La depresión: un desafío en la práctica médica general / La depresión: un desafío en la práctica médica general

Asociada o no a una enfermedad orgánica, la depresión tiene gran prevalencia en la práctica médica pero es subdiagnosticada. El trastorno del ánimo suele coexistir con variadas quejas somáticas y dolores crónicos, configurando síndromes mixtos con un diagnóstico diferencial complejo. En este artículo se describen distintas presentaciones clínicas de la depresión en medicina general, con énfasis en los estados depresivos atípicos, depresiones enmascaradas muy relevantes por su frecuencia y consecuencias: depresión posquirúrgica, cuadros dolorosos crónicos como cefaleas o lumbago, la fatiga crónica y la fibromialgia. Solo el reconocimiento y diagnóstico de la depresión subyacente posibilitará la implementación de las adecuadas intervenciones terapéuticas. Se revisan también algunas recomendaciones para el uso de antidepresivos en atención primaria y la eventual consulta psiquiátrica. (AU)

Associated or not with an organic disease, depression has a high prevalence in medical practice but is underdiagnosed. The mood disorder usually coexists with varied somatic complaints and chronic pain, forming mixed syndromes with a complex differential diagnosis. This article describes different clinical presentations of depression in general medicine, with emphasis on atypical depressive states, masked depressions very relevant for their frequency and consequences: post-surgical depression, chronic painful conditions such as headaches or lumbago, chronic fatigue and fibromyalgia. Only the recognition and diagnosis of the underlying depression will enable the implementation of appropriate therapeutic interventions. Some recommendations for the use of antidepressant drugs in primary care and the eventual psychiatric consultation are also reviewed. (AU)

Neonatal exposure to citalopram increases pyramidal and granular cell density in dorsal hippocampus of male but not female adult rats: a quantitative Nissl study / La exposición neonatal al citalopram aumenta la densidad de las células piramidales y granulares en el hipocampo dorsal de ratas adultas macho pero no en hembras: un estudio cuantitativo con tinción de Nissl

Antidepressants use during pregnancy was associated with an increased risk of autism spectrum disorders. Animal models based on early life alterations in serotonin availability replicate some of the anatomical and behavioral abnormalities observed in autistic individuals. In recent years there has been a growing interest in the possible role of the hippocampus in autism. The aim of study is to examine the effects of neonatal antidepressant (CTM) exposure during a sensitive period of brain development on pyramidal and granule cells density of hippocampal formation. We examined the pyramidal and granular cells density of dorsal hippocampus using Nissl stained sections obtained from neonatal citalopram (CTM) exposed rats (5 mg/kg, twice daily, s.c.), from postnatal day 8 to 21 (PN8-21), saline and non-exposed rats. The density of pyramidal cells was significantly increased by 10.2 % in CA1, 10.6 % in CA3 and 13.2 % in CA4 in CTM treated compared with non-treated or saline treated animals (p<0.0001). The density of granule cells in the dentate gyrus was significantly increased by 12.0 % in CTM treated compared with non-treated or saline treated animals (p<0.0001). These findings were obtained only from male rats, suggesting a sexual dimorphism in neural development after SSRI exposure. These data suggest that the neonatal exposure to CTM may induce long-lasting changes in the hippcampal formation in adults, and such effects appear to preferentially target males.

El uso de antidepresivos durante el embarazo se asoció con un mayor riesgo de trastornos del espectro autista. Los modelos animales basados en alteraciones tempranas de la vida en la disponibilidad de serotonina replican algunas de las anomalías anatómicas y de comportamiento observadas en individuos autistas. En los últimos años ha habido un interés creciente en el posible papel del hipocampo en el autismo. El objetivo del estudio fue examinar los efectos de la exposición al antidepresivo neonatal (CTM) durante un período sensible del desarrollo cerebral en la densidad de las células piramidales y granulares de la formación del hipocampo. Examinamos la densidad de las células piramidales y granulares del hipocampo dorsal utilizando secciones teñidas con Nissl obtenidas de ratas expuestas al citalopram neonatal (CTM) (5 mg / kg, dos veces al día, sc), desde el día postnatal 8 a 21 (PN8-21), solución salina y ratas no expuestas. La densidad de células piramidales se incrementó significativamente en un 10,2 % en CA1, 10,6 % en CA3 y 13,2 % en CA4 en CTM tratados en comparación con animales no tratados o tratados con solución salina (p <0,0001). La densidad de células granulares en el giro dentado aumentó significativamente en un 12,0 % en los animales tratados con CTM en comparación con los animales no tratados o tratados con solución salina (p <0,0001). Estos hallazgos se obtuvieron solo en ratas macho, lo que sugiere un dimorfismo sexual en el desarrollo neural después de la exposición a ISRS. Estos datos sugieren que la exposición neonatal a la CTM puede inducir cambios de larga duración en la formación del hipocampo en adultos, y estos efectos parecen dirigirse preferentemente a los machos.

Síndrome de abstinencia neonatal debido a exposición prenatal al citalopram: a propósito de un caso / Neonatal abstinence syndrome due to prenatally citalopram exposure: A case report

El síndrome de abstinencia neonatal (SAN) debido a la exposición prenatal al citalopram se desarrolla durante los primeros días de vida, incluso con una exposición al fármaco en dosis bajas. El tratamiento de apoyo es la primera opción, aunque puede usarse el fenobarbital en el tratamiento de este síndrome. No debe interrumpirse la lactancia. Debe hacerse un seguimiento de estos recién nacidos para establecer el desenlace del SAN y las consecuencias en el desarrollo neurológico. En este artículo presentamos el caso de un recién nacido con SAN debido a exposición al citalopram en una dosis más baja que lo informado previamente en la bibliografía durante los últimos seis meses del embarazo. Se utilizó el fenobarbital debido al fracaso del tratamiento no farmacológico.

Neonatal abstinence syndrome (NAS) due to prenatally exposure to citalopram can develop during the first days of life even with low dose of drug exposure. Supportive management is the first choice but phenobarbital can be used in treatment of this syndrome. Breastfeeding should not be interrupted. These neonates should be followed both for NAS and neurodevelopmental outcome. In this article, we reported a newborn with NAS due to citalopram exposure with a lower dose than previously reported in the literature, during the last six months of pregnancy. Phenobarbital was used because of non-pharmacological treatment failure.

Antidepressant-Induced Sexual Dysfunction: A comparison between Duloxetine and Escitalopram.

Background: Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) have the potential to produce delayed ejaculation in men, delayed orgasm or anorgasmia in women and decreased libido that is independent of the gender. The occurrence of medication-associated sexual dysfunction increases the likelihood of medication non-compliance (or non-adherence) in patients, which may contribute to untreated depression and/or disease relapse. Materials & Methods: 60 patients with diagnosis of Depressive episode (in remission at the time of study), divided into 2 groups of 30 patients taking Duloxetine and the remaining 30 patients taking Escitalopram, were recruited on consecutive basis from the patients attending Psychiatry OPD of Lady Hardinge Medical College (LHMC). Each subject was rated on Arizona Sexual Experience Scale (ASEX) and the results obtained were statistically analyzed. Results: In the present study the average ASEX score obtained in the Escitalopram group (12.63) was found to be more than that in Duloxetine group (12.36), though this difference was not found to be statistically significant. Conclusions: These results illustrate that antidepressant-induced sexual dysfunction is reported frequently by patients taking SSRIs or SNRIs. Our study did not find any significant difference between escitalopram and duloxetine with respect to their sexual dysfunction profile but in view of the limitations of our study there is need for further research in this domain of psychopharmacology.

An open-label multicentric study of the tolerability and response to escitalopram treatment in Indian patients with major depressive disorder.

To evaluate the tolerability and response to escitalopram in Indian patients with major depression, over an 8-week open-label multicentric study was carried out among 18-65 years old Indian patients suffering from DSM IV major depressive disorder with Montgomery-Asberg depression rating scale (MADRS) total score> or =22. Patients received a fixed dose of escitalopram 10 mg daily for 2 weeks, followed by flexible dose of 10 to 20 mg daily for 6 weeks. Patients were evaluated for depression and rated on MADRS score and clinical global impressions-severity (CGI-S) and--improvement (CGI-I) scores. They were monitored for treatment-emergent adverse effects. A total of 119 patients were enrolled and 103 completed the trial. There was a decrease from baseline in the MADRS total score after one week of treatment continuing until 8 weeks. By week 8, 76.9% patients had responded to treatment (> or =50% or more reduction of MADRS total score). A similar pattern of improvement to that seen with the MADRS total score was seen with CGI-S and CGI-I scores. Escitalopram was well tolerated, with only 2 patients (1.7%) withdrawing from the study due to adverse events. There were no serious adverse events.

Hiponatremia e hipokalemia graves, recientes, asociadas a hidroclorotiazida, enalaprila y citalopram: caso clínico / Severe and recent hyponatremia and hypokalemia associated to the use of hydrochlorothiazide, enalapril and cytalopram: clinical case

We report a 72 years old hypertensive female, treated with enalapril 10 mg/day and hydrochlorothiazide 25 mg/day during three years. She presented a depressive disorder and cytalopram was prescribed in a dose of 10 mg/day. Two weeks before admission, a serum electrolyte analysis disclosed normal results and the cytalopram dose was increased to 20 mg/day. The patient was admitted with a hyponatremic encephalopathy with a plasma sodium of 100 mEq/L and a plasma potassium of 2.0 mEq/L. cytalopram, enalapril and hydrochlorothiazide were discontinued, hypertonic NaCl and KCl were administered. The patient had a favorable evolution with a remarkable improvement of her symptoms

Interaçöes medicamentosas: Antidepressivos novos e o sistema citocromo P450 / Drug interactions: Newer antidepressants and the cytochrome P450 system

A maioria dos fármacos sofre biotransformaçäo, frequentemente envolvendo a oxidaçäo no fígado. Recentemente, descobriu-se que algumas enzimas do sistema enzimático citocromo P450 säo responsáveis pelos primeiros passos metabólicos d maioria dos fármacos. Algumas drogas podem inibir enzimas P450 e esta inibiçäo pode levar a interaçöes potenciais com outros fármacos. Muitos estudos têm focalizado o sistema citocromo P450 e seu papel em interaçöes medicamentosas potnciais. Este artigo apresenta as evidências in vitro e in vivo da inibiçäo de enzimas do sistema citocromo P450 (1A2, 2C9, 2C19, 2D6, 3A3/4) por antidepressivos recentemente introduzidos no mercado (citalopram, fluoxetina, fluvoxamina, nefazodona, paroxetina, sertralina e venlafaxetina) e sua relevância clínica potncial

Estudo aberto comparativo de eventos adversos no tratamento com citalopram e fluoxetina / Comparative open trial adverse reactions during treatment with citalopram or fluoxetine

88 pacientes com depressäo maior ou depressäo maior e distimia foram avaliados de forma aberta quanto "a incidência e gravidade de eventos adversos durante o uso de citalopram (52,3 por cento) ou fluoxetina (40, 9 por cento) ou cada uma das drogas sequencialmente (6,8 por cento). 38 pacientes relataram a ocorrência de eventos adversos, sendo 14 no grupo citalopam e 24 no grupo fluoxetina, diferenças quanto ao sexo dos pacientes. Um número significativamente menor de pacientes interrompeu o uso de citalopram quando comparado a fluoxetina por motivos relacionados ao aparecimento de eventos adversos. Os resultados sugerem maior tolerabilidade do citalopram quando comparado à fluoxetina

Disfunçäo sexual associada ao uso de antidepressivos / Sexual dysfunction associated with antidepressant therapy

A disfunçÝo sexual é um efeito colateral bastante conhecido relacionado ao uso de antidepressivos. Noventa pacientes em uso de vários antidepressivos foram avaliados. Observou-se que a maioria dos casos nÝo cumpriam seus programas terapêuticos devido à disfunçÝo sexual. As principais alteraçSes encontradas foram diminuiçÝo da libido, retardo ou inibiçÝo da ejaculaçÝo, inibiçÝo do orgasmo, disfunçÝo erétil e orgasmo doloroso