Use of antidepressants in the treatment of chronic orofacial pain caused by temporomandibular disorders: A randomized controlled clinical trial

BACKGROUND AND OBJECTIVE

Temporomandibular disorders (TMDs) are a common pathology, associated with pain in the facial territory and with associated psychological disorders, such as anxiety and depression. The aim of this study was to evaluate the efficacy of antidepressants in the treatment of pain associated with TMD.

MATERIALS AND METHODS

Sixty four patients suffering from chronic orofacial pain, randomly distributed in 3 groups: control group treated with night splint, group treated with 10mg/day of citalopram and group treated with 25mg/day of amitriptyline. Pain intensity was assessed, randomly, by a single blinded evaluator, according to the VAS at baseline and after one, three, six and nine weeks.

RESULTS

All groups showed a reduction of pain throughout the period of time evaluated, however, the group treated with amitriptyline showed the best pain reduction results 3.3±1.5, 1.5±1.4 and 0.9±1.3 at 3, 6 and 9 weeks, respectively.

CONCLUSIONS

Low doses of amitriptyline appear to be a good therapeutic option in patients with TMDs suffering from chronic orofacial pain.

Effectiveness of antidepressants in improving the prognosis of COVID-19: A systematic review and meta-analysis

OBJECTIVE, AND MATERIAL AND METHODS

A systematic review and meta-analysis was performed to evaluate the effectiveness of antidepressants in reducing the poor evolution of COVID-19 disease (a composite variable including death, hospitalization and need for mechanical ventilation), and mortality, according the guidelines for Systematic Reviews of Interventions published by the Cochrane library.

SOURCE OF DATA

MEDLINE, EMBASE and COCHRANE LIBRARY were consulted up to February 25, 2022. Unpublished studies were searched on clinicaltrials.gov platform.

SELECTION OF STUDIES

Seven masked and unmasked, observational and experimental studies evaluating death, hospitalization and need for mechanical ventilation were selected. A second subgroup analysis with mortality variable was performed.

DATA EXTRACTION

A full risk of bias assessment was performed addressing issues such as information and confounding bias. ROB2 and Robins-I tools for randomized and no randomized studies were employed respectively. In the quantitative analysis, the risk of publication bias, heterogeneity, estimation of pooled measure and a sensitivity analysis was performed. The pooled final measure was calculated as odds ratio with its correspondent 95% confidence interval. A random effects model was used for this purpose due to the heterogeneity between included studies. Finally, a sensitivity analysis was performed to assess the robustness of final pooled measure.

RESULTS

Seven studies were finally considered to calculate the final pooled measure. The effect of intervention was OR 0.73; 95% CI 0.56-0.94.

CONCLUSIONS

The use of antidepressants, and specially SSRI could be effective for reducing the risk of poor progression of COVID-19 disease.

[Impact of vortioxetine on sexual function compared to other antidepressants]

OBJECTIVE

To analyze the impact of the antidepressant vortioxetine on sexual function, compared to selective serotonin reuptake inhibitors (SSRIs) and mixed selective serotonin and norepinephrine reuptake inhibitors (IRSN or Dual) in patients with depression.

MATERIAL AND METHODS

Analytical, observational, longitudinal and prospective study, which included men and women over 18years of age, with depressive disorder and sexual activity with a partner, separating them into two groups: (i)study, starting treatment with vortioxetine; (2)control, maintaining treatment with SSRIs or Duals. Three visits were made: inclusion, follow-up at 4weeks and final 3months from inclusion. The total follow-up period was 3months.

RESULTS

A total of 87 patients were included (mean age 46.85years). At the end of the study, significant differences (SD) were found in the mean value of the sum of the scores of the evaluative domains of the sexual response of the Women's Sexual Function Questionnaire (FSM-2) between the study group and the control (22.42±4.39 and 16.13±7.76, respectively), with a lower risk of sexual dysfunction in women treated with vortioxetine. Also, lower risk of sexual dysfunction in these same women in the domains of desire, lubrication, orgasm, sexual frequency and sexual satisfaction. These differences were not found when assessing male sexual function.

CONCLUSIONS

Women treated with vortioxetine presented better sexual function than those treated with SSRIs or Duals and a lower risk of sexual dysfunction.

Role of vortioxetine in the treatment of neuropathic pain

Neuropathic pain is an important and disabling clinical problem, its management constitutes a challenge for healthcare professionals. Vortioxetine is a new antidepressant drug with multimodal action, which gives it a unique profile. Tricyclic antidepressants, in particular amitriptyline, and serotonin and norepinephrine reuptake inhibitors venlafaxine and duloxetine are first-line drugs in the treatment of neuropathic pain. The interaction between the pain and depression binomial is very frequent, being the most frequent psychological complication in patients with chronic pain. This comprehensive and descriptive review summarizes the most relevant pharmacological data on vortioxetine, as well as the specific literature on vortioxetine in neuropathic pain and chronic pain.

Antidepressant use and off-label prescribing in primary care in Spain (2013-2018)

INTRODUCTION

Recent studies show an increase in the use of antidepressants in minors (younger than 18 years), although few antidepressants are indicated for this age group. The aim of our study was to calculate the annual prevalence of antidepressant use in children and adolescents and to review the adherence of prescription to current indications.

METHODS

Study of the prevalence of antidepressant use in minors based on the records of the Electronic Database for Pharmacoepidemiologic Studies in Primary Care (BIFAP) of Spain for the 2013-2018 period, considering at least one prescription per year for each patient.

RESULTS

The prevalence of antidepressant prescription in patients from the BIFAP cohort increased between 2013 (7.97 prescriptions per 1000 patients) and 2018 (8.87 prescriptions per 1000 patients), in most groups and in both sexes. In this period, female patients received the most prescriptions, surpassing prescriptions in male patients by up to 2.5 points in the overall rates. In patients younger than 13 years, this trend was inverted and antidepressant use was higher in male patients. The prevalence of prescription rose with increasing patient age, as did the proportion of off-label prescriptions. The use of off-label medication decreased over time.

CONCLUSIONS

There was a gradual increase in the prevalence of antidepressant prescription in minors younger than 18 years, with a predominance of the female sex. The high proportion of unapproved medication use in this age group calls for more thorough investigation of the risk-benefit balance of these treatments and of safer treatment alternatives.

For what indications are antidepressants being used in adults in Colombia?

INTRODUCTION

Antidepressants are useful in the pharmacological treatment of different depressive and anxiety disorders, as well as being potentially useful in other indications. The aim of the study was to determine the indications for which antidepressants are being prescribed in patients over 18 years of age registered with the Colombian Health System.

METHODS

Retrospective study with data from patients over 18 years old, of either sex, registered with the Colombian Health System, who are prescribed antidepressants. Medical records were reviewed, looking for indications approved and not approved by regulatory agencies. Patients were identified randomly, as well as the sociodemographic, clinical and pharmacological variables that could be associated with prescriptions for unapproved indications.

RESULTS

351 patients were evaluated, with a mean age of 60.4 ± 15.3 years, of whom 72.6% were women. They were attended in 34 cities, with prescriptions mainly by general practitioners (n = 276; 78.6%), and psychiatrists (n = 42; 12.0%). Selective serotonin reuptake inhibitors were the most widely prescribed antidepressants (n = 204; 58.1%), followed by atypicals (n = 76; 21.7%). The most frequent indications were for depression (n = 169; 48.1%), anxiety (n = 48; 13.7%), pain (n = 22; 6.3%) and sleep disorders (n = 17; 4.8%). A total of 188 prescriptions (53.6%) were made for approved indications, and the remaining 163 (46.4%) were classified as unapproved.

CONCLUSIONS

Antidepressants are being prescribed for the treatment of depression, anxiety, pain and sleep disorders, especially in older adult women, but almost half of the formulations were for unapproved indications.

Vitamin D: Between the brightness of the sun and the darkness of depression

INTRODUCTION

The scientific literature suggests a relationship between vitamin D (VitD) and the onset, treatment and prognosis of depression. However, this line of research continues to be controversial. The aim of the study was to analyse the relationship between depression and VitD values, controlling for the influence of the season.

MATERIAL AND METHODS

Observational and cross-sectional study. The sample was made up of 150 adult female volunteer participants (aged between 28 and 78 years). The sample was stratified into three groups: a) depression without treatment, b) depression under treatment with antidepressants, and c) without depression (control). VitD values (ng/ml) were compared.

RESULTS

Significant differences were found between the three groups surveyed. The group of participants with depression without treatment obtained the lowest VitD values (mean 18.62ng/ml; SD 8.42), compatible with severe insufficiency. The group of participants with depression in treatment obtained higher values than the previous group, although in an insufficient range (mean 23.80ng/ml; SD 11.30). The third group (control) obtained the highest values and in accordance with the desirable range (mean 30.19ng/ml; SD 10.21). There were no age differences between the groups. When controlling for possible effects of the season, the previous differences in VitD between the three groups were maintained, with an evident decrease of all the mean levels in the winter period.

CONCLUSIONS

Depression is associated with insufficient VitD values. Treatment with antidepressants improves these values, although they continue to be insufficient. The findings of this study reinforce the evidence for an association between depression and VitD.

Efficacy and safety of antipsychotics and antidepressants in the treatment of anorexia nervosa: a systematic review

INTRODUCTION

The recommendations of the current guidelines are based on low quality evidence. Periodic updating is required, taking recent evidence into consideration.

OBJECTIVE

To synthesise the best available clinical evidence on the efficacy and safety of second-generation antidepressants and antipsychotics in patients with anorexia nervosa.

METHODS

Systematic review (CRD42020150577). We searched PubMed, SCOPUS, Ovid(Cochrane), EMBASE and LILACS for randomised clinical trials performed in patients with anorexia nervosa that evaluated the use of second-generation antipsychotics or oral antidepressants, at any dose and for any length of time, in outpatient and/or hospital treatment, taking weight (body mass index), psychopathological entities and safety as results.

RESULTS

Five studies were included, with four assessed as having a high risk of bias. The evidence indicates that patients receiving treatment with olanzapine or fluoxetine tend to stay in treatment programmes for longer. Olanzapine showed favourable results (one study) in terms of weight gain, but did not show the same results in psychopathology, where the evidence is contradictory.

CONCLUSIONS

In accordance with previous reviews, our work allows us to conclude that there is contradictory information on the efficacy of psychotropic drugs in the treatment of anorexia nervosa. Future work should focus on developing clinical trials of high methodological quality.

Role of vortioxetine in the treatment of neuropathic pain

Neuropathic pain is an important and disabling clinical problem, its management constitutes a challenge for healthcare professionals. Vortioxetine is a new antidepressant drug with multimodal action, which gives it a unique profile. Tricyclic antidepressants, in particular amitriptyline, and serotonin and norepinephrine reuptake inhibitors venlafaxine and duloxetine are first-line drugs in the treatment of neuropathic pain. The interaction between the pain and depression binomial is very frequent, being the most frequent psychological complication in patients with chronic pain. This comprehensive and descriptive review summarizes the most relevant pharmacological data on vortioxetine, as well as the specific literature on vortioxetine in neuropathic pain and chronic pain.

Efficacy and Safety of Antipsychotics and Antidepressants in the Treatment of Anorexia Nervosa: a Systematic Review

INTRODUCTION

The recommendations of the current guidelines are based on low quality evidence. Periodic updating is required, taking recent evidence into consideration.

OBJECTIVE

To synthesise the best available clinical evidence on the efficacy and safety of second-generation antidepressants and antipsychotics in patients with anorexia nervosa.

METHODS

Systematic review (CRD42020150577). We searched PubMed, SCOPUS, Ovid(Cochrane), EMBASE and LILACS for randomised clinical trials performed in patients with anorexia nervosa that evaluated the use of second-generation antipsychotics or oral antidepressants, at any dose and for any length of time, in outpatient and/or hospital treatment, taking weight (body mass index), psychopathological entities and safety as results.

RESULTS

Five studies were included, with four assessed as having a high risk of bias. The evidence indicates that patients receiving treatment with olanzapine or fluoxetine tend to stay in treatment programmes for longer. Olanzapine showed favourable results (one study) in terms of weight gain, but did not show the same results in psychopathology, where the evidence is contradictory.

CONCLUSIONS

In accordance with previous reviews, our work allows us to conclude that there is contradictory information on the efficacy of psychotropic drugs in the treatment of anorexia nervosa. Future work should focus on developing clinical trials of high methodological quality.

For What Indications are Antidepressants Being Used in Adults in Colombia?

INTRODUCTION

Antidepressants are useful in the pharmacological treatment of different depressive and anxiety disorders, as well as being potentially useful in other indications. The aim of the study was to determine the indications for which antidepressants are being prescribed in patients over 18 years of age registered with the Colombian Health System.

METHODS

Retrospective study with data from patients over 18 years old, of either sex, registered with the Colombian Health System, who are prescribed antidepressants. Medical records were reviewed, looking for indications approved and not approved by regulatory agencies. Patients were identified randomly, as well as the sociodemographic, clinical and pharmacological variables that could be associated with prescriptions for unapproved indications.

RESULTS

351 patients were evaluated, with a mean age of 60.4±15.3 years, of whom 72.6% were women. They were attended in 34 cities, with prescriptions mainly by general practitioners (n=276; 78.6%), and psychiatrists (n=42; 12.0%). Selective serotonin reuptake inhibitors were the most widely prescribed antidepressants (n=204; 58.1%), followed by atypicals (n=76; 21.7%). The most frequent indications were for depression (n=169; 48.1%), anxiety (n=48; 13.7%), pain (n=22; 6.3%) and sleep disorders (n=17; 4.8%). A total of 188 prescriptions (53.6%) were made for approved indications, and the remaining 163 (46.4%) were classified as unapproved.

CONCLUSIONS

Antidepressants are being prescribed for the treatment of depression, anxiety, pain and sleep disorders, especially in older adult women, but almost half of the formulations were for unapproved indications.

Vitamin D: Between the Brightness of the sun and the Darkness of Depression

INTRODUCTION

The scientific literature suggests a relationship between vitamin D (VitD) and the onset, treatment and prognosis of depression. However, this line of research continues to be controversial. The aim of the study was to analyse the relationship between depression and VitD values, controlling for the influence of the season.

MATERIAL AND METHODS

Observational and cross-sectional study. The sample was made up of 150 adult female volunteer participants (aged between 28 and 78 years). The sample was stratified into three groups: a) depression without treatment, b) depression under treatment with antidepressants, and c) without depression (control). VitD values (ng/ml) were compared.

RESULTS

Significant differences were found between the three groups surveyed. The group of participants with depression without treatment obtained the lowest VitD values (mean 18.62 ng/ml; SD 8.42), compatible with severe insufficiency. The group of participants with depression in treatment obtained higher values than the previous group, although in an insufficient range (mean 23.80 ng/ml; SD 11.30). The third group (control) obtained the highest values and in accordance with the desirable range (mean 30.19 ng/ml; SD 10.21). There were no age differences between the groups. When controlling for possible effects of the season, the previous differences in VitD between the three groups were maintained, with an evident decrease of all the mean levels in the winter period.

CONCLUSIONS

Depression is associated with insufficient VitD values. Treatment with antidepressants improves these values, although they continue to be insufficient. The findings of this study reinforce the evidence for an association between depression and VitD.

Association between affective disorders presenting before and during pregnancy and pre-term birth, considering socio-demographic factors, obstetric factors, health conditions, and use of medication

OBJECTIVE

To study the relationship between maternal affective disorders (AD) before and during pregnancy, and pre-term birth.

DESIGN

Retrospective observational study.

LOCATION

Sexual and reproductive health units at the Institut Català de la Salut (ICS) in Catalonia, Spain.

PARTICIPANTS

Pregnant women with a result of live-born child from 1/1/2012 to 30/10/2015.

INTERVENTIONS

Data were obtained from the ICS Primary Care electronic medical record.

MAIN MEASUREMENTS

Diagnosis of AD before and during pregnancy, months of pregnancy, and possible confusion factors were collected. Descriptive statistical analysis (median, interquartile range, and absolute and relative frequency), bivariate analysis (Wilcoxon test and Chi-square test), and multivariate analysis (logistic regression) were performed.

RESULTS

102,086 women presented valid information for the study. Prevalence of AD during pregnancy was 3.5% (4.29% in pre-term and 3.46% in term births; p<0.004). Pregnant women with pre-term births presented a higher age, smoking habit, lower inter-pregnancy interval, and a lower socio-economic status. Pre-term birth was significantly associated to previous history of stress and dissociative disorder (SDD), anxiety, obsessive-compulsive disorder (OCD) and eating disorders (ED), and use of antidepressants. It was also associated to abuse of alcohol, smoking, and use of psychoactive substances, as well as SDD, ED, use of antipsychotics, and divorce during pregnancy. Multivariate analysis confirmed the relationship between pre-term birth and history of AD, SDD, ED, and smoking, but not with AD during pregnancy.

CONCLUSIONS

Examining the previous history of SDD and ED in pregnant women, and SDD, and ED during pregnancy is highly relevant to avoid pre-term birth.

Antidepressants in Parkinson's disease. Recommendations by the movement disorder study group of the Neurological Association of Madrid

INTRODUCTION

Although antidepressants are widely used in Parkinson's disease (PD), few well-designed studies to support their efficacy have been conducted.

DEVELOPMENT

These clinical guidelines are based on a review of the literature and the results of an AMN movement disorder study group survey.

CONCLUSIONS

Evidence suggests that nortriptyline, venlafaxine, paroxetine, and citalopram may be useful in treating depression in PD, although studies on paroxetine and citalopram yield conflicting results. In clinical practice, however, selective serotonin reuptake inhibitors are usually considered the treatment of choice. Duloxetine may be an alternative to venlafaxine, although the evidence for this is less, and venlafaxine plus mirtazapine may be useful in drug-resistant cases. Furthermore, citalopram may be indicated for the treatment of anxiety, atomoxetine for hypersomnia, trazodone and mirtazapine for insomnia and psychosis, and bupropion for apathy. In general, antidepressants are well tolerated in PD. However, clinicians should consider the anticholinergic effect of tricyclic antidepressants, the impact of serotonin-norepinephrine reuptake inhibitors on blood pressure, the extrapyramidal effects of antidepressants, and any potential interactions between monoamine oxidase B inhibitors and other antidepressants.

[Economic evaluation of desvenlafaxine in the treatment of major depressive disorder in Spain]

INTRODUCTION

The objective of this analysis was to evaluate the clinical and economic value of the use of 50mg-desvenlafaxine compared to the usual care (mix of duloxetine and venlafaxine) in the outpatient treatment of major depressive disorder after first line treatment failure (relapse) in Spain.

MATERIALS AND METHODS

A Markov model was used to follow up a cohort of major depressive disorder patients for one year after failure of first-line treatment with a serotonin-specific reuptake inhibitor and estimate outcome measures (percentage remission and depression-free days) and accrued and direct costs incurred during outpatient treatment of major depressive disorder. In order to obtain the efficacy data related to the treatment alternatives, a literature review of clinical trials was performed. A panel of clinical experts validated the use of clinical resources employed in the estimation of economic outcomes together with model assumptions. The analysis was performed in 2014 from the perspective of the National Health System.

RESULTS

Due to fewer discontinuations, initiating second line treatment with desvenlafaxine was associated with more depression-free days and a higher percentage of patients in remission versus usual care: 1.7 days and 0.5%, respectively. This was translated into lower drug and events management costs, and an overall cost reduction of €108 for the National Health System.

CONCLUSIONS

In patients who have not responded to a first-line serotonin-specific reuptake inhibitor therapy, desvenlafaxine-50mg was clinically similar in effectiveness, but a less costly option, compared with a weighted average of duloxetine and venlafaxine for the second-line treatment of major depressive disorder patients from a payer (National Health System) perspective in Spain.

[Uveal effusion induced by escitalopram]

CASE REPORT

A 73 year-old woman with depression treated with escitalopram developed acute secondary angle closure glaucoma related to uveal effusion after duplicating the drug dose 3 days before. She evolved favorably once the antidepressant treatment was suspended and a new treatment with topical hypotensive therapy and oral prednisone was used.

DISCUSSION

The uveal effusion syndrome associated to medicines is rare; it may be associated with acute myopic shift and acute angle closure glaucoma. The correct diagnosis and discontinuation of the drug lead to the resolution of this nosology.

Association of antidepressant treatment with emergency admission to medical units for patients 65 years or older

INTRODUCTION

There is increasing evidence relating the presence of depression in seniors and the risk of hospital admission in medical departments from the Emergency Services.

OBJECTIVE

To determine the impact of antidepressant treatment (ATD) as a protective factor for emergency hospitalization in older people.

METHOD

All patients aged 65 and over who required urgent attention for medical reasons at the Emergency Department of the Corporació Sanitària i Universitària Parc Taulí (Sabadell, Barcelona, Spain) for the period between January and October 2012 were included in the study. Sociodemographic variables, alcohol and tobacco use, medical history and psychopharmacological treatment were obtained. The necessary sample size was calculated and a simple randomization was performed. Subsequently, a descriptive statistical analysis and parametric tests were conducted.

RESULTS

A total of 674 patients (53% women) were evaluated, with a mean age of 78.45 years, and 27.6% of the cases (71% women) were receiving ATD. Among the 333 admitted patients (50%), 83 individuals (24.6%) had previously received ATD; this contrasts with the 103 cases (30.6%) of prior ATD treatment among the patients who were not admitted. After comparative analysis, the relationship between previous use of ATD and being admitted to hospital was not statistically significant in our global sample. This relationship was only statistically significant among the group aged 75 and over (neg. sig. 0.012).

CONCLUSIONS

In our study, ATD was associated with a decreased risk of hospital admission for urgent medical conditions in people aged 75 and over. Treating depression may protect the elderly against admission to the Emergency department and may potentially be a quality criterion in preventing complications in this population.

The effects of antiepileptic inducers in neuropsychopharmacology, a neglected issue. Part I: A summary of the current state for clinicians

The literature on inducers in epilepsy and bipolar disorder is seriously contaminated by false negative findings. This is part i of a comprehensive review on antiepileptic drug (AED) inducers using both mechanistic pharmacological and evidence-based medicine to provide practical recommendations to neurologists and psychiatrists concerning how to control for them. Carbamazepine, phenobarbital and phenytoin, are clinically relevant AED inducers; correction factors were calculated for studied induced drugs. These correction factors are rough simplifications for orienting clinicians, since there is great variability in the population regarding inductive effects. As new information is published, the correction factors may need to be modified. Some of the correction factors are so high that the drugs (e.g., bupropion, quetiapine or lurasidone) should not co-prescribed with potent inducers. Clobazam, eslicarbazepine, felbamate, lamotrigine, oxcarbazepine, rufinamide, topiramate, vigabatrin and valproic acid are grouped as mild inducers which may (i)be inducers only in high doses; (ii)frequently combine with inhibitory properties; and (iii)take months to reach maximum effects or de-induction, definitively longer than the potent inducers. Potent inducers, definitively, and mild inducers, possibly, have relevant effects in the endogenous metabolism of (i)sexual hormones, (ii) vitamin D, (iii)thyroid hormones, (iv)lipid metabolism, and (v)folic acid.

[Adherence to patients antidepressant treatment and the factors associated of non-compiance]

Objetivo

Conocer la adherencia al tratamiento en pacientes que inician fármacos antidepresivos y analizar los factores asociados al incumplimiento, tanto clínicos como sociodemográficos.

Diseño

Estudio observacional longitudinal prospectivo.

Emplazamiento

Consultas de atención primaria y de salud mental de tres áreas sanitarias de Castilla-La Mancha.

Participantes

Un total de 185 pacientes mayores de 18 años que iniciaron tratamiento antidepresivo.

Mediciones principales

Cumplimiento terapéutico (test Haynes-Sackett, Morisky-Green, recuento de comprimidos y MEMS), efectos adversos, intensidad de los síntomas depresivos, características sociodemográficas y otras características relacionadas con los antidepresivos o con los participantes.

Resultados

Tras 6 meses del inicio del tratamiento antidepresivo, el 46,9% (IC 95%: 36,5-57,3) mostró un cumplimiento inadecuado mediante el método de recuento de comprimidos, y el 28,6% (IC 95%: 19,1-38,0) con el cuestionario de Morisky-Green. A los 15 días la falta de adherencia fue del 48,5% (IC 95%: 40,6-56,4) y del 33,5% (IC 95%: 26,1-41,0), respectivamente. El 38,4% (IC 95%: 31,1-45,7) manifestó algún efecto secundario durante el seguimiento. Mediante un modelo de riesgos proporcionales de Cox las variables relacionadas con incumplimiento fueron menor edad, nivel de instrucción inferior a enseñanza secundaria, prestación farmacéutica como pensionista, no recibir tratamiento psicoterápico, consumir menor número de fármacos no antidepresivos y frecuentación ≤ 3 visitas al médico de familia los 3 meses previos al inicio del estudio.

Conclusiones

El incumplimiento del tratamiento antidepresivo es elevado en atención primaria desde las primeras semanas tras iniciarlo. Constituyen factores condicionantes del mismo los relacionados con características sociodemográficas y con otras características de los pacientes como tipo de financiación de prestación farmacéutica y frecuentación a las consultas.

[Evolution of the use of antidepressants, anxiolytics and hypnotics in Valencia. Period 2000-2010]

Objetivo

Conocer la evolución de la utilización de antidepresivos (AD), ansiolíticos(A) e hipnóticos (H) en la Comunidad Valenciana (CV) entre los años 2000 y2010, su importe y el coste por dosis diaria definida (DDD).

Diseño

Estudio observacional retrospectivo.

Emplazamiento

Recetas dispensadas cargo del sistema público de salud de la CV durante los años 2000 a 2010.

Mediciones

Consumo de los principios activos pertenecientes a los grupos terapéuticos N05B (A), N05C (H) y N06A (AD) obtenidos a partir de la base de datos de farmacia de la Agencia Valenciana de Salud medido en dosis habitante día.

Resultados

Durante el período estudiado, el consumo de AD aumentó el 81,2% y el de A e H el 11,7%. Los inhibidores selectivos de la recaptación de serotonina fueron los AD más prescritos y los inhibidores de la recaptación de serotonina y noradrenalina los de mayor crecimiento (386,8%). Escitalopram aumentó el 1.013%. Lorazepam, alprazolam y diacepam, suman el 80,4% de los ansiolíticos prescritos, y lormetazepam y zolpidem el 88,7% de los hipnóticos. El importe de los AD aumentó el 78,2% y el de los A e H el 14,5%; el coste por DDD de ambos grupo descendió el 29%.

Conclusiones

La utilización de AD en la CV ha experimentado un gran incremento entre 2000-2010, mientras que el de A e H ha sido moderado, aunque su consumo todavía está por encima del de AD. A pesar de la reducción en el coste de la DDD en ambos grupos, el importe global de la factura en antidepresivos en la CV sigue en aumento.

[Suicide, antidepressant prescription and unemployment in Andalusia (Spain)]

OBJECTIVES

To analyze the trend in suicide mortality in Andalusia from 1975 to 2012 and its relationship with unemployment and the use of antidepressants.

METHODS

Poisson's segmented regression models were used to estimate changes over time. The association between suicide and the factors examined was measured using Spearman's correlation coefficient.

RESULTS

Suicide mortality patterns in men and women are rising. The largest increase was found in people aged from 15 to 44 years, with an annual percentage rate change of 1.21 (95%CI: 0.7-1.7) for men and 0.93 (95%CI: 0.4-1.4) for women.

CONCLUSIONS

Mortality by suicide has increased in Andalusia since 1975 in all age and gender groups except for women aged 65 years or above. During the last few decades, an upward trend has been observed in young people and a stable or falling trend in the remaining population. Temporary variations in suicide rates are not associated with unemployment rates or with changes in antidepressant prescription.

"When I Want to Cry I Can't": Inability to Cry Following SSRI Treatment

INTRODUCTION

We describe seven cases of patients with an inability to cry after treatment with selective serotonin re-uptake inhibitor (SSRI) medication, even during sad or distressing situations that would have normally initiated a crying episode, in the light of the role of the serotonergic system in emotional expression.

METHOD

Case series drawn from patients attended in a secondary care psychiatry service.

RESULTS

While excessive crying without emotional distress has been previously reported in the literature, and is associated with reduced serotonin function, these reports suggest cases of the reverse dissociation, where emotional distress and an urge to cry was present, but crying was impaired.

DISCUSSION

Although the case series presented here is new, these cases are consistent with the neuroscience of crying and their relationship with serotonergic function, and provide preliminary evidence for a double dissociation between subjective emotional experience and the behavioural expression of crying. This helps to further illuminate the neuroscience of emotional expression and suggests the possibility that the phenomenon is an under-recognised adverse effect of SSRI treatment.

Post-stroke depression: an update

INTRODUCTION

Post-stroke depression (PSD) is the most common mood disorder following a stroke, and also the main factor limiting recovery and rehabilitation in stroke patients. In addition, it may increase mortality by up to ten times.

DEVELOPMENT

PSD occurs in 1 in 3 stroke patients and more than half of all cases are neither diagnosed nor treated. Several mechanisms, including biological, behavioral, and social factors, are involved in its pathogenesis. Symptoms usually occur within the first three months after stroke (early onset PSD), and less frequently at a later time (late onset PSD). Symptoms resemble those of other types of depression, although there are some differences: PSD patients experience more sleep disturbances, vegetative symptoms, and social withdrawal. For PSD diagnosis, we recommended vigilance and use of specific diagnostic tools such as the Patient Health Questionnaire-2 (PHQ-2). The treatments of choice are selective serotonin reuptake inhibitors (SSRI). However, there are still many unanswered questions in the treatment of PSD, such as the best time to start treatment or the effects of antidepressants on cognition and motor function, among others.

CONCLUSIONS

Neurologists play a pivotal role in the care and management of patients recovering from stroke. They must be familiar with methods for early detection and treatment of PSD, as this can facilitate a patient's functional recovery and social reintegration, and improve quality of life for patients and their families.