ABSTRACT
Fourteen patients were treated over 2 years with cervical vagus nerve stimulation (VNS) for adjunctive therapy of severe, treatment-resistant depression. Here, we report the serendipitous observation that this treatment was associated with highly significant, gradual weight loss despite the patients' report of not dieting or exercising. The weight loss was proportional to the initial BMI, that is, the more severe the obesity, the greater the weight loss. Weight loss did not correlate with changes in mood symptoms. The vagus nerve carries visceral information to and from the brain; modulation of its activity may alter eating behavior. Chronic cervical VNS may merit controlled study for the treatment of severe obesity.
Subject(s)
Depressive Disorder, Major/therapy , Electric Stimulation Therapy/methods , Obesity/complications , Vagus Nerve/physiopathology , Weight Loss , Adult , Body Mass Index , Depressive Disorder, Major/complications , Depressive Disorder, Major/physiopathology , Female , Follow-Up Studies , Humans , Incidental Findings , Male , Middle Aged , Obesity/physiopathologyABSTRACT
OBJECTIVE: To report an unusual and life-threatening presentation of an overdose of sertraline and trazodone. CASE SUMMARY: A patient with a history of depression ingested sertraline 6,000 mg and trazodone 1,300 mg in a suicide attempt. Twenty-four hours after antidepressant administration, the patient presented with symptoms of selective serotonin-reuptake inhibitor (SSRI) overdose and serotonin syndrome, and later developed an enlarged tongue consistent with angioedema. A compromised airway resulted and endotracheal intubation was necessary. After intubation, the symptoms subsided and the patient recovered. DISCUSSION: Although SSRIs and trazodone are generally considered to be relatively safe in single-agent overdose, serious delayed reactions can occur, especially if several agents are involved. In this case the patient initially presented with symptoms typical of an SSRI overdose that did not appear to be exceptionally dangerous. Over time, symptoms consistent with angioedema appeared that necessitated intubation. Although previous reports of angioedema have been reported with SSRIs, this is the first report, to our knowledge, of a presentation this severe. CONCLUSIONS: This case demonstrates that overdose with the newer antidepressants can result in unusual and delayed presentations and must be treated with caution.
Subject(s)
Antidepressive Agents, Second-Generation/poisoning , Drug Overdose , Sertraline/poisoning , Suicide, Attempted , Trazodone/poisoning , Adult , Humans , Male , Serotonin Syndrome/chemically inducedABSTRACT
BACKGROUND: The authors' goal was to assess the efficacy and tolerability of naltrexone in the treatment of pathologic gambling disorder. METHODS: Eighty-three subjects who met criteria for DSM-IV pathologic gambling disorder were enrolled in a 1-week single-blind placebo lead-in followed by an 11-week double-blind naltrexone or placebo trial. Naltrexone was started at 25 mg/day and titrated upward until maximum symptom improvement or 250 mg/day was achieved. Gambling symptom change was assessed with the patient-rated Clinical Global Impression (PG-CGI-PT), clinician-rated CGI (PG-CGI-MD), and the Gambling Symptom Rating Scale (G-SAS). Side effects were monitored weekly and liver function tests biweekly. RESULTS: Data from 45 patients were analyzed. Using random regression analysis, significant improvement was noted in all three gambling symptom measures: patient-rated Clinical Global Impression, p <.001; clinician-rated CGI, p <.001; Gambling Symptom Rating Scale, p <.019. At study end, 75% of subjects taking naltrexone were much or very much improved on both the PE-CEI PT and the PG-CGI-MD, compared with only 24% of those on placebo. Elevated liver enzymes occurred in four subjects who were taking analgesics concurrently. Nausea was common during the first week of treatment. CONCLUSIONS: Results suggest that naltrexone is effective in reducing the symptoms of pathologic gambling. Until further studies corroborate the present findings, our report should be interpreted cautiously.
Subject(s)
Disruptive, Impulse Control, and Conduct Disorders/drug therapy , Disruptive, Impulse Control, and Conduct Disorders/psychology , Gambling/psychology , Naltrexone/therapeutic use , Narcotic Antagonists/therapeutic use , Adolescent , Adult , Aged , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Double-Blind Method , Humans , Interview, Psychological , Liver Function Tests , Middle Aged , Single-Blind Method , Surveys and QuestionnairesSubject(s)
Antidepressive Agents, Second-Generation/therapeutic use , Contraceptives, Oral, Combined/administration & dosage , Triazoles/therapeutic use , Adult , Cytochrome P-450 CYP3A , Cytochrome P-450 Enzyme Inhibitors , Drug Interactions/physiology , Enzyme Inhibitors/administration & dosage , Female , Humans , Mixed Function Oxygenases/antagonists & inhibitors , PiperazinesABSTRACT
Pharmacokinetic interactions involving the cytochrome P450 system have been a recent focus of clinical and research interest in psychopharmacology. The authors reviewed 100 consecutive patients seen on a consultation-liaison (C-L) psychiatry service for potential drug-drug interactions. The patients were taking a mean of 8.8 medications; for those undergoing organ transplantation the mean was 12.9. While both enzyme inhibitors (n = 87) and substrates (n = 89) were commonly used, only rarely were they used in the same patient (n = 14). The authors conclude that the potential for drug interactions on a C-L psychiatry service is significant, necessitating awareness of this potential complication.
Subject(s)
Cytochrome P-450 Enzyme Inhibitors , Mental Disorders/drug therapy , Organ Transplantation/psychology , Patient Care Team , Psychotropic Drugs/adverse effects , Cytochrome P-450 Enzyme System/physiology , Drug Interactions , Drug Therapy, Combination , Enzyme Inhibitors/administration & dosage , Enzyme Inhibitors/adverse effects , Enzyme Inhibitors/pharmacokinetics , Humans , Mental Disorders/blood , Mental Disorders/psychology , Psychotropic Drugs/administration & dosage , Psychotropic Drugs/pharmacokinetics , Risk FactorsSubject(s)
Anorexia Nervosa/complications , Pneumothorax/etiology , Adult , Female , Humans , Time FactorsABSTRACT
OBJECTIVE: To examine the rates of exclusion and inclusion in various research studies for a series of 51 treatment-seeking patients. METHOD: The inclusion and exclusion criteria employed in a sample of 41 studies were applied to a series of 51 treatment-seeking bulimia nervosa patients. RESULTS: Of the sample of 51, 11, (21.6%) would have been excluded from 16 (39%) of the studies because of an age greater than 30; 13 (32%) of the studies would have excluded 8 (16%) of our patients because of weight > 110% ideal body weight. Thirteen (26%) would have been excluded from 22 (54%) of the studies because of active psychotropic drug use, despite the lack of response. DISCUSSION: Some of the patients who may be most difficult to work with may be excluded from treatment studies.
Subject(s)
Bias , Bulimia/therapy , Patient Selection , Research Design , Adolescent , Adult , Age Factors , Aged , Body Weight , Child , Female , Humans , Male , Middle Aged , Sex FactorsABSTRACT
OBJECTIVE: The pathophysiology and symptomatology of the superior mesenteric artery syndrome (SMA syndrome) is discussed. METHOD: A review of much of the available literature concerning the SMA syndrome and the associated condition acute gastric dilatation is offered. RESULTS: Two new cases of acute gastric dilatation in patients with eating disorders, one of whom was diagnosed with SMA syndrome, are presented, along with a discussion of these conditions in reference to the eating disorders. CONCLUSION: The SMA syndrome and gastric dilatation are rare but potentially a very serious complication of eating disorders, and clinicians who work with these patients should be aware of such problems.
