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Cosci F, Chouinard VA, Chouinard G. Selective Serotonin Reuptake Inhibitor and Serotonin-Noradrenaline Reuptake Inhibitor Withdrawal Changes DSM Presentation of Mental Disorders: Results from the Diagnostic Clinical Interview for Drug Withdrawal. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024:1-6. [PMID: 39043160 DOI: 10.1159/000540031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/25/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) may cause withdrawal at dose decrease, discontinuation, or switch. Current diagnostic methods (e.g., DSM) do not take such phenomenon into account. Using a new nosographic classification of withdrawal syndromes due to SSRI/SNRI decrease or discontinuation [by Psychother Psychosom. 2015;84(2):63-71], we explored whether DSM is adequate to identify DSM disorders when withdrawal occurs. METHODS Seventy-five self-referred patients with a diagnosis of withdrawal syndrome due to discontinuation of SSRI/SNRI, diagnosed via the Diagnostic Clinical Interview for Drug Withdrawal 1 - New Symptoms of Selective Serotonin Reuptake Inhibitors or Serotonin-Norepinephrine Reuptake Inhibitors (DID-W1), and at least one DSM-5 diagnosis were analyzed. RESULTS In 58 cases (77.3%), the DSM-5 diagnosis of current mental disorder was not confirmed when the DID-W1 diagnosis of current withdrawal syndrome was established. In 13 cases (17.3%), the DSM-5 diagnosis of past mental disorder was not confirmed when criteria for DID-W1 diagnosis of lifetime withdrawal syndrome were met. In 3 patients (4%), the DSM-5 diagnoses of current and past mental disorders were not confirmed when the DID-W1 diagnoses of current and lifetime withdrawal syndromes were taken into account. The DSM-5 diagnoses most frequently mis-formulated were current panic disorder (50.7%, n = 38) and past major depressive episode (18.7%, n = 14). CONCLUSION DSM needs to be complemented by clinimetric tools, such as the DID-W1, to detect withdrawal syndromes induced by SSRI/SNRI discontinuation, decrease, or switch, following long-term use.
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Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
- International Lab of Clinical Measurements, University of Florence, Florence, Italy
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Virginie-Anne Chouinard
- Psychotic Disorders Division, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA
| | - Guy Chouinard
- University Mental Health Institute of Montreal, University of Montreal, Montreal, Québec, Canada
- Clinical Pharmacology and Toxicology Program, Royal College of Physicians and Surgeons, McGill University, Montreal, Québec, Canada
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Dold M, Möller HJ, Volz HP, Seifritz E, Schläfke S, Bartova L, Kasper S. Baseline symptom severity and efficacy of Silexan in patients with anxiety disorders: A symptom-based, patient-level analysis of randomized, placebo-controlled trials. Eur Psychiatry 2024; 67:e23. [PMID: 38425206 DOI: 10.1192/j.eurpsy.2024.16] [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] [Indexed: 03/02/2024] Open
Abstract
The influence of baseline severity on the efficacy of Silexan, a proprietary essential oil from Lavandula angustifolia, in anxiety disorders has not been investigated in a pooled dataset. We report on an individual patient data analysis of all five double-blind, randomized, placebo-controlled trials with Silexan in anxiety disorders. Eligible participants received Silexan 80 mg/d or placebo for 10 weeks. Analyses were based on the Hamilton Anxiety Rating Scale (HAMA), its psychic and somatic anxiety subscores, and the Clinical Global Impressions (CGI) scale. To correlate baseline severity with outcome, patients were segregated into mild, moderate, and severe cases. Altogether 1,172 patients (Silexan, n = 587; placebo, n = 585) were analyzed. For the HAMA total score, we found a significant association between the score at baseline and the treatment effect of Silexan versus placebo at week 10 (p < 0.001). HAMA items from the somatic domain scored lower at baseline and showed less improvement than items from the psychic domain, particularly in patients with mild or moderate baseline symptoms. For CGI item 2 (global improvement), significant efficacy favoring Silexan were observed in mild, moderate, and severe baseline symptom severity. Although significant improvements were found for all subsets, the more severe the initial symptoms, the greater the treatment effects documented by the HAMA. Overall this analysis confirms that Silexan is an effective treatment option in early or mild stages of anxiety disorder. Given its favorable safety profile, Silexan can thus fill a therapeutic gap in the treatment of (subsyndromal) anxiety disorders.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Switzerland
| | | | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
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Zolnour A, Eldredge CE, Faiola A, Yaghoobzadeh Y, Khani M, Foy D, Topaz M, Kharrazi H, Fung KW, Fontelo P, Davoudi A, Tabaie A, Breitinger SA, Oesterle TS, Rouhizadeh M, Zonnor Z, Moen H, Patrick TB, Zolnoori M. A risk identification model for detection of patients at risk of antidepressant discontinuation. Front Artif Intell 2023; 6:1229609. [PMID: 37693012 PMCID: PMC10484003 DOI: 10.3389/frai.2023.1229609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/04/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose Between 30 and 68% of patients prematurely discontinue their antidepressant treatment, posing significant risks to patient safety and healthcare outcomes. Online healthcare forums have the potential to offer a rich and unique source of data, revealing dimensions of antidepressant discontinuation that may not be captured by conventional data sources. Methods We analyzed 891 patient narratives from the online healthcare forum, "askapatient.com," utilizing content analysis to create PsyRisk-a corpus highlighting the risk factors associated with antidepressant discontinuation. Leveraging PsyRisk, alongside PsyTAR [a publicly available corpus of adverse drug reactions (ADRs) related to antidepressants], we developed a machine learning-driven algorithm for proactive identification of patients at risk of abrupt antidepressant discontinuation. Results From the analyzed 891 patients, 232 reported antidepressant discontinuation. Among these patients, 92% experienced ADRs, and 72% found these reactions distressful, negatively affecting their daily activities. Approximately 26% of patients perceived the antidepressants as ineffective. Most reported ADRs were physiological (61%, 411/673), followed by cognitive (30%, 197/673), and psychological (28%, 188/673) ADRs. In our study, we employed a nested cross-validation strategy with an outer 5-fold cross-validation for model selection, and an inner 5-fold cross-validation for hyperparameter tuning. The performance of our risk identification algorithm, as assessed through this robust validation technique, yielded an AUC-ROC of 90.77 and an F1-score of 83.33. The most significant contributors to abrupt discontinuation were high perceived distress from ADRs and perceived ineffectiveness of the antidepressants. Conclusion The risk factors identified and the risk identification algorithm developed in this study have substantial potential for clinical application. They could assist healthcare professionals in identifying and managing patients with depression who are at risk of prematurely discontinuing their antidepressant treatment.
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Affiliation(s)
- Ali Zolnour
- School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
| | | | - Anthony Faiola
- College of Health Sciences, University of Kentucky, Lexington, KY, United States
| | | | - Masoud Khani
- Biomedical and Health Informatics, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Doreen Foy
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Maxim Topaz
- School of Nursing and Data Science Institute, Columbia University, New York, NY, United States
- Center for Home Care Policy and Research, VNS Health, New York, NY, United States
| | - Hadi Kharrazi
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, United States
| | - Kin Wah Fung
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Paul Fontelo
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Anahita Davoudi
- Center for Home Care Policy and Research, VNS Health, New York, NY, United States
| | - Azade Tabaie
- Center of Biostatistics, Informatics, and Data Science, MedStar Health Research Institute, Washington, DC, United States
| | - Scott A. Breitinger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Tyler S. Oesterle
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Masoud Rouhizadeh
- Collage of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Zahra Zonnor
- Department of Biomechanics, Bu-Ali Sina University, Hamedan, Iran
| | - Hans Moen
- Department of Computer Science, Aalto University, Otaniemi, Finland
| | - Timothy B. Patrick
- Biomedical and Health Informatics, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Maryam Zolnoori
- School of Nursing and Data Science Institute, Columbia University, New York, NY, United States
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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Justesen TEH, Borghammer P, Aanerud J, Hovind P, Marner L. Sertraline treatment influences [ 18F]FE-PE2I PET imaging for Parkinsonism. EJNMMI Res 2023; 13:46. [PMID: 37221321 DOI: 10.1186/s13550-023-01000-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/16/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND The dopamine transporter (DaT) PET ligand [18F]FE-PE2I is used to aid the diagnosis of Parkinson's disease. After encountering four patients with a history of daily sertraline use, who all showed atypical findings on [18F]FE-PE2I PET, we suspected that the selective serotonin reuptake inhibitor (SSRI), sertraline, might interfere with the results and lead to globally reduced striatal [18F]FE-PE2I binding due to sertraline's high affinity for DaT. METHODS We rescanned the four patients with [18F]FE-PE2I PET after a 5-day sertraline pause. Sertraline plasma concentration was estimated based on body weight and dose, and specific binding ratios (SBR) in caudate nucleus, known to be more preserved in Parkinson's, were used to estimate the effect on tracer binding. Comparison was made to a patient with [18F]FE-PE2I PET before and after a 7-day Modafinil pause. RESULTS We found a significant effect of sertraline on caudate nucleus SBR (p = 0.029). The effect showed a linear dose-dependent relationship that corresponds to a reduction in SBR by 0.32 or 0.44 for a 75 kg male or a 65 kg female, respectively, taking a daily dose of 50 mg sertraline. CONCLUSION Sertraline is one of the most commonly used antidepressants and in contrast to other SSRI's, sertraline show high affinity for DaT. We recommend that sertraline treatment is taken into account when patients are undergoing [18F]FE-PE2I PET especially in patients showing apparent globally reduced PE2I binding. If tolerable, pausing of the sertraline treatment should be considered, especially for doses above 50 mg/day.
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Affiliation(s)
- Thomas E H Justesen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, Copenhagen, Denmark
| | - Per Borghammer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus N, Denmark
| | - Joel Aanerud
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus N, Denmark
| | - Peter Hovind
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, Copenhagen, Denmark
| | - Lisbeth Marner
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Belge JB, Sabbe ACF, Sabbe BGCC. An update on pharmacotherapy for recurrent depression in 2022. Expert Opin Pharmacother 2023; 24:1387-1394. [PMID: 37300545 DOI: 10.1080/14656566.2023.2223962] [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: 01/29/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Major depressive disorder remains a major challenge due to its biopsychosocial burden with increased morbidity and mortality. Despite successful treatment options for the acute episode, recurrence rates are high, on average four times in a life span. AREAS COVERED Both pharmacological as non-pharmacological evidence-based therapeutic options to prevent and treat recurrent depression are discussed. EXPERT OPINION Although some risk factors for recurrence are well known, better evidence is needed. Antidepressant medication should be continued after acute treatment at its full therapeutic dose for longer periods, at least 1 year. There are no clear differences between classes of antidepressant medication when treatment is focused on preventing relapse. Bupropion is the only antidepressant with a proven efficacy to prevent recurrence in seasonal affective disorder. Recent findings conclude maintenance subanesthetic ketamine and esketamine treatment can be effective in sustaining antidepressant effect following remission. Furthermore, the pharmacological approach must be integrated with lifestyle interventions, especially aerobic exercise. Finally, combining pharma- and psychotherapy seems to improve outcome. Network and complexity sciences will help to decrease the high recurrence rates of MDD by developing more integrative and personalized approaches.
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Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Amber C F Sabbe
- Department of Internal Medicine, University Hospital of Antwerp, Edegem, Belgium
- Campus Drie Eiken, Universiteitsplein 1, University of Antwerp, Wilrijk, Belgium
| | - Bernard G C C Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Villanueva V, Artal J, Cabeza-Alvarez CI, Campos D, Castillo A, Flórez G, Franco-Martin M, García-Portilla MP, Giráldez BG, Gotor F, Gutiérrez-Rojas L, Albanell AM, Paniagua G, Pintor L, Poza JJ, Rubio-Granero T, Toledo M, Tortosa-Conesa D, Rodríguez-Uranga J, Bobes J. Proposed Recommendations for the Management of Depression in Adults with Epilepsy: An Expert Consensus. Neurol Ther 2023; 12:479-503. [PMID: 36692706 PMCID: PMC10043101 DOI: 10.1007/s40120-023-00437-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Experts agree that there is a need for protocols to guide health professionals on how to best manage psychiatric comorbidities in patients with epilepsy (PWE). We aimed to develop practical recommendations for key issues in the management of depression in PWE. METHODS This was a qualitative study conducted in four steps: (1) development of a questionnaire on the management of depression in PWE to be answered; (2) literature review and, if evidence from guidelines/consensus or systematic reviews was available, drafting initial recommendations; (3) a nominal group methodology for reviewing initial recommendations and formulating new recommendations on those issues without available evidence; and (4) drafting and approving the final recommendations. A scientific committee (one neurologist and one psychiatrist) was responsible for the development of the project and its scientific integrity. The scientific committee selected a panel of experts (nine neurologists and nine psychiatrists with experience in this field) to be involved in the nominal group meetings and to formulate final recommendations. RESULTS Fifteen recommendations were formulated. Four on the screening and diagnosis: screening and diagnosis of depression, evaluation of the risk of suicide, and diagnosis of depression secondary to epilepsy; nine on the management of depression: referral to a psychiatrist, selection of the antiseizure medication, change of antiseizure medication, antidepressant treatment initiation, selection of antidepressant, use of antidepressants during pregnancy, use of psychotherapy, antidepressant treatment duration, and discontinuation of antidepressant treatment; two on the follow-up: duration of the follow-up under usual conditions, and follow-up of patients at risk of suicide. CONCLUSION We provide recommendations based on expert opinion consensus to help healthcare professionals assess depression in PWE. The detection and treatment of major depressive disorders are key factors in improving epilepsy outcomes and avoiding suicide risk.
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Affiliation(s)
- Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Jesús Artal
- Psychiatry Department, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Spain.
| | | | - Dulce Campos
- Neurology Department, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Ascensión Castillo
- Neurology Department, Consorcio Hospital General Universitario Valencia, Valencia, Spain
| | - Gerardo Flórez
- Psychiatry Department, Addiction Treatment Unit, Orense, Spain
| | - Manuel Franco-Martin
- Psychiatry Department, Zamora Hospital (Complejo Asistencial de Zamora), Zamora, Spain
| | - María Paz García-Portilla
- Psychiatry Department, University of Oviedo, ISPA, CIBERSAM, INEUROPA, and Mental Health Services of Principality of Asturias, Oviedo, Spain
| | - Beatriz G Giráldez
- Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Francisco Gotor
- Psychiatry Department, School of Medicine, University Hospital Virgen del Rocio, Seville, Spain
| | | | | | - Gonzalo Paniagua
- Psychiatry Department, University of Oviedo, Oviedo, Spain
- Mental Health Services of Principado de Asturias, SESPA, Oviedo, Spain
| | - Luis Pintor
- Psychiatry Department, Hospital Clínico of Barcelona, Barcelona, Spain
| | - Juan José Poza
- Neurology Department, Hospital Universitario Donostia, Donostia, Spain
| | - Teresa Rubio-Granero
- Psychiatry Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Manuel Toledo
- Epilepsy Unit, Vall D'Hebron University Hospital, Barcelona, Spain
| | - Diego Tortosa-Conesa
- Neurology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Julio Bobes
- Medicine-Psychiatry, Universidad de Oviedo, Oviedo, Spain
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Fornaro M, Cattaneo CI, De Berardis D, Ressico FV, Martinotti G, Vieta E. Antidepressant discontinuation syndrome: A state-of-the-art clinical review. Eur Neuropsychopharmacol 2023; 66:1-10. [PMID: 36345093 DOI: 10.1016/j.euroneuro.2022.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/13/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
Antidepressant drugs are prescribed to patients with depressive, anxiety disorders, and other conditions. Evidence about antidepressant discontinuation syndrome (ADS) and related outcomes is sparse, although potentially burdensome in some patients. The present state-of-the-art review aims to appraise the most current evidence about ADS critically. ADS has been documented for most antidepressant drugs, although most literature focuses on selective serotonin reuptake inhibitors prescribed for depression. While down-titration cannot exclude the chance of ADS, it is nonetheless warranted in the clinical setting, especially for short half-life and sedative compounds such as paroxetine. Integrative management with concurrent pharmacotherapy and psychotherapy may minimize the eventual unpleasant effects arising within the discontinuation process. In addition, patient-tailored interventions and education should be part of the discontinuation strategy. Future research must rely on broadly accepted definitions for ADS and related phenomena such as antidepressant withdrawal and shed further light on the underpinning neurobiology. Discriminating between ADS-related phenomena and relapse of depression is likewise warranted, along with a neuroscience-based nomenclature instead of a class one.
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Affiliation(s)
- M Fornaro
- Department of Psychiatry, Federico II University of Naples, via Pansini n.5, building 18, Psychiatry, Naples ZIP 80131, Italy.
| | - C I Cattaneo
- Department of Mental Health, Borgomanero ASL, Novara, Italy
| | - D De Berardis
- Department of Mental Health Psychiatric Service, Diagnosis and Treatment. Hospital "G. Mazzini", ASL 4, NHS, Teramo, Italy
| | - F V Ressico
- Department of Mental Health, Borgomanero ASL, Novara, Italy
| | - G Martinotti
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy; Department of Pharmacy, Pharmacology, Postgraduate Medicine, University of Hertfordshire, Herts AL10 9AB, UK
| | - E Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Withdrawal Syndrome Following Discontinuation of 28 Antidepressants: Pharmacovigilance Analysis of 31,688 Reports from the WHO Spontaneous Reporting Database. Drug Saf 2022; 45:1539-1549. [DOI: 10.1007/s40264-022-01246-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/19/2022]
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Sørensen A, Jørgensen KJ, Munkholm K. Description of antidepressant withdrawal symptoms in clinical practice guidelines on depression: A systematic review. J Affect Disord 2022; 316:177-186. [PMID: 35964766 DOI: 10.1016/j.jad.2022.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/26/2022] [Accepted: 08/06/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Antidepressant withdrawal symptoms may mimic symptoms of depression relapse and can be challenging for patients when tapering or discontinuing antidepressants. We aimed to assess how withdrawal symptoms are described in major clinical practice guidelines on depression. METHODS Systematic review of major clinical practice guidelines on depression from the United Kingdom, the United States, Canada, Australia, Singapore, Ireland, and New Zealand. We searched PubMed, 14 guideline registries, and the websites of relevant organisations (last search 10 July 2022). The guidelines were assessed for information and descriptions of antidepressant withdrawal symptoms regarding their type, incidence, duration, severity, onset, and presumed mechanism. RESULTS We included 21 guidelines, 15 (71 %) of which stated that withdrawal or discontinuation symptoms can occur. None of the guidelines provided an exhaustive list of potential withdrawal symptoms; ten (48 %) guidelines mentioned at least one specific symptom, ranging between four and 39 symptoms. The symptomatic overlap between withdrawal and relapse was mentioned in four (19 %) guidelines. Withdrawal symptoms were generally described as mild, brief, and self-limiting; and severe in a minority of cases. Estimates of the duration, incidence, or expected onset were reported in five (24 %) guidelines, and were in all cases lower than those reported in systematic reviews. LIMITATIONS We included clinical practice guidelines from English-speaking countries only; our findings may not be generalizable to non-English-speaking countries. CONCLUSIONS Clinical practice guidelines provide scarce and inadequate information on antidepressant withdrawal symptoms and limited guidance for distinguishing withdrawal symptoms from symptoms of relapse.
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Affiliation(s)
- Anders Sørensen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Denmark.
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
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Yin X, Li W, Liang T, Lu B, Yue H, Li S, Zhong VW, Zhang W, Li X, Zhou S, Mi Y, Wu H, Xu S. Effect of Electroacupuncture on Insomnia in Patients With Depression: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2220563. [PMID: 35797047 PMCID: PMC9264041 DOI: 10.1001/jamanetworkopen.2022.20563] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPORTANCE Electroacupuncture (EA) is a widely recognized therapy for depression and sleep disorders in clinical practice, but its efficacy in the treatment of comorbid insomnia and depression remains uncertain. OBJECTIVE To assess the efficacy and safety of EA as an alternative therapy in improving sleep quality and mental state for patients with insomnia and depression. DESIGN, SETTING, AND PARTICIPANTS A 32-week patient- and assessor-blinded, randomized, sham-controlled clinical trial (8-week intervention plus 24-week observational follow-up) was conducted from September 1, 2016, to July 30, 2019, at 3 tertiary hospitals in Shanghai, China. Patients were randomized to receive EA treatment and standard care, sham acupuncture (SA) treatment and standard care, or standard care only as control. Patients were 18 to 70 years of age, had insomnia, and met the criteria for depression as classified in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Data were analyzed from May 4 to September 13, 2020. INTERVENTIONS All patients in the 3 groups were provided with standard care guided by psychiatrists. Patients in the EA and SA groups received real or sham acupuncture treatment, 3 sessions per week for 8 weeks, for a total of 24 sessions. MAIN OUTCOMES AND MEASURES The primary outcome was change in Pittsburgh Sleep Quality Index (PSQI) from baseline to week 8. Secondary outcomes included PSQI at 12, 20, and 32 weeks of follow-up; sleep parameters recorded in actigraphy; Insomnia Severity Index; 17-item Hamilton Depression Rating Scale score; and Self-rating Anxiety Scale score. RESULTS Among the 270 patients (194 women [71.9%] and 76 men [28.1%]; mean [SD] age, 50.3 [14.2] years) included in the intention-to-treat analysis, 247 (91.5%) completed all outcome measurements at week 32, and 23 (8.5%) dropped out of the trial. The mean difference in PSQI from baseline to week 8 within the EA group was -6.2 (95% CI, -6.9 to -5.6). At week 8, the difference in PSQI score was -3.6 (95% CI, -4.4 to -2.8; P < .001) between the EA and SA groups and -5.1 (95% CI, -6.0 to -4.2; P < .001) between the EA and control groups. The efficacy of EA in treating insomnia was sustained during the 24-week postintervention follow-up. Significant improvement in the 17-item Hamilton Depression Rating Scale (-10.7 [95% CI, -11.8 to -9.7]), Insomnia Severity Index (-7.6 [95% CI, -8.5 to -6.7]), and Self-rating Anxiety Scale (-2.9 [95% CI, -4.1 to -1.7]) scores and the total sleep time recorded in the actigraphy (29.1 [95% CI, 21.5-36.7] minutes) was observed in the EA group during the 8-week intervention period (P < .001 for all). No between-group differences were found in the frequency of sleep awakenings. No serious adverse events were reported. CONCLUSIONS AND RELEVANCE In this randomized clinical trial of EA treatment for insomnia in patients with depression, quality of sleep improved significantly in the EA group compared with the SA or control group at week 8 and was sustained at week 32. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03122080.
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Affiliation(s)
- Xuan Yin
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei Li
- School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tingting Liang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing Lu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Acupuncture and Moxibustion, Huadong Hospital, Fudan University, Shanghai, China
| | - Hongyu Yue
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shanshan Li
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Victor W. Zhong
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Xia Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuang Zhou
- Department of Traditional Chinese Medicine, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Yiqun Mi
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huangan Wu
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shifen Xu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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11
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Herrman H, Patel V, Kieling C, Berk M, Buchweitz C, Cuijpers P, Furukawa TA, Kessler RC, Kohrt BA, Maj M, McGorry P, Reynolds CF, Weissman MM, Chibanda D, Dowrick C, Howard LM, Hoven CW, Knapp M, Mayberg HS, Penninx BWJH, Xiao S, Trivedi M, Uher R, Vijayakumar L, Wolpert M. Time for united action on depression: a Lancet-World Psychiatric Association Commission. Lancet 2022; 399:957-1022. [PMID: 35180424 DOI: 10.1016/s0140-6736(21)02141-3] [Citation(s) in RCA: 301] [Impact Index Per Article: 150.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Sangath, Goa, India; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael Berk
- Deakin University, IMPACT Institute, Geelong, VIC, Australia
| | - Claudia Buchweitz
- Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania L Vanvitelli, Naples, Italy
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Myrna M Weissman
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe; Centre for Global Mental Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina W Hoven
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shuiyuan Xiao
- Central South University Xiangya School of Public Health, Changsha, China
| | - Madhukar Trivedi
- Peter O'Donnell Jr Brain Institute and the Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Lakshmi Vijayakumar
- Sneha, Suicide Prevention Centre and Voluntary Health Services, Chennai, India
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12
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Groenwold RHH, Heerdink ER, Klungel OH. Challenges in the Design, Registration, and Reporting of Noninferiority Trials. JAMA Psychiatry 2022; 79:191-192. [PMID: 35080623 DOI: 10.1001/jamapsychiatry.2021.3932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Eibert R Heerdink
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
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13
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Comparative effects of 15 antidepressants on the risk of withdrawal syndrome: A real-world study using the WHO pharmacovigilance database. J Affect Disord 2022; 297:189-193. [PMID: 34699855 DOI: 10.1016/j.jad.2021.10.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/14/2021] [Accepted: 10/20/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND While case reports and clinical trials reported withdrawal syndrome after reduction and/or discontinuation of antidepressant drugs, no large study has been conducted to compare the risk between the different antidepressants. METHODS Using data recorded from January 1st, 1988, and December 31st, 2020 in VigiBase®, the World Health Organization's Global Individual Case Safety Reports database, we performed disproportionality analysis to investigate the risk of reporting withdrawal syndrome in patients treated by short half-life antidepressants compared with patients treated by long half-life antidepressants. In addition, we aimed to better inform clinical practice by comparing 15 antidepressants for the risk of reporting withdrawal syndrome. RESULTS Among the 338,498 reports with antidepressants of interest, we found 15,507 cases of withdrawal syndrome. Short half-lives antidepressants were associated with an increased risk of reporting a withdrawal syndrome compared to long half-life antidepressants (ROR 5.38; 95% CI 5.16-5.61). The risk was higher for 18-44 years old (ROR 6.88; 95% CI 6.17-7.62), women (ROR 1.38; 95% CI 1.33-1.43) and patients treated with Paroxetine, Desvenlafaxine, Venlafaxine and Duloxetine. LIMITATIONS The limitations of this study stem from the case-reporting process. CONCLUSIONS This large observational study in a real-world setting suggests that the use of short half-life antidepressants increases the risk of reporting withdrawal syndrome compared to long half-life antidepressants. Among the most common antidepressants, paroxetine and serotonin-noradrenaline reuptake inhibitors are associated with a greater risk of reporting withdrawal syndrome, while agomelatine and vortioxetine present a lower risk. Additional studies are needed to corroborate our results.
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14
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Wang QQ, Cheng L, Wu BY, Xu P, Qiu HY, Wang B, Yan XJ, Chen SL. Short-course antidepressant therapy reduces discontinuation syndrome while maintaining treatment efficacy in patients with refractory functional dyspepsia: A randomized controlled trial. Front Psychiatry 2022; 13:1063722. [PMID: 36569610 PMCID: PMC9772443 DOI: 10.3389/fpsyt.2022.1063722] [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: 10/07/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Long-course (LC) antidepressants for the treatment of disorders of gut-brain interaction, such as refractory functional dyspepsia (rFD), pose patients at risk of antidepressant discontinuation syndrome (ADS). Short-course (SC) therapy of rapid-acting antidepressant may reduce discontinuation syndromes while maintaining efficacy for dyspeptic symptoms. However, the evidence-based research is lacking. This study aims to determine whether SC therapy with antidepressants could decrease the risk of ADS with comparable treatment efficacy to LC therapy in rFD. METHODS This randomized clinical trial with rFD patients was conducted at a tertiary hospital in China. Participants (N = 240) were randomly allocated to receive flupentixol-melitracen (FM) plus omeprazole therapy for 2 (SC group) or 4 (LC group) weeks, respectively. Scores for Leeds Dyspepsia Questionnaire (LDQ), Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 for Depression (PHQ-9) were assessed at baseline and every 2 weeks, ending at 4 weeks after treatment. ADS was assessed after drug cessation. Medication possession ratio (MPR) for FM was calculated. RESULTS The severity and incidence of ADS of patients in SC group were significantly lower than those in LC group (0.60 ± 0.62 vs. 1.71 ± 1.58 and 3.64 vs. 39.45%; both P < 0.0001). The MPR values for FM were significantly higher in patients of SC group than in LC group (P < 0.0001). Scores for LDQ, GAD-7 and PHQ-9 decreased in patients of both groups, and the symptom improvement in SC group was comparable to that in LC group after treatment. CONCLUSIONS Compared to 4-week FM therapy, the 2-week FM therapy reduces the risk of ADS with non-inferior treatment efficacy in patients with rFD. CLINICAL TRIAL REGISTRATION Clinical trials.gov, identifier NCT05099913.
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Affiliation(s)
- Qian-Qian Wang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li Cheng
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bi-Yu Wu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Xu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong-Yi Qiu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Wang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiu-Juan Yan
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sheng-Liang Chen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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15
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Cosci F, Fava GA. Prescribing Pharmacotherapy for Major Depressive Disorder: How Does a Clinician Decide? Biomed Hub 2021; 6:118-121. [PMID: 34950673 PMCID: PMC8647051 DOI: 10.1159/000519656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Clinical Pharmacopsychology Laboratory, University of Florence, Florence, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
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16
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Thom RP, Alexander JL, Baron D, Garakani A, Gross L, Pine JH, Radhakrishnan R, Slaby A, Sumner CR. Selective Serotonin Reuptake Inhibitors: How Long Is Long Enough? J Psychiatr Pract 2021; 27:361-371. [PMID: 34529602 DOI: 10.1097/pra.0000000000000578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are among the most commonly prescribed medications. They are among the first-line medications for several chronic or relapsing-remitting psychiatric conditions, including major depressive disorder and anxiety disorders. The advantages of SSRI use include ease of titration and their tolerability and safety profile. Guidelines for the short-term use of SSRIs are widely available, but there is no well-organized guidance on how and whether to maintain a patient on SSRIs for the long-term. In this article, we discuss the benefits and possible adverse consequences of long-term SSRI use, as well as clinical practice considerations when using SSRIs chronically. The major benefit of long-term SSRI use is relapse prevention. The current literature suggests that the general health risks of long-term SSRI use are low; however, further research, particularly in special populations including youth and the elderly, is needed. Long-term SSRI use increases the risk of tachyphylaxis and discontinuation syndrome. Recognizing that many patients may remain on SSRIs for many years, there are several factors that prescribers should consider if they choose to use an SSRI when initiating treatment and during long-term monitoring. The decision to continue or to discontinue an SSRI should be an active one, involving both the patient and prescriber, and should be revisited periodically. Patients who remain on SSRIs for the long-term should also have periodic monitoring to reassess the risk-benefit ratio of remaining on the SSRI, as well as to assess the safety, tolerability, and efficacy of the medication.
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17
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Muntingh A, Batelaan N, Scholten W, van Balkom AJ. To continue or discontinue antidepressants in anxiety disorders? A dilemma for patients and clinicians. J Psychiatry Neurosci 2021; 46:E388-E389. [PMID: 34077149 PMCID: PMC8327981 DOI: 10.1503/jpn.200099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Anna Muntingh
- From the Amsterdam UMC, VU University, Psychiatry, Amsterdam Public Health research institute, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom); and the GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom)
| | - Neeltje Batelaan
- From the Amsterdam UMC, VU University, Psychiatry, Amsterdam Public Health research institute, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom); and the GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom)
| | - Willemijn Scholten
- From the Amsterdam UMC, VU University, Psychiatry, Amsterdam Public Health research institute, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom); and the GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom)
| | - Anton J van Balkom
- From the Amsterdam UMC, VU University, Psychiatry, Amsterdam Public Health research institute, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom); and the GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom)
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18
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Costa E, Sterzi E, Tedeschi F, Casari R, Marini P, Lugoboni F. Can oral formulation increase the risk of lormetazepam abuse? Intern Emerg Med 2021; 16:785-788. [PMID: 33095413 DOI: 10.1007/s11739-020-02538-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023]
Abstract
The slowness of dripping and the presence of alcohol have been offered/suggested as possible causes for the increased risk of developing dependence to the oral formulation of lormetazepam rather than to other anxiolytic and hypnotic drugs. We hence assessed the time of dripping of the most used benzodiazepines and z-drugs oral solution products under experimental conditions and the different employed excipients through a comparative analysis of the Summaries of Product Characteristics. A wide range of the median overall dispensing time was found across the eight products included in the analysis. Among the products containing LMZ, Minias® ranked in the fourth position, while LMZ Mylan Generics® and Noctamid® in the sixth and third, respectively. Our data suggest that the pace of dripping and the presence of alcohol cannot be considered themselves the cause that triggered the abuse of lormetazepam. More precisely, the quantity of alcohol per bottle has been found negligible at therapeutic doses; however, when these are exceeded, they may have clinical implications for patients. Further studies are needed to assess them. Meanwhile, the public-health problem remains and some improvements should be carried out at different levels, to guarantee the appropriate prescription and use of lormetazepam oral solution.
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Affiliation(s)
- Enrico Costa
- Department of Pharmacy, Azienda Ospedaliera Universitaria Integrata Verona,, P. le L.A. Scuro, 10, 37134, Verona, Italy.
| | - Enrico Sterzi
- Department of Pharmacy, Azienda Ospedaliera Universitaria Integrata Verona,, P. le L.A. Scuro, 10, 37134, Verona, Italy
| | - Federico Tedeschi
- Section of Psychiatry and Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Rebecca Casari
- Addiction Medicine Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Paola Marini
- Department of Pharmacy, Azienda Ospedaliera Universitaria Integrata Verona,, P. le L.A. Scuro, 10, 37134, Verona, Italy
| | - Fabio Lugoboni
- Addiction Medicine Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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19
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Zwanzger P, Singewald N, Bandelow B. [Pharmacotherapy of anxiety disorders-Guideline-conform treatment and new developments]. DER NERVENARZT 2021; 92:433-440. [PMID: 33502576 DOI: 10.1007/s00115-020-01051-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 01/07/2023]
Abstract
Besides cognitive behavioral therapy (CBT), psychopharmacotherapy belongs to the first-line treatment approaches for anxiety disorders according to all national and international guidelines. According to studies and meta-analyses, modern antidepressants in particular have been proven to be effective. Depending on the substance, there are approvals for panic disorder, generalized anxiety disorder and social phobia. There are also approvals for other substance groups, e.g. anticonvulsants for generalized anxiety disorder. Benzodiazepines should be used with caution in view of the risk of dependency. Although effective and well-tolerated medications are available, up to 30% of patients still do not respond or do not respond adequately to treatment. Consequently, research efforts to develop new substances are important. Based on a better understanding of the complex neurobiological mechanisms underlying anxiety disorders, a large number of substances are currently undergoing clinical trials. Modulators of current and new transmitter systems, in particular the glutamatergic and the endocannabinoid systems as well as neuropeptides, are being discussed as innovative substances. Strategies are also being investigated which, in combination with psychotherapy, aim at optimizing fear extinction memory. First studies are also underway on the use of psychedelic agents in combination with psychotherapy for anxiety.
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Affiliation(s)
- P Zwanzger
- Fachbereich Psychosomatische Medizin, Kompetenzschwerpunkt Angst, kbo-Inn-Salzach-Klinikum, Gabersee 7, 83512, Wasserburg am Inn, Deutschland. .,Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, München, Deutschland.
| | - N Singewald
- Center for Molecular Biosciences Innsbruck (CMBI), Department of Pharmacology and Toxicology, Institute of Pharmacy, Leopold-Franzens-Universität Innsbruck, Innsbruck, Österreich
| | - B Bandelow
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Göttingen, Deutschland
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20
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Fava GA. The Decline of Pluralism in Medicine: Dissent Is Welcome. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:1-5. [PMID: 31838479 DOI: 10.1159/000505085] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/21/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA,
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21
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Cosci F, Mansueto G, Fava GA. Relapse prevention in recurrent major depressive disorder. A comparison of different treatment options based on clinical experience and a critical review of the literature. Int J Psychiatry Clin Pract 2020; 24:341-348. [PMID: 32716222 DOI: 10.1080/13651501.2020.1779308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Reducing the risk of relapses is a critical component of major depressive disorders treatment. Guidelines suggest maintenance with antidepressant drugs in recurrent depression, but this solution has recently been questioned. OBJECTIVE The aim of this article is to provide a critical review of the literature of the main treatment options currently available to prevent relapse and recurrence in depression. METHODS We compared long-term antidepressant therapy (i.e., indefinite maintenance of antidepressant), intermittent antidepressant therapy (i.e., use of antidepressants mainly limited to the acute phases), use of psychotherapy in the sequential model (i.e., pharmacotherapy in the acute phase and psychotherapy in the residual phase). RESULTS We argue that the same solution may not apply to all patients and question the feasibility of a single course of treatment in the setting of complex disorders that are encountered in practice. The clinician should weigh advantages and disadvantages in the individual case. CONCLUSIONS The sequential model appears to be particularly indicated in recurrent depression. KEY POINTS Relapse is a major challenge of depressive disorders treatment Treatment options currently available include long-term antidepressants, intermittent antidepressants, addition of psychotherapy to pharmacotherapy in the sequential model Maintenance with antidepressants in recurrent depression has recently been questioned The sequential model appears to be particularly indicated in recurrent depression.
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Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Andrea Fava
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
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22
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Cosci F, Guidi J, Mansueto G, Fava GA. Psychotherapy in recurrent depression: efficacy, pitfalls, and recommendations. Expert Rev Neurother 2020; 20:1169-1175. [DOI: 10.1080/14737175.2020.1804870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni A. Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, NY, USA
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23
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Hengartner MP. How effective are antidepressants for depression over the long term? A critical review of relapse prevention trials and the issue of withdrawal confounding. Ther Adv Psychopharmacol 2020; 10:2045125320921694. [PMID: 32435449 PMCID: PMC7225779 DOI: 10.1177/2045125320921694] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/27/2020] [Indexed: 12/20/2022] Open
Abstract
The aim of this article is to discuss the validity of relapse prevention trials and the issue of withdrawal confounding in these trials. Recommendations for long-term antidepressant treatment are based almost exclusively on discontinuation trials. In these relapse prevention trials, participants with remitted depression are randomised either to have the antidepressant abruptly discontinued and replaced by inert placebo or to continue active treatment. The drug-placebo difference in relapse rates at the end of the maintenance phase is then interpreted as a prophylactic drug effect. These trials consistently produce remarkable benefits for maintenance treatment. However, the internal validity of this trial protocol is compromised, as research has shown that abruptly stopping antidepressants can cause severe withdrawal reactions that lead to (or manifest as) depression relapses. That is, there is substantial withdrawal confounding in discontinuation trials, which renders their findings uninterpretable. It is not clear to what degree the drug-placebo separation in relapse prevention (discontinuation) trials is due to withdrawal reactions, but various estimations suggest that it is presumably the majority. A review of findings based on other methodologies, including real-world long-term effectiveness trials like STAR*D and various naturalistic cohort studies, do not indicate that antidepressants have considerable prophylactic effects. As absence of evidence does not imply evidence of absence, no definitive conclusions can be drawn from the literature. To enable a thorough risk-benefit evaluation, real-world effectiveness trials should not only focus on relapse prevention, but also assess antidepressants' long-term effects on social functioning and quality of life. Thus far, reliable long-term data on these outcome domains are lacking.
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Affiliation(s)
- Michael P. Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), PO Box 707, Zurich, CH-8037, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
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24
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Yu Z, Zhang J, Zheng Y, Yu L. Trends in Antidepressant Use and Expenditure in Six Major Cities in China From 2013 to 2018. Front Psychiatry 2020; 11:551. [PMID: 32765307 PMCID: PMC7378967 DOI: 10.3389/fpsyt.2020.00551] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/29/2020] [Indexed: 01/21/2023] Open
Abstract
The objective of this study was to investigate the current status and trends in antidepressant use and expenditure in China from 2013 to 2018. The study had a retrospective design based on prescribing data on antidepressant drugs, which was sourced from the Hospital Prescription Analysis Cooperative Project. The trends in hospital visits and corresponding expenditure on antidepressant drugs were examined. Subgroup analyses were carried out by sex, age, and drug class. A total of 1,795,230 outpatient prescriptions were collected from 79 hospitals in six major cities in China. Hospital visits with antidepressant prescriptions rose significantly from 244,626 in 2013 to 348,718 in 2018, reflecting a 42.6% increase (P < 0.05). The antidepressant expenditure also rose, increasing from 48.0 million Chinese yuan in 2013 to 64.8 million Chinese yuan in 2018. There were approximately 1.6 times more antidepressant prescriptions written for women than for men. The most frequent age category for antidepressant prescriptions was 45-64 years. The most commonly prescribed antidepressants were selective serotonin reuptake inhibitors (N06AB) and other antidepressants (N06AX), whereas tricyclic antidepressants (N06AA) accounted for only a small part of the total antidepressant prescriptions. Flupentixol/melitracen and escitalopram were the most frequently prescribed antidepressants. Antidepressant prescribing rates continue to increase in China, although the prescribing patterns have changed over the past few years. The wide use of expensive antidepressants and those with weak clinical evidence raises concerns regarding the rational use of antidepressants. This study provides a basis for future stewardship by the government and medical institutions.
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Affiliation(s)
- Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jianying Zhang
- Department of Outpatient Nursing, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Zheng
- Department of Pharmacy, The 903 Hospital of the Joint Logistic Support Force of the PLA, Hangzhou, China
| | - Lingyan Yu
- Department of Pharmacy, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Hengartner MP, Schulthess L, Sorensen A, Framer A. Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum. Ther Adv Psychopharmacol 2020; 10:2045125320980573. [PMID: 33489088 PMCID: PMC7768871 DOI: 10.1177/2045125320980573] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Protracted withdrawal syndrome (PWS) after stopping antidepressants (frequently also referred to as post-acute withdrawal syndrome or PAWS) has been described in a few case reports. However, a detailed quantitative analysis of specific symptom manifestations in antidepressant PWS is still lacking. METHODS We extracted patient narratives from a large English-language internet forum SurvivingAntidepressants.org, a peer support site concerned about withdrawal from antidepressants. PWS was ascertained based on diagnostic criteria proposed by Chouinard and Chouinard, specifically ⩾6 months of continuous antidepressant use, with emergence of new and/or more intense symptoms after discontinuation that last beyond the initial 6 weeks of acute withdrawal. We assessed medication history, outcome of PWS, and the prevalence of specific symptoms. RESULTS In total, n = 69 individual reports of protracted withdrawal were selected for analysis. At time of the subjects' most recent reports, duration of PWS ranged from 5 to 166 months, mean = 37 months, median = 26 months. Length of time on the antidepressant causing protracted withdrawal ranged from 6 to 278 months, mean = 96 months, and median = 79 months. Throughout the withdrawal experience, affective symptoms, mostly anxiety, depression, emerging suicidality and agitation, were reported by 81%. Somatic symptoms, mostly headache, fatigue, dizziness, brain zaps, visual changes, muscle aches, tremor, diarrhea, and nausea were reported by 75%. Sleep problems (44%) and cognitive impairments (32%) were mentioned less frequently. These broad symptom domains were largely uncorrelated. CONCLUSION PWS or PAWS from antidepressants can be severe and long-lasting, and its manifestations clinically heterogeneous. Long-term antidepressant exposure may cause multiple body system impairments. Although both somatic and affective symptoms are frequent, they are mostly unrelated in terms of occurrence. Proper recognition and detection of PWS thus requires a comprehensive assessment of medication history, duration of the withdrawal syndrome, and its various somatic, affective, sleep, and cognitive symptoms.
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Affiliation(s)
- Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), PO Box 707, Zurich, 8037, Switzerland
| | - Lukas Schulthess
- Department of Applied Psychology, Zurich University of Applied Sciences, Switzerland
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Stefanou MI, Vittore D, Wolz I, Klingberg S, Wildgruber D. Recurrent Episodes of Paraphilic Behavior Possibly Associated With Olanzapine and Aripiprazole Treatment in a Patient With Schizophrenia. Front Psychiatry 2020; 11:318. [PMID: 32425825 PMCID: PMC7212450 DOI: 10.3389/fpsyt.2020.00318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/31/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Hypersexual and paraphilic disorders have been frequently associated with concomitant psychiatric disorders, including schizophrenia. A growing number of published cases has recently indicated that hypersexual behavior may also arise in conjunction with treatment with second-generation antipsychotics. Although hypersexuality has been acknowledged as a possible side effect of antipsychotic treatment with partial dopamine agonists, including aripiprazole, only very few cases of olanzapine-associated hypersexuality have been reported in the literature. CASE PRESENTATION A 29-year-old man presented with delusions of persecution and reference, auditory hallucinations, and negative symptoms, and was diagnosed with paranoid-hallucinatory schizophrenia. One and a half months after initiation of antipsychotic treatment with olanzapine, he developed compulsive sexual behavior and paraphilia, without signs of akathisia. After olanzapine discontinuation, a full remission of the hypersexual behavior was noted within one week, and treatment was switched to risperidone. Due to hyperprolactinemia, adjunct treatment with low-dose aripiprazole was initiated and a severe recurrence of identical hypersexual behavior occurred. The hypersexual behavior resolved completely within a week after aripiprazole discontinuation. CONCLUSION This case illustrates that hypersexuality may be a rare adverse effect of treatment with second-generation antipsychotics. Although aripiprazole is a drug with a well-established risk for hypersexuality, the question of whether a causal association between hypersexuality and olanzapine exists remains currently unresolved. As the currently limited amount of available evidence precludes any definitive conclusions, additional research is warranted to delineate the possible neurobiological substrates of hypersexual and paraphilic disorders in patients treated with second-generation antipsychotics.
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Affiliation(s)
- Maria-Ioanna Stefanou
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Debora Vittore
- Department of Psychiatry and Psychotherapy, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Ines Wolz
- Department of Psychiatry and Psychotherapy, Eberhard-Karls University of Tübingen, Tübingen, Germany.,Department of Clinical Psychology and Psychotherapy, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Dirk Wildgruber
- Department of Psychiatry and Psychotherapy, Eberhard-Karls University of Tübingen, Tübingen, Germany
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Groot PC, van Os J. How user knowledge of psychotropic drug withdrawal resulted in the development of person-specific tapering medication. Ther Adv Psychopharmacol 2020; 10:2045125320932452. [PMID: 32699604 PMCID: PMC7357127 DOI: 10.1177/2045125320932452] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
Coming off psychotropic drugs can cause physical as well as mental withdrawal, resulting in failed withdrawal attempts and unnecessary long-term drug use. The first reports about withdrawal appeared in the 1950s, but although patients have been complaining about psychotropic withdrawal problems for decades, the first tentative acknowledgement by psychiatry only came in 1997 with the introduction of the 'antidepressant-discontinuation syndrome'. It was not until 2019 that the UK Royal College of Psychiatrists, for the first time, acknowledged that withdrawal can be severe and persistent. Given the lack of a systematic professional response, over the years, patients who were experiencing withdrawal started to work out practical ways to safely come off medications themselves. This resulted in an experience-based knowledge base about withdrawal which ultimately, in The Netherlands, gave rise to the development of person-specific tapering medication (so-called tapering strips). Tapering medication enables doctors, for the first time, to flexibly prescribe and adapt the medication required for responsible and person-specific tapering, based on shared decision making and in full agreement with recommendations in existing guidelines. Looking back, it is obvious that the simple practical solution of tapering strips could have been introduced much earlier, and that the traditional academic strategy of comparisons from randomised trials is not the logical first step to help individual patients. While randomised controlled trials (RCTs) are the gold standard for evaluating interventions, they are unable to accommodate the heterogeneity of individual responses. Thus, a more individualised approach, building on RCT knowledge, is required. We propose a roadmap for a more productive way forward, in which patients and academic psychiatry work together to improve the recognition and person-specific management of psychotropic drug withdrawal.
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Affiliation(s)
- Peter C Groot
- User Research Centre NL, Utrecht University Medical Centre Postbus 85500, Utrecht 3508 GA, The Netherlands
| | - Jim van Os
- UMC Utrecht Brain Centre, Utrecht, The Netherlands
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