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Rojas-Solé C, Pinilla-González V, Lillo-Moya J, González-Fernández T, Saso L, Rodrigo R. Integrated approach to reducing polypharmacy in older people: exploring the role of oxidative stress and antioxidant potential therapy. Redox Rep 2024; 29:2289740. [PMID: 38108325 PMCID: PMC10732214 DOI: 10.1080/13510002.2023.2289740] [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] [Indexed: 12/19/2023] Open
Abstract
Increased life expectancy, attributed to improved access to healthcare and drug development, has led to an increase in multimorbidity, a key contributor to polypharmacy. Polypharmacy is characterised by its association with a variety of adverse events in the older persons. The mechanisms involved in the development of age-related chronic diseases are largely unknown; however, altered redox homeostasis due to ageing is one of the main theories. In this context, the present review explores the development and interaction between different age-related diseases, mainly linked by oxidative stress. In addition, drug interactions in the treatment of various diseases are described, emphasising that the holistic management of older people and their pathologies should prevail over the individual treatment of each condition.
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Affiliation(s)
- Catalina Rojas-Solé
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Víctor Pinilla-González
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - José Lillo-Moya
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Tommy González-Fernández
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Luciano Saso
- Department of Physiology and Pharmacology “Vittorio Erspamer”, Faculty of Pharmacy and Medicine, Sapienza University, Rome, Italy
| | - Ramón Rodrigo
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
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Tong Y, Wang Q, Wang X, Xiang Y, Cheng L, Hu X, Chen Y, Huo L, Xu Y, Liu S. A scoping review of functional near-infrared spectroscopy biomarkers in late-life depression: Depressive symptoms, cognitive functioning, and social functioning. Psychiatry Res Neuroimaging 2024; 341:111810. [PMID: 38555800 DOI: 10.1016/j.pscychresns.2024.111810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/21/2024] [Accepted: 03/13/2024] [Indexed: 04/02/2024]
Abstract
Late-life depression is one of the most damaging mental illnesses, disrupting the normal lives of older people by causing chronic illness and cognitive impairment. Patients with late-life depression, accompanied by changes in appetite, insomnia, fatigue and guilt, are more likely to experience irritability, anxiety and somatic symptoms. It increases the risk of suicide and dementia and is a major challenge for the public health systems. The current clinical assessment, identification and effectiveness assessment of late-life depression are primarily based on history taking, mental status examination and scale scoring, which lack subjectivity and precision. Functional near-infrared spectroscopy is a rapidly developing optical imaging technology that objectively reflects the oxygenation of hemoglobin in different cerebral regions during different tasks and assesses the functional status of the cerebral cortex. This article presents a comprehensive review of the assessment of functional near-infrared spectroscopy technology in assessing depressive symptoms, social functioning, and cognitive functioning in patients with late-life depression. The use of functional near-infrared spectroscopy provides greater insight into the neurobiological mechanisms underlying depression and helps to assess these three aspects of functionality in depressed patients. In addition, the study discusses the limitations of previous research and explores potential advances in the field.
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Affiliation(s)
- Yujie Tong
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Qiwei Wang
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Xiao Wang
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yuxian Xiang
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Long Cheng
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Xiaodong Hu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Yun Chen
- Department of Geriatrics, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Luyao Huo
- Department of Psychiatry, Children's Hospital of Shanxi, Women Health Center of Shanxi, Taiyuan, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China.
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Shariati F, Tandan N, Lavie CJ. Resistant hypertension. Curr Opin Cardiol 2024; 39:266-272. [PMID: 38456513 DOI: 10.1097/hco.0000000000001134] [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: 03/09/2024]
Abstract
PURPOSE OF REVIEW Resistant hypertension (RH) is characterized by persistently elevated blood pressure despite the concurrent use of three antihypertensive medications, including a diuretic, at optimal doses. This clinical phenomenon poses a significant burden on healthcare systems worldwide due to its association with increased cardiovascular disease morbidity and mortality. RECENT FINDINGS Ongoing studies on device-based treatment of RH, with aim to reduce sympathetic nervous system outflow, have shown promising evidence in management of RH which may in turn decrease the incidence of composite cardiovascular outcome faced by the affected population. SUMMARY This paper aims to provide a comprehensive overview of RH, and review some of the diagnostic and therapeutic approaches in management of RH.
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Affiliation(s)
- Farnoosh Shariati
- Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, Louisiana, USA
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Dzau VJ, Hodgkinson CP. Precision Hypertension. Hypertension 2024; 81:702-708. [PMID: 38112080 DOI: 10.1161/hypertensionaha.123.21710] [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] [Indexed: 12/20/2023]
Abstract
Hypertension affects >1 billion people worldwide. Complications of hypertension include stroke, renal failure, cardiac hypertrophy, myocardial infarction, and cardiac failure. Despite the development of various antihypertensive drugs, the number of people with uncontrolled hypertension continues to rise. While the lack of compliance associated with frequent side effects to medication is a contributory issue, there has been a failure to consider the diverse nature of hypertensive populations. Instead, we propose that hypertension can only be truly managed by precision. A precision medicine approach would consider each patient's unique factors. In this review, we discuss the progress toward precision medicine for hypertension with more predictiveness and individualization of treatment. We will highlight the advances in data science, omics (genomics, metabolomics, proteomics, etc), artificial intelligence, gene therapy, and gene editing and their application to precision hypertension.
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Affiliation(s)
- Victor J Dzau
- Mandel Center for Hypertension and Atherosclerosis, the Duke Cardiovascular Research Center, Duke University Medical Center, Durham, NC (V.J.D., C.P.H.)
- National Academy of Medicine, Washington, DC (V.J.D.)
| | - Conrad P Hodgkinson
- Mandel Center for Hypertension and Atherosclerosis, the Duke Cardiovascular Research Center, Duke University Medical Center, Durham, NC (V.J.D., C.P.H.)
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Lee J, Wang X, Liu C, Pathiravasan CH, Benjamin EJ, McManus DD, Murabito JM. Depressive symptoms are not associated with clinically important levels of digital home blood pressure in the electronic Framingham Heart Study. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:50-58. [PMID: 38765623 PMCID: PMC11096660 DOI: 10.1016/j.cvdhj.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background Depressive symptoms are common and share many biopsychosocial mechanisms with hypertension. Association studies between depressive symptoms and blood pressure (BP) have been inconsistent. Home BP monitoring may provide insight. Objective To investigate the association between depressive symptoms and digital home BP. Methods Electronic Framingham Heart Study (eFHS) participants were invited to obtain a smartphone app and digital BP cuff at research exam 3 (2016-2019). Participants with ≥3 weeks of home BP measurements within 1 year were included. Depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale (CES-D). Multivariable linear mixed models were used to test the associations of continuous CES-D score and dichotomous depressive symptoms (CES-D ≥16) (independent) with home BP (dependent), adjusting for age, sex, cohort, number of weeks since baseline, lifestyle factors, diabetes, and cardiovascular disease. Results Among 883 participants (mean age 54 years, 59% women, 91% White), the median CES-D score was 4. Depressive symptom prevalence was 7.6%. Mean systolic and diastolic BP at exam 3 were 119 and 76 mm Hg; hypertension prevalence was 48%. A 1 SD higher CES-D score was associated with 0.9 (95% CI: 0.18-1.56, P = .01) and 0.6 (95% CI: 0.06-1.07, P = .03) mm Hg higher home systolic BP and diastolic BP, respectively. Dichotomous depressive symptoms were not significantly associated with home BP (P > .2). Conclusion Depressive symptoms were not associated with clinically substantive levels of home BP. The association between depression and cardiovascular disease risk factors warrants more data, which may be supported by mobile health measures.
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Affiliation(s)
- Jasmine Lee
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Xuzhi Wang
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Chunyu Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts
| | | | - Emelia J. Benjamin
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - David D. McManus
- University of Massachusetts Chan Medical School, Boston, Massachusetts
| | - Joanne M. Murabito
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts
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Cao H, Baranova A, Zhao Q, Zhang F. Bidirectional associations between mental disorders, antidepressants and cardiovascular disease. BMJ MENTAL HEALTH 2024; 27:e300975. [PMID: 38490691 PMCID: PMC11021753 DOI: 10.1136/bmjment-2023-300975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/08/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Mental disorders have a high comorbidity with cardiovascular disease (CVD), but the causality between them has not been fully appreciated. OBJECTIVE This study aimed to systematically explore the bidirectional causality between the two broad categories of diseases. METHODS We conducted Mendelian randomisation (MR) and multivariable MR (MVMR) analyses to evaluate potential causal links between 10 mental disorders, the use of antidepressants and 7 CVDs. FINDINGS We discovered that major depressive disorder (MDD), attention-deficit/hyperactivity disorder (ADHD) and insomnia exhibit connections with elevated risks of two or more CVDs. Moreover, the use of antidepressants is linked to heightened risks of each CVD. Each distinct CVD is correlated with a greater probability of taking antidepressants. Our MVMR analysis demonstrated that the use of antidepressants is correlated with the elevation of respective risks across all cardiovascular conditions. This includes arrhythmias (OR: 1.28), atrial fibrillation (OR: 1.44), coronary artery disease (OR: 1.16), hypertension (OR: 1.16), heart failure (OR: 1.16), stroke (OR: 1.44) and entire CVD group (OR: 1.35). However, MDD itself was not linked to a heightened risk of any CVD. CONCLUSIONS The findings of our study indicate that MDD, insomnia and ADHD may increase the risk of CVD. Our findings highlight the utilisation of antidepressants as an independent risk factor for CVD, thus explaining the influence of MDD on CVD through the mediating effects of antidepressants. CLINICAL IMPLICATIONS When treating patients with antidepressants, it is necessary to take into consideration the potential beneficial and detrimental effects of antidepressants.
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Affiliation(s)
- Hongbao Cao
- School of Systems Biology, George Mason University, Fairfax, Virginia, USA
| | - Ancha Baranova
- School of Systems Biology, George Mason University, Fairfax, Virginia, USA
- Research Centre for Medical Genetics, Moscow, Russian Federation
| | - Qian Zhao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fuquan Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Institute of Neuropsychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Jiang Q, Velu P, Sohouli MH, Ziamanesh F, Shojaie S, Fatahi S, Li Q. The effects of bupropion alone and combined with naltrexone on blood pressure and CRP concentration: A systematic review and meta-regression analysis of randomized controlled trials. Eur J Clin Invest 2024; 54:e14118. [PMID: 37924302 DOI: 10.1111/eci.14118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Considering the conflicting effects of bupropion on parameters related to cardiovascular system including blood pressure and inflammation, in this meta-analysis study, we investigated the effects of this drug alone or in combination with naltrexone on systolic (SBP) and diastolic blood pressure (DBP) and C-reactive protein (CRP). METHODS Scopus, PubMed/Medline, Web of Science and Embase databases were searched using standard keywords to identify all controlled trials investigating effects of bupropion alone and combined with naltrexone on the BP and CRP. Pooled weighted mean difference and 95% confidence intervals (CIs) were achieved by random-effects model analysis for the best estimation of outcomes. RESULTS The pooled findings showed that that bupropion alone or in combination with naltrexone would significantly increase SBP (weighted mean difference (WMD): 1.34 mmHg, 95% CI: 0.38-2.29) and DBP (WMD: 0.93 mmHg, 95% CI 0.88-0.99) as well as decrease CRP (WMD: -0.89 mg/L, 95% CI -1.09 to -0.70). The findings of the subgroup also show the greater effect of bupropion on blood pressure (SBP and DBP) increase in a dose greater than 360 mg and a duration of intervention less equal to 26 weeks. In addition, the subgroup analysis showed that changes in SBP after receiving bupropion together with naltrexone were more compared to bupropion alone. CONCLUSIONS The addition of combination therapies such as bupropion and naltrexone can significantly improve CRP levels. However, its effect on blood pressure requires proper management of this drug.
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Affiliation(s)
- Qidong Jiang
- Intensive Care Unit, The Affiliated Hospital of Southwest Medical University, Luzhou City, China
| | - Periyannan Velu
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Chidambaram, Tamil Nadu, India
| | - Mohammad Hassan Sohouli
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fateme Ziamanesh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Shojaie
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Somaye Fatahi
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Qin Li
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Juraschek SP, Cortez MM, Flack JM, Ghazi L, Kenny RA, Rahman M, Spikes T, Shibao CA, Biaggioni I. Orthostatic Hypotension in Adults With Hypertension: A Scientific Statement From the American Heart Association. Hypertension 2024; 81:e16-e30. [PMID: 38205630 PMCID: PMC11067441 DOI: 10.1161/hyp.0000000000000236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Although orthostatic hypotension (OH) has long been recognized as a manifestation of autonomic dysfunction, a growing body of literature has identified OH as a common comorbidity of hypertension. This connection is complex, related to pathophysiology in blood pressure regulation and the manner by which OH is derived as the difference between 2 blood pressure measurements. While traditional therapeutic approaches to OH among patients with neurodegenerative disorders focus on increasing upright blood pressure to prevent cerebral hypoperfusion, the management of OH among patients with hypertension is more nuanced; resting hypertension is itself associated with adverse outcomes among these patients. Although there is substantial evidence that intensive blood pressure treatment does not cause OH in the majority of patients with essential hypertension, some classes of antihypertensive agents may unmask OH in patients with an underlying autonomic impairment. Practical steps to manage OH among adults with hypertension start with (1) a thorough characterization of its patterns, triggers, and cause; (2) review and removal of aggravating factors (often pharmacological agents not related to hypertension treatment); (3) optimization of an antihypertensive regimen; and (4) adoption of a tailored treatment strategy that avoids exacerbating hypertension. These strategies include countermaneuvers and short-acting vasoactive agents (midodrine, droxidopa). Ultimately, further research is needed on the epidemiology of OH, the impact of hypertension treatment on OH, approaches to the screening and diagnosis of OH, and OH treatment among adults with hypertension to improve the care of these patients and their complex blood pressure pathophysiology.
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Sun YY, Ni YJ, Wang RJ, Qin ZC, Liu Z, Xiao LH, Liu YQ. Establishment and Validation of a Transdermal Drug Delivery System for the Anti-Depressant Drug Citalopram Hydrobromide. Molecules 2024; 29:767. [PMID: 38398519 PMCID: PMC10892536 DOI: 10.3390/molecules29040767] [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: 01/04/2024] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
To enhance the bioavailability and antihypertensive effect of the anti-depressant drug citalopram hydrobromide (CTH) we developed a sustained-release transdermal delivery system containing CTH. A transdermal diffusion meter was first used to determine the optimal formulation of the CTH transdermal drug delivery system (TDDS). Then, based on the determined formulation, a sustained-release patch was prepared; its physical characteristics, including quality, stickiness, and appearance, were evaluated, and its pharmacokinetics and irritation to the skin were evaluated by applying it to rabbits and rats. The optimal formulation of the CTH TDDS was 49.2% hydroxypropyl methyl cellulose K100M, 32.8% polyvinylpyrrolidone K30, 16% oleic acid-azone, and 2% polyacrylic acid resin II. The system continuously released an effective dose of CTH for 24 h and significantly enhanced its bioavailability, with a higher area under the curve, good stability, and no skin irritation. The developed CTH TDDS possessed a sustained-release effect and good characteristics and pharmacokinetics; therefore, it has the potential for clinical application as an antidepressant.
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Affiliation(s)
- Yi-yang Sun
- College of Life Sciences, Nankai University, Tianjin 300071, China; (Y.-y.S.); (Y.-j.N.); (R.-j.W.); (Z.-c.Q.)
| | - Ya-jing Ni
- College of Life Sciences, Nankai University, Tianjin 300071, China; (Y.-y.S.); (Y.-j.N.); (R.-j.W.); (Z.-c.Q.)
| | - Run-jia Wang
- College of Life Sciences, Nankai University, Tianjin 300071, China; (Y.-y.S.); (Y.-j.N.); (R.-j.W.); (Z.-c.Q.)
| | - Zi-cheng Qin
- College of Life Sciences, Nankai University, Tianjin 300071, China; (Y.-y.S.); (Y.-j.N.); (R.-j.W.); (Z.-c.Q.)
| | - Zhao Liu
- Harvest Pharmaceutical Co., Ltd., Changsha 410000, China; (Z.L.); (L.-h.X.)
| | - Li-hui Xiao
- Harvest Pharmaceutical Co., Ltd., Changsha 410000, China; (Z.L.); (L.-h.X.)
| | - Yan-qiang Liu
- College of Life Sciences, Nankai University, Tianjin 300071, China; (Y.-y.S.); (Y.-j.N.); (R.-j.W.); (Z.-c.Q.)
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Michavila Puente-Villegas S, Apaza Ticona L, Rumbero Sánchez Á, Acebes JL. Diterpenes of Pinus pinaster aiton with anti-inflammatory, analgesic, and antibacterial activities. JOURNAL OF ETHNOPHARMACOLOGY 2024; 318:117021. [PMID: 37567424 DOI: 10.1016/j.jep.2023.117021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023]
Abstract
ETHNO-PHARMACOLOGICAL RELEVANCE The P. pinaster species, known as 'Pino nigral or rodeno', is used in the treatment of colds, asthma, flu, and tuberculosis. AIM OF THE STUDY This study determined the anti-inflammatory, analgesic, and antibacterial activities of the P. pinaster resin, identifying the compounds with higher biological activity. MATERIALS AND METHODS A bio-guided isolation of the compounds of P. pinaster was carried out by selecting the most active extracts with anti-inflammatory and analgesic effects in the HBEC3-KT, MRC-5, and THP-1 cell lines. The antibacterial activity was determined against the S. aureus, S. pneumoniae, K. pneumoniae and P. aeruginosa strains. RESULTS The following compounds were identified by NMR: dehydroabietic acid (1), ( + )-cis-abienol (2), pimaric acid (3), isopimaric acid (4), 7α-hydroxy-dehydroabietic acid (5), 7-oxo-dehydroabietic acid (6), 15-hydroxy-abietic acid (7), 7-oxo-15-hydroxy-dehydroabietic acid (8), 13-oxo-8 (14)-podocarpen-18-oic acid (9), and pinyunin A (10). Regarding their anti-inflammatory activity, all compounds inhibited NF-κB. Compound 9 was the most active (IC50 = 3.90-12.06 μM). Concerning the analgesic activity, all the compounds inhibited NK-1, yet compound 9 was the most active (IC50 = 0.28-0.33 μM). Finally, compounds 6 (MIC = 12.80-25.55 μM) and 9 (MIC = 9.80-24.31 μM) were the most promising antibacterial compounds in all strains. CONCLUSION This study managed to identify, for the first time, six diterpenes from the resin of P. pinaster, with anti-inflammatory, analgesic, and antibacterial activity. Among the identified compounds, compound 9 was the most active, being considered a promising candidate as an antagonist of the tachykinin NK-1 receptor and as an analgesic agent against inflammation and neuropathic pain. It also had an antibacterial effect against Gram negative bacteria.
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Affiliation(s)
- Santiago Michavila Puente-Villegas
- Plant Physiology Area, Department of Engineering and Agricultural Sciences, Faculty of Biological and Environmental Sciences, Universidad de León, Campus Vegazana, 24007, León, Spain
| | - Luis Apaza Ticona
- Department of Organic Chemistry, Faculty of Sciences, University Autónoma of Madrid, Cantoblanco, 28049, Madrid, Spain; Organic Chemistry Unit, Department of Chemistry in Pharmaceutical Sciences, Faculty of Pharmacy, Universidad Complutense de Madrid. Plza, Ramón y Cajal S/n, 28040, Madrid, Spain.
| | - Ángel Rumbero Sánchez
- Department of Organic Chemistry, Faculty of Sciences, University Autónoma of Madrid, Cantoblanco, 28049, Madrid, Spain
| | - José-Luis Acebes
- Plant Physiology Area, Department of Engineering and Agricultural Sciences, Faculty of Biological and Environmental Sciences, Universidad de León, Campus Vegazana, 24007, León, Spain
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Koo H, Jeong KH, Jeon N, Jung SY. Factors associated with the use of traditional doses of amitriptyline for chronic pain management: A cross-sectional study. Medicine (Baltimore) 2024; 103:e36790. [PMID: 38181253 PMCID: PMC10766233 DOI: 10.1097/md.0000000000036790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/05/2023] [Indexed: 01/07/2024] Open
Abstract
There are studies on the effect of low-dose amitriptyline on pain control, but there is a lack of studies on the use of amitriptyline for chronic pain and the factors associated with the prescription of traditional doses. We used a national sample cohort of patients aged ≥ 18 years who were prescribed amitriptyline along with chronic pain, without psychiatric disorders, between 2002 to 2015. We categorized the prescriptions into 2 groups according to the daily dose: low doses (≤25 mg) and traditional doses (>25 mg). Multivariable logistic regression models were used to identify factors associated with traditional dose prescriptions. Among 177,769 prescriptions for amitriptyline, 15,119 (8.5%) were prescribed for chronic pain. The prevalence of prescriptions and proportion of traditional doses of amitriptyline tended to decrease during the study period. Male sex (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.05-1.13); age 65-80 years (OR 1.12, 95% CI 1.08-1.16), especially ≥ 80 years (OR 1.55, 95% CI 1.45-1.65); headaches (OR 1.18, 95% CI 1.10-1.27), receiving medical aids (OR 2.58, 95% CI 2.46-2.71); and being prescribed benzodiazepines or zolpidem concomitantly (OR 1.10, 95% CI 1.06-1.15) were significantly associated with traditional dose prescriptions of amitriptyline. Although traditional dose prescriptions of amitriptyline have been declining, close monitoring is still required in the presence of the above-mentioned factors.
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Affiliation(s)
- Hyunji Koo
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | | | - Nakyung Jeon
- College of Pharmacy, Pusan National University, Pusan, Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Korea
- Department of Global Innovative Drugs, Graduate School of Chung-Ang University, Chung-Ang University, Seoul, Korea
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12
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Di Salvo G, Porceddu G, Perotti C, Maina G, Rosso G. Prevalence and Correlates of Serotonin Syndrome in Real-World Inpatients. J Clin Psychopharmacol 2024; 44:25-29. [PMID: 38032093 DOI: 10.1097/jcp.0000000000001798] [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: 12/01/2023]
Abstract
BACKGROUND Serotonin syndrome (SS) is a potentially life-threatening adverse drug reaction due to an increased central and peripheral serotonin activity, which usually presents as a triad of behavioral changes, neuromuscular excitability, and autonomic instability. Probably SS is often misdiagnosed, and its symptoms are mistaken for psychiatric symptoms or general medical issues: the true incidence of SS is not clear, and literature concerning potential risk factors is scarce. Our aims were to examine the prevalence of SS in a naturalistic sample of hospitalized patients and to evaluate potential factors related to the risk of developing the condition. METHODS The sample included 133 patients being treated with serotonergic medications admitted to the psychiatric inpatient unit of the San Luigi Gonzaga Hospital. All patients received a medical examination (including a neurological examination) within 24 hours of admission. Serotonin syndrome was diagnosed according to Hunter Criteria. RESULTS Sixteen patients (12%) were diagnosed with SS. In the subgroup of subjects with SS, we found a higher rate of male patients when compared with subjects with no SS (62.5% vs 33.3%, P = 0.023). CONCLUSIONS SS probably is an underestimated condition, which should be carefully assessed in patients on serotonergic medications. Male gender was the only factor found to be significantly related to a higher risk of developing SS. Further studies on larger samples are needed, to gain more information on possible risk factors and to identify subjects more prone to developing SS, given the potential risk for patients' health.
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Affiliation(s)
| | - Giorgia Porceddu
- From the Department of Neurosciences 'Rita Levi Montalcini', University of Torino
| | - Camilla Perotti
- From the Department of Neurosciences 'Rita Levi Montalcini', University of Torino
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Tsugiyama LE, Moraes RCM, Moraes YAC, Francis-Oliveira J. Promising new pharmacological targets for depression: The search for efficacy. Drug Discov Today 2023; 28:103804. [PMID: 37865307 DOI: 10.1016/j.drudis.2023.103804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/31/2023] [Accepted: 10/16/2023] [Indexed: 10/23/2023]
Abstract
Pharmacological treatment of major depressive disorder (MDD) still relies on the use of serotonergic drugs, despite their limited efficacy. A few mechanistically new drugs have been developed in recent years, but many fail in clinical trials. Several hypotheses have been proposed to explain MDD pathophysiology, indicating that physiological processes such as neuroplasticity, circadian rhythms, and metabolism are potential targets. Here, we review the current state of pharmacological treatments for MDD, as well as the preclinical and clinical evidence for an antidepressant effect of molecules that target non-serotonergic systems. We offer some insights into the challenges facing the development of new antidepressant drugs, and the prospect of finding more effectiveness for each target discussed.
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Affiliation(s)
- Lucila Emiko Tsugiyama
- Kansai Medical University, Graduate School of Medicine, iPS Cell Applied Medicine, Hirakata, Osaka, Japan
| | - Ruan Carlos Macedo Moraes
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Birmingham, AL, USA; Biomedical Sciences Institute, Department of Human Physiology, Sao Paulo University, Sao Paulo, Brazil
| | | | - Jose Francis-Oliveira
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Birmingham, AL, USA; Biomedical Sciences Institute, Department of Human Physiology, Sao Paulo University, Sao Paulo, Brazil.
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14
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Odame EA, Atandoh PH, Mamudu L, Adzrago D, Tagoe I, Sulley S, Boms M, Tetteh-Bator E, McNeel TS, Williams F. Associations of depression with hypertension and citizenship among U.S. adults: A cross-sectional study of the interactions of hypertension and citizenship. Prev Med Rep 2023; 36:102523. [PMID: 38116249 PMCID: PMC10728450 DOI: 10.1016/j.pmedr.2023.102523] [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] [Received: 02/03/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
With the increasing prevalence of hypertension-related cardiovascular deaths and depression, this study examined the associations of depression with hypertension, citizenship status, and interaction of hypertension and citizenship status among U.S. adults. Data from the 2015-2018 National Health Interview Survey (NHIS), including 63,985 individuals, were analyzed. Depression status was the outcome, with hypertension and U.S. citizenship status as the main independent variables. Using odds ratio (OR) estimates, we evaluated the associations between hypertension and depression, and citizenship status. The result indicates that a higher proportion of U.S. adults with hypertension reported depression compared to those who did not have hypertension (42.9 % vs. 37.5 %). In terms of U.S. citizenship status, a higher proportion of U.S. citizens reported depression than non-citizens (39.6 % vs. 31.6 %). However, non-citizens with hypertension were more likely to report depression compared to U.S. citizens without hypertension (OR = 1.46; 95 % CI = 1.15, 1.86). While hypertension marginally increased the odds of depression among the general U.S. population, being a non-U.S. citizen with hypertension significantly increased the risk of depression by 46 %. The findings imply that the healthy immigrant paradox, in the context of hypertension-depression prevention and control, may not apply to non-citizens with hypertension. We therefore recommend community-based screenings and more tailored interventions to address these health disparities while taking into consideration the unique cultural norms, behaviors and healthcare barriers encountered by specific immigrant communities.
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Affiliation(s)
- Emmanuel A. Odame
- Department of Environmental Health Sciences, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul H. Atandoh
- Department of Mathematics, Mercer University, Macon, GA, USA
| | - Lohuwa Mamudu
- Department of Public Health, California State University, Fullerton, CA, USA
| | - David Adzrago
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Ishmael Tagoe
- Division of Health Services, College of Nursing and Advanced Health Professions, The Chicago School of Professional Psychology, IL, USA
| | - Saanie Sulley
- National Healthy Start Association, Washington, DC, USA
| | - Maureen Boms
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erasmus Tetteh-Bator
- Department of Mathematics and Statistics, College of Arts and Sciences, University of South Florida, Tampa, FL, USA
| | | | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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15
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Izsak J, Falari D, Arnbert P, Pouragheli D, Kindblom JM, Lasaitiene D. Case report: Olanzapine-associated water retention, high blood pressure, and subsequent preterm preeclampsia. Front Psychiatry 2023; 14:1301348. [PMID: 38053540 PMCID: PMC10694189 DOI: 10.3389/fpsyt.2023.1301348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
Olanzapine is one of the most frequently used antipsychotic medications during pregnancy, but information about its safety and adverse effects profile during pregnancy is scarce. We herein describe a case of a pregnant woman with several psychiatric disorders who developed water retention, hypertension, and subsequent preterm preeclampsia 3 weeks after initiation of treatment with olanzapine. To the best of our knowledge, this is the first case of olanzapine-associated preeclampsia described in literature.
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Affiliation(s)
- Julia Izsak
- Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dimitra Falari
- Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pia Arnbert
- Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel Pouragheli
- Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jenny M. Kindblom
- Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daina Lasaitiene
- Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Rheumatology, Södra Älvsborg Hospital, Borås, Sweden
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16
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Qi H, Wen FY, Xie YY, Liu XH, Li BX, Peng WJ, Cao H, Zhang L. Associations between depressive, anxiety, stress symptoms and elevated blood pressure: Findings from the CHCN-BTH cohort study and a two-sample Mendelian randomization analysis. J Affect Disord 2023; 341:176-184. [PMID: 37598715 DOI: 10.1016/j.jad.2023.08.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND We aimed to determine whether depressive, anxiety, stress symptoms were associated with the risk of elevated blood pressure by performing longitudinal cohort and Mendelian Randomization (MR) analyses. METHODS We used data from the Cohort Study on Chronic Disease of Community Natural Population in the Beijing-Tianjin-Hebei region (CHCN-BTH) from 2017 to 2021. The Depression-Anxiety-Stress Scale was used to evaluate the depressive, anxiety, stress symptoms. The longitudinal associations between depressive, anxiety, stress symptoms and elevated blood pressure were estimated using Cox proportional regression models. Two-sample MR analysis was performed using the Inverse-variance weighted (IVW), weighted median, and MR-Egger to explore the causal relationships between depressive, anxiety, stress symptoms and elevated blood pressure. RESULTS In total, 5624 participants were included. The risk of SBP ≥ 140 mmHg or DBP ≥ 90 mmHg was significantly higher in participants with baseline anxiety symptoms (HR = 1.48, 95 % CI: 1.03 to 2.12, P = 0.033; HR = 1.56, 95 % CI: 1.05 to 2.32, P = 0.028), especially in men and individuals with higher educational levels, independent of baseline depression and anxiety at the two-year follow-up. The two-sample MR analysis showed positive associations between depressive, anxiety, stress symptoms and elevated blood pressure. LIMITATION Self-reported mental health symptoms, relatively shorter follow-up duration and the European-derived genome-wide association study data for MR analysis. CONCLUSIONS Anxiety symptoms were positively associated with elevated blood pressures in the longitudinal analysis independent of depression, stress, and other confounders. The results were verified in MR analysis, providing evidence for causal effects of anxiety symptoms on the risk of elevated blood pressure.
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Affiliation(s)
- Han Qi
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China; Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Fu-Yuan Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Yun-Yi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Xiao-Hui Liu
- Center for Evidence-Based Medicine, Beijing Luhe Hospital Affiliate to Capital Medical University, Beijing 101199, China
| | - Bing-Xiao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Wen-Juan Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Han Cao
- Department of Biostatistics, Peking University First Hospital, Beijing 100034, China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
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17
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van Hoogdalem E, Smith KL, Hartstra J, Constant J. Rethinking, reducing, and refining the classical oral tyramine challenge test of monoamine oxidase (MAO) inhibitors. Clin Transl Sci 2023; 16:2058-2069. [PMID: 37596819 PMCID: PMC10582662 DOI: 10.1111/cts.13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/05/2023] [Accepted: 08/02/2023] [Indexed: 08/20/2023] Open
Abstract
The oral tyramine challenge evaluates the safety of novel monoamine oxidase (MAO) inhibitors when taken with tyramine-containing food or drinks. In its current design, it comprises an extensive series of tyramine escalation steps until a blood pressure threshold is met. Due to the high variation in tyramine bioavailability, and thereby in blood pressure effect, this classical design has various limitations, including safety concerns. Based on data from a previously performed tyramine challenge study, the present study explored a reduced new design that escalates up to 400 mg, and evaluates the dose to a tyramine peak plasma concentration of ≥10 ng/mL, instead of a dose up to 800 mg, and to a blood pressure change of ≥30 mm Hg. Tested by trial simulation, the new design proves more efficient than the classical design in terms of better identifying tyramine sensitivity of test and reference treatments and reducing false-positive and false-negative rates in estimating tyramine sensitivity by more than 10-fold. Since it escalates over a lower tyramine dose range, the new design reduces risk to subjects associated with tyramine-induced blood pressure excursions, is less demanding for study participants, and is more efficient. By its focus on tyramine bioavailability as the primary concern for novel MAO inhibitors, the new tyramine challenge study provides better answers in a simplified and safer design compared with the classical design in trial simulation, warranting its use in future clinical studies.
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Affiliation(s)
| | | | - Jan Hartstra
- Drug Development Solutions – PharmacokineticsICONGroningenThe Netherlands
| | - John Constant
- Scientific AffairsICONVictoriaBritish ColumbiaCanada
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18
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Sırlıer Emir B, Yıldız S, Kazgan Kılıçaslan A, Kılıçarslan G, Kurt O, Korkmaz S, Atmaca M. Evaluation of Arterial Stiffness in Depression Patients. ALPHA PSYCHIATRY 2023; 24:193-199. [PMID: 38105785 PMCID: PMC10724755 DOI: 10.5152/alphapsychiatry.2023.221099] [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: 12/22/2022] [Accepted: 04/19/2023] [Indexed: 12/19/2023]
Abstract
Background It has been known that there is a significant correlation between depression and cardiovascular diseases. However, the reasons behind this correlation that could affect mortality and morbidity were not fully identified. The present study aimed to analyze arterial stiffness diagnosed with ultrasonography, which could be associated with cardiovascular disease risks in depression patients, and to compare the findings with those of healthy controls. Methods The study was conducted with 35 depression patients and 35 healthy individuals. Routine complete blood and biochemistry tests were requested for all patients, and their weight and height, waist circumference, and diastolic and systolic arterial blood pressure were measured. Femoral and carotid artery intima-media thickness and other arterial stiffness parameters were determined with Doppler ultrasonography. Results It was determined that the systolic pressure (P = .028) was higher in the patient group (P = .028). Also, the carotid elastic modulus (P = .048) was significantly higher in the patient group. A negative and significant correlation was determined between femoral compliance and chlorpromazine equivalent dose (P = .021, r = -0.389). Conclusion It was determined that the systolic blood pressure and carotid elastic modulus arterial stiffness parameters were significantly higher in depression patients. Measurable arterial stiffness parameters should be investigated in depression patients as cardiovascular risk markers. Furthermore, the determination of the effects of psychotropic drugs employed in arterial stiffness treatment could play an important role in the determination of cardiovascular disease risk in these patients.
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Affiliation(s)
- Burcu Sırlıer Emir
- Department of Psychiatry, Elazığ Fethi Sekin City Hospital, Elazığ, Turkey
| | - Sevler Yıldız
- Department of Psychiatry, University of Binali Yıldırım, Erzincan, Turkey
| | | | - Gülhan Kılıçarslan
- Department of Psychiatry, Elazığ Fethi Sekin City Hospital, Elazığ, Turkey
| | - Osman Kurt
- Department of Public Health, Adıyaman Provincial Health Directorate, Adıyaman, Turkey
| | - Sevda Korkmaz
- Department of Psychiatry, University of Fırat, Elazığ, Turkey
| | - Murad Atmaca
- Department of Psychiatry, University of Fırat, Elazığ, Turkey
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19
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Clark A, Tate B, Urban B, Schroeder R, Gennuso S, Ahmadzadeh S, McGregor D, Girma B, Shekoohi S, Kaye AD. Bupropion Mediated Effects on Depression, Attention Deficit Hyperactivity Disorder, and Smoking Cessation. Health Psychol Res 2023; 11:81043. [PMID: 37405312 PMCID: PMC10317506 DOI: 10.52965/001c.81043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Bupropion had been in use since the late 1980s as an unconventional treatment for depression. Unlike other antidepressants, bupropion has no serotonergic activity and inhibits the reuptake of norepinephrine and dopamine. The drug has been used to treat depression, Attention Deficit Hyperactivity Disorder (ADHD), and smoking cessation. This investigation reviews the pharmacokinetic and pharmacodynamic effects of bupropion and its mechanisms of action and interactions with other drugs. We evaluated the efficacy of major on and off-label uses of bupropion, focusing on the indications, benefits, and adverse effects. Our review demonstrates that bupropion is superior to placebo and non-inferior to SSRIs such as escitalopram in treating major depressive disorder. More research is needed to determine positive patient-centered outcomes such as increases in quality of life. In the case of ADHD, the evidence for efficacy is mixed with poorly conducted randomized clinical trials, small sample sizes, and a lack of long-term assessments. The same is true in the case of bipolar disorder in which there is still limited and controversial data available on bupropion's safety and efficacy. In the case of smoking cessation, bupropion is found to be an effective anti-smoking drug with synergistic benefits when used as a combination therapy. We conclude that bupropion has the potential to provide benefit for a subset of patients who do not tolerate other typical antidepressants or anti-smoking therapies or for those whose treatment goals align with bupropion's unique side effect profile, such as smokers who wish to quit and lose weight. Additional research is needed to determine the drug's full clinical potential, particularly in the areas of adolescent depression and combination therapy with varenicline or dextromethorphan. Clinicians should use this review to understand the varied uses of the drug and identify the situations and patient populations in which bupropion can lend its greatest benefit.
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20
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Lin Z, Chan YH, Cheung BMY. Dissecting Relations between Depression Severity, Antidepressant Use, and Metabolic Syndrome Components in the NHANES 2005-2020. J Clin Med 2023; 12:3891. [PMID: 37373586 PMCID: PMC10299566 DOI: 10.3390/jcm12123891] [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: 03/20/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
We aimed to dissect the complex relations between depressive symptoms, antidepressant use, and constituent metabolic syndrome (MetS) components in a representative U.S. population sample. A total of 15,315 eligible participants were included from 2005 to March 2020. MetS components were defined as hypertension, elevated triglycerides, reduced high-density lipoprotein cholesterol, central obesity, and elevated blood glucose. Depressive symptoms were classified as mild, moderate, or severe. Logistic regression was used to evaluate the relationship between depression severity, antidepressant use, individual MetS components and their degree of clustering. Severe depression was associated with the number of MetS components in a graded fashion. ORs for severe depression ranged from 2.08 [95%CI, 1.29-3.37] to 3.35 [95%CI, 1.57-7.14] for one to five clustered components. Moderate depression was associated with hypertension, central obesity, raised triglyceride, and elevated blood glucose (OR = 1.37 [95%CI, 1.09-1.72], 1.82 [95%CI, 1.21-2.74], 1.63 [95%CI, 1.25-2.14], and 1.37 [95%CI, 1.05-1.79], respectively). Antidepressant use was associated with hypertension (OR = 1.40, 95%CI [1.14-1.72]), raised triglyceride (OR = 1.43, 95%CI [1.17-1.74]), and the presence of five MetS components (OR = 1.74, 95%CI [1.13-2.68]) after adjusting for depressive symptoms. The depression severity and antidepressant use were associated with individual MetS components and their graded clustering. Metabolic abnormalities in patients with depression need to be recognized and treated.
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Affiliation(s)
- Ziying Lin
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong, China
| | - Yap-Hang Chan
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong, China
| | - Bernard Man Yung Cheung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong, China
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong, China
- Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
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21
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Poian LR, Chiavegatto S. Serotonin Syndrome: The Role of Pharmacology in Understanding Its Occurrence. Cureus 2023; 15:e38897. [PMID: 37309350 PMCID: PMC10257984 DOI: 10.7759/cureus.38897] [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: 05/11/2023] [Indexed: 06/14/2023] Open
Abstract
Serotonin syndrome (SS) is a potentially fatal adverse drug reaction characterized by an exaggerated increase in serotonergic activity in the central and peripheral nervous systems. It presents a constellation of signs and symptoms related to behavioral changes, neuromuscular excitability, and autonomic instability. These symptoms can occur in both mild and severe forms. SS can be triggered by the therapeutic use of a drug that increases serotonin (5-HT) availability in the synaptic cleft or by the co-administration of two or more drugs that provide this increase. With the escalating use of antidepressants by the world's population, this adverse reaction may be more recurrent. However, SS is often overlooked by patients or not diagnosed by doctors. This review aims to improve awareness about SS and provide a pharmacological perspective to explain its occurrence. Evidence shows that other neurotransmitters may also be involved with the pathology of SS. Furthermore, SS and neuroleptic malignant syndrome (NMS) seem to be part of the same pathological spectrum, especially in atypical NMS cases. The emergence of the syndrome's symptoms may be closely related to pharmacokinetic and/or pharmacodynamic polymorphisms that lead to an increase in the 5-HT available to or 5-HT signaling by specific receptors, thus constituting an important area for future investigations.
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Affiliation(s)
- Leila R Poian
- Department of Pharmacology, Biomedical Sciences Institute, University of Sao Paulo (ICB-USP), Sao Paulo, BRA
| | - Silvana Chiavegatto
- Department of Pharmacology, Biomedical Sciences Institute, University of Sao Paulo (ICB-USP), Sao Paulo, BRA
- Department of Psychiatry, Institute of Psychiatry, University of Sao Paulo Medical School (FMUSP), Sao Paulo, BRA
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22
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O' Riordan A, Young DA, Ginty AT. Disordered eating is associated with blunted blood pressure reactivity and poorer habituation to acute psychological stress. Biol Psychol 2023; 179:108553. [PMID: 37028794 DOI: 10.1016/j.biopsycho.2023.108553] [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: 11/04/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/09/2023]
Abstract
Psychological stress has been shown to influence the development and progression of disordered eating. Psychophysiological studies have reported that individuals with disordered eating behavior exhibit atypical cardiovascular reactions to acute psychological stress. However, prior studies have been limited by small sample sizes and have examined cardiovascular responses to a singular stress exposure. The current study examined the association between disordered eating and cardiovascular reactivity, as well as cardiovascular habituation to acute psychological stress. A mixed-sex sample (N = 450) of undergraduate students were categorized into a disordered eating or non-disordered eating group using a validated disordered eating screening questionnaire and attended a laboratory stress testing session. The testing session included two identical stress-testing protocols, each consisting of a 10-minute baseline and 4-minute stress task. Cardiovascular parameters including heart rate, systolic/diastolic blood pressure and mean arterial pressure (MAP) were recorded throughout the testing session. Post task measures of self-reported stress, as well as positive affect and negative affect (NA) reactivity were used to assess psychological reactions to stress. The disordered eating group exhibited greater increases in NA reactivity in response to both stress exposures. Additionally, in comparison to the control group, those in the disordered eating group exhibited blunted MAP reactivity to the initial stress exposure and less MAP habituation across both stress exposures. These findings indicate that disordered eating is characterized by dysregulated hemodynamic stress responsivity, which may constitute a physiological mechanism leading to poor physical health outcomes.
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Affiliation(s)
- Adam O' Riordan
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States.
| | - Danielle A Young
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
| | - Annie T Ginty
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
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23
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Keins S, Abramson JR, Mallick A, Castello JP, Rodriguez-Torres A, Popescu D, Hoffman D, Kourkoulis C, Gurol ME, Greenberg SM, Anderson CD, Viswanathan A, Rosand J, Biffi A. Association of Depression Onset and Treatment With Blood Pressure Control After Intracerebral Hemorrhage. Stroke 2023; 54:105-112. [PMID: 36444719 DOI: 10.1161/strokeaha.122.040331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Blood pressure (BP) control represents a crucial intervention to improve long-term outcomes following spontaneous intracerebral hemorrhage (ICH). However, fewer than half of ICH survivors achieve target treatment goals. ICH survivors are also at very high risk for poststroke depression, which may contribute to inadequate BP control. We, therefore, sought to determine whether depressive symptoms after ICH are associated with inadequate BP control. We also investigated whether associations between depression after ICH and BP measurements were mediated by treatment with selective serotonin reuptake inhibitors or norepinephrine-serotonin reuptake inhibitors antidepressants. METHODS We leveraged data from a single-center longitudinal study of ICH conducted at Massachusetts General Hospital (Boston, MA) between 2006 and 2018. We collected data from semiautomated review of electronic health records, baseline and follow-up interviews, and computed tomography imaging. Information on BP measurements, depression diagnoses, antidepressants medication use, and medical visits were collected longitudinally and analyzed using mixed effects models. Primary outcomes included systolic and diastolic BP measurements during long-term follow-up after ICH. RESULTS We included 1243 consecutive ICH patients without pre-stroke depression history. Of these, 721 (58%) were diagnosed with incident depression over a median follow-up time of 52.8 months (interquartile range, 42.1-60.5). Depression onset was associated with subsequent increase in systolic (+8.3 mm Hg, SE, 2.4 mm Hg, P=0.012) and diastolic (+4.4 mm Hg, SE, 1.2 mm Hg) BP measurements. Resolution of depressive symptoms was associated with subsequent decrease in systolic (-5.9 mm Hg, SE, 1.4 mm Hg, P=0.031) and diastolic (-3.4 mm Hg, SE, 1.1 mm Hg, P=0.041) BP measurements. We also found associations between higher systolic BP measurements and use of selective serotonin reuptake inhibitor and noradrenaline-serotonin reuptake inhibitor antidepressants, independent of whether depression symptoms were active or not (all P<0.05). CONCLUSIONS ICH survivors displayed increasing BP values after receiving a diagnosis of depression, followed by decreasing values among those experiencing resolution of depressive symptoms. Use of selective serotonin reuptake inhibitor and noradrenaline-serotonin reuptake inhibitor antidepressants was independently associated with higher systolic BP measurements. Clinicians ought to closely monitor BP for ICH survivors being treated for depression, especially using selective serotonin reuptake inhibitor and noradrenaline-serotonin reuptake inhibitor. Future studies will also be required to investigate the mechanisms underlying these associations.
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Affiliation(s)
- Sophia Keins
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Jessica R Abramson
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Akashleena Mallick
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Juan Pablo Castello
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Axana Rodriguez-Torres
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Dominique Popescu
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Danielle Hoffman
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Christina Kourkoulis
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston
| | - M Edip Gurol
- Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Steven M Greenberg
- Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Christopher D Anderson
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology, Brigham and Women's Hospital, Boston, MA (C.D.A.)
| | - Anand Viswanathan
- Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Alessandro Biffi
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
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Romanov DV, Samsonova MD, Iuzbashian PG. [Treatment of mental disorders caused or triggered by somatic and neurological diseases with the use of the multimodal antidepressant trazodone]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:81-89. [PMID: 37141133 DOI: 10.17116/jnevro202312304281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The purpose of this narrative review is to relate current data on the molecular mechanisms of action of trazodone with its clinical effects and applicability in mental disorders caused or triggered by somatic and neurological disease, according to available publications. In the article, the prospects for the use of the multimodal antidepressant trazodone are discussed in accordance with therapeutic targets. The latter are discussed in accordance with the typology of the mentioned above psychosomatic disorders. Trazodone is an antidepressant acting primarily due to the blockade of postsynaptic serotonin 5H2A- and 5H2C-receptors, as well as the blockade of serotonin reuptake, but also has affinity for a number of additional receptors. The drug has a favorable safety profile and a wide range of beneficial effects: antidepressive, somnolent, anxiolytic, anti-dysphoric and somatotropic. This makes it possible to influence a wide range of therapeutic targets in the structure of mental disorders caused or triggered by somatic and neurological diseases, carrying out safe and effective psychopharmacotherapy.
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Affiliation(s)
- D V Romanov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Mental Health Research Center, Moscow, Russia
| | - M D Samsonova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - P G Iuzbashian
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Alhawari H, AlShelleh S, Alhawari H, Akiely R, Abdallah B, Hajjaj N, Alkhalaileh S, AlRyalat SA. Hypertension and depression among medical students: is there an association? Heliyon 2022; 8:e12319. [PMID: 36582727 PMCID: PMC9792731 DOI: 10.1016/j.heliyon.2022.e12319] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/09/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Several studies suggested a higher prevalence of hypertension and depression among medical students. Patients with depression have a higher prevalence of hypertension and vice versa. In this study, we assessed the frequency of hypertension and depression in a sample of medical students and the impact of depression on hypertension. Methods We recruited medical students from the largest medical school in Jordan. For each participant, we measured blood pressure and heart rate under standardized measurement conditions. Participants were also surveyed using the 9-item Patient Health Questionnaire (PHQ-9). We performed univariate analysis followed by linear regression analysis of factors affecting mean arterial pressure. Results 354 medical students were included. The mean age was 21 years. 196 (55.4%) were females and 158 (44.6%) were males. 139 (70.9%) of females had normal blood pressure (BP), 7 (3.6%) had elevated BP, 44 (22.4%) had stage 1 hypertension (HTN), and 6 (3.1%) had stage 2 HTN. Within males: 60 (38.0%) had normal BP, 27 (17.1%) had elevated BP, 55 (34.8%) had stage 1 HTN, and 16 (10.1%) had stage 2 HTN. 114 participants (32.2%) had no or minimal depression, 197 (55.6%) had mild-moderate depression and 43 (12.1%) had moderately severe-severe depression. There was an association between higher depression scores and higher diastolic blood pressure. Conclusion The frequency of hypertension and depression was notably high in our sample. There was an association between higher depression scores and higher diastolic blood pressure. We strongly believe that this association should encourage us again to screen our hypertensive patients in general for depression and vice versa. We also recommend adopting screening programs for depression and hypertension in general.
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Affiliation(s)
- Hussein Alhawari
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan,Corresponding author.
| | - Sameeha AlShelleh
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Hussam Alhawari
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Reem Akiely
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Bayan Abdallah
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Nada Hajjaj
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Saja Alkhalaileh
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Saif Aldeen AlRyalat
- Department of Special Surgery, School of Medicine, The University of Jordan, Amman, Jordan
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Acid Sphingomyelinase Inhibitor, Imipramine, Reduces Hippocampal Neuronal Death after Traumatic Brain Injury. Int J Mol Sci 2022; 23:ijms232314749. [PMID: 36499076 PMCID: PMC9740309 DOI: 10.3390/ijms232314749] [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] [Received: 10/07/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Traumatic brain injury (TBI) broadly degrades the normal function of the brain after a bump, blow, or jolt to the head. TBI leads to the aggravation of pre-existing brain dysfunction and promotes neurotoxic cascades that involve processes such as oxidative stress, loss of dendritic arborization, and zinc accumulation. Acid sphingomyelinase (ASMase) is an enzyme that hydrolyzes sphingomyelin to ceramide in cells. Under normal conditions, ceramide plays an important role in various physiological functions, such as differentiation and apoptosis. However, under pathological conditions, excessive ceramide production is toxic and activates the neuronal-death pathway. Therefore, we hypothesized that the inhibition of ASMase activity by imipramine would reduce ceramide formation and thus prevent TBI-induced neuronal death. To test our hypothesis, an ASMase inhibitor, imipramine (10 mg/kg, i.p.), was administrated to rats immediately after TBI. Based on the results of this study, we confirmed that imipramine significantly reduced ceramide formation, dendritic loss, oxidative stress, and neuronal death in the TBI-imipramine group compared with the TBI-vehicle group. Additionally, we validated that imipramine prevented TBI-induced cognitive dysfunction and the modified neurological severity score. Consequently, we suggest that ASMase inhibition may be a promising therapeutic strategy to reduce hippocampal neuronal death after TBI.
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Stachowicz K, Sowa-Kućma M. The treatment of depression - searching for new ideas. Front Pharmacol 2022; 13:988648. [PMID: 36278184 PMCID: PMC9585175 DOI: 10.3389/fphar.2022.988648] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/20/2022] [Indexed: 10/06/2023] Open
Abstract
Depression is a severe mental health problem that affects people regardless of social status or education, is associated with changes in mood and behavior, and can result in a suicide attempt. Therapy of depressive disorders is based mainly on drugs discovered in the 1960s and early 1970s. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are frontline pharmacological strategies for the medical treatment of depression. In addition, approved by FDA in 2019, esketamine [as nasal spray; N-methyl-D-aspartate (NMDA) receptors antagonist with additional effects on α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, L-type voltage-dependent calcium channel (L-VDCC), opioid receptors, and monoaminergic receptors] is an essential compound in suicide and drug-resistant depression. However, the treatment of depression is burdened with severe side effects, and in many cases, it is ineffective. An equally important issue is the choice of antidepressant therapy in people with comorbid somatic diseases, for example, due to possible interactions with the patient's other drugs. Therefore, there is a great need for new antidepressants with different mechanisms of action and the need to refine the search for new substances. The purpose of this review was to discuss new research directions and new trends that dominate laboratories worldwide. We have reviewed the literature to present new points on the pharmacological target of substances with antidepressant activity. In addition, we propose a new perspective on depressive therapies.
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Affiliation(s)
- Katarzyna Stachowicz
- Department of Neurobiology, Maj Institute of Pharmacology, Polish Academy of Sciences, Kraków, Poland
| | - Magdalena Sowa-Kućma
- Department of Human Physiology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
- Centre for Innovative Research in Medical and Natural Sciences, Medical College of Rzeszow University, Rzeszow, Poland
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Yousuf FS, Arif A, Bibi R, Almas A. Association of Depression and Anxiety With Hypertensive Crisis: A Cross-Sectional Study From a Hospital Setting in Karachi, Pakistan. Cureus 2022; 14:e29792. [PMID: 36340519 PMCID: PMC9618291 DOI: 10.7759/cureus.29792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Hypertension, a leading risk factor for cardiovascular death, has been closely linked with depression and anxiety. The aim of this study was to examine the association of depression or anxiety with hypertensive crisis in patients and also see if the association is affected by age group or gender. This was carried out in a hospital setting. Methods This cross-sectional study was conducted between July 2019 and March 2022 on 290 patients admitted to the Aga Khan University Hospital (AKUH), Karachi, Pakistan. All adult patients more than 18 years of age admitted with uncontrolled hypertension with a systolic blood pressure of >140 and a diastolic blood pressure of >90 admitted through emergency were included. A hypertensive crisis was defined as a systolic blood pressure greater than 180 mm Hg or a diastolic blood pressure greater than or equal to 120 mm Hg, with or without accompanying end organ damage. Symptoms of depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale (HADS), with a cut-off score ≥8. Results Of the patients identified with uncontrolled hypertension, a total of 140 (48.3%) of the patients presented with a hypertensive crisis, while 150 (51.3%) did not have a hypertensive crisis at presentation. In the hypertensive crisis group, 60 (49.3%) had HADS scores consistent with depression, while 83 (59.3%) had HADS scores consistent with anxiety. In patients with hypertensive crisis, HADS depression and anxiety were most prevalent in the 61-75 age group (39.7%). In the comparison of gender, it was found that males and females with hypertensive crisis had an almost equal prevalence of anxiety (49.4% in males versus 50.6% in females). A slightly higher prevalence of depression was seen in females with hypertensive crises when compared to males. Conclusion We found no association between depression or anxiety with hypertensive crisis, and the association is not affected by age group or gender. However, do note that half of the patients with hypertensive crises had depression or anxiety. Future large multicentered studies are required to study the link in greater detail.
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Fu JL, Perloff MD. Pharmacotherapy for Spine-Related Pain in Older Adults. Drugs Aging 2022; 39:523-550. [PMID: 35754070 DOI: 10.1007/s40266-022-00946-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 12/12/2022]
Abstract
As the population ages, spine-related pain is increasingly common in older adults. While medications play an important role in pain management, their use has limitations in geriatric patients due to reduced liver and renal function, comorbid medical problems, and polypharmacy. This review will assess the evidence basis for medications used for spine-related pain in older adults, with a focus on drug metabolism and adverse drug reactions. A PubMed/OVID search crossing common spine, neck, and back pain terms with key words for older adults and geriatrics was combined with common drug classes and common drug names and limited to clinical trials and age over 65 years. The results were then reviewed with identification of commonly used drugs and drug categories: nonsteroidal anti-inflammatories (NSAIDs), acetaminophen, corticosteroids, gabapentin and pregabalin, antispastic and antispasmodic muscle relaxants, tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tramadol, and opioids. Collectively, 138 double-blind, placebo-controlled trials were the focus of the review. The review found a variable contribution of high-quality studies examining the efficacy of medications for spine pain primarily in the geriatric population. There was strong evidence for NSAID use with adjustments for gastrointestinal and renal risk factors. Gabapentin and pregabalin had mixed evidence for neuropathic pain. SNRIs had good evidence for neuropathic pain and a more favorable safety profile than TCAs. Tramadol had some evidence in older patients, but more so in persons aged < 65 years. Rational therapeutic choices based on geriatric spine pain diagnosis are helpful, such as NSAIDs and acetaminophen for arthritic and myofascial-based pain, gabapentinoids or duloxetine for neuropathic and radicular pain, antispastic agents for myofascial-based pain, and combination therapy for mixed etiologies. Tramadol can be well tolerated in older patients, but has risks of cognitive and classic opioid side effects. Otherwise, opioids are typically avoided in the treatment of spine-related pain in older adults due to their morbidity and mortality risk and are reserved for refractory severe pain. Whenever possible, beneficial geriatric spine pain pharmacotherapy should employ the lowest therapeutic doses with consideration of polypharmacy, potentially decreased renal and hepatic metabolism, and co-morbid medical disorders.
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Affiliation(s)
- Jonathan L Fu
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, 85 E. Concord St, 1122, Boston, MA, 02118, USA
| | - Michael D Perloff
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, 85 E. Concord St, 1122, Boston, MA, 02118, USA.
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Gundugurti PR, Bhattacharyya R, Koneru A. Management of Psychiatric Disorders in Patients with Cardiovascular Diseases. Indian J Psychiatry 2022; 64:S355-S365. [PMID: 35602356 PMCID: PMC9122167 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_42_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Prasad Rao Gundugurti
- Division of Schizophrenia and Psychopharmacology, Asha Hospital, Hyderabad, Telangana, India
| | - Ranjan Bhattacharyya
- Department of Psychiatry, Murshidabad Medical College and Hospital & Charak Square Diagnostic and Research Center, Berhampore, West Bengal, India
| | - Amulya Koneru
- Department of Reproductive Psychiatry, Asha Hospital, Hyderabad, Telangana, India E-mail:
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