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1.
Evid. actual. práct. ambul ; 25(1): e002065, 2022. tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1367549

ABSTRACT

La depresión es un trastorno del estado de ánimo que se caracteriza por la existencia de un sentimiento de tristeza lo suficientemente intenso como para interferir en el desarrollo de las actividades habituales. A partir de un caso clínico real, en el que una paciente con depresión solicita a su médico de cabecera sumar un suplemento de vitaminas a su plan terapéutico, revisamos la evidencia disponible sobre el uso de estos micronutrientes para el tratamiento de la depresión, y encontramos que no existen pruebas robustas que avalen la suplementación vitamínica en pacientes con este problema de salud. (AU)


Depression is a mood disorder characterised by the existence of a feeling of sadness intense enough to interfere with the performance of normal activities. Based on a real clinical case, in which a patient with depression asked her family doctor to add a vitamin supplement to her therapeutic plan, we reviewed the available evidence on the use of these micronutrients for the treatment of depression and found that there is no robust evidence to support vitamin supplementation in patients with this health problem. (AU)


Subject(s)
Humans , Female , Aged, 80 and over , Vitamin B Complex/therapeutic use , Vitamin D/therapeutic use , Depression/drug therapy , Folic Acid/therapeutic use , Anxiety , Exercise , Serotonin Uptake Inhibitors/therapeutic use , Depression/physiopathology , Depression/therapy , Systematic Reviews as Topic , Antidepressive Agents/therapeutic use
2.
Article in Portuguese | ColecionaSUS, LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1367185

ABSTRACT

Lisdexanfetamina e drogas disponíveis no SUS (metilfenidato, bupropiona, amitriptilina, clomipramina, nortriptilina). Indicação: Transtorno do Déficit de Atenção e Hiperatividade (TDAH) em crianças e adolescentes. Pergunta: Lisdexanfetamina é eficaz e segura para melhoria de sintomática, comparada ao placebo e medicações disponíveis no SUS, no tratamento de crianças e adolescentes com TDAH? Métodos: Revisão rápida de evidências (overview) de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews). Resultados: Foram selecionadas 3 revisões sistemáticas, que atenderam aos critérios de inclusão. Conclusão: Lisdexanfetamina e metilfenidato são mais eficazes que placebo, e similares entre si, para reduzir sintomas em escalas de avaliação. Lisdexanfetamina e metilfenidato têm risco similar ao placebo de abandono do tratamento devido a efeitos adversos. Bupropiona não é mais eficaz que placebo para alívio sintomático. Lisdexanfetamina tem efeitos adversos de redução do apetite e insônia/ dificuldades do sono. Não foram encontradas evidências na literatura sobre os efeitos terapêuticos de amitriptilina, clomipramina e nortriptilina no tratamento de crianças e adolescentes com TDAH


Lisdexamfetamine and drugs available in the Brazilian Public Health System (BPHS) (methylphenidate, bupropion, amitriptyline, clomipramine, nortriptyline, bupropion). Indication: Children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). Question: Lisdexamfetamine is effective and safe for symptomatic improvement, compared to placebo and drugs available in the BPHS, for treatment of children and adolescents with ADHD? Methods: Rapid response review of evidence (overview) of systematic reviews, with bibliographic search in the PUBMED database, using a structured strategy. The methodological quality of systematic reviews was assessed with AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews). Results: 3 systematic reviews met the inclusion criteria and were selected. Conclusion: Lisdexamfetamine and methylphenidate are more effective than placebo, and similar to each other, to reduce symptoms on rating scales. Lisdexamfetamine and methylphenidate are not different from placebo in the risk of treatment discontinuation due to adverse effects. Bupropion is no more effective than placebo for symptomatic relief. Lisdexamfetamine has adverse effects of decreased appetite and insomnia/sleep troubles. No evidence was found in the literature about therapeutic effects of amitriptyline, clomipramine and nortriptyline for treatment of children and adolescents with ADHD


Subject(s)
Humans , Child, Preschool , Child , Adolescent , Attention Deficit Disorder with Hyperactivity/drug therapy , Bupropion , Lisdexamfetamine Dimesylate/therapeutic use , Methylphenidate/therapeutic use , Placebos , Clomipramine , Evidence-Informed Policy , Amitriptyline , Antidepressive Agents/therapeutic use , Nortriptyline
3.
Rev. méd. Urug ; 37(3): e37304, set. 2021. tab, graf
Article in Spanish | LILACS, BNUY | ID: biblio-1341552

ABSTRACT

Resumen: Objetivo: conocer el consumo de antidepresivos en la población uruguaya en el período 2010-2014. Material y método: se realizó un estudio de utilización de medicamentos para evaluar el consumo de antidepresivos utilizando el dato de dispensación de medicamentos de las farmacias de las instituciones participantes. Se utilizó la variable dosis diaria definida (DDD) por 1.000 habitantes/día (DHD). Resultados: se incluyó el 69% de la población uruguaya. Las DHD globales de antidepresivos para los años 2010, 2011, 2012, 2013 y 2014 fueron: 26,49, 29,71, 30,17, 30,79 y 32,55 (promedio en los 5 años: 30,04) siendo el aumento porcentual global en dicho período de 22,88%. Los ISRS fueron el grupo de antidepresivos más consumidos. Sertralina fue el antidepresivo más consumido en los 5 años de estudio (DHD 13,65), y el de mayor aumento porcentual fue duloxetina, seguido por escitalopram. Conclusión: el consumo de antidepresivos a nivel nacional en el período analizado es inferior al constatado en otros países, con una tendencia al aumento. Éste puede ser visto como una señal para la evaluación evolutiva en el periodo 2015-2020 y para realizar análisis de las prácticas de prescripción y actuales indicaciones, utilizando otras metodologías como los estudios de prevalencia o estudios de indicación-prescripción o de prescripción-indicación.


Abstract: Objective: to learn about antidepressant use in the Uruguayan population between 2010 and 2014. Method: the use of drugs was studied to evaluate the consumption of antidepressants by analysing the dispensing of drugs in the pharmacies that are part of the participating institutions. The study used the defined daily dose variable (DDD) by 1.000 inhabitants/day (DHD). Results: 69% of the Uruguayan population was included in the study. The global antidepressant dose by inhabitants per day for 2010, 2011, 2012, 2013 and 2014 was 26,49, 29,71, 30,17; 30,79 and 32,55 respectively (average in the five years 30,4) being the global increase of percentage 22,88%5 for that period. The SSRIs (selective serotonin reuptake inhibitor) were the most widely used group of antidepressants. Sertraline was the antidepressant of greatest consumption in the 5 years of the study (DHD 13,65), and the one that presented the highest percentage increase was duloxetine, followed by escitalopram. Conclusion: antidepressant use at the national level during the period analysed is lower than that seen in other countries, although a tendency to increase was found. This may be interpreted as a sign for the need to evaluate the evolution in the 2015-2020 period, and to conduct studies on prescription practices and current indications using other methodologies, such as prevalence studies or indication-prescription or prescription-indication studies.


Resumo: Objetivo: conhecer o consumo de antidepressivos na população uruguaia no período 2010-2014. Material e método: foi realizado um estudo sobre o uso de medicamentos para avaliar o consumo de antidepressivos a partir dos dados de dispensação de medicamentos nas farmácias das instituições participantes. Foi utilizada a variável dose diária definida (DDD) por 1.000 habitantes/dia (DHD). Resultados: 69% da população uruguaia foram incluídas. Os DHDs globais de antidepressivos para os anos de 2010, 2011, 2012, 2013 e 2014 foram: 26,49, 29,71, 30,17; 30,79 e 32,55 (média nos 5 anos, 30,04) sendo o aumento percentual global no referido período de 22,88%. Os inibidores seletivos da recaptação da serotonina foram o grupo de antidepressivos mais amplamente utilizado. A sertralina foi o antidepressivo mais utilizado nos 5 anos do estudo (DHD 13,65), e o que apresentou maior aumento percentual foi a duloxetina, seguida do escitalopram. Conclusão: o consumo de antidepressivos em nível nacional no período analisado é inferior ao encontrado em outros países, com tendência de aumento. Isto pode ser visto como um sinal para a avaliação evolutiva no período 2015-2020 e para a realização de análises das práticas de prescrição e indicações atuais, utilizando outras metodologias como estudos de prevalência ou estudos de indicação-prescrição ou prescrição-indicação.


Subject(s)
Antidepressive Agents/therapeutic use , Prescription Drugs/supply & distribution
4.
Neuroscience Bulletin ; (6): 1303-1313, 2021.
Article in English | WPRIM | ID: wpr-922625

ABSTRACT

Food deprivation can rescue obesity and overweight-induced mood disorders, and promote mood performance in normal subjects. Animal studies and clinical research have revealed the antidepressant-like effect of calorie restriction, but little is known about the mechanism of calorie restriction-induced mood modification. Previous studies have found that astrocytes modulate depressive-like behaviors. Inositol 1,4,5-trisphosphate receptor type 2 (IP3R2) is the predominant isoform in mediating astrocyte Ca


Subject(s)
Adenosine Triphosphate , Animals , Antidepressive Agents/therapeutic use , Caloric Restriction , Mice , Mice, Knockout , Prefrontal Cortex
5.
Rev. Méd. Clín. Condes ; 31(2): 114-121, mar.-abr. 2020. tab
Article in Spanish | LILACS | ID: biblio-1223379

ABSTRACT

Los trastornos del ánimo (uni o bipolares) constituyen un significativo problema de salud pública, tanto por su alta prevalencia como por el elevado índice de discapacidad que generan. El presente artículo aborda el problema de la resistencia a tratamiento como también las estrategias y guías clínicas para el manejo de los cuadros de mayor complejidad. Se analizan los aportes de la terapia farmacológica, de la psicoterapia y de las terapias somáticas no farmacológicas, intentando un enfoque integrativo. El equipo multidisciplinario de la Unidad de Trastornos del Ánimo del Departamento de Psiquiatría de Clínica Las Condes busca aplicar un modelo integrativo con una mirada amplia, con el objetivo de encontrar el mejor manejo para cada paciente, orientado no solo a la remisión sintomática sino también a la recuperación funcional (autonomía, calidad de vínculos, etc.), para incidir de este modo en la calidad de vida global de los pacientes.


Affective disorders (uni­ or bipolar) represent a significant public health issue, due both to its high prevalence as well as the high index of disability that they generate. This article addresses the problem of treatment resistance, as well the use of clinical guidelines and strategies for the treatment of more complex cases. We analyze the contributions of pharmacological treatments, psychotherapy and non-pharmacological somatic therapies, from an integrative point of view. The multidisciplinary team of Mood Disorders Unit at Clínica Las Condes Psychiatry Department seeks to apply a broad-view integrative model with the aim of finding the better management strategy for each patient. Our objectives are both symptomatic remission and functional recovery (autonomy, quality of affective bonds, etc.), in order to make a difference on the patients' overall quality of life.


Subject(s)
Humans , Practice Guidelines as Topic , Mood Disorders/therapy , Psychotherapy/methods , Bipolar Disorder/therapy , Remission Induction , Mood Disorders/drug therapy , Recovery of Function , Depression/therapy , Antidepressive Agents/therapeutic use
6.
Rev. Méd. Clín. Condes ; 31(2): 122-129, mar.-abr. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1223502

ABSTRACT

La relación entre función tiroidea y trastornos del ánimo se ha observado desde hace más de 50 años. Las hormonas tiroideas, actúan en el cerebro modulando génicamente proteínas asociadas a la fisiopatología de los trastornos del ánimo y potenciando los sistemas de neurotransmisión serotoninérgica y noradrenérgica. En el tratamiento de un episodio depresivo, la normalización de hormonas tiroideas es fundamental, y debe realizarse en todo paciente con sintomatología anímica, especialmente en aquellos con respuestas insuficientes a tratamiento, que requieren niveles de hormonas más estrictos que lo recomendado para población general. En pacientes eutiroideos, la potenciación con triyodotironina ha sido probada, pero también se ha utilizado T4 en altas dosis en casos resistentes, en que se postula que pudiese existir un estado de resistencia a hormonas tiroideas, no reflejado en los niveles hormonales periféricos evaluados rutinariamente. Las enzimas deiodasas, el receptor de hormona tiroidea, y el transportador de hormona tiroidea en la barrera hematoencefálica son blancos a investigar. Los objetivos de la presente revisión son ofrecer orientaciones respecto del uso de hormonas tiroideas en pacientes con trastornos del ánimo, una puesta al día sobre la relación entre hormonas tiroídeas y sistema nervioso central, y las interacciones entre psicofármacos y función tiroidea.


The relationship between thyroid function and mood disorders has been observed for more than 50 years. Thyroid hormones act in the brain genetically modulating proteins associated with the pathophysiology of mood disorders and potentiating the serotonergic and noradrenergic neurotransmission systems. In the treatment of a depressive episode, the normalization of thyroid hormones is essential, and should be performed in all patients with mood symptoms, especially in those with insufficient responses to treatment, which require more stringent hormone levels than recommended for the general population. In euthyroid patients, potentiation with triiodothyronine has been proven, but T4 has also been used in high doses in resistant cases, in which it is postulated that there might be a state of resistance to thyroid hormones, not reflected in the peripheral hormonal levels evaluated routinely. The enzymes deiodasas, the thyroid hormone receptor, and the thyroid hormone transporter in the blood brain barrier are white to investigate. The objectives of this review are to provide guidance regarding the use of thyroid hormones in patients with mood disorders, an update on the relationship between thyroid hormones and central nervous system, and the interactions between psychoactive drugs and thyroid function.


Subject(s)
Humans , Thyroid Diseases/psychology , Thyroid Diseases/epidemiology , Mood Disorders/psychology , Mood Disorders/epidemiology , Thyroid Diseases/drug therapy , Thyroid Gland/physiopathology , Thyroid Hormones/therapeutic use , Bipolar Disorder , Mood Disorders/drug therapy , Depression , Antidepressive Agents/therapeutic use
7.
Rev. Méd. Clín. Condes ; 31(2): 130-138, mar.-abr. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1223504

ABSTRACT

La depresión y la obesidad son patologías altamente prevalentes y corresponden a los principales problemas de salud pública. Estas patologías tienen un gran impacto en la morbilidad y mortalidad de los pacientes y afectan la salud y el bienestar de quienes las padecen, así como también afectan en el aspecto socioeconómico consecuencia del deterioro funcional y el gasto de recursos en salud ocasionados. Resultados de estudios epidemiológicos, ensayos clínicos y meta-análisis apoyan la asociación entre los estados depresivos y la obesidad, ya que ambos ocurren conjuntamente en todas las razas de poblaciones evaluadas. El objetivo es abordar la evidencia con respecto a 4 aspectos: (1) obesidad y respuesta a los antidepresivos, (2) trastornos depresivos y su impacto sobre la progresión de la obesidad, (3) tratamiento de la obesidad y el impacto sobre los resultados entre pacientes con trastornos depresivos, (4) el tratamiento de los trastornos depresivos y su impacto sobre los resultados de la obesidad. La evidencia existente apoya la asociación entre obesidad y los resultados adversos para la salud en individuos con trastornos depresivos. Además, destaca el concepto que el tratamiento de una de las dos enfermedades (obesidad o trastornos depresivos) es relevante para mejorar el curso de la otra patología. Puede ser beneficioso explorar dirigidamente la presencia de un trastorno depresivo en sujetos con sobrepeso u obesidad, así como el aumento de peso en personas con depresión. Conocer el efecto de los fármacos antidepresivos sobre el peso corporal es también relevante para facilitar la adherencia al tratamiento en el largo plazo.


Depression and obesity are highly prevalent illness and a mayor public health concern. These diseases have a great impact on morbidity and mortality of patients and affect the health and well-being of those who suffer them, as well as being affected in the socioeconomic aspect as a result of the functional deterioration and the spending of resources. Results of epidemiological studies, clinical trials and meta-analysis support the association between mood disorders and obesity, since both occur together in all the populations evaluated. The objective is to address the evidence regarding four aspects: (1) obesity and response to antidepressants, (2) depressive disorders and their effect on the progression of obesity, (3) treatment of obesity and the effect on outcomes among patients with depressive disorders, (4) the treatment of depressive disorders and their effect on obesity outcomes. Existing evidence supports the association between obesity and adverse health outcomes in individuals with depressive disorders. In addition, it highlights the concept that the treatment of one of the two diseases (obesity or depressive disorders) is relevant to improve the course of the other disease. It may be beneficial to explore the presence of a depressive disorders in overweight or obese subjects, as well as weight gain in subjects with depression. Knowing the effect of antidepressant drugs on body weight is relevant to facilitate adherence to long-term treatment.


Subject(s)
Humans , Depressive Disorder/psychology , Depressive Disorder/epidemiology , Obesity/psychology , Obesity/epidemiology , Body Weight , Body Mass Index , Depressive Disorder/physiopathology , Depressive Disorder/drug therapy , Overweight , Antidepressive Agents/therapeutic use , Obesity/physiopathology , Obesity/therapy
8.
Arch. Clin. Psychiatry (Impr.) ; 47(1): 7-12, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088740

ABSTRACT

Abstract Objectives This study aimed to explore the effect of antidepressant treatment on the HPA axis, changes in depression score, and serum levels of TNF-α in depressed infertile women. Methods In this randomized controlled trial research, 60 infertile women who had undergone in vitro fertilization (IVF) treatment with depression scores between 16-47 were divided into two groups. The intervention group with fluoxetine capsule was under treatment for two months before the embryo transfer, while the control group was given placebo. Depression score, serum levels of tumor necrosis factor alpha (TNF-α) as well as cortisol hormone levels were measured and recorded both before and after the intervention. The data were analyzed using SPSS version 21 software. Results We analyzed the data related to 55 subjects who had undergone embryo transfer. 7 subjects in the intervention group and 3 in the control group got pregnant. We observed a significant decrease in the depression score (p < 0/001) and serum levels of cortisol (p = 0/001) in the intervention group. There was a significant increase in the serum levels of TNF-α in the intervention group (p < 0/001). There was a significant difference between the two groups in the number of pregnancies (p = 0.04). However, there was no statistical difference between them with regard to the number of harvested oocytes (p = 0.174). Discussion Decrease in depression score and cortisol level, and an increase in the levels of TNF-α in the intervention group caused any changes in the number of oocytes in comparison with the control group. However, the number of pregnancies was larger in the intervention group.


Subject(s)
Humans , Female , Adult , Fluoxetine/therapeutic use , Tumor Necrosis Factor-alpha/blood , Depression/drug therapy , Hypothalamo-Hypophyseal System/drug effects , Infertility, Female/psychology , Antidepressive Agents/therapeutic use , Hydrocortisone/blood , Fertilization in Vitro , Tumor Necrosis Factor-alpha/drug effects , Treatment Outcome , Infertility, Female/therapy
11.
Rev. bras. epidemiol ; 23: e200059, 2020. tab
Article in English | LILACS | ID: biblio-1101583

ABSTRACT

ABSTRACT: Objective: Antidepressant use is increasing worldwide, but national data on psychotropic drug use by depressed patients in Brazil is lacking. Methodology: Between 2013 and 2014, a representative sample of urban adult individuals were asked if they had a diagnosis of chronic disease, had a medical indication for drug treatment, and were taking chronic medications at the time for each reported diagnosis. We analyzed the frequencies of reported depression and the medications related to this disease. Results: Overall, 6.1% of respondents reported depression. The prevalence increased with age - 9.5% among the elders - was higher among women (8.9%) and in the south of the country (8.9%). As a single disease, the prevalence of depression was higher among young people (17.6%). Among those with multimorbidity, the prevalence of depression rose to 25.7%. Of those who reported depression, 81.3% had medical indication for treatment and 90.3% were under treatment - this proportion was lower among young people (84.5%) and those living in the poorest region (78.6%). Antidepressants accounted for 47.2% of psychotropic drugs taken by respondents with depression, with regional differences - only 30% used antidepressants in the North. Polypharmacy was reported by 22% of those with depression and other chronic diseases. Conclusion: Depression in Brazil, is common among young adults as a single chronic disease and highly prevalent among people with chronic multimorbidity, especially the young. The treatment gap was larger among young people and in the less developed regions of the country.


RESUMO: Objetivo: O uso de antidepressivos está aumentando em todo o mundo, mas faltam dados nacionais sobre o uso de drogas psicotrópicas por pacientes deprimidos no Brasil. Metodologia: Entre 2013 e 2014, uma amostra representativa de indivíduos adultos urbanos foi questionada sobre a presença diagnóstica de doença crônica, a indicação médica para tratamento medicamentoso e o uso de medicamentos crônicos à época de cada diagnóstico relatado. Foram analisadas as frequências de depressão relatada e os medicamentos relacionados a essa doença. Resultados: No geral, 6,1% dos entrevistados relataram depressão. A prevalência aumentou com a idade (9,5% entre os idosos) foi maior entre as mulheres (8,9%) e no sul do país (8,9%). Como doença única, a prevalência de depressão foi maior entre os jovens (17,6%). Entre aqueles com multimorbidade, a prevalência de depressão subiu para 25,7%. Dos que relataram depressão, 81,3% tinham indicação médica para tratamento e 90,3% estavam em tratamento - essa proporção foi menor entre os jovens (84,5%) e os que moram na região mais pobre (78,6%). Os antidepressivos representaram 47,2% dos medicamentos psicotrópicos tomados pelos entrevistados com depressão, com diferenças regionais - apenas 30% usavam antidepressivos no Norte. Polifarmácia foi relatada por 22% das pessoas com depressão e outras doenças crônicas. Conclusão: A depressão no Brasil é comum entre adultos jovens como doença crônica única e altamente prevalente entre as pessoas com multimorbidade crônica, principalmente os jovens. A lacuna de tratamento foi maior entre os jovens e nas regiões menos desenvolvidas do país.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Psychotropic Drugs/therapeutic use , Urban Population/statistics & numerical data , Depressive Disorder/drug therapy , Depressive Disorder/epidemiology , Self Report , Antidepressive Agents/therapeutic use , Socioeconomic Factors , Brazil/epidemiology , Cross-Sectional Studies , Sex Distribution , Age Distribution , Polypharmacy , Middle Aged
12.
Evid. actual. práct. ambul ; 23(1): e002045, 2020. tab
Article in Spanish | LILACS | ID: biblio-1103172

ABSTRACT

Una mujer de 36 años, diagnosticada con síndrome de intestino irritable a predominio de diarrea (SII-D) acude a la consulta médica. Ella pregunta si el uso de probióticos sería útil para controlar los episodios de diarrea, ya que los fármacos con los que está siendo tratada no le resultan eficaces. Se realizó una búsqueda bibliográfica con el objetivo de en contrar evidencia en respuesta a su consulta, tras la cual se seleccionaron dos ensayos clínicos y una revisión sistemática. Se evidenciaron diversos resultados en cuanto al uso de probióticos en el SII-D y se discutieron los riesgos y beneficios del tratamiento, así como las implicancias en la vida de la paciente. (AU)


A 36-year-old woman diagnosed with diarrhea predominant irritable bowel syndrome (D-IBS) goes to meet the doctor. She raises whether the use of probiotics would be useful for controlling diarrhea episodes, since the drugs which she is being treated with, are not effective. A bibliographic search was conducted with the objective of finding evidence in response toher query. Two clinical trials and a systematic review were found. Variable results were found regarding the use of probioticsin D-IBS. The risks and benefits of the treatment were discussed, as well as the implications in the patient's lifestyle. (AU)


Subject(s)
Humans , Female , Adult , Probiotics/therapeutic use , Irritable Bowel Syndrome/therapy , Diarrhea/therapy , Parasympatholytics/therapeutic use , Quality of Life , Review Literature as Topic , Abdominal Pain/therapy , Cholestyramine Resin/therapeutic use , Clinical Trials as Topic , Probiotics/administration & dosage , Probiotics/adverse effects , Irritable Bowel Syndrome/diagnosis , Irritable Bowel Syndrome/etiology , Diarrhea/complications , Duration of Therapy , Gastrointestinal Motility/immunology , Intestinal Mucosa/immunology , Loperamide/therapeutic use , Antidepressive Agents/therapeutic use
17.
Rev. Assoc. Med. Bras. (1992) ; 65(3): 361-369, Mar. 2019. tab, graf
Article in English | SES-SP, LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-1003035

ABSTRACT

SUMMARY BACKGROUND: There is no strong evidence on the link between inflammatory profile and pattern of drug treatment response in depressive patients that could result in Coronary Artery Disease occurrence. OBJECTIVE: This study aimed to compare the subclinical atherosclerosis markers, inflammatory profile, and BDNF production in Resistant Depression (RD) or Bipolar Affective Disorder (BAD) patients under conventional treatment. METHODS: The population evaluated was comprised of 34 RD, 43 BAD, and 41 controls. Subclinical atherosclerosis markers were evaluated using ultrasonography, tomography, and exercise stress test. Plasma concentrations of TNFα, IL-1β, IL-6, and BDNF were measured using Luminex100™. The usCRP concentration was measured using turbidimetric immunoassay. IL1B, IL6, and TNFA expression were determined using TaqMan®. For the statistical analysis, the significance level was established at p<0.05. RESULTS: Concerning subclinical atherosclerosis markers, only O2 consumption was reduced in the BAD group (p = 0.001). Although no differences were found in gene expression, BDNF and IL-1β plasma concentration was increased in the RD group (p = 0.002 and p = 0.005, respectively) even with an antidepressant treatment, which suggests that these drugs have no effect in IL-1β secretion and that the inflammasome may play a role in therapy response. CONCLUSION: Taken together, both BDNF and IL-1β plasma concentrations could be used to the early identification of RD patients.


RESUMO FUNDAMENTAÇÃO: Não há fortes evidências sobre a associação entre o perfil inflamatório e o padrão de resposta ao tratamento medicamentoso em pacientes depressivos que podem resultar em ocorrência de doença coronariana. OBJETIVO: O objetivo deste estudo foi comparar os marcadores de aterosclerose subclínica, o perfil inflamatório e a produção de BDNF em pacientes com Depressão Resistente (DR) ou Transtorno Afetivo Bipolar (BAD) sob tratamento convencional. MÉTODOS: A população avaliada incluiu 34 RD, 43 BAD e 41 controles. Os marcadores de aterosclerose subclínica foram avaliados por ultrassonografia, tomografia e teste de esforço. As concentrações plasmáticas de TNFα, IL-1β, IL-6 e BDNF foram medidas utilizando Luminex100TM. A concentração de usCRP foi medida por imunoensaio turbidimétrico. A expressão de IL1B, IL6 e TNFA foi determinada usando TaqMan®. Para as análises estatísticas, foi estabelecido o nível de significância de p < 0,05. RESULTADOS: Quanto aos marcadores de aterosclerose subclínica, apenas o consumo de O2 foi reduzido no grupo BAD (p = 0,001). Embora não tenham sido encontradas diferenças na expressão gênica, a concentração plasmática de BDNF e IL-1β foi aumentada no grupo RD (p = 0,002 e p = 0,005, respectivamente) mesmo sob tratamento antidepressivo, o que sugere que esses medicamentos não têm efeito na secreção de IL-1β e que o inflamassomo pode desempenhar um papel na resposta terapêutica. CONCLUSÃO: Juntas, as concentrações BDNF e IL-1β poderiam ser usadas para a identificação precoce de pacientes com DR.


Subject(s)
Humans , Male , Female , Adult , Bipolar Disorder/blood , Brain-Derived Neurotrophic Factor/blood , Interleukin-1beta/blood , Depressive Disorder, Treatment-Resistant/blood , Reference Values , Bipolar Disorder/diagnosis , Bipolar Disorder/drug therapy , Biomarkers/blood , Body Mass Index , Logistic Models , Predictive Value of Tests , Interleukin-6/blood , Tumor Necrosis Factor-alpha/blood , Statistics, Nonparametric , Atherosclerosis/blood , Real-Time Polymerase Chain Reaction , Depressive Disorder, Treatment-Resistant/diagnosis , Depressive Disorder, Treatment-Resistant/drug therapy , Middle Aged , Anti-Inflammatory Agents/therapeutic use , Antidepressive Agents/therapeutic use
18.
Säo Paulo med. j ; 136(6): 579-585, Nov.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-991688

ABSTRACT

ABSTRACT CONTEXT AND OBJECTIVE: Insomnia is a frequent complaint that generates more than five million visits to doctors per year in the United States. This study summarizes all Cochrane systematic reviews (SRs) that evaluated interventions to treat insomnia. DESIGN AND SETTING: Review of SRs, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: A sensitive search was carried out in the Cochrane Database of Systematic Reviews to identify Cochrane SRs that assessed the effects of any type of intervention for people with insomnia. The results, main characteristics of the SRs and the certainty of the evidence obtained from them were synthesized and discussed. RESULTS: Seven SRs were included. They addressed the benefits and harm of acupuncture (n = 1), behavioral interventions (n = 1), music (n = 1), pharmacotherapy (n = 2), phototherapy (n = 1) and physical exercise (n = 1). The certainty of the evidence ranged from moderate to very low. CONCLUSION: Acupuncture, music, physical exercise, paroxetine, doxepin, trimipramine and trazodone seem to present some benefit for patients with insomnia. However, the uncertainty around these results means that no robust and definitive recommendations for clinical practice can be made until the benefits and harms from each intervention for patients with insomnia have been confirmed through further studies.


Subject(s)
Humans , Evidence-Based Medicine , Systematic Reviews as Topic , Sleep Initiation and Maintenance Disorders/therapy , Sleep/physiology , Exercise , Acupuncture Therapy/standards , Randomized Controlled Trials as Topic , Sleep Initiation and Maintenance Disorders/drug therapy , Music Therapy/standards , Antidepressive Agents/therapeutic use
19.
Rev. bras. psiquiatr ; 40(4): 449-458, Oct.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-959255

ABSTRACT

Objective: Amantadine blocks N-methyl-D-aspartate (NMDA) receptors and has dopaminergic and noradrenergic action, a neurochemical profile that suggests its potential as an antidepressant drug. We conducted a systematic review of preclinical and clinical studies addressing the effects of amantadine in animal models of depression and in patients with depression. Methods: PubMed, Science Direct, and Web of Science were searched up to September 1, 2017 to identify clinical and preclinical studies. The following search terms were used: "amantadine AND depress*"; "amantadine AND mood"; "amantadine AND animal models AND antidepres*"; and "amantadine AND (forced swim, learned helplessness, reserpine, chronic mild stress, anhedonia, sucrose preference)." Results: Amantadine had antidepressant-like effects in animal models and appeared to potentiate the antidepressant effects of other antidepressants. These preclinical findings have received some support from the results of small open-label clinical trials, suggesting that amantadine can reduce depressive symptomatology and potentiate the antidepressant effects of monoaminergic drugs. In addition to its glutamatergic and dopaminergic effects, the potential antidepressant-like effects of amantadine have been linked to molecular and cellular actions, such as increased expression of neurotrophic factors (e.g., brain-derived neurotrophic factor), activation of σ1 receptors, decreased corticosterone levels, and decreased inflammatory response to stress. Conclusion: Amantadine is an interesting candidate as new antidepressant drug for the treatment of depression.


Subject(s)
Humans , Animals , Amantadine/therapeutic use , Depressive Disorder/drug therapy , Antidepressive Agents/therapeutic use , Biogenic Monoamines , Clinical Trials as Topic , Disease Models, Animal , Drug Evaluation, Preclinical
20.
Rev. bras. psiquiatr ; 40(3): 325-334, July-Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-959245

ABSTRACT

Post-stroke depression (PSD) is a very common complication that leads to increased physical disability, poor functional outcome, and higher mortality. Therefore, early detection and treatment are very important. Since there are currently no specific guidelines for this disorder in China, the purpose of this study was to develop PSD guidelines and provide suggestions for clinicians and related workers.


Subject(s)
Humans , Stroke/psychology , Depressive Disorder/diagnosis , Depressive Disorder/therapy , Psychotherapy , Time Factors , Severity of Illness Index , China/epidemiology , Risk Factors , Practice Guidelines as Topic , Survivors/psychology , Depression/etiology , Depressive Disorder/drug therapy , Depressive Disorder/epidemiology , Self Report , Stroke Rehabilitation/standards , Antidepressive Agents/therapeutic use
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