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Reber S, Herr AS, Unterecker S, Scherf-Clavel M. Serum Concentration of Antidepressant Drugs in Geriatric Day Care Patients With Renal Insufficiency and Multimorbidity. Ther Drug Monit 2025; 47:297-302. [PMID: 39588925 DOI: 10.1097/ftd.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2024] [Indexed: 11/27/2024]
Abstract
BACKGROUND Geriatric depression is challenging to treat owing to age-related changes in pharmacokinetics and comorbidities. Although renal insufficiency and multimorbidity are typical geriatric complications that cannot be completely separated from each other, no study has examined the influence of these factors on the serum concentrations of antidepressants. For the first time, we evaluated the effects of these factors in combination on the dose-corrected serum concentration (C/D) of antidepressants in geriatric patients. METHODS In this retrospective study, data from 123 geriatric patients in a gerontopsychiatric day care unit at the University Hospital of Würzburg were analyzed. Multiple linear regression analysis and analysis of variance with confounders were used to examine the associations between glomerular filtration rate (GFR) and stages of renal impairment and the C/D of venlafaxine, mirtazapine, sertraline, and escitalopram corrected for multimorbidity, sex, lithium intake, and the number of triple whammy drugs. RESULTS GFR ( P < 0.001, ß = -0.070) was associated with the C/D of the active moiety of venlafaxine (N = 32). GFR, multimorbidity, and sex were not associated with the C/D of mirtazapine, escitalopram, or sertraline. CONCLUSIONS As the influence of sex may be less pronounced than that of decreasing GFR in terms of the C/D of the active moiety of venlafaxine in geriatric patients, we recommend considering the GFR for dose adjustment rather than sex. In conclusion, even in patients with mild renal impairment, serum venlafaxine concentration should be monitored to prevent overdosing. Mirtazapine, sertraline, and escitalopram may be well-suited antidepressants for geriatric patients with renal function impairment stage 2-3 as well as multimorbidity.
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Affiliation(s)
- Sibylle Reber
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
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Pan X, Gao Y, Guan K, Chen J, Ji B. Ghrelin/GHSR System in Depressive Disorder: Pathologic Roles and Therapeutic Implications. Curr Issues Mol Biol 2024; 46:7324-7338. [PMID: 39057075 PMCID: PMC11275499 DOI: 10.3390/cimb46070434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Depression is the most common chronic mental illness and is characterized by low mood, insomnia, and affective disorders. However, its pathologic mechanisms remain unclear. Numerous studies have suggested that the ghrelin/GHSR system may be involved in the pathophysiologic process of depression. Ghrelin plays a dual role in experimental animals, increasing depressed behavior and decreasing anxiety. By combining several neuropeptides and traditional neurotransmitter systems to construct neural networks, this hormone modifies signals connected to depression. The present review focuses on the role of ghrelin in neuritogenesis, astrocyte protection, inflammatory factor production, and endocrine disruption in depression. Furthermore, ghrelin/GHSR can activate multiple signaling pathways, including cAMP/CREB/BDNF, PI3K/Akt, Jak2/STAT3, and p38-MAPK, to produce antidepressant effects, given which it is expected to become a potential therapeutic target for the treatment of depression.
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Affiliation(s)
- Xingli Pan
- School of Biological Sciences, Jining Medical University, Jining 272067, China;
| | - Yuxin Gao
- School of Clinical Medicine, Jining Medical University, Jining 272067, China; (Y.G.); (K.G.)
| | - Kaifu Guan
- School of Clinical Medicine, Jining Medical University, Jining 272067, China; (Y.G.); (K.G.)
| | - Jing Chen
- Neurobiology Institute, Jining Medical University, Jining 272067, China
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Bingyuan Ji
- Institute of Precision Medicine, Jining Medical University, Jining 272067, China
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3
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Haussmann R, Donix M. Pharmacologic treatment of depression in Alzheimer's disease. Int Clin Psychopharmacol 2023; 38:81-88. [PMID: 36719337 DOI: 10.1097/yic.0000000000000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Major depressive disorder and Alzheimer's disease are common among older people, frequently co-occur and severely impact the quality of life. Unfortunately, data on the efficacy of pharmacologic treatment of depressive symptoms in patients with the neurodegenerative disease remain inconclusive. The heterogeneity of treatment study designs, from varying diagnostic specificity to diverse outcome measures, contributes to conflicting evidence across single trials and meta-analyses. In this literature review, we focus on commercially available products for antidepressant treatment in demented individuals and show how insights from randomized controlled trials could still guide and be aligned with common clinical practice.
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Affiliation(s)
- Robert Haussmann
- Department of Psychiatry, University Hospital Carl Gustav Carus, Technische Universität Dresden
| | - Markus Donix
- Department of Psychiatry, University Hospital Carl Gustav Carus, Technische Universität Dresden
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
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Osterland SL, Adli M, Saritas T, Schlattmann P, Behr J, Müller-Mertel R, Hoffmann K, Stamm TJ, Bschor T, Richter C, Steinacher B, Jockers-Scherübl MC, Köhler S, Heinz A, Ricken R, Buspavanich P. Acute effects of lithium augmentation on the kidney in geriatric compared with non-geriatric patients with treatment-resistant depression. Acta Psychiatr Scand 2023; 147:267-275. [PMID: 36585782 DOI: 10.1111/acps.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/13/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Lithium augmentation (LA) of antidepressants is a first-line therapy option for treatment-resistant depression (TRD). Nevertheless, it is rarely used in geriatric patients mostly because of the fear of kidney toxicity. The purpose of this study is to investigate estimated glomerular filtration rate (eGFR) changes and number of acute kidney injuries (AKI) using LA in geriatric compared with non-geriatric patients. METHODS In a prospective multicenter cohort study, eGFR changes were measured in 201 patients with unipolar depression (nage≥65years = 29; nage<65years = 172) at baseline and over 2-6 weeks of LA. We used linear mixed models to investigate changes in eGFR upon LA and assessed the number of AKIs, according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. RESULTS Both age groups showed a significant eGFR decline over the course of treatment with lower eGFR in geriatric patients. The lithium serum level (interpretable as "effect of LA") had a significant effect on eGFR decline. Both effects (age group and lithium serum level) on eGFR decline did not influence each other, meaning the effect of LA on eGFR decline did not differ between age groups. Two AKIs were observed in the geriatric age group when serum lithium levels exceeded the therapeutic range of >0.8 mmol/L. CONCLUSION This is the first study investigating eGFR change and AKI upon LA for TRD in geriatric compared with non-geriatric patients. Our data suggest that LA, as an effective treatment option in geriatric patients, should be closely monitored to avoid AKIs.
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Affiliation(s)
- Sarah Luise Osterland
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany
| | - Turgay Saritas
- Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany.,University Hospital RWTH Aachen, Institute of Experimental Medicine and Systems Biology, Aachen, Germany
| | - Peter Schlattmann
- Department of Statistics, Informatics and Data Sciences, Jena University Hospital, Jena, Germany
| | - Joachim Behr
- Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.,Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany.,Research Department of Experimental and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ronja Müller-Mertel
- Department of Psychology - Clinical Psychology and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Kai Hoffmann
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychology - Clinical Psychology and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Tom Bschor
- Department of Psychiatry and Psychotherapy, Technical University of Dresden Medical School, Dresden, Germany
| | - Christoph Richter
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Vivantes Klinikum Kaulsdorf, Berlin, Germany
| | - Bruno Steinacher
- Department of Psychiatry and Psychotherapy, Vivantes Wenckebach-Klinikum, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | | | - Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Roland Ricken
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pichit Buspavanich
- Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.,Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany.,Research Unit Gender in Medicine, Department of Psychiatry and Psychotherapy, Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Tan W, Ouyang X, Huang D, Wu Z, Liu Z, He Z, Long Y. Disrupted intrinsic functional brain network in patients with late-life depression: Evidence from a multi-site dataset. J Affect Disord 2023; 323:631-639. [PMID: 36521664 DOI: 10.1016/j.jad.2022.12.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Late-life depression (LLD) is a common and serious mental disorder, whose neural mechanisms are not yet fully understood. In this study, we aimed to characterize LLD-related changes in intrinsic functional brain networks using a large, multi-site sample. METHODS Using resting-state functional magnetic resonance imaging, the edge-based functional connectivity (FC) as well as multiple topological brain network metrics at both global and nodal levels were compared between 206 LLD patients and 210 normal controls (NCs). RESULTS Compared with NCs, the LLD patients had extensive alterations in the intrinsic brain FCs, especially significant decreases in FCs within the default mode network (DMN) and within the somatomotor network (SMN). The LLD patients also showed alterations in several global brain network metrics compared with NCs, including significant decreases in global efficiency, local efficiency, clustering coefficient, and small-worldness, as well as a significantly increased characteristic path length. Moreover, significant alterations in nodal network metrics (increased nodal betweenness and decreased nodal efficiency) were found in patients with LLD, which mainly involved the DMN and SMN. Post-hoc subgroup analyses indicated that the above changes in FC strengths were present in both first-episode, drug-naïve (FEDN) and non-FEDN patients, and were correlated with depression severity in the FEDN patients. Moreover, changes in FC strengths were found in both the early/late-onset (depression starts before/after the age of 50) patients, while altered topological metrics were found in only the late-onset patients. CONCLUSIONS These results may help to strengthen our understanding of the underlying neural mechanisms and biological heterogeneity in LLD.
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Affiliation(s)
- Wenjian Tan
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuan Ouyang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Danqing Huang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhipeng Wu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhening Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhong He
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Clinical Research Center For Medical Imaging in Hunan Province, Changsha, Hunan, China.
| | - Yicheng Long
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Therapy Strategies for Late-life Depression: A Review. J Psychiatr Pract 2023; 29:15-30. [PMID: 36649548 DOI: 10.1097/pra.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Depression in the elderly requires different treatment options because therapies that are commonly used for depression in younger patients show different effects later in life. Treatment options for late-life depression (LLD) are summarized in this article. METHODS A literature search in Medline/PubMed performed in June 2020 identified 83 relevant studies. RESULTS Pharmacotherapy with selective serotonin reuptake inhibitors can be an effective first-line treatment in LLD, but >50% of elderly patients do not adequately respond. Switching to other selective serotonin reuptake inhibitors or augmenting with mood stabilizers or antipsychotics is often effective in achieving a therapeutic benefit. Severely depressed patients with a high risk of suicidal behavior can be treated with electroconvulsive therapy. Psychotherapy provides a measurable benefit alone and when combined with medication. LIMITATIONS LLD remains an underrepresented domain in research. Paucity of data concerning the effect of specific therapies for LLD, heterogeneity in the quality of study designs, overinterpretation of results from meta-analyses, and discrepancies between study results and guideline recommendations were often noted. CONCLUSIONS Treating LLD is complex, but there are several treatment options with good efficacy and tolerability. Some novel pharmaceuticals also show promise as potential antidepressants, but evidence for their efficacy and safety is still limited and based on only a few trials conducted to date.
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7
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Needs and Needs Communication of Nursing Home Residents with Depressive Symptoms: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063678. [PMID: 35329364 PMCID: PMC8949340 DOI: 10.3390/ijerph19063678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/03/2022]
Abstract
Nursing home residents are affected by depressive symptoms more often than elders living at home. There is a correlation between unmet needs and depression in nursing home residents, while met needs positively correlate with greater satisfaction and well-being. The study aims to examine the needs of nursing home residents with depressive symptoms and the communication of those needs, as no previous study has explicitly addressed the needs of this group of people and the way they are communicated. We conducted semi-structured interviews with 11 residents of three nursing homes and analyzed them using content-structuring content analysis. The residents reported diverse needs, assigned to 12 categories. In addition, barriers such as health impairments prevented the fulfillment of needs. As to the communication of needs, various interlocutors, facilitators, and barriers were identified. The findings reveal that residents can express their needs and are more likely to do so if the interlocutors are patient and take them seriously. However, lack of confidants, missing or non-functioning communication tools, impatience and perceived lack of understanding on the part of caregivers, and residents’ insecurities limit communication of needs.
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Mate K, Kerr K, Priestley A, Weaver N, Broe GA, Daylight G, Draper B, Cumming R, Robinson-Kingi H, Delbaere K, Radford K. Use of tricyclic antidepressants and other anticholinergic medicines by older Aboriginal Australians: association with negative health outcomes. Int Psychogeriatr 2022; 34:71-78. [PMID: 32985391 DOI: 10.1017/s104161022000174x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Aboriginal and Torres Strait Islander Australians have a relatively high prevalence of multimorbidity requiring treatment with medications. This study examines medication use and anticholinergic burden (ACB) among a cohort of older Aboriginal and Torres Strait Island people. METHOD This cross-sectional study involving five Aboriginal communities (two in metropolitan Sydney and three on the mid-north coast of New South Wales) used a structured interview process to assess cognition, depression, and activities of daily living for a cohort of older adults (aged 60 years and over). Participants also reported on their health status, medical history, and prescription medications during the interview. ACB was calculated, and its association with adverse health outcomes including cognitive impairment, falls, hospitalization, and depressive symptoms were examined. RESULTS Most participants (95%) were taking at least one regular medication with polypharmacy (≥5 medications) observed in 43% of participants; 12.2% had a significant ACB (≥3) with antidepressants being a major contributor. Anticholinergic medication use was associated with cognitive impairment, recent hospitalization (past 12 months), and depressive symptoms. After controlling for age, sex, and comorbidity, only the presence of depressive symptoms remained significantly associated with the use of anticholinergic medication (odds ratio 2.86; 95% confidence interval 1.48-5.51). CONCLUSIONS Clinically significant ACB was common in older Aboriginal Australians and was largely attributable to inappropriate use of tricyclic antidepressants. Greater awareness of medication-related risk factors among both health care professionals and Aboriginal communities can play an important role in improving health and quality of life outcomes.
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Affiliation(s)
- Karen Mate
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Karen Kerr
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Alison Priestley
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Natasha Weaver
- School of Medicine & Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Gerald A Broe
- Neuroscience Research Australia, Randwick, NSW, Australia
- Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Gail Daylight
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Brian Draper
- Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
- Department of Old Age Psychiatry, Prince of Wales Hospital, RandwickNSW, Australia
| | - Robert Cumming
- School of Public Health, University of Sydney, Darlington, NSW, Australia
| | - Hemi Robinson-Kingi
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, Randwick, NSW, Australia
- Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Kylie Radford
- Neuroscience Research Australia, Randwick, NSW, Australia
- Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
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González-Bermejo D, Castillo-Cano B, Rodríguez-Pascual A, García-Martín MF, Álvarez-Gutiérrez A, Montero-Corominas D, Huerta-Álvarez C. Effect of regulatory interventions on agomelatine use in Spain: A multiple intervention time-series analysis in a nationwide electronic healthcare record database. Pharmacoepidemiol Drug Saf 2021; 31:294-301. [PMID: 34676940 DOI: 10.1002/pds.5374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/25/2021] [Accepted: 10/15/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Liver injury is an important identified risk for agomelatine and several measures were put in place to prevent and minimize such risk. The study aims to assess the impact of four interventions on the incidence of agomelatine use, particularly among patients aged ≥75 in Spain between 2011 and 2018. METHODS Quasi-experimental interrupted time-series analysis to examine data from a nationwide electronic healthcare record database (BIFAP). Quarterly cumulative incidence of agomelatine use per 100 000 patients was calculated and the impact of four regulatory interventions was quantified. RESULTS The incidence of agomelatine use decreased by 85% and 87% from first quarter 2011 to last quarter 2018 in patients below and above 75 years old, respectively. Regulatory actions taken were not associated with an immediate and significant falling level of use or slope. The incidence was less than expected 6 months after the first and third intervention for patients below and above 75 years old, and more than expected after the second and fourth intervention for both populations, though these analyses were underpowered to observe significant results. The downward trend became less pronounced, reaching a residual level of use, which remained stable in the last segment of the study period. CONCLUSION New users of agomelatine decreased throughout the study period, starting before interventions took place. The effect of specific interventions might be masked by the progressive decrease tendency, constant over the study period. The effects of external factors that might overlap, unintended consequences, and issues concerning statistical modeling in situations where rates are already falling, should be considered when interpreting the results.
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Affiliation(s)
- Diana González-Bermejo
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Belén Castillo-Cano
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Alfonso Rodríguez-Pascual
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Mª Félix García-Martín
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Arturo Álvarez-Gutiérrez
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Dolores Montero-Corominas
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Consuelo Huerta-Álvarez
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
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10
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Forgerini M, Schiavo G, Lucchetta RC, Mastroianni PDC. Drug interactions for elderly people with mental and behavioral disorders: a systematic scoping review. Arch Gerontol Geriatr 2021; 93:104283. [PMID: 33227533 DOI: 10.1016/j.archger.2020.104283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/08/2020] [Accepted: 10/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To identify drug interactions of potentially inappropriate medications and mental and behavioral disorders, according to explicit potentially inappropriate medications criteria-based tools. METHODOLOGY A systematic scoping review was conducted in February 2020. Study characteristics, potentially inappropriate medications, drug interactions, rationale, and therapeutic management proposed were extracted. The commercialization and potentially inappropriate medications standard as essential in Brazil and in the world were identified. Therapeutic management was proposed for the most cited potentially inappropriate medications. RESULTS 36 tools including 151 drug interactions, in addition to 132 potentially inappropriate medications with concerns related to six mental and behavioral disorders were identified. Cognitive impairment and dementia were the most frequently disorders reported and antipsychotics, anticholinergics, and benzodiazepines were the pharmacological classes more involved in the drug interactions. Despite the tools recommended risperidone and quetiapine when the use of antipsychotics were inevitable; levodopa + carbidopa for Parkinson's disease; and short and intermediate half-life benzodiazepines; the quality of the evidence needs to be assessed. In this review, sleep hygiene; deprescription; medication review; and clinical monitoring of adverse drug reactions are strongly recommended. In addition, to consider agomelatine, bupropion, moclobemide and melatonin as potential safer options for benzodiazepines. CONCLUSION Knowing the clinical conditions or risk morbidities associated with the use of potentially inappropriate medications and management of these medications for safer therapeutic equivalents or non-pharmacotherapeutic alternatives are relevant for patient safety.
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Affiliation(s)
- Marcela Forgerini
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil.
| | - Geovana Schiavo
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil.
| | - Rosa Camila Lucchetta
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil.
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Scarante FF, Ribeiro MA, Almeida-Santos AF, Guimarães FS, Campos AC. Glial Cells and Their Contribution to the Mechanisms of Action of Cannabidiol in Neuropsychiatric Disorders. Front Pharmacol 2021; 11:618065. [PMID: 33613284 PMCID: PMC7890128 DOI: 10.3389/fphar.2020.618065] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/03/2020] [Indexed: 12/18/2022] Open
Abstract
Cannabidiol (CBD) is a phytocannabinoid with a broad-range of therapeutic potential in several conditions, including neurological (epilepsy, neurodegenerative diseases, traumatic and ischemic brain injuries) and psychiatric disorders (schizophrenia, addiction, major depressive disorder, and anxiety). The pharmacological mechanisms responsible for these effects are still unclear, and more than 60 potential molecular targets have been described. Regarding neuropsychiatric disorders, most studies investigating these mechanisms have focused on neuronal cells. However, glial cells (astrocytes, oligodendrocytes, microglia) also play a crucial role in keeping the homeostasis of the central nervous system. Changes in glial functions have been associated with neuropathological conditions, including those for which CBD is proposed to be useful. Mostly in vitro studies have indicated that CBD modulate the activation of proinflammatory pathways, energy metabolism, calcium homeostasis, and the proliferative rate of glial cells. Likewise, some of the molecular targets proposed for CBD actions are f expressed in glial cells, including pharmacological receptors such as CB1, CB2, PPAR-γ, and 5-HT1A. In the present review, we discuss the currently available evidence suggesting that part of the CBD effects are mediated by interference with glial cell function. We also propose additional studies that need to be performed to unveil the contribution of glial cells to CBD effects in neuropsychiatric disorders.
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Affiliation(s)
- Franciele F. Scarante
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Melissa A. Ribeiro
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana F. Almeida-Santos
- Department of Physiology and Biophysics, Biological Science Institute, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Francisco S. Guimarães
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Alline C. Campos
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Treatment response of lithium augmentation in geriatric compared to non-geriatric patients with treatment-resistant depression. J Affect Disord 2019; 251:136-140. [PMID: 30921597 DOI: 10.1016/j.jad.2019.03.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/09/2019] [Accepted: 03/19/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Lithium augmentation (LA) of antidepressants is an effective strategy for treatment-resistant depression (TRD). Nevertheless, it is rarely used in geriatric patients. The purpose of this study was to investigate treatment response of LA in geriatric compared to non-geriatric patients. METHOD In a prospective multicenter cohort study, severity of depression was measured weekly in 167 patients with unipolar depression (nage≥65years = 22; nage<65years = 145) at baseline and over at least four weeks of LA. RESULTS Geriatric patients showed a significantly better response to LA compared to non-geriatric patients (Hazard Ratio = 1.91; p = 0.04). LIMITATIONS An important limitation of our study is the lack of a control group of LA and the missing evaluation of side effects in both groups. CONCLUSIONS This is the first study investigating the efficacy of LA for TRD in geriatric compared to non-geriatric patients. Our data suggest that LA is an effective treatment option in geriatric patients that clinicians might consider more frequently and earlier on in the course of treatment.
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Jia Y, Li M, Cheng Z, Cui L, Zhao J, Liu Y, Leng M, Li F, Chen L. Morita therapy for depression in adults: A systematic review and meta-analysis. Psychiatry Res 2018; 269:763-771. [PMID: 30380592 DOI: 10.1016/j.psychres.2018.08.108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 08/19/2018] [Accepted: 08/27/2018] [Indexed: 11/16/2022]
Abstract
Morita therapy is a systematic psychological therapy that aims to improve everyday functioning rather than target specific symptoms. However, there has been no systematic review evaluating the evidence of the effectiveness of Morita therapy in the treatment of depression. The aim of this study was to assess the clinical efficacy of Morita therapy in combination with pharmacotherapy in patients 18 and older who were diagnosed with current depressive disorder. A total of 840 patients with depression from 11 randomized controlled trial (RCT) studies were included in this meta-analysis after a literature search of 10 databases was performed from database inception to July 1, 2017. All the eligible studies were determined to have an unclear or high risk of bias. Morita therapy plus pharmacotherapy was significantly superior to pharmacotherapy alone in reducing depression severity. The remission rate of the Morita therapy plus pharmacotherapy group was better than that of the pharmacotherapy alone group. Morita therapy significantly reduced depression severity symptoms and improved the remission rate. Due to the relatively weak quality of the included studies, definitive conclusions cannot be made. Thus, multi-center, well-designed clinical trials with larger cohorts are urgently needed to support the clinical application of Morita therapy.
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Affiliation(s)
- Yong Jia
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Min Li
- Invasive Technology Department, The First Hospital Jilin University, No. 18 Ziqiang Street, Changchun, Jilin 130041, China.
| | - Zhaohua Cheng
- Hepatobiliary and Pancreatic Surgery Department, The Second Hospital Jilin University, No. 71 Xinmin Street, Changchun, Jilin 130021, China.
| | - Lianzhi Cui
- Clinical Laboratory, Jilin Cancer Hospital, Changchun, China
| | - Jinping Zhao
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Yufei Liu
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Minmin Leng
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Feng Li
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Li Chen
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China; Department of Pharmacology, college of Basic Medical sciences, Jilin University, No. 126 Xinmin Street, Changchun, Jilin 130021, China.
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Limandri BJ. Treatment-Resistant Depression: Identification and Treatment Strategies. J Psychosoc Nurs Ment Health Serv 2018; 56:11-15. [DOI: 10.3928/02793695-20180808-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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15
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Vartolomei L, Ferro M, Mirone V, Shariat SF, Vartolomei MD. Systematic Review: Depression and Anxiety Prevalence in Bladder Cancer Patients. Bladder Cancer 2018; 4:319-326. [PMID: 30112443 PMCID: PMC6087432 DOI: 10.3233/blc-180181] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Depression affects more than 300 million people of all ages worldwide. In patients with cancer the reported prevalence is up to 24%. Objective: To systematically review the literature to report the prevalence of depression and anxiety among patients with bladder cancer (BC). Methods: Web of Science, MEDLINE/PubMed, and The Cochrane Library were searched between January and March 2018 using the terms “bladder carcinoma OR bladder cancer AND depression OR anxiety”. Results: Thirteen studies encompassing 1659 patients with BC were included. Six studies assessed depression prior and after treatment at 1, 6 and 12 months. Three were conducted in the US, one each in Turkey, Sweden/Egypt and China. Four studies showed a reduction of depression after radical cystectomy (RC) at 1, 6 and 12 months, respectively. Contrary, two studies showed no significant difference in depression between baseline and follow-up. Four studies investigated anxiety; they reported a slight reduction in anxiety score compared to baseline. Seven additional studies reported the prevalence of depression and anxiety (five studies) among patients with BC at a specific time-point. Studies were conducted in Sweden (2), Italy, Greece, US, China and Spain. Pretreatment depression rates ranged from 5.7 to 23.1% and post-treatment from 4.7 to 78%. Post-treatment anxiety rates ranged from 12.5 to 71.3%. Conclusions: The prevalence of reported depression and anxiety among BC patients is high with large geographic heterogeneity. Gender and geriatric specific screening and management for anxiety and depression should be implemented to alleviate suffering.
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Affiliation(s)
- Liliana Vartolomei
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Clinical Psychology, University "Dimitrie Cantemir", Tirgu Mures, Romania
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples, Naples, Italy
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Mihai Dorin Vartolomei
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania
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Seifert R. Rethinking Pharmacological Nomenclature. Trends Pharmacol Sci 2018; 39:785-797. [PMID: 30025604 DOI: 10.1016/j.tips.2018.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/19/2018] [Accepted: 06/25/2018] [Indexed: 12/12/2022]
Abstract
Pharmacological nomenclature has been continuously developed over the last century and taught to generations of medical, pharmacy, and science students. Many pharmacological terms coined decades ago remain in textbooks and the scientific literature. With the advancement in the field and the identification of molecular drug targets, rethinking the pharmacological terms in the context of these new findings has become imperative. Some examples of such terms are antihistamine, beta blocker, calcium antagonist, disease-modifying antirheumatic drug (DMARD), and non-steroidal anti-inflammatory drug (NSAID). This opinion article is an attempt to generate discussion in the community that the better way forward to name/rename pharmacological terms would be according to their mechanism of action. A mechanism-based nomenclature provides important information about therapeutic and adverse effects of drugs. Abbreviations for drug classes have also been suggested. A parsimonious, practical, and mechanism-oriented pharmacological nomenclature will ultimately improve quality and safety of drug therapy.
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Affiliation(s)
- Roland Seifert
- Institute of Pharmacology, Hannover Medical School, Carl-Neuberg-Straße 1, D-30625 Hannover, Germany.
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