Meta-analysis on the efficacy and tolerability of the augmentation of antidepressants with atypical antipsychotics in patients with major depressive disorder

We assessed the efficacy and tolerability of the augmentation of antidepressants (ATDs) with atypical antipsychotics (AAPs) to treat patients with major depressive disorder. A retrograde study to identify relevant patient data included databases of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Database of Abstracts of Reviews of Effects. Data from 17 trials, involving 3807 participants, were identified. The remission rate (RR) and overall response rate (ORR) of adjunctive treatment with AAPs were significantly higher than placebo treatment: RR=1.90 (95%CI=1.61-2.23, z=7.74, P<0.00001) and ORR=1.68 (95%CI=1.45-1.94, z=7.07, P<0.00001). We found that the short-term (4 weeks) treatment [ORR=1.70 (95%CI=0.98-2.95, Z=1.89, P=0.06)] was significantly different from the long-term (6-12 weeks) treatment [ORR=1.68 (95%CI=1.45-1.94, z=7.07, P<0.00001)]. No significant difference in ORR was observed between groups with or without sedative drugs. The discontinuation rate due to adverse effects was higher for adjunctive treatment with AAPs: ORR=3.32 (95%CI=2.35-4.70, z=6.78, P<0.00001). These results demonstrate that the augmentation of ATDs with AAPs (olanzapine, quetiapine, aripiprazole, and risperidone) was more effective than a placebo in improving response and remission rates, although associated with a higher discontinuation rate due to adverse effects.

Venomous snakebites and antivenom treatment according to a protocol for pediatric patients in taiwan

Children bitten by venomous snakes comprise emergency cases that present high morbidity and mortality, especially in some regions of Asia and Africa. Reports on clinical features and management of envenomated children are scarce. This observational study implemented a protocol for antivenom use in pediatric snakebite victims in Taiwan, between 1994 and 2007. The present work investigated demographics, clinical features and effects of antivenom therapy and the complications and prognosis for snakebites. A total of 55 children and adolescents, with a median age of 9.9 years (ranging from 2 to 18 years), was identified. Forty-five patients (82 percent) were bitten between May and September. Thirty-five patients (64 percent) received antivenom therapy, 28 of them (80 percent) within two hours after being bitten. No fatalities occurred and only five of 35 patients (14 percent) had major morbidity when treated according to the protocol. Thirty-one snakes (56 percent) were identified and 12 of them (38 percent) were Naja atra. This study indicates that a protocol for children affected by snakebites is valuable for guiding emergency physicians to treat these patients immediately. Further strategies are required to reduce the morbidity rate that occurs as a result of Naja atra bite.(AU)