresión. Esta revisión sistemática no halló evidencias consistentes, sugiriendo que el consumo de ADs durante el embarazo incremente el riesgo de TEA, TDAH, y déficits en el desarrollo neurocognitivo. Algunos estudios, no obstante, encontraron evidencias de que la depresión materna incrementa riesgos de TEA.
Subject(s)
Humans , Female , Pregnancy , Infant , Child, Preschool , Prenatal Exposure Delayed Effects , Schizophrenia/epidemiology , Attention Deficit Disorder with Hyperactivity/epidemiology , Autism Spectrum Disorder/epidemiology , Antidepressive Agents/adverse effects , Schizophrenia/chemically induced , Attention Deficit Disorder with Hyperactivity/chemically induced , Brazil/epidemiology , Risk Factors , Autism Spectrum Disorder/chemically inducedABSTRACT
Depression is a common affective disorder. The application of antidepressants can significantly alleviate the symptoms of depression, which is the most important way to treat depression in clinical practice. Due to the complex etiology, wide variety, as well as diversity and severity of serious concomitant symptoms, rational addition of other drugs into antidepressants can significantly improve the cure rates of depression, reduce adverse reactions, and improve patient compliances. Therefore, the combined applications of differential drugs have been commonly used in clinic. In this paper, more than 600 literatures about depression from 2010 to 2019 were collected based on the key words of antidepressant, depression, combined medication, synergism and increase efficiency. Based on this, by summarizing and classifying the existing combinations of antidepressant drugs, this paper systematically expounds the current combined applications of antidepressant drugs in three categories, i.e. western medicines combined with western medicines, western medicines combined with traditional Chinese medicines, and traditional Chinese medicines combined with traditional Chinese medicines, in the expectation of providing the direction and basis for the selection of rational combinations of antidepressant drugs in clinic.
Subject(s)
Humans , Antidepressive Agents , Drug Interactions , Medicine, Chinese TraditionalABSTRACT
Depression has a high incidence in patients with cardiovascular diseases (CVD) and shows adverse effects on their life quality and prognosis. With the advent of new antidepressant drugs, oral antidepressant drugs are increasingly used in CVD patients with depression, and their efficacy and safety have attracted attention. Commonly used antidepressant drugs have many adverse reactions. When applying antidepressant drugs in CVD patients, we should pay special attention to their cardiovascular adverse reactions and their interaction drugs with commonly used CVD drugs. Clinicians should comprehensively evaluate and select appropriate antidepressant drugs for patients.
Subject(s)
Humans , Antidepressive Agents/adverse effects , Cardiovascular Diseases/chemically induced , Cardiovascular System , Incidence , PatientsABSTRACT
Resumen: INTRODUCCIÓN: La depresión mayor (DM) se debe a la interacción de factores ambientales, genéticos y epigenéticos, que atenúan la transmisión monoaminérgica en el cerebro. Sin embargo, poco se conoce sobre los mecanismos fisiopatológicos que subyacen a ella. OBJETIVO: Proponer una visión integral sobre la fisiopatología de la DM y los mecanismos de acción de los fármacos antidepresivos. MÉTODO: Se empleó la base PubMed para la búsqueda bibliográfica. La mayoría son investigaciones experimentales y estudios de genética molecular o de imágenes cerebrales en humanos. RESULTADOS: La DM se asocia con: i) menor volumen de la corteza cingulada anterior; ii) hiper-metabolismo del área Cg25; iii) menor expresión del receptor 5-HT1A; iv) mayor expresión de la monoamino oxidasa A. Algunos polimorfismos están asociados a la fisiopatología. El estrés crónico reduce la expresión del 5-HT1A. Los antidepresivos atenúan el hiper-metabolismo del área Cg25, estimulan la neurogénesis y activan la vía del AMPc. Encontramos que la imipramina aumenta y reduce la expresión de G α s y G α z, respectivamente (datos sin publicar). DISCUSIÓN Y CONCLUSIÓN: El déficit en la transmisión monoaminérgica puede deberse a: i) el polimorfismo G1463A en el gen de la enzima hTPH2 que reduce la síntesis de serotonina; ii) el polimorfismo C(-1019)G en el gen del receptor 5-HT1A, aumentando su transcripción en el rafé e implicando menor liberación del neurotransmisor; iii) mayor degradación de las monoaminas. La menor expresión del receptor 5-HT1A se discute considerando su acción inhibitoria en la corteza prefrontal. Los cambios en la expresión de G α s y G α z coinciden con la estimulación de la vía del AMPc.
Abstract: INTRODUCTION: The major depressive disorder (MDD) arises from the interaction of environmental, genetic and epigenetic factors, producing a deficit in monoaminergic transmission within the brain. However, our understanding of its pathophysiology is quite limited. OBJECTIVE: To reach an integrative view of the MDD pathophysiology, as well as the mechanisms of action of antidepressant drugs. METHOD: We used the PubMed database to search for the documents by using the appropriate key words. Most of them are experimental research and molecular genetics and brain imaging studies in humans. RESULTS: The pathophysiology of MDD is characterized by: i) shrinkage of the cingulate anterior cortex; ii) hyper-metabolism of the Cg25 area; iii) lower expression of the 5-HT1A receptor; iv) enhanced expression of monoamine oxidase A. Besides, certain gene polymorphisms are strongly linked to the pathophysiology, and there is evidence that 5-HT1A receptor expression is reduced by psychological stress. Antidepressants reverse the hyper-metabolic state of Cg25, stimulate neurogenesis and the cAMP pathway. We found that imipramine increases and reduces the expression of G α s and G α z, respectively (data no published). DISCUSSION AND CONCLUSION: The disruption in monoaminergic transmission could be mediated by: i) the G1463A hTPH2 polymorphism that reduces the serotonin synthesis; ii) the C(-1019)G 5-HT1A polymorphism that increases the receptor expression in the dorsal rafe, and reduces serotonin release; iii) an increase in monoamine degradation. The reduced 5-HT1A expression is discussed considering its inhibitory properties in the prefrontal cortex. The effects of imipramine on G α s and G α z are in agreement with the antidepressant-induced stimulation of the cAMP pathway.
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Background: Drugs are available in many different brands and costs of all brands are different. Patients of depression have to take the antidepressant drug for a long duration. If the cost of a drug is high patient has to pay more money for complete treatment. It can result in noncompliance and treatment failure. This study was aimed to evaluate the cost of antidepressant drugs of different classes and to analyze price variation in various antidepressant drugs available in India. Hence, we decided to do the study of price variations of antidepressant drugs. Methods: We had evaluated the cost of a different class of antidepressant drugs. Current Index of Medical Specialties October-December 2014 and Indian Drug Review 2015 issue 1 drug manuals were used to derive the cost of antidepressant drugs. Data about the cost of antidepressant drugs were collected for all the strength and dosage forms. The maximum price and minimum price for the different antidepressant drugs were identified, and calculation for the percentage of price variation was done. Results: Maximum percentage of price variation in different groups were 900% in reboxetine 2 mg (tricyclic antidepressants group), 495.23% in escitalopram 10 mg (selective serotonin reuptake inhibitors group), 318.66% in duloxetine 20 mg capsules (serotonin and noradrenaline reuptake inhibitors group), 243.58% in moclobemide 150 mg tablet (reversible monoamine oxidase-A inhibitor), 84.93% in bupropion 150 mg sustained-release tablet (atypical antidepressants group). In combination escitalopram 10 mg + clonazepam 0.5 mg shows maximum price variation of 1101.92%. Conclusion: Price variation was wide for antidepressant drugs. Generic drug prescribing can decrease the expenditure of patient on the drug. Prescribers should be provided updated knowledge of the cost of different drugs. Modifications in pharmaceutical policy are required, and prices of the drug should be controlled in effective way for all the drugs.
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The etiology of depression is complex, and its incidence is related to many factors, such as social factors, genetic factors, endocrine and central nervous system functions. Antidepressant treatment effect by affecting one or more factors of the depression regulation system. This paper, based on the various hypotheses on the pathogenesis of depression proposes that the depression pathogenesis may involve central monoamine neurotransmitter systems, neural nutrients, neuro-endocrine system, nervous system and the immune system, and central nervous system tissue morphology changes, and summarizes the antidepressant drug research progress.
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OBJECTIVE:To provide reference for rational use of antidepressant drugs in the clinic. METHODS:The utilization of antidepressant drugs in Nanjing during the period of 2011-2013 were analyzed statistically in respect of DDD,DDDs,DDC,av-erage annual growth rate and ratio of ranking method . RESULTS:From 2011 to 2013,consumption sum and DDDs of antidepres-sant drugs increased year by year in 31 hospitals of Nanjing;paroxetine occupied the first place in the list of consumption sum. Se-lective serotonin reuptake inhibitors (SSRI) got the top place ranked by DDDs,followed by serotonin/norepinephrine reuptake in-hibitors and special serotonin antidressant. CONCLUSIONS:The application of antidepressant drugs in Nanjing area is basically rea-sonable. SSRIs,such as fluvoxamine,fluoxetine,citalopram,sertraline and paroxetine,are still the first-line antidepressant drugs recent years in Nanjing.
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The etiology of depression is complex, and its incidence is related to many factors, such as social factors, genetic factors, endocrine and central nervous system functions. Antidepressant treatment effect by affecting one or more factors of the depression regulation system. This paper, based on the various hypotheses on the pathogenesis of depression proposes that the depression pathogenesis may involve central monoamine neurotransmitter systems, neural nutrients, neuro-endocrine system, nervous system and the immune system, and central nervous system tissue morphology changes, and summarizes the antidepressant drug research progress.
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Objective To determine how genetic polymorphisms in norepinephrine transporter (NET) gene influence the response of antidepressant treatment and how they interact with childhood trauma and recent life stress in a Chinese depressive patients.Methods 281 Chinese Han depressive patients received single antidepressant drugs for 6 weeks.Hamilton Depression Scale-17 (HAMD-17),the Childhood Trauma Questionnaire short term (CTQ-SF) and the Life Events Scale (LES) were used to evaluate severity of depressive symptoms and the occurrence of stressful life events respectively.Three single nucleotide polymorphisms (SNPs) in norepinephrine transporter were genotyped.Associations of single locus and haplotypes with antidepressant treatment response were analyzed using UNPHASED 3.0.13.The interaction of gene and life stress was analyzed by SPSS13.0 software.Results One NET SNP rs2242446 was significantly associated with antidepressant response in this Chinese male sample(0.4118vs0.2375,x2=7.046,P=0.0079,OR=0.445,95％ CI (0.243-0.815)),as was the haplotype CG(rs2242446 and rs5569;x2 =5.886,P=0.0153,OR=0.457,95％ CI (0.198-1.054)) and another haplotype CG-G(rs2242446,rs1532701 and rs5569;x2=5.360,P=0.0206,OR=0.530,95％ CI (0.202-1.386)) of NET in male samples.The NET SNPs rs5569 demonstrated interaction with childhood trauma to influence antidepressant response(β=-2.727,SE =1.195,P=0.023,OR=0.065,95％ CI (0.006-0.681)).Conclusion Antidepressant drug response was influenced by not only NET genetic polymorphisms in norepinephrine transporter gene but also interaction between the NET genetic polymorphisms and early life stress.
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OBJECTIVE:To investigate the clinical utilization and the tendency of antidepressant drugs in Beijing area.METHODS:Using the analytical method of the defined daily dose(DDD)recommended by WHO,the application of antidepressant drugs in Beijing from 2005 to 2007 was analyzed statistically.RESULTS:The consumptive sum and DDDs of antidepressants increased significantly year by year,with SSRIs representing more than 88% of all the antidepressant drugs in terms of the consumptive sum,leading the first 3 places in terms of consumption sum and DDDs were fluoxetine,paroxetine and citalopram.The market share of traditional tricyclics and tetracyclines showed a slight reduction,but there were still a stable population of these drugs.CONCLUSION:SSRIs such as fluoxetine have been dominated the antidepressants market in Beijing area.