Antidepressants in adolescence.

In adolescence, antidepressants are second-line treatment options after psychological therapy for anxiety and obsessive compulsive disorder. They may be first- or second-line options for severe cases of major depressive disorder. The response to antidepressant treatment is generally good for anxiety and obsessive compulsive disorder, but is less convincing for major depressive disorder. Adolescents who do not respond to an adequate trial of one antidepressant should be referred for a psychiatric opinion. Patients must be monitored for rare but serious adverse effects. These include suicide-related behaviours, switching to mania, and serotonin syndrome.

Placebo response rates in trials of antidepressant drugs in adults with clinical depression: Increasing, decreasing, constant or all of the above?

OBJECTIVE: A seminal study quantified an increase in placebo (and drug) response rates in antidepressant trials during the eighties, with subsequent key systematic reviews reporting placebo response rates as either having continued to increase or stabilize in trial subjects with major depression. We therefore undertook an additional study examining a more recent period. METHOD: We analyze response rate data from 121 studies published over the 2001-2015 period and sourced from a previous meta-analysis of antidepressant drugs. RESULTS: Our analyses indicated trends for decreasing placebo response rates over the whole study period. Analyses of consolidated year blocks quantified a significant linear decrease and a significant cubic pattern in placebo response rates. Visual inspection of the yearly data patterns revealed wide fluctuations as well as distinct and correlated peaks and troughs for both placebo and drug responses. LIMITATIONS: The key studies we analyzed differed in a number of ways, including selection of inclusion criteria (especially in relation to analyzing published studies alone or together with unpublished studies) and analytic techniques. CONCLUSIONS: The markedly fluctuating placebo response patterns evidence an unstable 'signal' so leading principal studies to generate three mutually contradictory conclusions. We suggest that the increase in rates in the 1980s studies reflected the uptake and impact of 'major depression' being used as the diagnostic criterion, while the striking peaks and troughs observable over our study period argue for varying trial characteristics over time or rater biases in judging depression.

Changes of BDNF in patients with depression at perimenopausal period after treatment with venlafaxine / 实用医学杂志

Objective To explore the changes of depressive symptoms and serum level of brain derived neurotrophic factor(BDNF)before and after venlafaxine treatment in female patients with depression. Methods 40 perimenopausal women patients with depression received treatment with venlafaxine for 4 weeks. Before and after treatment,the patients were assessed by the Hamilton Depression Scale(table 24 item version)and serum levels of BDNF were measured. The results were compared with those from 40 healthy menopausal women. Results In the treatment group,the depressive symptoms were improved(P < 0.05);and the BDNF level was elevated(P < 0.05). The serum BDNF levels were higher in the effective group than in the non-effective group (P<0.05);the BDNF levels were increased(P<0.05)before and after treatment.Conclusions Treatment with venlafaxine for depression in perimenopausal women,BDNF levels are increased and depression symptoms are mproved significantly.The effect is associated with the level of BDNF.

Diagnosing and treating depression in epilepsy.

At least one third of patients with active epilepsy suffer from significant impairment of their emotional well-being. A targeted examination for possible depression (irrespective of any social, financial or personal burdens) can identify patients who may benefit from medical attention and therapeutic support. Reliable screening instruments such as the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) are suitable for the timely identification of patients needing help. Neurologists should be capable of managing mild to moderate comorbid depression but referral to mental health specialists is mandatory in severe and difficult-to-treat depression, or if the patient is acutely suicidal. In terms of the therapeutic approach, it is essential first to optimize seizure control and minimize unwanted antiepileptic drug-related side effects. Psychotherapy for depression in epilepsy (including online self-treatment programs) is underutilized although it has proven effective in ten well-controlled trials. In contrast, the effectiveness of antidepressant drugs for depression in epilepsy is unknown. However, if modern antidepressants are used (e.g. SSRI, SNRI, NaSSA), concerns about an aggravation of seizures and or problematic interactions with antiepileptic drugs seem unwarranted. Epilepsy-related stress ("burden of epilepsy") explains depression in many patients but acute and temporary seizure-related states of depression or suicidality have also been reported. Limbic encephalitits may cause isolated mood alteration without any recognizable psychoetiological background indicating a possible role of neuroinflammation. This review will argue that, overall, a bio-psycho-social model best captures the currently available evidence relating to the etiology and treatment of depression as a comorbidity of epilepsy.

Application of Antidepressive Drugs Used in 31 Hospitals of Nanjing Area during 2013 to 2015 / 中国药房

OBJECTIVE:To provide reference for rational use of antidepressive drugs. METHODS:In retrospective study,the utilization of antidepressive drugs in 31 hospitals of Nanjing area during 2013-2015 was analyzed statistically in respects of consump-tion sum,DDDs,DDC,B/A,etc. RESULTS:There were a total of 20 kinds of antidepressive drugs in 31 hospitals of Nanjing ar-ea,and total consumption sum increased year by year,increasing from 76 085 200 yuan in 2013 to 100 812 500 yuan in 2015,in-creased by 17.43% compared to 2014 and by 12.83% compared to 2015. The top 4 drugs in the list of consumption sum and DDDs were paroxetine,escitalopram,sertraline and venlafaxine. The sum of their consumption sum accounted for more than 60% of total consumption sum. The consumption sum of plant antidepressive drugs increased rapidly. B/A and DDC of antidepressive drugs kept sta-ble each year compared to last year,among which DDC of doxepin,clomipramine and amitriptyline was less than 2 yuan,B/A val-ues of sertraline,fluvoxamine,flupentixol and melitracen,doxepin,clomipramine and amitriptyline were all more than 1.00. CON-CLUSIONS:Of antidepressive drugs in 31 hospitals of Nanjing area during 2013-2015,selective serotonin reuptake inhibitors and se-lective serotonin-norepinephrine reuptake inhibitors took up dominant place,and plant antidepressive drugs is promising in the future.

Aspectos clínicos y tratamiento farmacológico del dolor neuropático / Clinical aspects and drug treatment of the neuropathic pain

El dolor neuropático surge como consecuencia directa de una lesión o enfermedad que afecta al sistema somatosensorial. En el niño existen numerosas causas de dolor neuropático: traumáticas, síndrome doloroso regional complejo tipo 1, enfermedades neurológicas y neuromusculares, infecciones crónicas, cáncer y causas genéticas. Su diagnóstico puede ser difícil en los niños. El tratamiento del dolor neuropático es un reto para los médicos que se dedican a su atención. Los medicamentos antidepresivos tricíclicos como la amitriptilina y la imipramina y los antiepilépticos, se emplean con frecuencia en el tratamiento del dolor neuropático en los niños. También se emplean el acetaminofén (paracetamol), medicamentos antiinflamatorios no esteroideos y el tramadol. A todo niño y adolescente con sospecha de dolor neuropático se le debe realizar una evaluación clínica, que incluya una exhaustiva anamnesis y examen físico general, regional y por aparatos, con especial énfasis en el examen neurológico. Un examen neurológico normal no excluye la presencia de dolor neuropático.

Neuropathic pain occurs as direct result of a lesion or a disease affecting the somatosensory system. The neuropathic pain in a child has a number of causes: traumas, complex regional pain syndrome type 1, neurological and neuromuscular diseases, chronic infections, cancer and genetic causes. Its diagnosis may be difficult in children, so the treatment is a challenge posed to physicians who specialized in the field. Tricyclic antidepressive drugs as amitryptiline and imipramine and antiepilepsy drugs are often used in the treatment of neuropathic pain in children. Acetaminophen (paracetamol), non-steroidal anti-inflammatory drugs and tramadol are also used. Every child and adolescent suspected of neuropathic pain should be clinically assessed including exhaustive anamnesis and general, regional physical examination and use of equipment, with special emphasis on the neurological examination. A normal neurological test does not exclude the presence of neuropathic pain.

Aspectos clínicos y tratamiento farmacológico del dolor neuropático / Clinical aspects and drug treatment of the neuropathic pain

El dolor neuropático surge como consecuencia directa de una lesión o enfermedad que afecta al sistema somatosensorial. En el niño existen numerosas causas de dolor neuropático: traumáticas, síndrome doloroso regional complejo tipo 1, enfermedades neurológicas y neuromusculares, infecciones crónicas, cáncer y causas genéticas. Su diagnóstico puede ser difícil en los niños. El tratamiento del dolor neuropático es un reto para los médicos que se dedican a su atención. Los medicamentos antidepresivos tricíclicos como la amitriptilina y la imipramina y los antiepilépticos, se emplean con frecuencia en el tratamiento del dolor neuropático en los niños. También se emplean el acetaminofén (paracetamol), medicamentos antiinflamatorios no esteroideos y el tramadol. A todo niño y adolescente con sospecha de dolor neuropático se le debe realizar una evaluación clínica, que incluya una exhaustiva anamnesis y examen físico general, regional y por aparatos, con especial énfasis en el examen neurológico. Un examen neurológico normal no excluye la presencia de dolor neuropático(AU)

Neuropathic pain occurs as direct result of a lesion or a disease affecting the somatosensory system. The neuropathic pain in a child has a number of causes: traumas, complex regional pain syndrome type 1, neurological and neuromuscular diseases, chronic infections, cancer and genetic causes. Its diagnosis may be difficult in children, so the treatment is a challenge posed to physicians who specialized in the field. Tricyclic antidepressive drugs as amitryptiline and imipramine and antiepilepsy drugs are often used in the treatment of neuropathic pain in children. Acetaminophen (paracetamol), non-steroidal anti-inflammatory drugs and tramadol are also used. Every child and adolescent suspected of neuropathic pain should be clinically assessed including exhaustive anamnesis and general, regional physical examination and use of equipment, with special emphasis on the neurological examination. A normal neurological test does not exclude the presence of neuropathic pain(AU)

Depression and anxiety in women with epilepsy during pregnancy and after delivery: a prospective population-based cohort study on frequency, risk factors, medication, and prognosis.

OBJECTIVE: To assess incidence, prevalence, risk factors, and prognosis of peripartum depression and anxiety in a prospective study of women with epilepsy. METHOD: Pregnancies in women with epilepsy (n=706) were compared to pregnancies in all women without epilepsy (n=106,511) including women with specified nonepileptic chronic diseases (n=8,372) in the Norwegian Mother and Child Cohort Study. The database was linked to the Medical Birth Registry of Norway. Depression and anxiety were assessed with validated questionnaires five times from the second trimester to 36 months after delivery. Blood was drawn for analysis of antiepileptic drug (AED) concentrations. RESULTS: Women with epilepsy more often had peripartum depression (26.7%) or anxiety (22.4%) than women without epilepsy (18.9% and 14.8%, respectively, p<0.001 for both comparisons) and women with other chronic diseases (23.1% and 18.4%, respectively, p=0.03 and 0.01). Women using AEDs during pregnancy were especially at risk regardless of AED type. The risk further increased with the use of multiple AEDs and with high doses and/or plasma levels. Risk factors associated with peripartum depression and/or anxiety in the epilepsy cohort were high seizure frequency, a history of physical and/or sexual abuse, adverse socioeconomic factors, previous loss of a child, AED use, unplanned pregnancy, and prepregnancy depression and/or anxiety. The recovery rate 3 years after delivery was lower for women with epilepsy with a history of depression/anxiety or physical/sexual abuse than for women without epilepsy. Depressed women with epilepsy were less frequently treated with antidepressive drugs during pregnancy than women without epilepsy. SIGNIFICANCE: Women with epilepsy frequently have depression and anxiety during and after pregnancy. Patients at risk should be identified before delivery as depressive symptoms could be undertreated in this group.