Análisis del conocimiento sobre los inhibidores selectivos de la recaptura de serotonina (ISRS) en el manejo de la depresión por médicos residentes y concurrentes de clínica médica de 5 hospitales de CABA / Review of the Knowledge on Selective Serotonin Reuptake Inhibitors (SSRIs) for Depression Management by Resident and Intern Physicians of the Medical Clinic of 5 Hospitals in CABA

Introducción: la depresión es un trastorno cada vez más prevalente alrededor del mundo. Los médicos generales son los profesionales de la salud más consultados por pacientes deprimidos. Más del 70% de los pacientes con depresión son vistos por médicos generales y no por especialistas en Psiquiatría. Según estudios realizados en Buenos Aires, más del 25% de los pacientes internados en Servicios de Clínica Médica en hospitales generales presenta depresión. Estos pacientes suelen ser atendidos y seguidos por médicos en formación, sean residentes o concurrentes de Clínica Médica. El objetivo del trabajo fue analizar el conocimiento sobre los inhibidores selectivos de la recaptura de serotonina (ISRS) que tienen los médicos residentes y concurrentes de Clínica Médica de 5 hospitales de la Ciudad Autónoma de Buenos Aires (CABA) y describir el tratamiento de un paciente depresivo por ellos. Material y métodos: se realizó un estudio descriptivo de corte transversal con un muestreo de tipo no probabilístico. Se utilizó como instrumento de medición un cuestionario semiestructurado organizado en dos secciones, una de datos demográficos que permiten caracterizar la muestra. La otra, de 15 ítems, explora los conocimientos sobre los ISRS y el tratamiento de la depresión. Dicho cuestionario fue revisado por 4 expertos. El instrumento es anónimo. Se aplicó a 59 médicos en formación en Clínica Médica, residentes y concurrentes, de 5 hospitales de la CABA, que participaron de forma voluntaria, durante el período agosto-septiembre de 2022. Resultados: la mayoría de los médicos en formación en Clínica Médica no tratan cuadros depresivos y, ante un paciente deprimido, solicitan la evaluación por un especialista en Salud Mental. Solo un 6,8% lo medica con un antidepresivo. Más del 75% de la muestra refiere recordar los conocimientos que tiene sobre de los ISRS de la cursada de Farmacología y un 13,6 de la cursada de Psiquiatría en la Facultad de Medicina. Conclusión: se observa un conocimiento deficitario sobre los ISRS en médicos residentes y concurrentes de Clínica Médica. Se considera necesario reforzar la formación sobre depresión y manejo de antidepresivos durante la residencia/concurrencia de Clínica Médica. (AU)

Introduction: depression is an increasingly common disorder around the world. General practitioners are the most frequently consulted health professionals by depressed patients. More than 70% of all depressed patients receive treatment by general practitioners and not by psychiatric specialists. According to studies conducted in Buenos Aires, more than 25% of all patients admitted to the Clinical Services in public hospitals present depression. These patients are usually under the care and follow-up of clinical trainee physicians, residents, or interns.This study aimed to analyze the knowledge about selective serotonin reuptake inhibitors (SSRIs) of clinical trainee residents and interns in five hospitals in the Ciudad Autónoma de Buenos Aires (CABA) and to describe their treatment of a depressive patient. Material and methods: we conducted a descriptive cross-sectional study with a non-probabilistic sampling. We used a semi-structured questionnaire arranged into two sections as a measuring tool. One, with demographic data to describe the sample. The other, with 15 items, explores respondents' knowledge of SSRIs and the treatment of depression. Four experts reviewed the questionnaire, which was anonymous. We applied it to 59 clinical medical trainees, residents, and interns from five CABA hospitals who volunteered to participate during August-September 2022. Results: most clinical trainees do not treat depressive conditions and, when confronted with a depressed patient, request an assessment by a Mental Health specialist. Only 6.8% medicate the patient with an antidepressant. More than 75% of the sample reported remembering their knowledge of SSRIs from the Pharmacology course and 13.6% from the Psychiatry course at the School of Medicine. Conclusion: there is a deficient knowledge about SSRIs in trainee residents and interns of Clínica Médica. We believe it is necessary to reinforce training on depression and management of antidepressants during residency/internship practice in Clínica Médica. (AU)

Efficacy and safety of agomelatine and SSRIs in the treatment of depressive disorder： a network Meta-analysis / 四川精神卫生

ObjectiveTo evaluate the efficacy and safety of agomelatin and selective serotonin reuptake inhibitors （SSRIs） in the treatment of depressive disorder via network Meta-analysis. MethodsThe literature databases such as China National Knowledge Network （CNKI）， Wanfang Data Knowledge Service Platform， VIP Database for Chinese Technical Periodical （VIP）， Chinese Biomedical Literature Database （CBM）， PubMed， Embase and Cochrane Library were searched from the inception to November 2021. Based on the preset inclusion and exclusion criteria， literature screening， quality assessment of methodology and data extraction were conducted by two researchers separately， then statistical analysis was carried out using ADDIS software. ResultsA total of 7 256 patients with depressive disorder in 22 randomized controlled trials were included. According to the consistency assessed in Bayesian network Meta-analysis and the estimation of the probability of being the best treatment， escitalopram （P=0.63） ranked first for response rate and paroxetine （P=0.31） was associated with the best ranking for cure rate in terms of the effectiveness， meantime， paroxetine （P=0.44） had the highest adverse events risk and sertraline （P=0.74） had the highest study drop-outs proportion in terms of safety. ConclusionEscitalopram and paroxetine may be superior to sertraline， agomelatine， citalopram and fluoxetine in the treatment of depressive disorder， furthermore， paroxetine and sertraline demonstrate poor safety profiles.

The Patient with Depression: Assessment and Management

@#Depression in adults is a condition that is treatable by family physicians. The current Clinical Practice Guidelines from the Ministry of Health recommends a selective serotonin reuptake inhibitor (SSRI) as the first-line of pharmacotherapy. Care should be taken to assess the patient’s psychological and social factors contributing to the illness. These factors should be managed by referring the patient to an appropriate allied health professional, such as a psychologist or community based social worker. Specialist referral should be made under certain circumstances (such as treatment-resistance), or if issues pertaining to risk arise. This review aims to give an update on the recently published DSM-5 criteria for diagnosis, and the treatment of the adult patient with depression.

Analysis of the clinical efficacy of acupuncture combined with selective serotonin reuptake inhibitors (SSRIs) in the treatment depression / 药学实践杂志

Objective To explore the clinical efficacy of acupuncture combined with SSRIs in the treatment of patients with depression. Methods A total of 83 patients with depression admitted to our hospital between January 2019 and January 2020 were selected as the research objects. Patients in the control group were treated with SSRIs, and the combined treatment (observation) group was treated with acupuncture on the basis of the control group. The clinical efficacy, anxiety (HAMD) and depression scale (HAMD) of patients in the two groups were compared. Results After treatment, the clinical efficacy of depression patients in the observation group was significantly higher than that in the control group (P<0.05). HAMA and HAMD scores showed statistical difference between the two groups. HAMA and HAMD scores of patients in the observation group were lower than those in the control group (P<0.05). Conclusion Acupuncture combined with SSRIs in the treatment of depression can significantly improve the patient's condition, reduce the patient's anxiety and depression, and has a positive significance for the treatment of the patients.

Predictive role of the degree of prospective memory impairment on treatment response to SSRIs in patients with obsessive-compulsive disorder / 四川精神卫生

ObjectiveTo explore the predictive role of the degree of prospective memory impairment on the treatment response to Selective Serotonin Reuptake Inhibitors （SSRIs） in patients with obsessive-compulsive disorder. MethodsA total of 30 patients with obsessive-compulsive disorder who met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders， fourth edition， text revision （DSM-IV-TR） were selected， and all patients were treated with SSRIs for 4 weeks. The severity of obsessive-compulsive symptom was assessed using Yale-Brown Obsessive Compulsive Scale （Y-BOCS）， and the efficacy was evaluated by the reduction rate of Y-BOCS score. Moreover， the performance of event-based， time-based and activity-based prospective memory tasks were compared before and after treatment. ResultsAfter treatment， the total Y-BOCS score of patients was lower than before treatment ［（27.07±4.63） vs. （24.87±5.93）， F（1，29）=4.984， P=0.033］， meantime， the performance of event- and time- based prospective memory tasks was improved ［（0.78±0.21） vs. （0.88±0.11）， F（1，29）=9.022， P=0.005； （0.81±0.17） vs. （0.91±0.11）， F（1，29）=9.063， P=0.005］. Correlation analysis showed that the performance of event-based prospective memory at baseline was positively correlated with the reduction of Y-BOCS score （r=0.478， P=0.014）. The event-based prospective memory performance at baseline could positively predict the treatment response to SSRIs treatment in patients （β=0.441， P=0.014）. ConclusionThe event-based prospective memory function of patients with obsessive-compulsive disorder can positively predict SSRIs treatment outcome， and patients with better prospective memory performance yield better treatment responses.

Effect Of Paroxetine In Anxiety Disorder Among School Dropout Teenager In South Indian Population

Objective: Anxiety disorders are the most common group of psychiatric illnesses in children. This study is to observe the effectiveness of Paroxetine in anxiety disorder among teenagers in South India population using Hamilton Anxiety Rating Scale (HAM-A) and to screen the possible risk for paroxetine in anxiety disorder among teenagers. Methods: This study is a prospective observational study that was conducted for a period of 6 mo. Of 84 teenage patients with anxiety disorder assessed using Hamilton Anxiety Rating Scale (HAM-A) were followed-up in an outpatient psychiatric ward. Study population includes both sexes, age group between 13 to 19 y, Teenage patient receiving paroxetine for anxiety disorder were included and patients unwilling to give written informed consent or assent form were excluded. Results: Out of 84 patients the prevalence of symptoms before the drug treatment, 65 patients were falling in very severe category, which was assessed by HAM-A scale. Then reassessed with drug Paroxetine at week 4 and week 8. There was a drastic reduction in the prevalence of symptoms in week 8 than compared to week 4. A significant reduction in body weight was also observed during the study period. Among various side effects, nausea was the prominent risk found during the study. Conclusion: The present study demonstrated that paroxetine is effective and well-tolerated for the treatment of various types of anxiety disorder in teenagers with few side effects.

THE PATIENT WITH DEPRESSION: ASSESSMENT AND MANAGEMENT

@#Depression in adults is a condition that is treatable by family physicians. The current Clinical Practice Guidelines from the Ministry of Health recommends a selective serotonin reuptake inhibitor (SSRI) as the first-line of pharmacotherapy. Care should be taken to assess the patient’s psychological and social factors contributing to the illness. These factors should be managed by referring the patient to an appropriate allied health professional, such as a psychologist or community-based social worker. Specialist referral should be made under certain circumstances (such as treatment-resistance), or if issues pertaining to risk arise. This review aims to give an update on the recently published DSM-5 criteria for diagnosis, and the treatment of the adult patient with depression.

Prescription pattern of antidepressants in five tertiary care psychiatric centres of India.

Background & objectives: Limited data are available on prescription patterns of the antidepressants from India.We studied antidepressants’ prescription pattern from five geographically distant tertiary psychiatric care centers of the India. Method: In this cross-sectional study, all patients who attended outpatients department or were admitted in the psychiatry wards at Lucknow, Chandigarh, Tiruvalla, Mumbai and Guwahati on a fixed day, who were using or had been prescribed antidepressant medications, were included. The data were collected on a unified research protocol. Results: A total of 312 patients were included. Mean age was 39±14.28 yr and 149 (47.76%) were females, 277 (87.5%) were outpatients. Among the patients receiving antidepressants, 150 (48.1%) were of diagnoses other than depression. Diabetes mellitus 18 (5.78%) was the most common co-morbid medical illness. A total of 194 (62.2%) patients were using selective serotonin reuptake inhibitors (SSRIs) with escitalopram 114 (36.53%) being the most common antidepressant used. Overall, 272 (87.18%) patients were using newer antidepressants. Thirty (9.62%) were prescribed more than one antidepressant; 159 (50.96%) patients were prescribed hypnotic or sedative medications with clonazepam being the most common (n=116; 37.18%). Interpretation & conclusions: About half of the patients with diagnoses other than depression were prescribed antidepressants. SSRIs were the most common group and escitalopram was the most common medication used. Concomitant use of two antidepressants was infrequent. Hypnotic and sedatives were frequently prescribed along with antidepressants.

Escitalopram Induced Hyponatremia

National and international pharmacovigilance committee reports and case-control studies also implicate paroxetine, fluoxetine, sertraline. However, there have been only few reported cases of hyponatremia associated with escitalopram. The objective of this case report is to highlight a strong association of hyponatremia and SIADH (Syndrome of Inappropriate ADH secretion) in a middle-aged patient receiving escitalopram, a drug less commonly known to cause such side effects. Methods: We report a case of escitalopram induced severe hyponatremia in a middle-aged man where the association of hyponatremia with escitalopram is clearly established. Patient developed hyponatremia on the rechallenge with escitalopram (serum sodium = 94 mEq/L) within two days of initiation of treatment. The patient was free from other medical illnesses and was not taking other medications known to cause hyponatremia (confounders present in previous case reports suggesting an association between escitalopram and SIADH). Results: Our case suggests a strong association of escitalopram use and development of hyponatremia and SIADH in the absence of another drug use and medical comorbidity. Conclusion: Escitalopram, an SSRI is associated with hyponatremia and SIADH even in middle-aged individuals. There is a need for case-control studies especially involving a younger and middle age group. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.

A meta-analysis of safety of agomelatine and SSRIs for depression / 中华行为医学与脑科学杂志

Objective To compare the safety of agomelatine and selective serotonin reuptake inhibitors (SSRIs) in the treatment of depression.Methods Retrieved literatures in the database at home and abroad from the built of the databases to March in 2016.The databases included Pubmed,Cochrance library,CNKI,Wanfang database and VIP database.Two researchers selected literatures,evaluated quality and extracted data independeatly.5.3.5 RevMan software was used to analyze.Result 87 literatures were retrieved,and nine English literatures and two Chinese literatures were included.Agomelatine had a lower risk than paroxetine in insomnia (RR:0.40,95％ CI:[0.17,0.92],P=0.03) and sexual dysfunction (RR:0.13,95％ CI:[0.04,0.39],P=0.0003),than fluoxetine(RR:0.68,95％ CI:[0.48,0.96],P=0.03) and paroxetine(RR:0.37,95％ CI:[0.25,0.55],P＜0.01) in nausea and vomiting,and than escitalopram in sweating(RR:0.34,95％ CI:[0.13,0.85],P=0.02) and headaches(RR:0.63,95％ CI:[0.43,0.91],P=0.01).The difference of them was statistically significant.Agomelatine had a higher risk than sertraline (RR:4.65,95％ CI:[1.02,21.16],P=0.05) in drowsiness,and than escitalopram in constipation (RR:3.46,95％ CI:[1.16,10.36],P=0.03),the difference was statistically significant too.Compared agomelatine and SSRIs,the occurrence risk of dry mouth and diarrhea were no significant difference.Conclusion Both agomelatine and selective serotonin reuptake inhibitors (SSRIs) had its pros and cons in terms of safety.Safety of agomelatine is better than paroxetine.Agomelatine and escitalopram had its own advantages and disadvantages respectively in safety.The evidence of the safety among agomelatine,fluoxetine and sertraline need further explore.

Research on effect of central 5-HTergic system in early-onset depression / 中国药理学通报

Nowadays the pathogenesis of early-onset depression is still uncertain. Only SSRIs are currently approved for clinical use as antidepressants in children and adolescents, indicating that 5-HT is the most important neurotransmitter involved in the dis-ease. Current studies with regard to central 5-HTergic system in early-onset depression mainly focus on 5-HT synthesis deficien-cy, 5-HT transportation dysregulation, as well as the earlier mat-uration of 5-HT system than norepinephrine system. 5-HT precur-sor tryptophan malabsorption and dysregulation of 5-HT synthesis can contribute to 5-HT deficiency. Moreover, the 5-HTTLPR low-expressing genotypes may increase the risk of early-onset de-pression. It is necessary to make preclinical and clinical studies more widely and deeply about the effect of central 5-HTergic sys-tem in early-onset depression in future.

Autolesión no suicida en adolescentes peruanas: Una aproximación diagnóstica y psicopatológica / Non suicidal self-injury in Peruvian adolescents

Una aproximación diagnóstica y psicopatológica a la autolesión no suicida es planteada a partir de la recolección de datos de un grupo de diez adolescentes peruanas que sufrían esta patología. Se revisan las aproximaciones del DSM 5 a este diagnóstico, las que dan lugar a su configuración como una entidad que requiere mayor estudio para ser considerada como independiente de la sintomatología del trastorno límite de personalidad. Se formulan algunas tesis acerca de su psicopatología y las características que la singularizan frente a ese trastorno y la llamada conducta suicida. A partir de una formulación cognitivo-conductual, se examina el papel de esta sintomatología autolesiva como refuerzo automático y social, tanto en su vertiente positiva como la negativa. Ulteriormente se toman en cuenta las once creencias irracionales de Ellis como un instrumento para dilucidar la adaptación a la realidad de las pacientes que conformaron el grupo explorado. Finalmente se esbozan algunos alcances en torno a la terapia dialéctico-conductual de Linehan, mentalizing de Bateman y el uso del aripiprazol y los inhibidores selectivos de recaptación de serotonina (ISRS) en estos casos.

A psychopathological and diagnostic approach regarding non suicidal self-injury is proposed as a result of an exploratory study of a group of ten Peruvian adolescents suffering that condition. The DSM 5 status for this category is taken into account, as well as its relationship with entities like suicidal behavior and the borderline personality disorder diagnosis. On the basis of a cognitive-behavioral formulation, the meaning of this self damaging pathology in terms of automatic and social reinforcement, both positive and negative, is elucidated in order to clarify further developments. One of them being the use of Ellis’ irrational beliefs as a tool to evaluate the sense of reality of the patients. Some comments about Linehan’s dialectical behavioral psychotherapy, Bateman’s mentalizing and aripiprazole or selective serotonine reuptake inhibitors (SSRIs) in the treatment of these patients are proposed.

Serotonin syndrome due to fluoxetine and tramadol in renal impaired patient.

Serotonin syndrome causes confusion or altered mental status; other symptoms include myoclonus, shivering, tremors, diaphoresis, hyperreflexia, incoordination, fever and diarrhoea. Tramadol possesses dual pharmacological effects i.e., a weak opiate agonist at mu, kappa and delta opiate receptors along with reuptake inhibition of norepinephrine and serotonin. Risk associated with tramadol increases when co-administered with serotonergic antidepressants or MAOIs (monoamine oxidase inhibitors) and in renal impaired. The incidence of this syndrome is less than 1% as most of the cases remain unreported. The case highlights the fact that interaction between serotonergic agents like fluoxetine and tramadol especially in the presence of co-morbid medical illness can lead to serotonin syndrome.

Serotonin Transporter Promoter Region (5-HTTLPR) Polymorphism Is Not Associated With Paroxetine-Induced Ejaculation Delay in Dutch Men With Lifelong Premature Ejaculation

PURPOSE: To investigate the association between the 5-HT-transporter-gene-linked promoter region (5-HTTLPR) polymorphism and 20-mg paroxetine-induced ejaculation delay in men with lifelong premature ejaculation (LPE). MATERIALS AND METHODS: This was a prospective study of 10 weeks of paroxetine treatment in 54 men with LPE. Intravaginal ejaculation latency time (IELT) was measured by stopwatch. Controls consisted of 92 Caucasian men. All men with LPE were genotyped for the 5-HTTLPR polymorphism. Allele frequencies and genotypes of short (S) and long (L) variants of the polymorphism were compared between patients and controls. Associations between the LL, SL, and SS genotypes and fold increase of mean IELT were investigated. RESULTS: Of the 54 patients, 43 (79.6%) responded to 20-mg paroxetine treatment with an ejaculation delay, whereas 11 patients (20.4%) did not respond; 44%, 18%, and 18% of the patients showed a fold increase in mean IELT of 2-10, 10-20, and more than 20, respectively. Of the 54 men, 14 (25.9%) had the LL genotype, 29 (53.7%) had the SL genotype, and 11 (20.4%) had the SS genotype. In the 92 controls, the LL, SL, and SS genotypes were present in 27 (29.3%), 41 (44.6%), and 24 (26.1%), respectively. No statistically significant differences were found in 5-HTTLPR allelic variations or in 5-HTTLPR gene variations. In all men treated with 20 mg paroxetine, analysis of variance of the natural logarithm of fold increase in the IELT showed no statistically significant difference according to genotype (p=0.83). CONCLUSIONS: The 5-HTTLPR polymorphism is not associated with daily 20-mg paroxetine treatment-induced ejaculation delay in men with LPE.

Selective serotonin reuptake inhibitors and the risk of bleeding.

Background: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed agents for various conditions in general psychiatry. There is a strong consensus that blockade of serotonin reuptake affects primary hemostasis, namely platelet activity, thus resulting in a bleeding tendency. Considering that SSRIs are commonly prescribed, this study was conducted to assess if they were associated with an increased risk of bleeding. Methods: This was a prospective, open-label study of 30 patients attending the Psychiatry out-patient department, Dr. B. R. Ambedkar Medical College, Bangalore who satisfied DSM-IV criteria for a primary diagnosis of depression, treated with SSRIs. Bleeding time, clotting time, prothrombin time, partial thromboplastin time and platelet count were assessed at baseline and at the end of 6 weeks of treatment or occurrence of bleeding symptom. Results: The patients aged between 18-55 years of whom 21 were females, were treated with an SSRI (fluoxetine 12, escitalopram 12 and sertraline 6 patients). Six patients had overt symptoms of bleeding (upper gastrointestinal bleeding (hematemesis) 4; epistaxis 2 and petechiae 2) of whom one patient gave a history of both hematemesis and petechiae and another of hematemesis and epistaxis. The average day after treatment beginning, on which patients reported with bleeding was 30.33 (26-40 days). There was a significant increase in the bleeding time (p=0.028) and clotting time (p=0.042), implying derangement in platelet aggregation. There was no significant change in the other parameters. Conclusion: Treatment with SSRIs increases the risk of bleeding. However, large, randomized controlled trials are required to re-affirm these findings.

Acatisia associada à bromoprida em um paciente deprimido usando fluvoxamina / Akathisia associated with bromopride in a depressed patient using fluvoxamine

CONTEXTO: A acatisia é definida clinicamente como uma sensação de agitação associada à necessidade de produção de movimentos, comumente deflagrada por bloqueadores dopaminérgicos, como os neurolépticos, podendo ocorrer também durante o tratamento com inibidores seletivos de recaptação de serotonina. É possível que drogas não psiquiátricas que bloqueiem receptores dopaminérgicos, como a bromoprida, possam causar sintomas extrapiramidais. OBJETIVOS: Descrever um desfecho desfavorável caracterizado por acatisia em um paciente depressivo previamente estabilizado com fluvoxamina, após usar bromoprida. MÉTODOS: Descrição de um caso. RESULTADOS: Sr. J., paciente deprimido de 47 anos, estava estabilizado com fluvoxamina 200 mg por dia. Iniciou abruptamente com quadro de inquietação e necessidade de produzir movimentos voluntariamente a fim de aliviar esse desconforto. Há quatro dias havia iniciado o uso de bromoprida 30 mg por dia para tratamento de dispepsia. A suspensão da bromoprida promoveu alívio imediato dos sintomas. CONCLUSÃO: A bromoprida, um bloqueador dopaminérgico, pode ter deflagrado acatisia em um paciente em uso de fluvoxamina. Os mecanismos farmacológicos relacionados a esse desfecho são discutidos.

BACKGROUND: Akathisia is clinically defined as a sensation of restlessness associated to a necessity to produce movements, commonly triggered by dopaminergic blockers, like neuroleptics, and it might occur during treatment with selective serotonine reuptake inhibitors. It is possible that non psychiatric drugs that block dopaminergic receptors, like bromopride, might cause patients to develop extrapyramidal symptoms. OBJECTIVES: To describe an unfavorable outcome clinically characterized by akathisia in a depressed patient previously stabilized with fluvoxamine, after using bromopride. METHODS: Case report. RESULTS: Mr J, 47 year-old depressed patient, had been stabilized with fluvoxamine 200 mg a day. He began abruptly with restlessness and an urgency to produce voluntary movements in order to alleviate such discomfort. Four days earlier he began using bromopride 30 mg a day to treat dyspepsia. Withdrawn of bromopride promoted an immediate relieve of the symptoms. CONCLUSION: Bromopride, a dopaminergic blocker, might have triggered akathisia in a patient using fluvoxamine. The pharmacologic mechanisms regarding this outcome are discussed.

Comparison of Effect of SSRIs, SNRIs, and NaSSA on Pain / 대한정신약물학회지

OBJECTIVE: Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and noradrenergic and specific serotonergic antidepressant (NaSSA) are extensively used to treat the patients with depression. Although depressed patients are complaining of somatic pain as a complication of depression, there has not been any straight-forward comparative data of the effect of SSRIs, SNRIs, and NaSSA on pain. Therefore, in this study, we tried to figure out the effect of each drug i.e.SSRIs, SNRIs, and NaSSA, on pain by administrating each drug to three different groups of patient with depression. METHODS: We conducted a chart review of patients, who visited a university hospital. From January, 2010 to February, 2012, total 150 inpatients who had been diagnosed as major depression by Diagnostic and Statistical Manual of Mental Disorders-4th edition criteria, and administered any of three drugs [SSRIs (n=50), SNRIs (n=50), and NaSSA (n=50)] at least for fore weeks in the department of psychiatry in Chung-Ang University Hospital, were enrolled for this study. We compared and analyzed depressive symptoms and pain between three groups. Depressive symptoms and pain were evaluated by Korean version of the Hamilton Depression Rating Scale and visual analogue scale at baseline and fore weeks later. RESULTS: There was no difference in the age, gender, severity of depression and pain among three groups. However, there was difference in 50% depressive symptomatic improvement rate in the following four weeks among three groups. The number of patient found to achieve 50% symptomatic improvement in SSRIs, SNRIs, and NaSSA group was 17 (34%), 20 (40%), and 34 (54%) in each group, respectively, indicating significantly higher improvement rate in NaSSA compared to SSRIs. During four weeks of administration period, significant difference in 50% pain improvement rate was observed among three groups. The number of patient found to achieve 50% pain improvement in SSRIs, SNRIs, and NaSSA group was 14 (28%), 20 (40%), and 27 (54%) in each group, respectively, showing twice higher pain improvement rate in NaSSA compared to SSRIs. CONCLUSION: This result indicates better efficacy of NaSSA on pain improvement compared to SSRIs, and SNRIs in depressed patients. Although the effect of pain improvement has been mainly focused on SNRIs, result from this study suggests the need for further research and validation on the effect of NaSSA for pain control.

Efficacy of Venlafaxine and Reboxitine in treatment of selective serotonin reuptake inhibitors non-responder with major depressive disorder / 中华行为医学与脑科学杂志

Objective The purpose of this study was to access the efficacy of Venlafaxine and Reboxitine on treatment of depressive patients who had not responded to selective serotonin reuptake inhibitors for eight weeks. Methods 117 cases depressive patients who had not responded to selective serotonin reuptake inhibitors for eight weeks were divided into three Venlafaxine group(n =41),Reboxitine group(n =39),Original medicine group(n =37) by randomly and were treated by corresponding drugs for 8 weeks. The therapeutic response and safety were evaluated by scale of HAMD and TESS at before and after treatment the end of 1,2,4,8 week. Results The score of HAMD in Venlafaxine and Reboxitine groups were significantly lower than Original medicine group at the end of 4,8 weeks after treatment and the score of HAMD in Venlafaxine group were significantly lower than Reboxitine group at the end of 8 weeks after treatment. The score of HAMD in Venlafaxine and Original medicine groups were marked descendanter than before treatment from after treatment second weekend(P <0.01),while reboxitine group did not marked descent until the 4th weekend after treatment. The reduce score of factors in cognition,retardition and desperation of Venlafaxine and Reboxitine groups were significantly higher than Original medicine group at the end of treatment. The curative effect of Venlafaxine group were supper than Original medicine group. The side reaction of three groups were not difference. Conclusions There are obviously curative effect using Venlafaxine to treat the depressive patients who had not responded to selective serotonin reuptake inhibitors. The time of initial effect in Venlafaxine were rapider than Reboxitine group.

Efeito dos antidepressivos ISRS sobre os hormônios tireoidianos / SSRI antidepressant effects on thyroid hormones

O objetivo deste artigo é realizar uma atualização sobre a ação de antidepressivos, com destaque aos inibidores seletivos de recaptação de serotonina (ISRS) na função tireoidiana de pacientes com depressão. Sete ensaios clínicos investigaram o efeito dos ISRS sobre a função tireoidiana. Apesar das diferenças metodológicas, o principal achado foi a tendência à diminuição dos níveis plasmáticos de tiroxina, não necessariamente relacionada com a resposta clínica, e sem efeito sobre a tireotropina na maioria das pesquisas. Os estudos sugerem que os ISRS promovem efeitos na função tireoidiana em alguns pacientes com depressão, especificamente diminuição nos níveis plasmáticos de tiroxina. Porém, observou-se que a relação entre o uso de antidepressivos ISRS e a função tireoidiana não está suficientemente esclarecida. Mesmo nos casos de alteração nos níveis plasmáticos dos hormônios tireoidianos em resposta a ação dos ISRS, esta pode ser uma ação não específica sobre a função tireoidiana.

This article aims at updating antidepressant action, especially using selective serotonin reuptake inhibitors, on thyroid function in depressed patients. Seven clinical trials investigated the status of thyroid hormones after treatment with SSRIs. Despite methodological differences, the main finding indicated a tendency towards decreased serum thyroxine levels, The majority of studies could not find a positive relationship between lower serum thyroxine level and a favorable treatment response. Also, an effect on thyrotropin could not be found. Those study results suggest SSRIs promote effects on thyroid function in some depressed patients, specifically decreased serum thyroxine levels. However, the relation between SSRIs antidepressant use and thyroid function is not clear. Even when there was a change in serum thyroid hormone levels due to SSRI therapy, this could be a non-specific effect on thyroid function.

Comparison of Side Effect Profiles between Mirtazapine and Selective Serotonin Reuptake Inhibitors; A Naturalistic Setting / 대한정신약물학회지

OBJECTIVES: Since the efficacy is similar among different antidepressants, side effects, costs, and overdose toxicity are considered preferentially as factors to choose antidepressant. Recently, selective serotonin reuptake inhibitors (SSRIs) are more frequently prescribed than tricyclic antidepressants because of their less frequent side effects. Also the use of noradrenergic and specific serotonergic antidepressants (NaSSA) are increasing. These new antidepressants have characteristic side effect profiles in terms of gastrointestinal side effects, weight gain and sexual dysfunction which serve as direct cause of noncompliance. In the present study, we compared the drug side effects of patients with major depressive disorder who have taken either mirtazapine or SSRIs. METHODS: Among those patients who were treated at Department of Psychiatry, St. Mary's Hospital, The Catholic University of Korea, from Jun, 2002 to July, 2002, we included patients who met DSM-IV criteria for major depressive disorder. Patients who reveive either mirtazapine or SSRIs (fluoxetine, paroxetine) monotherapy as an antidepressant were enrolled. Patients with physical illnesses or poor drug compliance were excluded. A self-rating questionnaire was used to assess the drug side effects. RESULTS: Total 86 patients (mirtazapine;24, SSRIs;62 (fluoxetine 18, paroxetine 44)) were participated in this study. There was no difference at age (mirtazapine;48.0+/-14.0 years, SSRIs;43.3+/-15.6 years), sex ratio (mirtazapine;male 12: female 12, SSRIs;male 24: female 38), and mean duration of administration (mirtazapine;20.2+/-21.5 weeks, SSRIs;32.1+/-50.9 weeks) between two groups. Patients taking mirtazapine have significantly less side effects in terms of decreased appetite, yawn, decreased libido, and anorgasmia. Patients taking SSRIs have significantly less side effects in terms of peripheral edema than mirtazapine. CONCLUSION: Mirtazapine and SSRIs showed differences in some side effects. Mirtazapine showed more favorable side effect profiles in the gastrointestinal and sexual side effects than SSRIs. This data was thought to be useful guidelines in selecting antidepressants hereafter.