ABSTRACT
Objetivo Revisar la eficacia y seguridad de medicamentos para cesación del tabaquismo en el contexto de construcción de guías de práctica clínica (GPC). Métodos Revisión sistemática de GPC para adaptación mediante ADAPTE. Los desenlaces fueron cesación ≥6 meses y seguridad de las intervenciones. Las GPC se calificaron por pares con DELBI. Se extrajeron resultados de estudios agregativos incluidos en las guías seleccionadas. Resultados Los fármacos duplican la cesación comparados con placebo (tasas de 25,0 % hasta 27,0 % al combinarse con consejería). Los mayores incrementos en cesación se obtienen con ansiolíticos y antidepresivos (8,7% a 19,4%), y los menores con terapia de reemplazo nicotínico -TRN- (5,2% a 12,9%). La nortriptilina tiene eficacia similar al bupropion (aproximadamente 10,0 %). Con limitadas excepciones (parche e inhalador, tabletas y bupropion), las combinaciones de medicamentos no incrementan la abstinencia. Conclusiones TRN, vareniclina, bupropion y nortriptilina son eficaces para dejar de fumar. Las combinaciones de medicamentos requieren más evidencia y deberían restringirse a personas con alta dependencia o con falla terapéutica inicial. Serían deseables análisis de costo-efectividad para valorar implementación de programas en países en desarrollo.
Objective To review the efficacy and safety of pharmacotherapy for smoking cessation in the context of clinical practice guidelines (CPG). Methods A systematic review of CPGs was conducted, aimed at adapting recommendations for Colombia following the ADAPTE methodology. Outcomes comprised 6-months or higher smoking cessation rates and intervention safety. CPGs were peer-assessed based on DELBI. Results from aggregative studies included in selected CPGs were obtained. Results Pharmacotherapy doubles smoking cessation rates as compared with placebos (rates @25% and up to 27 % when combined with counseling). The highest efficacy was observed for ansyolitic and antidepressive drugs (8.7 % to 19.4 %), and the lowest for nicotine replacement therapy -NRT- (5.2 % to 12.9 %). Nortriptiline shows an efficacy similar to that of bupropion (@10%). With limited exceptions, combined pharmacotherapy for smoking cessation has shown no significant increase in cessation rates. Conclusions NRT, varenicline, bupropion and nortriptiline are effective treatments for smoking cessation. Combination of drugs deserves further clinical evidence and should be restricted to highly dependent smokers or initial therapeutic failure. Cost-effectiveness analyses might help to introduce smoking cessation programs in low and middle income countries.
Subject(s)
Humans , Practice Guidelines as Topic , Smoking Cessation , Tobacco Use Cessation Devices , Anti-Anxiety Agents/adverse effects , Anti-Anxiety Agents/therapeutic use , Antidepressive Agents/adverse effects , Antidepressive Agents/therapeutic use , Arrhythmias, Cardiac/chemically induced , Bupropion/adverse effects , Bupropion/therapeutic use , Chest Pain/chemically induced , Clonidine/adverse effects , Clonidine/therapeutic use , Colombia , Cost-Benefit Analysis , Drug Administration Routes , Drug Eruptions/etiology , Drug Therapy, Combination , Gastrointestinal Diseases/chemically induced , Mucositis/chemically induced , Nortriptyline/adverse effects , Nortriptyline/therapeutic use , Sleep Initiation and Maintenance Disorders/chemically induced , Smoking Cessation/economics , Smoking Cessation/methods , Tobacco Use Cessation Devices/adverse effects , Tobacco Use Cessation Devices/economics , Treatment Outcome , Varenicline/adverse effects , Varenicline/therapeutic useABSTRACT
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.
Subject(s)
Humans , Antidepressive Agents/adverse effects , Depressive Disorder/drug therapy , Sleep Initiation and Maintenance Disorders/etiology , Comorbidity , Depressive Disorder/complications , Sleep Wake Disorders/chemically induced , Sleep Wake Disorders/drug therapy , Sleep Initiation and Maintenance Disorders/chemically inducedABSTRACT
Insomnia is one of the symptoms of inorganic mercury poisoning (IMP). The objective of this study is to analyze the chief psychological aspects in the adjustment of workers with chronic insomnia associated with IMP. For this purpose the Preventive Clinical Interview and the Ryad Simon Operational Adaptive Diagnostic Scale (Escala Diagnóstica Adaptativa Operacionalizada-EDAO) were utilized. Fifteen subjects with mean age of 40 years (10 males and 5 females) were studied. Nine were diagnosed with High Adaptive Inefficacy, five with Moderate Inefficient Adaptation and only one with Mild Inefficient Adaptation. Impairment occurred in four adaptive sectors: affective relationship, social-cultural, productivity and organic. Adaptive efficiency indicated that in all the 15 subjects studied the adaptive solutions were frustrating and led to psychic suffering and/or environmental conflict confirming the severity of the involvement in chronic IMP.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Adaptation, Psychological , Mercury Poisoning/psychology , Occupational Diseases/psychology , Sleep Initiation and Maintenance Disorders/psychology , Chronic Disease , Mercury Poisoning/complications , Occupational Diseases/chemically induced , Sleep Initiation and Maintenance Disorders/chemically inducedABSTRACT
A double blind comparative study was conducted to evaluate the efficacy and safety of penfluridol and trifluoperazine in patients of chronic schizophrenia. Penfluridol was administered once weekly while trifluoperazine was administered twice daily by preparing identical capsules. The data revealed that both the compounds were similarly effective in maintaining control of symptoms of chronic schizophrenia. However, penfluridol has a definite advantage over trifluoperazine since it is administered once a week instead of twice a day.