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Chiarentin R, Pereira Bottcher D, Zeni B, Grave C, Neutzling Kaufmann F, Emmanoella Sebulsqui Saraiva T, da Costa Berna G, Aline Führ G, Saraiva Hermann B, Hoffmeister B, Dal Pont Morisso F, Feiffer Charão M, Gasparin Verza S, Deise Fleck J, Heemann Betti A, Bastos de Mattos C. Development and pharmacological evaluation of liposomes and nanocapsules containing paroxetine hydrochloride. Int J Pharm 2024; 660:124304. [PMID: 38848799 DOI: 10.1016/j.ijpharm.2024.124304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024]
Abstract
Depression is one of the most common psychiatric disorders. Nanotechnology has emerged to optimize the pharmacological response. Therefore, the aim of this work was to develop and characterize liposomes and nanocapsules containing paroxetine hydrochloride and evaluate their antidepressant-like effect using the open field and tail suspension tests in mice. Liposomes and nanocapsules were prepared using the reverse-phase evaporation and nanoprecipitation methods, respectively. The particle size of the formulation ranged from 121.81 to 310.73 nm, the polydispersity index from 0.096 to 0.303, the zeta potential from -11.94 to -34.50 mV, the pH from 5.31 to 7.38, the drug content from 80.82 to 94.36 %, and the association efficiency was 98 %. Paroxetine hydrochloride showed slower release when associated with liposomes (43.82 %) compared to nanocapsules (95.59 %) after 10 h. In Vero cells, in vitro toxicity showed a concentration-dependent effect for paroxetine hydrochloride nanostructures. Both nanostructures decreased the immobility time in the TST at 2.5 mg/kg without affecting the number of crossings in the open field test, suggesting the antidepressant-like effect of paroxetine. In addition, the nanocapsules decreased the number of groomings, reinforcing the anxiolytic effect of this drug. These results suggest that the nanostructures were effective in preserving the antidepressant-like effect of paroxetine hydrochloride even at low doses.
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Affiliation(s)
- Raquel Chiarentin
- Bioanalysis Laboratory, Health Sciences Institute, Feevale University, Novo Hamburgo, RS, Brazil; Postgraduate Program in Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, RS, Brazil
| | | | - Bruna Zeni
- Bioanalysis Laboratory, Health Sciences Institute, Feevale University, Novo Hamburgo, RS, Brazil
| | - Carolina Grave
- Bioanalysis Laboratory, Health Sciences Institute, Feevale University, Novo Hamburgo, RS, Brazil; Postgraduate Program in Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, RS, Brazil
| | | | - Thalia Emmanoella Sebulsqui Saraiva
- Bioanalysis Laboratory, Health Sciences Institute, Feevale University, Novo Hamburgo, RS, Brazil; Postgraduate Program in Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, RS, Brazil
| | - Gabriel da Costa Berna
- Bioanalysis Laboratory, Health Sciences Institute, Feevale University, Novo Hamburgo, RS, Brazil
| | - Giulia Aline Führ
- Bioanalysis Laboratory, Health Sciences Institute, Feevale University, Novo Hamburgo, RS, Brazil
| | - Bruna Saraiva Hermann
- Molecular Microbiology Laboratory, Health Sciences Institute, Feevale University, Novo Hamburgo, RS, Brazil; Postgraduate Program in Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, RS, Brazil
| | - Bruna Hoffmeister
- Molecular Microbiology Laboratory, Health Sciences Institute, Feevale University, Novo Hamburgo, RS, Brazil; Postgraduate Program in Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, RS, Brazil
| | - Fernando Dal Pont Morisso
- Advanced Materials Studies Laboratory, Creative and Technological Sciences Institute, Feevale University, Novo Hamburgo, RS, Brazil; Postgraduate Program in Materials Technology and Industrial Processes, Feevale University, Novo Hamburgo, RS, Brazil
| | - Mariele Feiffer Charão
- Bioanalysis Laboratory, Health Sciences Institute, Feevale University, Novo Hamburgo, RS, Brazil; Postgraduate Program in Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, RS, Brazil
| | - Simone Gasparin Verza
- Bioanalysis Laboratory, Health Sciences Institute, Feevale University, Novo Hamburgo, RS, Brazil; Postgraduate Program in Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, RS, Brazil
| | - Juliane Deise Fleck
- Molecular Microbiology Laboratory, Health Sciences Institute, Feevale University, Novo Hamburgo, RS, Brazil; Postgraduate Program in Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, RS, Brazil
| | - Andresa Heemann Betti
- Bioanalysis Laboratory, Health Sciences Institute, Feevale University, Novo Hamburgo, RS, Brazil; Postgraduate Program in Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, RS, Brazil
| | - Cristiane Bastos de Mattos
- Bioanalysis Laboratory, Health Sciences Institute, Feevale University, Novo Hamburgo, RS, Brazil; Postgraduate Program in Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, RS, Brazil.
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Yadla VS, Nj P, Kamarthy P, Matti MR. Effect of Integrated Yoga as an Adjuvant to Standard Care for Panic Disorder: A Randomized Control Trial Study. Cureus 2024; 16:e53286. [PMID: 38435873 PMCID: PMC10905419 DOI: 10.7759/cureus.53286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Individuals wrestling with panic disorder (PD) know all too well its debilitating impact. Sudden, intense fear episodes disrupt lives and erode well-being. Fortunately, integrating complementary therapies like yoga with standard treatment offers a glimmer of hope for improved outcomes. Yoga's unique blend of physical postures (asanas), breathing exercises (pranayama), and meditative practices holds promise for mitigating anxiety and fostering a sense of inner peace, potentially making it a valuable tool in the fight against panic disorder. METHODS AND MATERIALS This study investigated the effect of yoga as an adjuvant to standard care for panic disorder. Sixty-four panic disorder patients of both genders previously diagnosed with panic disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were randomly assigned to the yoga group (n = 32) and the control group. The yoga group participated in integrated yoga sessions lasting 60 minutes, five days a week, for 12 weeks. Both groups received standard care. Pre- and post-intervention data were collected for HAM-A and WHOQOL-BREF. RESULTS The yoga group exhibited a significant reduction in HAM-A scores (Pre: 49.13 ± 4.55, Post: 13.53 ± 5.54, p < 0.001) with a substantial effect size of 7.02. Quality of life significantly improved across all domains (physical, psychological, social, and environmental) in the yoga group (p < 0.001), demonstrating effect sizes ranging from 4.11 to 4.57. Control group participants also experienced improvements, though less pronounced. Between-group comparisons revealed significant differences in anxiety reduction (p = 0.042) and quality of life enhancement (p < 0.001), favouring the yoga group. CONCLUSION The results suggest that yoga can be a valuable complementary or alternative approach to traditional treatments for anxiety disorders.
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Affiliation(s)
- Vishwa Sree Yadla
- Department of Integrative Medicine, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Patil Nj
- Department of Integrative Medicine, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
- Department of Yoga, Center for Integrative Medicine and Research (CIMR), Manipal, IND
| | - Prabhakar Kamarthy
- Department of General Medicine, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Mohan Reddy Matti
- Department of Psychiatry, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
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Aksu S, Soyata AZ, Mursalova Z, Eskicioğlu G, Tükel R. Transcranial direct current stimulation does not improve clinical and neurophysiological outcomes in panic disorder: A randomized sham-controlled trial. Psychiatry Clin Neurosci 2022; 76:384-392. [PMID: 35587504 DOI: 10.1111/pcn.13378] [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: 12/10/2021] [Revised: 05/08/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
AIM Emerging evidence suggests that transcranial direct current stimulation (tDCS) has anxiolytic effects and may enhance emotional processing of threat and reduce threat-related attentional bias. Panic disorder (PD) is considered to be a fear network disorder along with prefrontal activity alterations. We aim to assess the effect of tDCS on clinical and physiological parameters in PD for the first time. METHODS In this triple-blind randomized sham-controlled pilot study, 30 individuals with PD were allocated into active and sham groups to receive 10 sessions of tDCS targeting the dorsolateral prefrontal cortex bilaterally at 2 mA for 20-min duration over 2 weeks. The clinical severity, threat-related attentional bias, interoceptive accuracy, and emotional recognition were assessed before, immediately after, and 1 month after tDCS. RESULTS Active tDCS, in comparison to sham, did not elicit more favorable clinical and neuropsychological/physiological outcomes in PD. CONCLUSION The present study provides the first clinical and neurobehavioral results of prefrontal tDCS in PD and indicates that prefrontal tDCS was not superior to sham in PD.
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Affiliation(s)
- Serkan Aksu
- Department of Physiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.,Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Zhala Mursalova
- Department of Psychiatry, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gaye Eskicioğlu
- Department of Psychology, Istanbul University, Istanbul, Turkey
| | - Raşit Tükel
- Department of Psychiatry, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Understanding the Life, Pain, and Barriers to Physical Activity in Korean Patients with Panic Disorder: Photovoice Inquiry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158140. [PMID: 34360432 PMCID: PMC8346144 DOI: 10.3390/ijerph18158140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
Purpose: This study attempted to understand the life, pain, and barriers to physical activity in the daily life of patients with panic disorder (PD). It aimed to provide specific evidence to promote physical activity for patients, suggesting that suitable physical activity strategies for patients with PD would be of value. Methods: Seven patients were invited to participate in a photovoice study. Photovoice is one example of participatory action research. Results: This study inductively identified two main themes: the life and pain of patients with PD and perceived barriers to participate in physical activity by patients with panic disorder. Conclusion: Based on a specific understanding of the population, this study attempted to provide evidence why patients with panic disorder need appropriate physical-activity-promoting strategies.
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Caldirola D, Alciati A, Cuniberti F, Perna G. Experimental Drugs for Panic Disorder: An Updated Systematic Review. J Exp Pharmacol 2021; 13:441-459. [PMID: 33889031 PMCID: PMC8055642 DOI: 10.2147/jep.s261403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/25/2021] [Indexed: 01/02/2023] Open
Abstract
Several effective pharmacological therapies for panic disorder (PD) are available, but they have some drawbacks, and unsatisfactory outcomes can occur. Expanding the variety of anti-panic medications may allow for improving PD treatment. The authors performed an updated systematic review of preclinical and clinical (Phase I–III) pharmacological studies to look for advances made in the last six years concerning novel-mechanism-based anti-panic compounds or using medications approved for nonpsychiatric medical conditions to treat PD. The study included seven published articles presenting a series of preclinical studies, two Phase I clinical studies with orexin receptor (OXR) antagonists, and two clinical studies investigating the effects of D-cycloserine (DCS) and xenon gas in individuals with PD. The latest preclinical findings confirmed and expanded previous promising indications of OXR1 antagonists as novel-mechanism-based anti-panic compounds. Translating preclinical research into clinical applications remains in the early stages. However, limited clinical findings suggested the selective OXR1 antagonist JNJ-61393115 may exert anti-panic effects in humans. Overall, OXR1 antagonists displayed a favorable profile of short-term safety and tolerability. Very preliminary suggestions of possible anti-panic effects of xenon gas emerged but need confirmation with more rigorous methodology. DCS did not seem promising as an enhancer of cognitive-behavioral therapy in PD. Future studies, including objective panic-related physiological parameters, such as respiratory measures, and expanding the use of panic vulnerability biomarkers, such as hypersensitivity to CO2 panic provocation, may allow for more reliable conclusions about the anti-panic properties of new compounds.
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Affiliation(s)
- Daniela Caldirola
- Department of Biomedical Sciences, Humanitas University, Milan, 20090, Italy.,Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Como, 22032, Italy
| | - Alessandra Alciati
- Department of Biomedical Sciences, Humanitas University, Milan, 20090, Italy.,Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Como, 22032, Italy.,Humanitas Clinical and Research Center, IRCCS, Milan, Rozzano, 20089, Italy
| | - Francesco Cuniberti
- Department of Biomedical Sciences, Humanitas University, Milan, 20090, Italy.,Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Como, 22032, Italy
| | - Giampaolo Perna
- Department of Biomedical Sciences, Humanitas University, Milan, 20090, Italy.,Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Como, 22032, Italy
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Fordham B, Sugavanam T, Edwards K, Hemming K, Howick J, Copsey B, Lee H, Kaidesoja M, Kirtley S, Hopewell S, das Nair R, Howard R, Stallard P, Hamer-Hunt J, Cooper Z, Lamb SE. Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis. Health Technol Assess 2021; 25:1-378. [PMID: 33629950 PMCID: PMC7957459 DOI: 10.3310/hta25090] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials. OBJECTIVES This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy. DATA SOURCES The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019. REVIEW METHODS Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality. RESULTS A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions. LIMITATIONS Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them. CONCLUSION Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes. FUTURE WORK Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality. STUDY REGISTRATION This study is registered as PROSPERO CRD42017078690. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Beth Fordham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Thavapriya Sugavanam
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Katherine Edwards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Bethan Copsey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Hopin Lee
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Milla Kaidesoja
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Shona Kirtley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Roshan das Nair
- Department of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | | | | | - Zafra Cooper
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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Tretiakov A, Malakhova A, Naumova E, Rudko O, Klimov E. Genetic Biomarkers of Panic Disorder: A Systematic Review. Genes (Basel) 2020; 11:genes11111310. [PMID: 33158196 PMCID: PMC7694264 DOI: 10.3390/genes11111310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/30/2022] Open
Abstract
(1) Background: Although panic disorder (PD) is one of the most common anxiety disorders severely impacting quality of life, no effective genetic testing exists; known data on possible genetic biomarkers is often scattered and unsystematic which complicates further studies. (2) Methods: We used PathwayStudio 12.3 (Elsevier, The Netherlands) to acquire literature data for further manual review and analysis. 229 articles were extracted, 55 articles reporting associations, and 32 articles reporting no associations were finally selected. (3) Results: We provide exhaustive information on genetic biomarkers associated with PD known in the scientific literature. Data is presented in two tables. Genes COMT and SLC6A4 may be considered the most promising for PD diagnostic to date. (4) Conclusions: This review illustrates current progress in association studies of PD and may indicate possible molecular mechanisms of its pathogenesis. This is a possible basis for data analysis, novel experimental studies, or developing test systems and personalized treatment approaches.
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Affiliation(s)
- Artemii Tretiakov
- Faculty of Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (A.T.); (A.M.); (E.N.); (O.R.)
- Center of Genetics and Life Sciences, Sirius University of Science and Technology, 354340 Sochi, Russia
| | - Alena Malakhova
- Faculty of Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (A.T.); (A.M.); (E.N.); (O.R.)
| | - Elena Naumova
- Faculty of Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (A.T.); (A.M.); (E.N.); (O.R.)
- Center of Genetics and Life Sciences, Sirius University of Science and Technology, 354340 Sochi, Russia
| | - Olga Rudko
- Faculty of Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (A.T.); (A.M.); (E.N.); (O.R.)
- Center of Genetics and Life Sciences, Sirius University of Science and Technology, 354340 Sochi, Russia
| | - Eugene Klimov
- Faculty of Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (A.T.); (A.M.); (E.N.); (O.R.)
- Center of Genetics and Life Sciences, Sirius University of Science and Technology, 354340 Sochi, Russia
- Correspondence:
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Caldirola D, Alciati A, Daccò S, Micieli W, Perna G. Relapse prevention in panic disorder with pharmacotherapy: where are we now? Expert Opin Pharmacother 2020; 21:1699-1711. [PMID: 32543949 DOI: 10.1080/14656566.2020.1779220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: A substantial number of patients with PD experience relapse after the discontinuation of effective pharmacotherapy, leading to detrimental effects on the individuals and considerable societal costs. This suggests the need to optimize pharmacotherapy to minimize relapse risk. Area covered: The present systematic review examines randomized, double-blind, placebo-controlled relapse prevention studies published over the last 20 years involving recommended medications. The authors aim to provide an overview of this topic and evaluate whether recent advances were achieved. Only seven studies were included, providing limited results. One-year maintenance pharmacotherapy with constant doses had protective effects against relapse in patients who had previously exhibited satisfactory responses to the same medication at the same doses. The duration of maintenance treatment did not influence relapse risk. No data were available concerning the use of lower doses or the predictors of relapse. Expert opinion: Relapse prevention in PD has received limited attention. Recent progress and conclusive indications are lacking. Rethinking pharmacological research in PD may be productive. Collecting a wide range of clinical and individual features/biomarkers in large-scale, multicenter long-term naturalistic studies, and implementing recent technological innovations (e.g., electronic medical records/'big data' platforms, wearable devices, and machine learning techniques) may help identify reliable predictive models.
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Affiliation(s)
- Daniela Caldirola
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias , Albese Con Cassano (Como), Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele (Milan), Italy
| | - Alessandra Alciati
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias , Albese Con Cassano (Como), Italy.,Humanitas Clinical and Research Center, IRCCS , Rozzano (Milan), Italy
| | - Silvia Daccò
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias , Albese Con Cassano (Como), Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele (Milan), Italy
| | - Wilma Micieli
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias , Albese Con Cassano (Como), Italy
| | - Giampaolo Perna
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias , Albese Con Cassano (Como), Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele (Milan), Italy.,Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht, The Netherlands.,Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, Miami University , Miami, FL, USA
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Šago D, Babić G, Bajić Ž, Filipčić I. Panic Disorder as Unthinkable Emotions: Alexithymia in Panic Disorder, a Croatian Cross-Sectional Study. Front Psychiatry 2020; 11:466. [PMID: 32581863 PMCID: PMC7282461 DOI: 10.3389/fpsyt.2020.00466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/06/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Previous research on alexithymia has led to controversy over its prevalence in panic disorder. The aim of this study was to assess the difference in the prevalence of alexithymia in panic disorder and other anxiety disorders. DESIGN AND METHODS We performed a cross-sectional study on a sample of 71 patients diagnosed with panic disorder and 113 patients diagnosed with other anxiety disorders; both groups were 18-50 years old. Primary outcome was the 20-item Toronto Alexithymia Scale (TAS) score. Secondary outcome was the prevalence of alexithymia defined as a TAS score ≥61. RESULTS Patients diagnosed with panic disorder had a 25% higher score on the TAS subscale of difficulty identifying feelings than patients diagnosed with other anxiety disorders. The prevalence of alexithymia was 27% in patients with panic disorder and 13% in patients with other anxiety disorders. Patients diagnosed with panic disorder had significantly higher odds for alexithymia. CONCLUSIONS The results of our study support the hypothesis of higher prevalence of alexithymia in individuals with panic disorder than in individuals with other anxiety disorders. In addition, difficulty identifying feelings as a salient feature of alexithymia is higher in panic disorder than in other anxiety disorders.
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Affiliation(s)
- Daniela Šago
- Day Hospital for Psychotic Disorder, Psychiatric Hospital Sveti Ivan, Zagreb, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Goran Babić
- Independent Researcher, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Žarko Bajić
- Day Hospital for Psychotic Disorder, Psychiatric Hospital Sveti Ivan, Zagreb, Croatia
| | - Igor Filipčić
- Day Hospital for Psychotic Disorder, Psychiatric Hospital Sveti Ivan, Zagreb, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia.,Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Davanço MG, Meulman J, Guzmán MRP, Palomino DMH, Tuiran CMG, Duarte FG, de Campos DR. A randomized, single-dose, two-sequence, two-period, crossover study to assess the bioequivalence between two formulations of clonazepam tablet in healthy subjects. Drug Dev Ind Pharm 2019; 45:1982-1987. [PMID: 31702402 DOI: 10.1080/03639045.2019.1689994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Clonazepam is a benzodiazepine commonly prescribed to treat panic disorder, epilepsy, anxiety, depression and certain types of seizures. This study aimed to evaluate the bioequivalence between two formulations of clonazepam tablets in order to meet regulatory requirements for marketing in Colombia and other countries in Latin America. An open-label, randomized, single-dose, two-period, two-sequence, two-treatment crossover study was conducted in 36 healthy subjects of both genders. Subjects received a single dose of clonazepam 2 mg test tablet (Sanofi-Aventis de Colombia S.A.) and reference product (Rivotril®, Produtos Roche Químicos e Farmacêuticos S.A.) under fasting conditions according to a randomly assigned order with a 21-day washout period. Serial blood samples were collected up to 96 h post-dose. Plasma concentrations of clonazepam were obtained by a validated liquid chromatography-tandem mass spectrometry method. Pharmacokinetic parameters were calculated using non-compartmental methods. A total of 36 healthy subjects were enrolled and 31 of them completed the study. Twenty-nine adverse events were reported (11 events with test product versus 18 events with reference product). There were no serious adverse events during the study. Geometric mean ratios (90% confidence intervals) for Cmax and AUC0-96h were 103.28% (98.10-108.64) and 102.50% (99.87-105.19), respectively. The test formulation of clonazepam 2 mg tablet manufactured by Sanofi-Aventis de Colombia S.A. was considered bioequivalent to reference product Rivotril® (Produtos Roche Químicos e Farmacêuticos S.A.) according to regulatory requirements. Both formulations were safe and well-tolerated during the study.
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Affiliation(s)
| | - Jessica Meulman
- Sanofi Medley Farmacêutica Ltda, Industrial Development, Campinas, Brazil
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Caldirola D, Perna G. Toward a personalized therapy for panic disorder: preliminary considerations from a work in progress. Neuropsychiatr Dis Treat 2019; 15:1957-1970. [PMID: 31371969 PMCID: PMC6628946 DOI: 10.2147/ndt.s174433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/20/2019] [Indexed: 12/18/2022] Open
Abstract
Although several treatment options for panic disorder (PD) are available, the best intervention for each individual patient remains uncertain and the use of a more personalized therapeutic approach in PD is required. In clinical practice, clinicians combine general scientific information and personal experience in the decision-making process to choose a tailored treatment for each patient. In this sense, clinicians already use a somehow personalized medicine strategy. However, the influence of their interpretative personal models may lead to bias related to personal convictions, not sufficiently grounded on scientific evidence. Hence, an effort to give some advice based on the science of personalized medicine could have positive effects on clinicians' decisions. Based on a narrative review of meta-analyses, systematic reviews, and experimental studies, we proposed a first-step attempt of evidence-based personalized therapy for PD. We focused on some phenomenological profiles, encompassing symptoms during/outside panic attacks, related patterns of physiological functions, and some aspects of physical health, which might be worth considering when developing treatment plans for patients with PD. We considered respiratory, cardiac, vestibular, and derealization/depersonalization profiles, with related implications for treatment. Given the extensiveness of the topic, we considered only medications and some somatic interventions. Our proposal should be considered neither exhaustive nor conclusive, as it is meant as a very preliminary step toward a future, robust evidence-based personalized therapy for PD. Clearly much more work is needed to achieve this goal, and recent technological advances, such as wearable devices, big data platforms, and the application of machine learning techniques, may help obtain reliable findings. We believe that combining the efforts of different research groups in this work in progress can lead to largely shared conclusions in the near future.
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Affiliation(s)
- Daniela Caldirola
- Humanitas University, 20090 Pieve Emanuele, Milan, Italy.,Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, 22032 Albese Con Cassano, Como, Italy
| | - Giampaolo Perna
- Humanitas University, 20090 Pieve Emanuele, Milan, Italy.,Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, 22032 Albese Con Cassano, Como, Italy.,Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 Maastricht, The Netherlands.,Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, Miami University, Miami, FL 33136 -1015, USA
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Affiliation(s)
- Yong-Ku Kim
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
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