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Kwon Y, Lauffenburger JC. Antidepressant discontinuation patterns and characteristics across sociodemographic groups in the United States. J Affect Disord 2024; 355:82-85. [PMID: 38554879 DOI: 10.1016/j.jad.2024.03.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND While antidepressants are frequently used, less is known about contemporary discontinuation patterns, especially across different sociodemographic populations. METHODS Patients 16-84 years initiating antidepressants between 2016 and 2019 within a large US health insurer were identified. The association between patient characteristics and time until antidepressant discontinuation was evaluated using adjusted Cox proportional hazard regression. RESULTS Across 1,365,576 patients, mean time to discontinuation was 168.1 days (SD: 223.6). Men were more likely to discontinue than women (HR: 0.94, 95%CI: 0.94-0.94). Younger patients (16-24 years) were more likely to discontinue than older patients. Patients who were non-White (Asian HR: 1.33, 95%CI: 1.31-1.34; Black HR: 1.27, 95%CI: 1.27-1.28; Hispanic HR: 1.34, 95%:CI 1.34-1.35), with evidence of a substance use disorder (HR: 1.31, 95%CI: 1.27-1.35), or taking tricyclic antidepressants (HR:1.26, 95%CI: 1.25-1.27) were more likely to discontinue. LIMITATIONS Information on reasons for discontinuation was not available, and wide standard deviations for the primary outcome were reported. The results may not be generalized to non-commercially insured beneficiaries. CONCLUSIONS Discontinuation is common within the first 6 months of treatment but varies across populations, highlighting patients who may benefit from potential intervention.
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Affiliation(s)
- Yoojung Kwon
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, United States of America; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, United States of America
| | - Julie C Lauffenburger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, United States of America.
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2
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González-Bermúdez M, López-Lorente ÁI, Lucena R, Cárdenas S. Sustainable beeswax modified cellulose paper for the determination of tricyclic antidepressants in biofluids. Talanta 2024; 273:125860. [PMID: 38479029 DOI: 10.1016/j.talanta.2024.125860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 04/09/2024]
Abstract
This article describes the synthesis of sorptive phases for bioanalysis based on the modification of cellulose paper with natural beeswax as sorbent, resulting in a substrate completely renewable and sustainable. The preparation of the sorptive phases consisted of the dissolution of beeswax in hexane, followed by its drop-casting on cellulose paper and subsequent evaporation of the solvent. The beeswax modification of paper renders it hydrophobic, enabling the extraction of the target analytes, i.e., imipramine, desipramine, amitriptyline and trimipramine, via hydrophobic interactions. The main variables affecting the extraction performance were investigated (e.g., pH, ionic strength, extraction time, eluent composition, agitation speed). The analytical workflow combines a straightforward sampling, simultaneous extraction of 30 samples in 1 h, and the rapid (<2 min) determination of the analytes via direct infusion mass spectrometry. The method provided limits of detection in the range 2.0 and 3.2 μg L-1, and the precision, expressed as relative standard deviation, was better than 5.4 % and 8.5 % for intra and inter-day analyses, respectively. The accuracy, in terms of relative recovery, ranged from 90 % to 121 % using saliva as model biofluid.
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Affiliation(s)
- Marisol González-Bermúdez
- Affordable and Sustainable Sample Preparation (AS(2)P) Research Group, Departamento de Química Analítica, Instituto Químico para la Energía y el Medioambiente IQUEMA, Universidad de Córdoba, Campus de Rabanales, Edificio Marie Curie, E-14071, Córdoba, Spain
| | - Ángela I López-Lorente
- Affordable and Sustainable Sample Preparation (AS(2)P) Research Group, Departamento de Química Analítica, Instituto Químico para la Energía y el Medioambiente IQUEMA, Universidad de Córdoba, Campus de Rabanales, Edificio Marie Curie, E-14071, Córdoba, Spain.
| | - Rafael Lucena
- Affordable and Sustainable Sample Preparation (AS(2)P) Research Group, Departamento de Química Analítica, Instituto Químico para la Energía y el Medioambiente IQUEMA, Universidad de Córdoba, Campus de Rabanales, Edificio Marie Curie, E-14071, Córdoba, Spain
| | - Soledad Cárdenas
- Affordable and Sustainable Sample Preparation (AS(2)P) Research Group, Departamento de Química Analítica, Instituto Químico para la Energía y el Medioambiente IQUEMA, Universidad de Córdoba, Campus de Rabanales, Edificio Marie Curie, E-14071, Córdoba, Spain.
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3
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Kim H, Lee YB, Lee J, Kang D, Kim G, Jin SM, Kim JH, Hur KY, Jeon HJ. Association between depression, antidepressant use, and the incidence of atherosclerotic cardiovascular diseases. J Affect Disord 2024; 352:214-221. [PMID: 38378089 DOI: 10.1016/j.jad.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/30/2024] [Accepted: 02/11/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To examine the association between depression, the use of antidepressants, and atherosclerotic cardiovascular disease (ASCVD). METHODS The South Korean national claims data was used. Among a nationally representative population, 273,656 subjects who had been diagnosed with depression and prescribed antidepressants ("DEP with antidepressants") and 78,851 subjects who had been diagnosed with depression but not prescribed antidepressants ("DEP without antidepressants") were identified to be eligible. Healthy controls (HCs) were 1:1 matched with DEP with antidepressants group for age and sex. We followed up on the occurrence of ASCVD including ischemic heart diseases and ischemic stroke. RESULTS The risk of ASCVD was increased in the DEP with antidepressants group and decreased in the DEP without antidepressants group compared to HCs. Among those under antidepressants, tricyclic antidepressant users showed the highest risk of ASCVD compared to HCs. Among young adults, the risk of ASCVD was increased in both groups. CONCLUSION The risk of ASCVD increased in depression patients taking antidepressants, while it decreased in depression patients not taking antidepressants. However, the relationship showed differences according to drug class and age group.
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Affiliation(s)
- Hyewon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jungkuk Lee
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, South Korea
| | - Dongwoo Kang
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, South Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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4
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Choudhary D, Kumar B, Kaur R. Nitrogen-containing heterocyclic compounds: A ray of hope in depression? Chem Biol Drug Des 2024; 103:e14479. [PMID: 38361139 DOI: 10.1111/cbdd.14479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/12/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
Depression is not similar to daily mood fluctuations and temporary emotional responses to day-to-day activities. Depression is not a passing problem; it is an ongoing problem. It deals with different episodes consisting of several symptoms that last for at least 2 weeks. It can be seen for several weeks, months, or years. At its final stage, or can say, in its worst condition, it can lead to suicide. Antidepressants are used to inhibit the reuptake of the neurotransmitters by some selective receptors, which increase the concentration of specific neurotransmitters around the nerves in the brain. Drugs that are currently being used for the management of various types of depression include selective serotonin reuptake inhibitors, tricyclic antidepressants, atypical antidepressants, serotonin, noradrenaline reuptake inhibitors, etc. In this review, we have outlined different symptoms, causes, and recent advancements in nitrogen-containing heterocyclic drug candidates for the management of depression. This article highlights the various structural features along with the structure-activity relationship (SAR) of nitrogen-containing heterocyclics that play a key role in binding at target sites for potential antidepressant action. The in silico studies were carried out to determine the binding interactions of the target ligands with the receptor site to determine the potential role of substitution patterns at core pharmacophoric features. This article will help medicinal chemists, biochemists, and other interested researchers in identifying the potential pharmacophores as lead compounds for further development of new potent antidepressants.
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Affiliation(s)
- Diksha Choudhary
- Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab, India
| | - Bhupinder Kumar
- Department of Pharmaceutical Sciences, HNB Garhwal University, Chauras Campus, Srinagar, Uttarakhand, India
- Department of Chemistry, Graphic Era (Deemed to be University), Dehradun, Uttarakhand, India
| | - Rajwinder Kaur
- Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab, India
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Kajitani N, Okada-Tsuchioka M, Inoue A, Miyano K, Masuda T, Boku S, Iwamoto K, Ohtsuki S, Uezono Y, Aoki J, Takebayashi M. G protein-biased LPAR1 agonism of prototypic antidepressants: Implication in the identification of novel therapeutic target for depression. Neuropsychopharmacology 2024; 49:561-572. [PMID: 37673966 PMCID: PMC10789764 DOI: 10.1038/s41386-023-01727-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/01/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
Prototypic antidepressants, such as tricyclic/tetracyclic antidepressants (TCAs), have multiple pharmacological properties and have been considered to be more effective than newer antidepressants, such as selective serotonin reuptake inhibitors, in treating severe depression. However, the clinical contribution of non-monoaminergic effects of TCAs remains elusive. In this study, we discovered that amitriptyline, a typical TCA, directly binds to the lysophosphatidic acid receptor 1 (LPAR1), a G protein-coupled receptor, and activates downstream G protein signaling, while exerting a little effect on β-arrestin recruitment. This suggests that amitriptyline acts as a G protein-biased agonist of LPAR1. This biased agonism was specific to TCAs and was not observed with other antidepressants. LPAR1 was found to be involved in the behavioral effects of amitriptyline. Notably, long-term infusion of mouse hippocampus with the potent G protein-biased LPAR agonist OMPT, but not the non-biased agonist LPA, induced antidepressant-like behavior, indicating that G protein-biased agonism might be necessary for the antidepressant-like effects. Furthermore, RNA-seq analysis revealed that LPA and OMPT have opposite patterns of gene expression changes in the hippocampus. Pathway analysis indicated that long-term treatment with OMPT activated LPAR1 downstream signaling (Rho and MAPK), whereas LPA suppressed LPAR1 signaling. Our findings provide insights into the mechanisms underlying the non-monoaminergic antidepressant effects of TCAs and identify the G protein-biased agonism of LPAR1 as a promising target for the development of novel antidepressants.
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Affiliation(s)
- Naoto Kajitani
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
- Center for Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
- Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, 737-0023, Japan
| | - Mami Okada-Tsuchioka
- Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, 737-0023, Japan
| | - Asuka Inoue
- Laboratory of Molecular and Cellular Biochemistry, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, 980-8578, Japan
| | - Kanako Miyano
- Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, 105-8461, Japan
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, Tokyo, 104-0045, Japan
| | - Takeshi Masuda
- Department of Pharmaceutical Microbiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, 862-0973, Japan
| | - Shuken Boku
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
| | - Kazuya Iwamoto
- Department of Molecular Brain Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
| | - Sumio Ohtsuki
- Department of Pharmaceutical Microbiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, 862-0973, Japan
| | - Yasuhito Uezono
- Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, 105-8461, Japan
| | - Junken Aoki
- Department of Health Chemistry, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Minoru Takebayashi
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan.
- Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, 737-0023, Japan.
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Berlato DG, Bezerra Pacheco AL, Ugalde GA, Reginato FZ, Saldanha GDA, Oliveira TFD, Eller S, Bairros AVD. Dispersive liquid-liquid microextraction (DLLME) for determination of tricyclic antidepressants in whole blood and plasma samples and analysis by liquid chromatography with diode array detector (LC-DAD). Toxicol Mech Methods 2024; 34:189-202. [PMID: 37830174 DOI: 10.1080/15376516.2023.2269236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/05/2023] [Indexed: 10/14/2023]
Abstract
Microextractions have been developed for the tricyclic antidepressants (TCAs) analysis in biological matrices, including dispersive liquid-liquid microextraction (DLLME). The proposed DLLME employed 490 µL of biological sample (whole blood or plasma), which were added 15 mg of NaCl, 10 µL of medazepam as internal standard (10 µg/mL) and 100 µL of 2 M NaOH. This mixture was homogenized by vortex (2800 rpm/10 s) and 400 µL of hexane (extractor solvent) with 600 µL of methanol (dispersing solvent) were added to the sample. After the vortex step (2800 rpm/5 s), an ultrasonic bath for 300 s was employed. Then, this content was centrifuged (10 min/10000 rpm), organic phase was collected and dried under air flow. After, 30 µL of the mobile phase was used for resuspension and 20 µL is injected into LC-DAD. This method was optimized and fully validated according to UNODC and SWGTOX guidelines, reaching limits of detection equivalent to analytical methodologies that employ mass spectrometry (MS). Also, it was applied in real cases involving suspected exposure to TCAs. So, the developed DLLME for the determination of TCAs in whole blood and plasma samples proved to be a simple, reliable, robust and reproducible method that can be used in toxicology and clinical laboratories.
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Affiliation(s)
- Dener Gomes Berlato
- Nucleous Applied to Toxicology (NAT), Department of Clinical and Toxicological Analysis, Federal University of Santa Maria, Santa Maria, Brazil
| | - André Lucas Bezerra Pacheco
- Nucleous Applied to Toxicology (NAT), Department of Clinical and Toxicological Analysis, Federal University of Santa Maria, Santa Maria, Brazil
| | - Gustavo Andrade Ugalde
- Nucleous Applied to Toxicology (NAT), Department of Clinical and Toxicological Analysis, Federal University of Santa Maria, Santa Maria, Brazil
| | - Fernanda Ziegler Reginato
- Nucleous Applied to Toxicology (NAT), Department of Clinical and Toxicological Analysis, Federal University of Santa Maria, Santa Maria, Brazil
| | - Geovane de Almeida Saldanha
- Nucleous Applied to Toxicology (NAT), Department of Clinical and Toxicological Analysis, Federal University of Santa Maria, Santa Maria, Brazil
| | - Tiago Franco de Oliveira
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, RS, Brazil
| | - Sarah Eller
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, RS, Brazil
| | - André Valle de Bairros
- Nucleous Applied to Toxicology (NAT), Department of Clinical and Toxicological Analysis, Federal University of Santa Maria, Santa Maria, Brazil
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Fattahi N, Heidari R, Ghazanfaripoor B, Masoudipour E, Gharehdaghi J, Nejad KS. Standardization of the analytical procedure based on deep eutectic solvent for the extraction and measurement of tricyclic antidepressants drugs in post-mortem blood samples. J Pharm Biomed Anal 2024; 238:115811. [PMID: 37879218 DOI: 10.1016/j.jpba.2023.115811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/15/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023]
Abstract
Measuring drugs in post-mortem blood samples is one of the most important challenges in forensic medicine. The development of sensitive analytical techniques for the measurement of drugs in biological samples is of great use in forensic medicine. In this research an easy, safe and environmental friendly vortex-assisted liquid phase microextraction (VA-LPME) based on deep eutectic solvent (DES) followed by high performance liquid chromatography-ultraviolet detector (HPLC-UV) was developed for the extraction, preconcentration and analysis of tricyclic antidepressants drugs (TCAs) in post-mortem blood samples. DES synthesized from thymol as hydrogen bond acceptor (HBA) and ethylene glycol (EG) as hydrogen bond donor (HBD) with a molar ratio of 2:1 was used as an extractant. After adding DES to the sample solution, the resulting mixture was vortexed in order to increase the contact surface and increase the extraction efficiency. Next, phase separation was done using centrifugation. Some effective parameters on the extraction were studied and optimized. Under the optimum conditions, intra- and inter-day %RSDs of the method based on 7 replicate measurements of 100 μg L-1 of TCAs in blood samples were in the range of 2.4-5.1 and 3.7-6.8 %, respectively. The analytical performance of the method showed linearity over the concentration of 3-500 μg L-1 with the detection limits ranging from 1.0-2.0 μg L-1. The trueness of the method was confirmed by spiking different concentrations of TCAs in real blood samples and obtaining relative recoveries in the range of 91.2-108 %.
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Affiliation(s)
- Nazir Fattahi
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Islamic Republic of Iran.
| | - Rohollah Heidari
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Islamic Republic of Iran
| | - Behzad Ghazanfaripoor
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Islamic Republic of Iran
| | - Elham Masoudipour
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Islamic Republic of Iran
| | - Jaber Gharehdaghi
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Islamic Republic of Iran
| | - Kambiz Soltani Nejad
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Islamic Republic of Iran
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Schürfeld R, Pamporaki C, Peitzsch M, Rayes N, Sabri O, Rohm S, Biemann R, Sandner B, Tönjes A, Eisenhofer G. False-positive results for pheochromocytoma associated with norepinephrine reuptake blockade. Endocr Relat Cancer 2024; 31:e230063. [PMID: 37955319 PMCID: PMC10762534 DOI: 10.1530/erc-23-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/13/2023] [Indexed: 11/14/2023]
Abstract
Measurements of plasma metanephrines and methoxytyramine provide a sensitive test for diagnosis of pheochromocytoma/paraganglioma. False-positive results remain a problem, particularly in patients taking norepinephrine reuptake-blocking drugs. Therefore, in this retrospective observational study, we measured plasma metanephrines and methoxytyramine in 61 patients taking norepinephrine reuptake blockers (tricyclic antidepressants or serotonin-norepinephrine reuptake inhibitors) and 17 others taking selective serotonin reuptake inhibitors, all without pheochromocytoma/paraganglioma. We highlight a singular case with strongly elevated plasma normetanephrine and methoxytyramine concentrations associated with norepinephrine reuptake blockade. Data were compared to results from 252 and 1804 respective patients with and without tumors. Plasma normetanephrine was 40% higher (P < 0.0001) in patients on norepinephrine reuptake blockers and methoxytyramine was 127% higher (P = 0.0062) in patients taking tricyclic antidepressants compared to patients not taking uptake blockers and without tumors. The corresponding false-positive rates rose (P < 0.0001) from 4.8% to 23.0% for normetanephrine and from 0.9% to 28.6% for methoxytyramine. Selective serotonin reuptake inhibitors did not increase plasma concentrations of metabolites. In the highlighted case, plasma normetanephrine and methoxytyramine were elevated more than six times above upper reference limits. A pheochromocytoma/paraganglioma, however, was excluded by functional imaging. All biochemical test results normalized after discontinuation of norepinephrine reuptake blockers. These findings clarify that norepinephrine reuptake blockers usually result in mild elevations of normetanephrine and methoxytyramine that, nevertheless, significantly increase the number of false-positive results. There can, however, be exceptions where increases in normetanephrine and methoxytyramine reach pathological levels. Such exceptions may reflect failure of centrally mediated sympathoinhibition that normally occurs with the norepinephrine reuptake blockade.
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Affiliation(s)
- Robin Schürfeld
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University of Leipzig, Leipzig, Germany
| | - Christina Pamporaki
- TU Dresden, Medical Clinic III, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Mirko Peitzsch
- TU Dresden, Institute of Clinical Chemistry and Laboratory Medicine, Dresden, Germany
| | - Nada Rayes
- Center of Surgery, Division of Endocrine Surgery, Department for Visceral, Transplant, Thoracic, and Vascular Surgery, University of Leipzig, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Silvio Rohm
- Center of Surgery, Department for Visceral, Transplant, Thoracic, and Vascular Surgery, University of Leipzig, Leipzig, Germany
- Center of Surgery, Department for Vascular Surgery, Diakonissen Hospital of Leipzig, Leipzig, Germany
| | - Ronald Biemann
- Institute of Clinical Chemistry and Laboratory Medicine, University of Leipzig, Leipzig, Germany
| | - Benjamin Sandner
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University of Leipzig, Leipzig, Germany
| | - Anke Tönjes
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University of Leipzig, Leipzig, Germany
| | - Graeme Eisenhofer
- TU Dresden, Medical Clinic III, University Hospital Carl Gustav Carus, Dresden, Germany
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Ciuca MD, Racovita RC. Development of Visible Spectrophotometric Methods for the Determination of Tricyclic Antidepressants Based on Formation of Molecular Complexes with p-Benzoquinones. Int J Mol Sci 2023; 24:16744. [PMID: 38069067 PMCID: PMC10706237 DOI: 10.3390/ijms242316744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Tricyclic antidepressants are commonly employed in the management of major depressive disorders. The present work describes two visible (VIS) spectrophotometric techniques that utilize the formation of charge transfer complexes between four antidepressant compounds, namely, amitriptyline hydrochloride (AMI), imipramine hydrochloride (IMI), clomipramine hydrochloride (CLO), and trimipramine maleate (TRI) acting as electron donors and two p-benzoquinones, namely, p-chloranilic acid (pCA) and 2,3-dichloro-5,6-dicyano-1,4-benzoquinone (DDQ), serving as electron acceptors. The stoichiometry of the compounds produced exhibited a consistent 1:1 ratio in all instances, as established by Job's method. Molar absorptivities, equilibrium association constants, and several other spectroscopic properties were determined for all complexes. The developed spectrophotometric techniques were validated intra-laboratory and successfully applied for quantitative assessment of the four antidepressant active ingredients in several commercial pharmaceutical formulations. The methods are relatively simple, fast, and use readily available laboratory instrumentation, making them easily applicable by most quality control laboratories worldwide.
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Affiliation(s)
| | - Radu C. Racovita
- Department of Inorganic Chemistry, Physical Chemistry and Electrochemistry, Faculty of Chemical Engineering and Biotechnologies, National University of Science and Technology POLITEHNICA Bucharest, 1-7 Gh. Polizu St., District 1, 011061 Bucharest, Romania;
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10
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He L, Fu Y, Tian Y, Wang X, Zhou X, Ding RB, Qi X, Bao J. Antidepressants as Autophagy Modulators for Cancer Therapy. Molecules 2023; 28:7594. [PMID: 38005316 PMCID: PMC10673223 DOI: 10.3390/molecules28227594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/22/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
Cancer is a major global public health problem with high morbidity. Depression is known to be a high-frequency complication of cancer diseases that decreases patients' life quality and increases the mortality rate. Therefore, antidepressants are often used as a complementary treatment during cancer therapy. During recent decades, various studies have shown that the combination of antidepressants and anticancer drugs increases treatment efficiency. In recent years, further emerging evidence has suggested that the modulation of autophagy serves as one of the primary anticancer mechanisms for antidepressants to suppress tumor growth. In this review, we introduce the anticancer potential of antidepressants, including tricyclic antidepressants (TCAs), tetracyclic antidepressants (TeCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). In particular, we focus on their autophagy-modulating mechanisms for regulating autophagosome formation and lysosomal degradation. We also discuss the prospect of repurposing antidepressants as anticancer agents. It is promising to repurpose antidepressants for cancer therapy in the future.
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Affiliation(s)
- Leping He
- Key Laboratory of Tropical Biological Resources of Ministry of Education, School of Pharmaceutical Sciences, Collaborative Innovation Center of One Health, Hainan University, Haikou 570228, China; (L.H.); (Y.F.); (Y.T.); (R.-B.D.); (X.Q.)
| | - Yuanfeng Fu
- Key Laboratory of Tropical Biological Resources of Ministry of Education, School of Pharmaceutical Sciences, Collaborative Innovation Center of One Health, Hainan University, Haikou 570228, China; (L.H.); (Y.F.); (Y.T.); (R.-B.D.); (X.Q.)
| | - Yuxi Tian
- Key Laboratory of Tropical Biological Resources of Ministry of Education, School of Pharmaceutical Sciences, Collaborative Innovation Center of One Health, Hainan University, Haikou 570228, China; (L.H.); (Y.F.); (Y.T.); (R.-B.D.); (X.Q.)
| | - Xiaofeng Wang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, China; (X.W.); (X.Z.)
| | - Xuejun Zhou
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, China; (X.W.); (X.Z.)
| | - Ren-Bo Ding
- Key Laboratory of Tropical Biological Resources of Ministry of Education, School of Pharmaceutical Sciences, Collaborative Innovation Center of One Health, Hainan University, Haikou 570228, China; (L.H.); (Y.F.); (Y.T.); (R.-B.D.); (X.Q.)
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao 999078, China
| | - Xingzhu Qi
- Key Laboratory of Tropical Biological Resources of Ministry of Education, School of Pharmaceutical Sciences, Collaborative Innovation Center of One Health, Hainan University, Haikou 570228, China; (L.H.); (Y.F.); (Y.T.); (R.-B.D.); (X.Q.)
| | - Jiaolin Bao
- Key Laboratory of Tropical Biological Resources of Ministry of Education, School of Pharmaceutical Sciences, Collaborative Innovation Center of One Health, Hainan University, Haikou 570228, China; (L.H.); (Y.F.); (Y.T.); (R.-B.D.); (X.Q.)
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao 999078, China
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11
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Siraj J. Assessment of psychotropic medications prescribing pattern in Gebretsadik Shawo General Hospital, South West Ethiopia. Pan Afr Med J 2023; 45:165. [PMID: 37900209 PMCID: PMC10611909 DOI: 10.11604/pamj.2023.45.165.30374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/30/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction due to the widespread prescription of antipsychotic medications, their usage is cumulative. Evidence on the trends of medication use in Ethiopia and other parts of the world is lacking. The scant information on prescription trends and medication usage suggests that drug use is generally not sensible in both industrialized and emerging nations. So, the aim of this study was to assess the psychotropic medications prescribing pattern in Gebretsadik Shawo General Hospital, South West Ethiopia. Methods from June 1st to July 31st, 2019, a cross-sectional study on prescriptions for psychiatric drugs was conducted at Gebretsadik Shawo General Hospital. Using systematic random sampling, prescription records were obtained from the pharmacy dispensing book. Version 21 of the statistical program for social science was used to code and analyze the data. Results the study included 355 prescription records containing psychotropic drugs in total. The bulk of those taking the psychotropic medication were aged 20 to 49. The most often administered classes of drugs remained antipsychotic, followed by tricyclic antidepressants, antiepileptics, anxiolytics/sedatives, anticholinergic and selective serotonin reuptake inhibitors. The most often ordered antipsychotic medication, which included 102 (23.18%) medications, was chlorpromazine. Tricyclic antidepressants, which included 56 medicines (12.73%) and 24 medications (5.45%), included amitriptyline and imipramine. Conclusion the results of this investigation showed that psychiatrists preferred traditional psychotropic medications, such as Antipsychotic tricyclic, antidepressants (TCAs) and phenothiazines, in high amounts possibly because these medications were readily available in this hospital and their prices suited patients' needs. Health care workers' interdisciplinary relationships and coherence would improve for the benefit of patients and services of higher quality.
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Affiliation(s)
- Jafer Siraj
- Department of Pharmacy, School of Applied Natural Science, Adama Science and Technology University, Adama, Ethiopia
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12
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Angelopoulou E, Stanitsa E, Karpodini CC, Bougea A, Kontaxopoulou D, Fragkiadaki S, Koros C, Georgakopoulou VE, Fotakopoulos G, Koutedakis Y, Piperi C, Papageorgiou SG. Pharmacological and Non-Pharmacological Treatments for Depression in Parkinson's Disease: An Updated Review. Medicina (Kaunas) 2023; 59:1454. [PMID: 37629744 PMCID: PMC10456434 DOI: 10.3390/medicina59081454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/19/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
Depression represents one of the most common non-motor disorders in Parkinson's disease (PD) and it has been related to worse life quality, higher levels of disability, and cognitive impairment, thereby majorly affecting not only the patients but also their caregivers. Available pharmacological therapeutic options for depression in PD mainly include selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants; meanwhile, agents acting on dopaminergic pathways used for motor symptoms, such as levodopa, dopaminergic agonists, and monoamine oxidase B (MAO-B) inhibitors, may also provide beneficial antidepressant effects. Recently, there is a growing interest in non-pharmacological interventions, including cognitive behavioral therapy; physical exercise, including dance and mind-body exercises, such as yoga, tai chi, and qigong; acupuncture; therapeutic massage; music therapy; active therapy; repetitive transcranial magnetic stimulation (rTMS); and electroconvulsive therapy (ECT) for refractory cases. However, the optimal treatment approach for PD depression is uncertain, its management may be challenging, and definite guidelines are also lacking. It is still unclear which of these interventions is the most appropriate and for which PD stage under which circumstances. Herein, we aim to provide an updated comprehensive review of both pharmacological and non-pharmacological treatments for depression in PD, focusing on recent clinical trials, systematic reviews, and meta-analyses. Finally, we discuss the pharmacological agents that are currently under investigation at a clinical level, as well as future approaches based on the pathophysiological mechanisms underlying the onset of depression in PD.
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Affiliation(s)
- Efthalia Angelopoulou
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.A.); (E.S.); (A.B.); (D.K.); (S.F.); (C.K.)
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Evangelia Stanitsa
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.A.); (E.S.); (A.B.); (D.K.); (S.F.); (C.K.)
| | - Claire Chrysanthi Karpodini
- Sport and Physical Activity Research Centre, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton WV1 1LY, UK;
| | - Anastasia Bougea
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.A.); (E.S.); (A.B.); (D.K.); (S.F.); (C.K.)
| | - Dionysia Kontaxopoulou
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.A.); (E.S.); (A.B.); (D.K.); (S.F.); (C.K.)
| | - Stella Fragkiadaki
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.A.); (E.S.); (A.B.); (D.K.); (S.F.); (C.K.)
| | - Christos Koros
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.A.); (E.S.); (A.B.); (D.K.); (S.F.); (C.K.)
| | | | - George Fotakopoulos
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece;
| | - Yiannis Koutedakis
- Functional Architecture of Mammals in Their Environment Laboratory, Department of Physical Education and Sport Science, University of Thessaly, 38221 Volos, Greece;
| | - Christina Piperi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Sokratis G. Papageorgiou
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.A.); (E.S.); (A.B.); (D.K.); (S.F.); (C.K.)
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13
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Zitoune Z, Kugener L, Jonckheer J, Lanckmans K, Hantson P, Devriendt J, Honore PM. Effective Treatment of Acute Tricyclic Antidepressant Poisoning with Cardiogenic Shock and Severe Rhabdomyolysis Using ECMO and CytoSorb® Adsorber. Am J Case Rep 2023; 24:e939884. [PMID: 37542369 PMCID: PMC10411287 DOI: 10.12659/ajcr.939884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/08/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Tricyclic antidepressant (TCA) drugs are a common cause of fatal poisoning because of their cardiotoxic and arrhythmogenic effects. Classic supportive management includes sodium bicarbonate, gastrointestinal chelating agents, and vasopressors. Recently, intravenous lipid emulsion (supported by a low evidence level) has also been used. CASE REPORT We report the case of a 55-year-old woman admitted to our Intensive Care Unit (ICU) with acute imipramine self-poisoning. She arrived at the emergency department 7 hours after imipramine ingestion; she had severe rhabdomyolysis upon admission, with creatine phosphokinase levels at about 52 500 IU/L (normal, <200 IU/L). She quickly developed cardiogenic shock and malign arrhythmia requiring veno-arterial extra corporeal membrane oxygenation (VA-ECMO). Continuous renal replacement therapy (CRRT) with CytoSorb® (CytoSorbents, Monmouth Junction, New York, United Sates of America) was started 19 hours after admission. We performed serial blood measurements of imipramine and its active metabolite desipramine as well as viewing the levels on the CRRT-circuit monitor. Cardiac function improved and ECMO was explanted after 4 days. She also had severe acute respiratory distress syndrome, which resolved spontaneously. The neurologic outcome was favorable despite early myoclonus. The patient regained consciousness on the fifth day. Her clinical evolution was marked by acute ischemia of the lower left limb due to the arterial ECMO cannula. CONCLUSIONS These measurements document the efficacy of the CytoSorb® adsorber in removing a lipophilic drug from a patient's bloodstream. To our knowledge, this is the first published case of CytoSorb® extracorporeal blood purification therapy for acute TCA poisoning.
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Affiliation(s)
- Zakaria Zitoune
- Intensive Care Department, CHU UCL Godinne Namur, Louvain Medical School, Namur, Belgium
| | - Luc Kugener
- Intensive Care Unit, IRIS Sud Hospitals, Brussels, Belgium
| | - Joop Jonckheer
- Department of Intensive Care, Universiteit Ziekenhuis Brussel, Brussels, Belgium
| | - Katrien Lanckmans
- Toxicology Laboratory, Department of Biology, Universiteit Ziekenhuis Brussel, Brussels, Belgium
| | - Philippe Hantson
- Department of Intensive Care, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Jacques Devriendt
- Department of Intensive Care, Brugmann University Hospital, Brussels, Belgium
| | - Patrick M. Honore
- Intensive Care Department, CHU UCL Godinne Namur, Louvain Medical School, Namur, Belgium
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14
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Novikov MV, Snytnikova OA, Fedunov RG, Yanshole VV, Grivin VP, Plyusnin VF, Xu J, Pozdnyakov IP. A new view on the mechanism of UV photodegradation of the tricyclic antidepressant carbamazepine in aqueous solutions. Chemosphere 2023; 329:138652. [PMID: 37040836 DOI: 10.1016/j.chemosphere.2023.138652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 05/03/2023]
Abstract
Mechanism of direct UV photolysis of the tricyclic antidepressant carbamazepine (CBZ) at neutral pH was revealed by a combination of nanosecond laser flash photolysis, steady-state photolysis combined with high resolution LC-MS and DFT quantum-chemical calculations. The detection of short-lived intermediates and the detailed identification of final products were performed for the first time. The quantum yield of CBZ photodegradation (282 nm) is about 0.1% and 0.18% in air-equilibrated and argon-saturated solutions. The primary stage is photoionization with the formation of CBZ cation radical followed by a rapid nucleophilic attack by a solvent molecule. The primary photoproducts are 10-oxo-9-hydro-carbamazepine, 9-formylacridine-10(9H)-carboxamide (a result of ring contraction) and various isomers of hydroxylated CBZ. Prolonged irradiation results to accumulation of acridine derivatives, which should lead to an increase of the toxicity of photolyzed CBZ solutions. The obtained results may be important for understanding the fate of tricyclic antidepressants in processes of UVC disinfection and in natural waters under action of sunlight.
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Affiliation(s)
- Mikhail V Novikov
- Novosibirsk State University, 630090, 2 Pirogova Str., Novosibirsk, Russian Federation; Voevodsky Institute of Chemical Kinetics and Combustion SB RAS, 630090, 3 Institutskaya Str., Novosibirsk, Russian Federation
| | - Olga A Snytnikova
- Novosibirsk State University, 630090, 2 Pirogova Str., Novosibirsk, Russian Federation; International Tomography Center SB RAS, 630090, 3a Institutskaya Str., Novosibirsk, Russian Federation
| | - Roman G Fedunov
- Novosibirsk State University, 630090, 2 Pirogova Str., Novosibirsk, Russian Federation; Voevodsky Institute of Chemical Kinetics and Combustion SB RAS, 630090, 3 Institutskaya Str., Novosibirsk, Russian Federation
| | - Vadim V Yanshole
- Novosibirsk State University, 630090, 2 Pirogova Str., Novosibirsk, Russian Federation; International Tomography Center SB RAS, 630090, 3a Institutskaya Str., Novosibirsk, Russian Federation
| | - Vyacheslav P Grivin
- Voevodsky Institute of Chemical Kinetics and Combustion SB RAS, 630090, 3 Institutskaya Str., Novosibirsk, Russian Federation
| | - Victor F Plyusnin
- Novosibirsk State University, 630090, 2 Pirogova Str., Novosibirsk, Russian Federation; Voevodsky Institute of Chemical Kinetics and Combustion SB RAS, 630090, 3 Institutskaya Str., Novosibirsk, Russian Federation
| | - Jing Xu
- State Key Laboratory of Water Resources and Hydropower Engineering Science, Wuhan University, 430072, Wuhan, PR China
| | - Ivan P Pozdnyakov
- Novosibirsk State University, 630090, 2 Pirogova Str., Novosibirsk, Russian Federation; Voevodsky Institute of Chemical Kinetics and Combustion SB RAS, 630090, 3 Institutskaya Str., Novosibirsk, Russian Federation.
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15
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Wilson GC, Patel SH, Wang J, Xu K, Turner KM, Becker KA, Carpinteiro A, Szabo I, Ahmad SA, Gulbins E. Acid sphingomyelinase expression is associated with survival in resectable pancreatic ductal adenocarcinoma. J Mol Med (Berl) 2023; 101:891-903. [PMID: 37246980 PMCID: PMC10300164 DOI: 10.1007/s00109-023-02331-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/04/2023] [Accepted: 05/03/2023] [Indexed: 05/30/2023]
Abstract
Pancreatic adenocarcinoma (PDAC) is one of the most common cancers worldwide. Unfortunately, the prognosis of PDAC is rather poor, and for instance, in the USA, over 47,000 people die because of pancreatic cancer annually. Here, we demonstrate that high expression of acid sphingomyelinase in PDAC strongly correlates with long-term survival of patients, as revealed by the analysis of two independent data sources. The positive effects of acid sphingomyelinase expression on long-term survival of PDAC patients were independent of patient demographics as well as tumor grade, lymph node involvement, perineural invasion, tumor stage, lymphovascular invasion, and adjuvant therapy. We also demonstrate that genetic deficiency or pharmacological inhibition of the acid sphingomyelinase promotes tumor growth in an orthotopic mouse model of PDAC. This is mirrored by a poorer pathologic response, as defined by the College of American Pathologists (CAP) score for pancreatic cancer, to neoadjuvant therapy of patients co-treated with functional inhibitors of the acid sphingomyelinase, in particular tricyclic antidepressants and selective serotonin reuptake inhibitors, in a retrospective analysis. Our data indicate expression of the acid sphingomyelinase in PDAC as a prognostic marker for tumor progression. They further suggest that the use of functional inhibitors of the acid sphingomyelinase, at least of tricyclic antidepressants and selective serotonin reuptake inhibitors in patients with PDAC, is contra-indicated. Finally, our data also suggest a potential novel treatment of PDAC patients with recombinant acid sphingomyelinase. KEY MESSAGES: Pancreatic ductal adenocarcinoma (PDAC) is a common tumor with poor prognosis. Expression of acid sphingomyelinase (ASM) determines outcome of PDAC. Genetic deficiency or pharmacologic inhibition of ASM promotes tumor growth in a mouse model. Inhibition of ASM during neoadjuvant treatment for PDAC correlates with worse pathology. ASM expression is a prognostic marker and potential target in PDAC.
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Affiliation(s)
- Gregory C Wilson
- Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML 05, Cincinnati, OH, 45267-0558, USA.
| | - Sameer H Patel
- Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML 05, Cincinnati, OH, 45267-0558, USA
| | - Jiang Wang
- Departments of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kui Xu
- Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML 05, Cincinnati, OH, 45267-0558, USA
| | - Kevin M Turner
- Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML 05, Cincinnati, OH, 45267-0558, USA
| | - Katrin Anne Becker
- Institute of Molecular Biology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Alexander Carpinteiro
- Institute of Molecular Biology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Ildiko Szabo
- Department of Biology and CNR Institute of Neurosciences, University of Padua, Padua, Italy
| | - Syed A Ahmad
- Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML 05, Cincinnati, OH, 45267-0558, USA
| | - Erich Gulbins
- Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML 05, Cincinnati, OH, 45267-0558, USA.
- Institute of Molecular Biology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany.
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16
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Perez ASC, Challis JK, Ji X, Giesy JP, Brinkmann M. Impacts of wastewater effluents and seasonal trends on levels of antipsychotic pharmaceuticals in water and sediments from two cold-region rivers. Sci Total Environ 2022; 851:158247. [PMID: 36007655 DOI: 10.1016/j.scitotenv.2022.158247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
Most pharmaceuticals are found at trace concentrations in aquatic systems, but their continuous release and potential accumulation can lead to adverse health effects in exposed organisms. Concentrations can vary temporally, driven by variations in discharges of receiving waters, sorption to sediments, and other biotic and abiotic exchange processes. The principal aim of this research was to better understand the occurrence, trends, and dynamics of pharmaceuticals in a cold-climate, riverine environment. To this end, a suite of seven representative antipsychotic pharmaceuticals was measured upstream and downstream of two wastewater treatment plants (WWTPs) in Saskatchewan, Canada, located in the South Saskatchewan River and Wascana Creek, respectively, across three seasons. Concentrations of analytes were in the ng/L range and generally greater downstream of both WWTPs compared to upstream. Some compounds, including the tricyclic antidepressant amitriptyline, which was the most abundant analyte in water and sediment from both sites and across seasons, reached low μg/L concentrations. Data collected from this research effort indicate contamination with antipsychotic pharmaceuticals, with the potential to adversely impact exposed organisms.
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Affiliation(s)
- Ana Sharelys Cardenas Perez
- School of Environment and Sustainability, University of Saskatchewan, 117 Science Place Saskatoon, Saskatoon, SK S7N 5C8, Canada; Global Institute for Water Security, University of Saskatchewan, Innovation Blvd, Saskatoon, SK S7N 3H5, Canada
| | - Jonathan K Challis
- Toxicology Centre, University of Saskatchewan, 44 Campus Dr, Saskatoon, SK S7N 5B3, Canada
| | - Xiaowen Ji
- School of Environment and Sustainability, University of Saskatchewan, 117 Science Place Saskatoon, Saskatoon, SK S7N 5C8, Canada; Global Institute for Water Security, University of Saskatchewan, Innovation Blvd, Saskatoon, SK S7N 3H5, Canada
| | - John P Giesy
- Toxicology Centre, University of Saskatchewan, 44 Campus Dr, Saskatoon, SK S7N 5B3, Canada; Department of Veterinary Biomedical Sciences, University of Saskatchewan, 52 Campus Dr, Saskatoon, SK S7N 5B4, Canada; Department of Environmental Sciences, Baylor University, Waco, TX 76706, USA; Department of Zoology and Center for Integrative Toxicology, Michigan State University, 426 Auditorium Road East Lansing, MI 48824, USA
| | - Markus Brinkmann
- School of Environment and Sustainability, University of Saskatchewan, 117 Science Place Saskatoon, Saskatoon, SK S7N 5C8, Canada; Global Institute for Water Security, University of Saskatchewan, Innovation Blvd, Saskatoon, SK S7N 3H5, Canada; Toxicology Centre, University of Saskatchewan, 44 Campus Dr, Saskatoon, SK S7N 5B3, Canada; Centre for Hydrology, University of Saskatchewan, 101 - 121 Research Drive, Saskatoon, SK S7N 1K2, Canada.
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17
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Magnuson JT, Longenecker-Wright Z, Havranek I, Monticelli G, Brekken HK, Kallenborn R, Schlenk D, Sydnes MO, Pampanin DM. Bioaccumulation potential of the tricyclic antidepressant amitriptyline in a marine Polychaete, Nereis virens. Sci Total Environ 2022; 851:158193. [PMID: 35995163 DOI: 10.1016/j.scitotenv.2022.158193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
The continual discharge of pharmaceuticals from wastewater treatment plants (WWTPs) into the marine environment, even at concentrations as low as ng/L, can exceed levels that induce sublethal effects to aquatic organisms. Amitriptyline, a tricyclic antidepressant, is the most prescribed antidepressant in Norway, though the presence, potential for transport, and uptake by aquatic biota have not been assessed. To better understand the release and bioaccumulative capacity of amitriptyline, laboratory exposure studies were carried out with field-collected sediments. Influent and effluent composite samples from the WWTP of Stavanger (the 4th largest city in Norway) were taken, and sediment samples were collected in three sites in the proximity of this WWTP discharge at sea (WWTP discharge (IVAR), Boknafjord, and Kvitsøy (reference)). Polychaetes (Nereis virens) were exposed to field-collected sediments, as well as to Kvitsøy sediment spiked with 3 and 30 μg/g amitriptyline for 28 days. The WWTP influent and effluent samples had concentrations of amitriptyline of 4.93 ± 1.40 and 6.24 ± 1.39 ng/L, respectively. Sediment samples collected from IVAR, Boknafjord, and Kvitsøy had concentrations of 6.5 ± 3.9, 15.6 ± 12.7, and 12.7 ± 8.0 ng/g, respectively. Concentrations of amitriptyline were below the limit of detection in polychaetes exposed to sediment collected from Kvitsøy and IVAR, and 5.2 ± 2.8 ng/g in those exposed to Boknafjord sediment. Sediment spiked with 3 and 30 μg/g amitriptyline had measured values of 423.83 ± 33.1 and 763.2 ± 180.5 ng/g, respectively. Concentrations in worms exposed to the amended sediments were 9.5 ± 0.2 and 56.6 ± 2.2 ng/g, respectively. This is the first known study to detect measurable concentrations of amitriptyline in WWTP discharge in Norway and accumulation in polychaetes treated with field-collected sediments, suggesting that amitriptyline has the potential for trophic transfer in marine systems.
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Affiliation(s)
- Jason T Magnuson
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger 4036, Norway.
| | - Zoe Longenecker-Wright
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger 4036, Norway
| | - Ivo Havranek
- Faculty of Chemistry, Biotechnology & Food Sciences, Norwegian University of Life Sciences, Ås 1433, Norway
| | - Giovanna Monticelli
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger 4036, Norway
| | - Hans Kristian Brekken
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger 4036, Norway
| | - Roland Kallenborn
- Faculty of Chemistry, Biotechnology & Food Sciences, Norwegian University of Life Sciences, Ås 1433, Norway
| | - Daniel Schlenk
- Department of Environmental Sciences, University of California, Riverside, CA 92521, USA
| | - Magne O Sydnes
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger 4036, Norway
| | - Daniela M Pampanin
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger 4036, Norway
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18
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Wadström MG, Hailer YD. Pediatric Hip Disease Increases the Risk for Opioid Use in Adulthood: Long-term Burden of Pain and Depression. Pain Physician 2022; 25:E1153-E1160. [PMID: 36288602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Legg-Calvé-Perthes disease (LCPD) and slipped capital femoral epiphysis (SCFE) can result in painful deformation of the hip joint with impaired range of motion and early development of secondary osteoarthritis. It has not been investigated whether having LCPD or SCFE is associated with increased use of pain or antidepressant drug prescriptions later in life. OBJECTIVE With this study, we aimed to investigate if patients with a history of LCPD or SCFE have an increased risk of prescription analgesic or antidepressant drugs in adulthood compared with matched controls. STUDY DESIGN The included patients were identified by the Swedish Patient Register and matched for age, gender, and residency with 10 control individuals not exposed to any of the mentioned pediatric hip diseases, by the Swedish National Population Register. SETTING This was a nationwide, registry-based cohort study which included 1,292 patients diagnosed with LCPD at age 2-15 years and 1,613 patients diagnosed with SCFE at age 5-16 years and > 17 years from 2005 through 2011. METHODS Prescription data of first-line analgesic drugs (acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids), or first-line antidepressant drugs (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants) were derived from the Swedish Prescribed Drugs Register. Conditional logistic regression models were fitted to estimate the relative risk for the prescription in exposed compared with unexposed individuals. Adjustment was performed for gender and birth year. RESULTS In the group with an LCPD diagnosis, the adjusted odds ratio for analgesic prescriptions overall was 1.3 (95% CI, 1.2-1.5). For patients with an SCFE diagnosis, the adjusted odds ratio for analgesic prescriptions overall was 1.4 (95% CI, 1.3-1.6). Among patients with an LCPD diagnosis, the adjusted odds ratio for antidepressant prescriptions overall was 1.0 (95% CI, 0.8-1.2). For patients with an SCFE diagnosis, the adjusted odds ratio was 1.2 (95% CI, 1.1-1.4). LIMITATIONS As with all register studies, there are known associated biases such as selection, detection, and observational bias as well as the uncertain quality of input data. Further, the Swedish Prescribed Drugs Register only includes drugs that were prescribed by a physician and dispensed at a pharmacy. This is also a factor that may lead to underestimating the use of acetaminophen and nonsteroidal anti-inflammatory drugs, as these drugs can be acquired "over the counter." CONCLUSION During childhood, patients with LCPD or SCFE seem to suffer long-term pain and have an increased risk of requiring analgesic medication in adulthood, including opioids. It is important to assess the causes, type, and severity of pain to optimize pain management to counteract possible overuse in these patients. Seemingly, patients with LCPD do not have an increased risk for antidepressant drug therapy in adulthood whereas we did see an increased risk for that in patients with previous SCFE compared with the general population.
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Affiliation(s)
- Miriam G Wadström
- Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Yasmin D Hailer
- Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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19
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Bogaert B, Sauvage F, Guagliardo R, Muntean C, Nguyen VP, Pottie E, Wels M, Minnaert AK, De Rycke R, Yang Q, Peer D, Sanders N, Remaut K, Paulus YM, Stove C, De Smedt SC, Raemdonck K. A lipid nanoparticle platform for mRNA delivery through repurposing of cationic amphiphilic drugs. J Control Release 2022; 350:256-270. [PMID: 35963467 PMCID: PMC9401634 DOI: 10.1016/j.jconrel.2022.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022]
Abstract
Since the recent clinical approval of siRNA-based drugs and COVID-19 mRNA vaccines, the potential of RNA therapeutics for patient healthcare has become widely accepted. Lipid nanoparticles (LNPs) are currently the most advanced nanocarriers for RNA packaging and delivery. Nevertheless, the intracellular delivery efficiency of state-of-the-art LNPs remains relatively low and safety and immunogenicity concerns with synthetic lipid components persist, altogether rationalizing the exploration of alternative LNP compositions. In addition, there is an interest in exploiting LNP technology for simultaneous encapsulation of small molecule drugs and RNA in a single nanocarrier. Here, we describe how well-known tricyclic cationic amphiphilic drugs (CADs) can be repurposed as both structural and functional components of lipid-based NPs for mRNA formulation, further referred to as CADosomes. We demonstrate that selected CADs, such as tricyclic antidepressants and antihistamines, self-assemble with the widely-used helper lipid DOPE to form cationic lipid vesicles for subsequent mRNA complexation and delivery, without the need for prior lipophilic derivatization. Selected CADosomes enabled efficient mRNA delivery in various in vitro cell models, including easy-to-transfect cancer cells (e.g. human cervical carcinoma HeLa cell line) as well as hard-to-transfect primary cells (e.g. primary bovine corneal epithelial cells), outperforming commercially available cationic liposomes and state-of-the-art LNPs. In addition, using the antidepressant nortriptyline as a model compound, we show that CADs can maintain their pharmacological activity upon CADosome incorporation. Furthermore, in vivo proof-of-concept was obtained, demonstrating CADosome-mediated mRNA delivery in the corneal epithelial cells of rabbit eyes, which could pave the way for future applications in ophthalmology. Based on our results, the co-formulation of CADs, helper lipids and mRNA into lipid-based nanocarriers is proposed as a versatile and straightforward approach for the rational development of drug combination therapies.
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Affiliation(s)
- Bram Bogaert
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Félix Sauvage
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Roberta Guagliardo
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Cristina Muntean
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Van Phuc Nguyen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.
| | - Eline Pottie
- Laboratory of Toxicology, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Mike Wels
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - An-Katrien Minnaert
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Riet De Rycke
- Ghent University Expertise Center for Transmission Electron Microscopy and VIB BioImaging Core, 9052 Ghent, Belgium.
| | - Qiangbing Yang
- Experimental Cardiology Laboratory, Regenerative Medicine Center Utrecht and Circulatory Health Laboratory, University Medical Center Utrecht, University Utrecht, Heidelberglaan 100, Utrecht, the Netherlands.
| | - Dan Peer
- Laboratory of Precision NanoMedicine, Shmunis School of Biomedicine and Cancer Research, Tel-Aviv University, Ramat Aviv, Tel-Aviv 69978, Israel.
| | - Niek Sanders
- Laboratory of Gene Therapy, Faculty of Veterinary Medicine, Ghent University, Heidestraat 19, 9820 Merelbeke, Belgium.
| | - Katrien Remaut
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Yannis M Paulus
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.
| | - Christophe Stove
- Laboratory of Toxicology, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Stefaan C De Smedt
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Koen Raemdonck
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
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Marconi E, Crescioli G, Bonaiuti R, Lorini C, Collini F, Pepe P, Lucenteforte E, Cavallini MC, Di Bari M, Bonaccorsi G, Vannacci A, Lombardi N. Potentially inappropriate prescribing before and after nursing home admission: a retrospective observational study in a sample of Italian nursing homes. Epidemiol Prev 2022; 46:268-272. [PMID: 36259343 DOI: 10.19191/ep22.4.a372.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES to assess the occurrence of potentially inappropriate prescribing (PIP) in residents of Tuscany nursing homes (NHs) and its variation before and after NH entry. DESIGN retrospective observational study using data from the Regional Administrative Database of Tuscany. SETTING AND PARTICIPANTS the study involved residents of 67 Tuscan NHs identified between 2011 and 2012. To estimate PIP prevalence before and after NH, a subset of 10 indicators of the Screening Tool of Older Person's Prescriptions (STOPP) criteria were selected. MAIN OUTCOME MEASURES prevalence of PIP. RESULTS: considering 2,801 NH residents, the proportion of PIP ranged from 0.0% to 55.2% and from 0.0% to 33.9% before and after the NH admission, respectively. Overall, this study showed a decrease in the occurrence of PIP after the NH admission for most of the indicators, reaching statistical significance for indicator 3 (tricyclic antidepressants in combination with an opiate or calcium channel blockers), 7 (prescription of NSAIDs in heart failure patients), and 9 (warfarin in combination with NSAIDs). CONCLUSIONS although the reduction of PIP after NH admission may suggest greater awareness about the appropriateness of drug use, more efforts still need to be made.
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Affiliation(s)
- Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence (Italy)
- These authors equally contributed to the article
| | - Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence (Italy)
- Tuscan Regional Centre of Pharmacovigilance, Florence (Italy)
- These authors equally contributed to the article
| | - Roberto Bonaiuti
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence (Italy)
| | - Chiara Lorini
- Department of Health Science, University of Florence, Florence (Italy)
| | - Francesca Collini
- Quality and Equity Unit, Regional Health Agency of Tuscany, Florence (Italy)
| | - Pasquale Pepe
- Quality and Equity Unit, Regional Health Agency of Tuscany, Florence (Italy)
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa (Italy)
| | | | - Mauro Di Bari
- Geriatric Intensive Care Medicine, Careggi University Hospital, Florence (Italy)
| | | | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence (Italy);
- Tuscan Regional Centre of Pharmacovigilance, Florence (Italy)
- These authors equally contributed to the article
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence (Italy)
- Tuscan Regional Centre of Pharmacovigilance, Florence (Italy)
- These authors equally contributed to the article
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21
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de Vries LJ, Boekema J, Sediq R, Bontemps-Visser A, de Haan-Lauteslager MI. [Antidepressant overdose resulting in coma and hypothermia]. Ned Tijdschr Geneeskd 2022; 166:D6166. [PMID: 35499563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cognitive disorders lead to an increased risk of misuse of medication, resulting in possible auto-intoxication. CASE DESCRIPTION We describe the case of a 68-year-old patient, with hypothermia and a coma, with accidental tricyclic antidepressant (TCA) intoxication. What is remarkable about this case is that there were no cardiac or hemodynamic abnormalities, which is to be expected with both hypothermia and TCA-intoxication. CONCLUSION Intoxication should be considered in patients with hypothermia and a decreased level of consciousness, in addition to primarily neurological or metabolic causes. A good (hetero)anamnesis with attention to pre-existent cognitive functioning is important. Early screening for intoxication in patients with cognitive disorders with a coma and hypothermia is advisable, even in the absence of a typical toxidrome.
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Affiliation(s)
- Linda J de Vries
- Medisch Centrum Leeuwarden, Leeuwarden: Afd. Spoedeisende Hulp
- Contact: Linda J. de Vries
| | - Jeroen Boekema
- Medisch Centrum Leeuwarden, Leeuwarden: Afd. Interne Geneeskunde
| | - Rahmat Sediq
- Medisch Centrum Leeuwarden, Leeuwarden: Afd. Klinische Farmacie
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22
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Letellier B, Kremer M, Becker LJ, Andry V, Goumon Y, Leboulleux Q, Hener P, Inquimbert P, Couqueberg N, Waltisperger E, Yalcin I, Mouthon F, Droguerre M, Charvériat M, Barrot M. Action of mefloquine/amitriptyline THN101 combination on neuropathic mechanical hypersensitivity in mice. Pain 2021; 162:2841-2853. [PMID: 33769363 PMCID: PMC8600545 DOI: 10.1097/j.pain.0000000000002276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Tricyclic antidepressants that inhibit serotonin and noradrenaline reuptake, such as amitriptyline, are among the first-line treatments for neuropathic pain, which is caused by a lesion or disease affecting the somatosensory nervous system. These treatments are, however, partially efficient to alleviate neuropathic pain symptoms, and better treatments are still highly required. Interactions between neurons and glial cells participate in neuropathic pain processes, and importantly, connexins-transmembrane proteins involved in cell-cell communication-contribute to these interactions. In a neuropathic pain model in rats, mefloquine, a connexin inhibitor, has been shown to potentiate the antihyperalgesic effect of amitriptyline, a widely used antidepressant. In this study, we further investigated this improvement of amitriptyline action by mefloquine, using the cuff model of neuropathic pain in mice. We first observed that oral mefloquine co-treatment prolonged the effect of amitriptyline on mechanical hypersensitivity by 12 hours after administration. In addition, we showed that this potentiation was not due to pharmacokinetic interactions between the 2 drugs. Besides, lesional and pharmacological approaches showed that the prolonged effect was induced through noradrenergic descending pathways and the recruitment of α2 adrenoceptors. Another connexin blocker, carbenoxolone, also improved amitriptyline action. Additional in vitro studies suggested that mefloquine may also directly act on serotonin transporters and on adenosine A1 and A2A receptors, but drugs acting on these other targets failed to amplify amitriptyline action. Together, our data indicate that pharmacological blockade of connexins potentiates the therapeutic effect of amitriptyline in neuropathic pain.
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Affiliation(s)
- Baptiste Letellier
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
- Theranexus, Lyon, France
| | - Mélanie Kremer
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Léa J. Becker
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Virginie Andry
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Yannick Goumon
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Quentin Leboulleux
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Pierre Hener
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Perrine Inquimbert
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Nolwenn Couqueberg
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Elisabeth Waltisperger
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Ipek Yalcin
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | | | | | | | - Michel Barrot
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
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23
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Kamasak T, Kader Ş, Mutlu M, Özkaya K, Erduran E, Orhan F, Dilber E, Kalyoncu M, Karagüzel G, Cakır M, Bahat E, Cansu A. Amitriptyline Intoxication in Children: Twenty Years' Experience in a Tertiary Care Center in Turkey. Pediatr Emerg Care 2021; 37:e1377-e1381. [PMID: 32150000 DOI: 10.1097/pec.0000000000002055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Amitriptyline ingestion is an important cause of poisoning morbidity and mortality in Turkey and other countries. In contrast to adults, data concerning amitriptyline intoxication in children are limited. The purpose of this study was to investigate amitriptyline intoxication findings in the pediatric population, based on age groups and reported dosages. METHODS The medical records of 192 patients admitted to the Karadeniz Technical University Medical Faculty Farabi Hospital Pediatric Emergency Department, Turkey, due to amitriptyline intoxication in 1997-2017 were examined retrospectively. Patients were divided into 6 groups based on amitriptyline doses and 4 groups based on age. Complete blood count, blood glucose, serum electrolytes, renal and liver function tests, coagulation tests (prothrombin time and partial thromboplastin time), and blood gas analysis were studied in all patients. Electrocardiography was performed on all children, and chest radiography and electroencephalography on those with respiratory or central nervous system symptoms. RESULTS Amitriptyline intoxication was most frequently observed between the ages of 1 and 4 years. The most common signs and symptoms observed at time of hospital admission were lethargy and drowsiness (45.3%), sinus tachycardia (19.2%), and nausea and vomiting (13%). The most common laboratory finding was hyperglycemia (17.7). Six patients were intubated because of respiratory failure, and mechanical ventilation was initiated in these cases. One patient with amitriptyline overdose had persistent supraventricular tachycardia. Four children died due to amitriptyline intoxication. CONCLUSIONS Tricyclic antidepressant intoxication is a leading cause of mortality and morbidity in children. It is therefore particularly important to identify the clinical and laboratory findings that develop with high-dose consumption.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Elif Bahat
- Pediatric Nephrology, Karadeniz Technical University, Trabzon, Turkey
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24
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Khan A, Mar KF, Brown WA. Consistently Modest Antidepressant Effects in Clinical Trials: the Role of Regulatory Requirements. Psychopharmacol Bull 2021; 51:79-108. [PMID: 34421147 PMCID: PMC8374926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Despite being widely heralded following their discovery, the effectiveness and clinical utility of antidepressants has been questioned, in part due to the release of several decades of regulatory trial data. Upon investigation, contemporary regulatory trials of antidepressants have demonstrated a nearly identical effect size (0.3) for the past 40 years, regardless of placebo response or attempts to improve trial design. In this review, we examine the historical methods of antidepressant trials and re-evaluate regulatory trial data over time and according to drug class (SSRIs, SNRIs, and atypicals) with the addition of two classes of antidepressants not previously analyzed: tricyclics used as active comparators and the recently-approved NMDA receptor antagonist, esketamine. We show that among these five classes of antidepressants there were no significant differences between effect sizes or percent symptom reduction. We suggest that within the context of a regulatory trial of antidepressants, effect sizes will remain modest (~0.3) regardless of class or novel drug mechanism, possibly due to regulatory changes to trial design and conduct following the Kefauver-Harris Act of 1962. We comment that the regulatory double-blind, parallel, placebo-controlled trial model is an artificial creation for a narrow purpose-designed to demonstrate simple superiority over placebo and to determine basic safety. We should be cautious of stretching trial results beyond their limited capacity to inform clinical practice as trials are not representative of real-world patients or medication management practices. There is a substantial need to develop more realistic models to evaluate the clinical utility of antidepressants.
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Affiliation(s)
- Arif Khan
- Khan, MD, Fahl Mar, MA, Northwest Clinical Research Center, Bellevue, WA, United States of America. Khan, MD, Department of Psychiatry, Duke University School of Medicine, Durham, NC, United States of America, Adjunct Professor, Clinical Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, United States of America. Brown, MD, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States of America
| | - Kaysee Fahl Mar
- Khan, MD, Fahl Mar, MA, Northwest Clinical Research Center, Bellevue, WA, United States of America. Khan, MD, Department of Psychiatry, Duke University School of Medicine, Durham, NC, United States of America, Adjunct Professor, Clinical Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, United States of America. Brown, MD, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States of America
| | - Walter A Brown
- Khan, MD, Fahl Mar, MA, Northwest Clinical Research Center, Bellevue, WA, United States of America. Khan, MD, Department of Psychiatry, Duke University School of Medicine, Durham, NC, United States of America, Adjunct Professor, Clinical Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, United States of America. Brown, MD, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States of America
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25
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Choi JW, Bediako JK, Zhao Y, Lin S, Sarkar AK, Han M, Song MH, Cho CW, Yun YS. Adsorptive removal of cationic tricyclic antidepressants using cation-exchange resin. Environ Sci Pollut Res Int 2020; 27:24760-24771. [PMID: 31925694 DOI: 10.1007/s11356-019-06549-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/16/2019] [Indexed: 06/10/2023]
Abstract
This study aimed to select a high-performance cation-exchange resin (CER) and estimate its uptake of positively ionized tricyclic antidepressants (TCAs), i.e., amitriptyline (AMI), imipramine (IMI), clomipramine (CLO), and desipramine (DES), which are frequently used, and detected in wastewater treatment systems. For the selection of the resin, the one-point check test of AMI in distilled water was examined using several CERs. As a result, the strong-acid polystyrene CER, Dowex 50WX4-200, was selected on the basis of its outstanding uptake of AMI. The maximum adsorption capacities of Dowex 50WX4-200 for removal of the TCAs ranged from 2.53 ± 0.20 mmol/g to 3.76 ± 0.12 mmol/g, which are significantly higher when compared with those of previously reported adsorbents. This is likely because the combination of electrostatic and π-π interactions between the TCAs and Dowex 50WX4-200 may lead to high uptakes of the TCAs. Additionally, the removal efficiency of DES as a representative of the TCAs was tested in actual wastewater system containing activated sludge and miscellaneous cations. Consequently, the removal efficiencies of the DES in distilled water, aerobic wastewater, and filtered wastewater were 95.68%, 77.99%, and 56.66%, respectively. It is interesting to note that the activated sludge could also contribute to adsorption of the DES, leading to increased removability, while the cations present in the wastewater acted as competing ions, decreasing the removal efficiency.
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Affiliation(s)
- Jong-Won Choi
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea
| | - John Kwame Bediako
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea
| | - Yufeng Zhao
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea
| | - Shuo Lin
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea
| | - Amit Kumar Sarkar
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea
| | - Minhee Han
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea
| | - Myung-Hee Song
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea
| | - Chul-Woong Cho
- Department of Bioenergy Science and Technology, Chonnam National University, Yongbong-ro 77, Buk-gu, Gwangju, 61186, Republic of Korea.
| | - Yeoung-Sang Yun
- Environmental Biotechnology National Research Laboratory, School of Chemical Engineering Chonbuk National University, Beakje-dearo 567, Deokjin-gu, Jeonju, 54896, Republic of Korea.
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Sundaram V. Urologic Conditions in Infants and Children: Toilet Training and Nocturnal Enuresis. FP Essent 2020; 488:21-24. [PMID: 31894952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Toilet training is a developmental task that typically can be accomplished without medical intervention. Parent counseling about it can begin approximately at the 18- to 24-month well child visit. Guidelines from the American Academy of Pediatrics recommend beginning toilet training when the child shows signs of readiness, but typically not before age 2 years; praising success using positive terms; avoiding punishment, shaming, or force; and making training positive, nonthreatening, and natural. Nocturnal enuresis is defined as urinary incontinence that occurs at night during sleep in children 5 years or older for 3 consecutive months. It is common, affecting 5%-10% of 7-year-old children in the United States. Nonpharmacologic management includes behavioral interventions (eg, limiting fluid intake before bedtime, waking the child at night to attempt to urinate, lifting the sleeping child onto the toilet and then waking him or her to urinate, bladder training to increase bladder capacity, or instituting a reward system). Bed alarms are the first-line intervention but typically are not reimbursed by health insurance. Pharmacotherapy includes desmopressin, tricyclic antidepressants, and anticholinergics. The combination of a bed alarm with pharmacotherapy can be considered as initial management or after an unsuccessful initial intervention.
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Affiliation(s)
- Vishalakshi Sundaram
- LewisGale Medical Center Family Medicine Residency Program, 1900 Electric Rd Salem, VA 24153
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27
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Mandell BF. Off-label and oft-prescribed. Cleve Clin J Med 2019; 86:766-767. [PMID: 31821134 DOI: 10.3949/ccjm.86b.12019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Joshi A. Selective Serotonin Re-uptake Inhibitors: An overview. Psychiatr Danub 2018; 30:605-609. [PMID: 30439857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Selective serotonin re-uptake inhibitors (SSRIs) are front-line pharmacotherapies in the treatment of major depressive disorder (MDD), a disorder characterized by a persistent low mood, anhedonia and feelings of worthlessness. Since their formulation over 40 years ago, there have been several conflicting studies exploring the efficacy of these highly prevalent drugs. The nature of their therapeutic effect has also remained elusive, with several hypothesises pertaining to neurotransmitter and endocrine modulation proposed. While the medications are better tolerated than their predecessors, the tricyclic antidepressant family (TCAs), the side effect profile of SSRIs is not insubstantial and novel cases have highlighted adverse effects enduring past the cessation of drug treatment. Data gathered from clinical practice also highlights that the prevalence of these side effects is often underestimated, leading to patient frustration and non-compliance. This report will seek to outline the rise of SSRI usage in the last half century while exploring possible avenues of pharmacotherapeutic action, with a particular focus on the side effect profile of these drugs.
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Affiliation(s)
- Amol Joshi
- Emmanuel College, University of Cambridge, Cambridge, CB23AP, UK,
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29
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Agius M, Bonnici H. Antidepressants in use in clinical practice. Psychiatr Danub 2017; 29:667-671. [PMID: 28953850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The object of this paper, rather than producing new information, is to produce a useful vademecum for doctors prescribing antidepressants, with the information useful for their being prescribed. Antidepressants need to be seen as part of a package of treatment for the patient with depression which also includes psychological treatments and social interventions. Here the main Antidepressant groups, including the Selective Serotonin uptake inhibiters, the tricyclics and other classes are described, together with their mode of action, side effects, dosages. Usually antidepressants should be prescribed for six months to treat a patient with depression. The efficacy of anti-depressants is similar between classes, despite their different mechanisms of action. The choice is therefore based on the side-effects to be avoided. There is no one ideal drug capable of exerting its therapeutic effects without any adverse effects. Increasing knowledge of what exactly causes depression will enable researchers not only to create more effective antidepressants rationally but also to understand the limitations of existing drugs.
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Affiliation(s)
- Mark Agius
- Clare College Cambridge, University of Cambridge, Cambridge, UK,
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Gheshlaghi F. Comment on "'Lipid Rescue' for Tricyclic Antidepressant Cardiotoxicity". J Emerg Med 2016; 52:103. [PMID: 27693074 DOI: 10.1016/j.jemermed.2012.11.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 11/19/2012] [Indexed: 02/05/2023]
Affiliation(s)
- Farzad Gheshlaghi
- Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran
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31
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Affiliation(s)
- Don M Tucker
- University of Oregon and Electrical Geodesics, Inc
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32
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Castaño-Monsalve B. [Antidepressants in epilepsy]. Rev Neurol 2013; 57:117-122. [PMID: 23881616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Depression is a common condition in patients with epilepsy that entails a deterioration of the quality of life of this population and that, therefore, requires appropriate treatment. The potential risk of antidepressants in relation to the seizure threshold is overestimated by many professionals, and this has an influence when it comes to making the decision to treat them. It sometimes means that the patients do not receive antidepressant drugs. In this regard, the aim of this review is to present the current state of the art in terms of the safety of antidepressants in patients with epilepsy. A search of the medical literature was conducted and, following its analysis, the most significant results are presented. Current information indicates that most antidepressants are safe for epileptic patients at therapeutic doses and that the risk of seizures occurs mainly in cases of overdose. Preferred drugs for treating depression in epilepsy are serotonin reuptake inhibitors. Bupropion and tricyclic antidepressants must be avoided.
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Affiliation(s)
- Beatriz Castaño-Monsalve
- Unidad de Daño Cerebral, Institut Universitari de Neurorehabilitació Guttmann, Universitat Autònoma de Barcelona, Badalona, Barcelona, España.
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Slattery C, Agius M, Zaman R. Bipolar disorder associated with paraneoplastic cerebellar degeneration: a case report. Psychiatr Danub 2010; 22 Suppl 1:S137-S138. [PMID: 21057423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We Present a case report of a patient who suffers from Paraneoplastic cerebellar degeneration (PCD) secondary to which the patient, a young woman, developed Bipolar Affective Disorder. Here we focus on the mental health aspects of this case.
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Affiliation(s)
- Catherine Slattery
- The National Hospital For Neurology and Neurosurgery, Queens Square, London, UK
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Abstract
Post-traumatic stress disorder (PTSD) is a prevalent psychiatric disorder that may result in significant social and occupational debilitation unless symptoms are recognized and treated appropriately. Considerable research effort has been devoted over the last 20 years to developing effective pharmacological treatments for this illness. At this time, the bulk of the agents investigated include antidepressants, anticonvulsants, atypical antipsychotics, benzodiazepines, and antiadrenergic agents. Herein, we review the existing evidence base for these different classes of psychotropics in PTSD. Emphasis is placed on discussion of evidence stemming from randomized placebo-controlled clinical trials wherever possible. A brief description of novel agents that have shown initial promise for PTSD treatment is also provided.
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Affiliation(s)
- Lakshmi N Ravindran
- Department of Psychiatry, University of California San Diego, 8939 Villa La Jolla Drive, Suite 200, La Jolla, CA 92037, USA
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35
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Kiddoo D. Nocturnal enuresis. BMJ Clin Evid 2007; 2007:0305. [PMID: 19450363 PMCID: PMC2943787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Nocturnal enuresis affects 15-20% of 5-year-old children, 5% of 10 year-old-children and 1-2% of people aged 15 years and over. Without treatment, 15% of affected children will become dry each year. Nocturnal enuresis is not diagnosed in children younger than 5 years, and treatment may be inappropriate for children younger than 7 years. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions for relief of symptoms? We searched: Medline, Embase, The Cochrane Library and other important databases up to March 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 14 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, anticholinergics (oxybutynin, tolterodine, hyoscyamine), desmopression, dry bed training, enuresis alarm, hypnotherapy, standard home alarm clock, tricyclics (imipramine, desipramine).
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Abstract
BACKGROUND Postmarketing studies of prescription drugs are challenging because prognostic variables that determine treatment choices are often unmeasured. In this setting, instrumental variable (IV) methods that exploit differences in prescribing patterns between physicians may be used to estimate treatment effects; however, IV methods require strong assumptions to yield consistent estimates. We sought to explore the validity of physician-level IV in a comparative study of short-term mortality risk among elderly users of conventional versus atypical antipsychotic medications (APM). METHODS We studied a cohort of patients initiating APMs in Pennsylvania who were eligible for Medicare and a state-funded pharmaceutical benefit plan. The IV was defined as the type of the APM prescription written by each physician before the index prescription. To evaluate whether the IV was related to other therapeutic decisions that could affect mortality, we explored the association between the instrument and 2 types of potentially hazardous coprescriptions: a tricyclic antidepressant (TCA) not recommended for use in the elderly or a long-acting benzodiazepine. To insure that the IV analysis was not biased by case-mix differences between physicians, we examined the associations between the observed patient characteristics and the IV. RESULTS The cohort consisted of 15,389 new users of APMs. Our multivariable model indicated that physicians who had most recently prescribed a conventional APM were not significantly more or less likely to coprescribe a potentially hazardous TCA [odds ratio (OR), 0.78; 95% confidence interval (CI), 0.58-1.02] but were less likely to prescribe a long-acting benzodiazepine (OR, 0.57; 95% CI, 0.45-0.72) with their current APM prescription. The association between long-acting benzodiazepine prescribing and APM preference was no longer significant when the analysis was restricted to primary care physicians (OR, 0.84; 95% CI, 0.62-1.15). Multivariable regression indicated that important medical comorbidities (eg, cancer, hypertension, stroke) were unrelated to the IV. CONCLUSIONS The previous APM prescription written by the physician was unassociated with major medical comorbidities in the current patient, suggesting that the IV estimates were not biased by case-mix differences between physicians. However, we did find that the IV was associated with the use of long-acting benzodiazepines. This association disappeared when the study was restricted to the patients treated by primary care physicians. Our study illustrates how internal validation approaches may be used to improve the design of quasi-experimental studies.
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Affiliation(s)
- M Alan Brookhart
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA.
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Ikenouchi-Sugita A, Yoshimura R, Nakamura J. [Review of pharmacological efficacies and side effects of antidepressants]. Nihon Rinsho 2007; 65:1633-7. [PMID: 17876986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
We reviewed the pharmacological efficacies and side effects of antidepressants. Selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs) are most popularly prescribed for anxiety disorders as well as mild or moderate depression. These drugs have less orthostatic, cognitive, cardiovascular, and anticholinergic side effects. Tricyclic antidepressants are still important for treating severe depression, and mianserin and trazodone are useful for treating delirium. Clinicians should select antidepressants considering their pharmacologic profiles and avoiding adverse effects.
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Raone A, Cassanelli A, Scheggi S, Rauggi R, Danielli B, De Montis MG. Hypothalamus-pituitary-adrenal modifications consequent to chronic stress exposure in an experimental model of depression in rats. Neuroscience 2007; 146:1734-42. [PMID: 17481824 DOI: 10.1016/j.neuroscience.2007.03.027] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 03/16/2007] [Accepted: 03/21/2007] [Indexed: 11/24/2022]
Abstract
UNLABELLED The modifications in the hypothalamus-pituitary-adrenal (HPA) axis function induced by repeated unavoidable stress exposure, according to a standardized procedure used for inducing an experimental model of depression, were studied. Rats exposed to this procedure show hyporeactivity to both pleasurable and aversive stimuli and this condition is antagonized by the repeated administration of classical antidepressant drugs. We also studied whether imipramine administration during stress exposure would interfere with the possible modifications in the HPA axis. Rats were exposed to a 4-week stress procedure with and without imipramine treatment and then tested for escape, as compared with non-stressed control animals. Twenty-four hours later all rats were bled through a tail nick for plasma corticosterone measurement before and after dexamethasone (10 microg/kg) or corticotropin-releasing hormone (CRH, 1 microg/kg) administration. Rats were then killed, adrenals and thymus weighed, brain areas dissected out and frozen for glucocorticoid receptors (GRs) and corticotropin-releasing hormone receptor 1 (CRHR1) immunoblotting and for the assessment of hypothalamic corticotropin-releasing hormone levels. RESULTS Rats exposed to a 4-week unavoidable stress showed escape deficit and their basal plasma corticosterone levels were higher than those of control animals. Moreover, they had decreased response to dexamethasone administration, adrenal hypertrophy, and decreased GR expression in the hippocampus, hypothalamus, medial prefrontal cortex and pituitary. No significant modifications in CRHR1 expression were observed in the pituitary nor in different discrete brain areas. CRH levels in the hypothalamus and the plasma corticosterone response to CRH administration were found to be higher in stressed rats than in controls. Imipramine treatment offset all the behavioral and neurochemical stress-induced modifications. In conclusion, the present results strengthen the assumption that the escape/avoidance behavioral deficit induced by inescapable stress exposure is accompanied by steadily increased HPA activity, and that imipramine effect is strongly related to a normalization of HPA axis activity.
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MESH Headings
- Animals
- Antidepressive Agents, Tricyclic
- Behavior, Animal/physiology
- Corticosterone/blood
- Corticotropin-Releasing Hormone/administration & dosage
- Depression/blood
- Depression/etiology
- Dexamethasone/administration & dosage
- Disease Models, Animal
- Escape Reaction/physiology
- Gene Expression Regulation/drug effects
- Hypothalamo-Hypophyseal System/drug effects
- Hypothalamo-Hypophyseal System/physiopathology
- Imipramine/therapeutic use
- Male
- Pituitary-Adrenal System/drug effects
- Pituitary-Adrenal System/physiopathology
- Rats
- Rats, Sprague-Dawley
- Receptors, Corticotropin-Releasing Hormone/metabolism
- Receptors, Corticotropin-Releasing Hormone/therapeutic use
- Receptors, Glucocorticoid/metabolism
- Stress, Psychological/blood
- Stress, Psychological/complications
- Stress, Psychological/drug therapy
- Stress, Psychological/pathology
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Affiliation(s)
- A Raone
- Department of Neuroscience, Pharmacology Unit, University of Siena, Via A. Moro 4, 53100 Siena, Italy
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Abstract
BACKGROUND Mirtazapine, which enhances central noradrenergic and serotonergic activity, is a commonly prescribed drug for mood disorders in elderly patients due to the low incidence of adverse effects. A heterocyclic antidepressant, mirtazapine has pharmacodynamics similar to selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants. Nevertheless, geriatric patients in general are more prone to experience adverse drug effects. OBJECTIVE To report a case of hyponatremia in an elderly hospice patient associated with mirtazapine use. CASE SUMMARY A 72-year-old Latino male with stage IV colon cancer entered into hospice care and was treated for major depressive disorder with mirtazapine. On day 6 of treatment, he was somnolent and confused. He was found to have severe hyponatremia (serum sodium of 116 mmol/L) without any immediately identifiable physiologic cause. His previous sodium levels were within normal limits over a 6-month period including when mirtazapine was started. Upon discontinuation of mirtazapine, the patient's mental status improved, and his sodium level returned to normal. DISCUSSION Hyponatremia resulting from antidepressant use, particularly SSRIs, is rare in the general population, but in the elderly population the incidence increases because of multiple factors. There are few reports in the literature regarding hyponatremia induced by mirtazapine. CONCLUSIONS The benefit of treating mood disorders at the end of life outweighs the risks of untreated depression. Hyponatremia, although an uncommon adverse effect of mirtazapine therapy, should be considered in the elderly patient with altered mental status or delirium who has recently initiated mirtazapine therapy.
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Affiliation(s)
- Marco Ladino
- Department of Medicine, University of Miami Miller School of Medicine, Florida, 33125, USA
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Saatçioğlu O, Erim R, Cakmak D. [A case of tianeptine abuse]. Turk Psikiyatri Derg 2006; 17:72-5. [PMID: 16528638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Tianeptine is an antidepressant agent like the selective serotonin reuptake inhibitors (SSRIs). The anxiolytic efficacy of tianeptine is similar to that of tricyclic and tetracyclic antidepressants. Very few cases have been reported in connection with excessive consumption of tianeptine. Although it is not reconciled with results of many studies on excessive consumption of tianeptine, stimulant action has been specifically emphasized on some case reports of tianeptine abuse. These reports indicate that a tolerance is developed, there is a strong mode of feeling, and there are physical withdrawal symptoms if not taken again. Treatment with tianeptine can pose a risk for addicted patients in terms of high doses as well as tolerability. In this article, we report a 24-year-old patient who abused tianeptine for one year. The biological tolerance was excellent, and hepatic parameters were not affected. The patient experienced and seeks a psychostimulant effect. The patient had a previous history of addiction to cannabis, opiates and cocaine. We concluded that the effect of tianeptine and its addiction risk at the patient who had a history of addiction to multiple substances, and spontaneously increased dose of tianeptine during the last one year up to 3000 mg per day at present. In the literature, reports of addictions to antidepressants are scarce and most of them involve agents with amphetamine-like properties, including amineptine and tranylcypromine. Other reports involving other antidepressant agents, including amitriptyline, fluoxetine and tianeptine remain exceptional.
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Affiliation(s)
- Omer Saatçioğlu
- Mazhar Osman Ruh Sağliği ve Sinir Hastaliklari Eğitim ve Araştirma Hastanesi, Istambul.
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Abstract
AIMS To investigate the triggering effects of alcohol, illegal substances and major classes of prescribed psychotropic drugs on criminal violence. DESIGN A case-crossover design, using each subject as its own control. SETTING AND PARTICIPANTS A consecutive sample of 133 violent offenders was recruited from a forensic psychiatric evaluation unit and a national prison evaluation unit in Sweden during 2002-03. Measurements Offenders were assessed with structured interviews. Risk estimates were based on hazard periods of 24 hours. We used standard Mantel-Haenszel methods for statistical analyses. FINDINGS A 13.2-fold increase of risk of violence [95% confidence interval (CI): 8.2-21.2] was found within 24 hours of alcohol consumption. This increase in violence risk was similar among individuals combining alcohol with benzodiazepines [Relative risk (RR) = 13.2, 95% CI: 4.9-35.3]. Use of benzodiazepines alone in regular doses (RR = 0.4, 95% CI: 0.2-0.5) or antidepressants [selective serotonin reuptake inhibitors (SSRIs) or tricyclics] (RR = 0.4, 95% CI: 0.3-0.8) was associated with a lowered risk for violence. CONCLUSIONS This study confirmed that alcohol is a strong trigger of criminal violence. Benzodiazepines in combination with alcohol caused no further increase of violence risk. Benzodiazepines in regular doses and antidepressants may inhibit violence, but further studies are needed to verify causality. The case-crossover method can contribute to research on the proximal causes of criminal violence.
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Affiliation(s)
- Ulrika Haggård-Grann
- Department of Clinical Neuroscience, Centre for Violence Prevention, Karolinska Institutet, Stockholm, Sweden.
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Richardson D, Green J, Ritcheson A, Goldmeier D, Harris JRW. A review of controlled trials in the pharmacological treatment of premature ejaculation. Int J STD AIDS 2005; 16:651-8. [PMID: 16212710 DOI: 10.1258/095646205774357299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Premature ejaculation is a common sexual problem which presents to genitourinary (GU) medicine services. Five main treatment approaches have been used in clinical trials: behavioural therapy, antidepressants, phosphodiesterase-5 (PDE5) inhibitors, topical anaesthetic agents and alpha-blockers. We have carried out a systematic review of published pharmacological trials. All antidepressants appeared to delay ejaculation to some extent at all doses. Anaesthetic creams appeared to be as successful in slowing ejaculation as antidepressants without systemic side-effects, although some patients did experience erectile problems or unpleasant local symptoms. Anecdotally, behavioural therapy is effective and appears to have long-lasting efficacy. There is a need for quality comparative trial of behavioural therapy, topical anaesthetic agents and antidepressants, including appropriate measures of relapse, follow-up and acceptability of continuing long-term treatment.
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Affiliation(s)
- Daniel Richardson
- Jane Wadsworth Clinic, Jefferiss Wing, St Mary's Hospital, London, UK.
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Juurlink DN, Mamdani MM, Kopp A, Herrmann N, Laupacis A. A population-based assessment of the potential interaction between serotonin-specific reuptake inhibitors and digoxin. Br J Clin Pharmacol 2005; 59:102-7. [PMID: 15606447 PMCID: PMC1884963 DOI: 10.1111/j.1365-2125.2005.02230.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIM In vitro evidence suggests that some serotonin-specific reuptake inhibitors (SSRIs) inhibit P-glycoprotein, a multidrug efflux pump responsible for the elimination of several drugs including digoxin. We sought to determine if some SSRIs cause digoxin toxicity in the clinical setting. METHODS Population-based nested case-control study set in Ontario, Canada from 1994 to 2001. We studied all patients 66 years or older treated with digoxin. Prescription and hospital admission records were analysed to determine the relationship between the initiation of SSRI therapy and hospital admission for digoxin toxicity in the subsequent 30 days. RESULTS Among 245 305 older patients treated with digoxin, we identified 3144 cases of digoxin toxicity. After adjusting for potential confounders, we observed an increased risk of digoxin toxicity following initiation of paroxetine [odds ratio (OR) 2.8; 95% confidence interval (CI) 1.6, 4.7], fluoxetine (OR 2.9; 95% CI 1.5, 5.4), sertraline (OR 3.0; 95% CI 1.9, 4.7), and fluvoxamine (OR 3.0; 95% CI 1.5, 5.7). However, an elevated risk was also seen with tricyclic antidepressants (OR 1.5; 95% CI 1.0, 2.4) and benzodiazepines (OR 2.1; 95% CI 1.7, 2.5), drugs classes having no known pharmacokinetic interaction with digoxin. There was no statistical difference in the risk of digoxin toxicity among any of the agents tested. CONCLUSIONS We found no major discrepancy in the risk of digoxin toxicity after initiation of various SSRI antidepressants, suggesting that the inhibition of P-glycoprotein by sertraline and paroxetine observed in vitro is unlikely to be of major clinical significance.
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Affiliation(s)
- David N Juurlink
- Clinical Epidemiology and Healthcare Research Program, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Vázquez-Palacios G, Bonilla-Jaime H, Velázquez-Moctezuma J. Antidepressant effects of nicotine and fluoxetine in an animal model of depression induced by neonatal treatment with clomipramine. Prog Neuropsychopharmacol Biol Psychiatry 2005; 29:39-46. [PMID: 15610943 DOI: 10.1016/j.pnpbp.2004.08.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2004] [Indexed: 01/22/2023]
Abstract
The association between smoking and depression has been widely investigated. Most of these reports suggest that nicotine (NIC) may act as an antidepressant. To examine the suggested antidepressant effect of nicotine and its possible interaction with the serotonergic system, we assessed the effect of nicotine and fluoxetine (FLX) in an animal model of depression induced by neonatal treatment with clomipramine (CLI) and submitted to the forced swim test (FST). Results corroborated that CLI-treated rats displayed higher levels of immobility. After the administration of nicotine (0.4 mg/kg sc) acutely (1 day), subchonically (7 days), and chronically (14 days), CLI-treated rats significantly reduced the immobility and increased swimming without affecting climbing. These effects were similar to the effects induced for subchronic and chronic administration of the antidepressant fluoxetine (5 mg/kg sc), a selective serotonin re-uptake inhibitor. However, fluoxetine failed to affect immobility when it was administered acutely. No synergism was observed when both drugs were administered simultaneously. The present results further corroborate the antidepressant action of nicotine and fluoxetine. The increase of swimming during the FST has been linked to an increase of serotonergic activity. Thus, it could be possible that the antidepressant action of nicotine is mediated by the serotonergic system.
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Affiliation(s)
- Gonzalo Vázquez-Palacios
- Neuroscience Laboratory, Department of Reproductive Biology, Universidad Autónoma Metropolitana-Iztapalapa, México City C.P. 09340. México.
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Singh GP, Kaur P, Bhatia S. Dothiepin dependence syndrome. Indian J Med Sci 2004; 58:253-4. [PMID: 15226578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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46
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Vela Navarrete R, Pérez Martínez FC, Ramírez Pérez del Yerro M, Cabrera Pérez J, González Enguita C. Duloxetina y otros antidepresivos tricíclicos: efectos farmacodinámicos en el tracto urinario inferior. Actas Urol Esp 2004; 28:252. [PMID: 15141426 DOI: 10.1016/s0210-4806(04)73070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Abstract
Effects of imipramine on plasma glucose levels were investigated in mice. Imipramine i. p. induced dose-dependent hyperglycemia, which was enhanced by pretreatment with 5-HT (1/2/5/7) receptor antagonist methysergide and 5-HT (2A/2B/2C) receptor antagonist LY 53857. 5-HT (2C/2B) receptor antagonist SB 206553 also augmented imipramine-induced hyperglycemia although 5-HT (1A) and 5-HT (1B) receptor antagonist (-)-propranolol,5-HT (2A) receptor antagonist ketanserin and 5-HT (3/4) receptor antagonist tropisetron each had no effect. Imipramine i. p.-induced hyperglycemia was antagonized by the 5-HT (2C/2B) receptor agonist 1-(3-chlorophenyl)piperazine (mCPP), while the 5-HT (2B) receptor agonist BW 723C86 had no effect. Intracerebroventricular injection of imipramine also elevated plasma glucose levels, which is enhanced by SB 206553. Hyperglycemia elicited by central injection of imipramine was abolished by adrenalectomy. These results suggest that imipramine-induced hyperglycemia in mice is related to its inhibition of the central 5-HT (2C) receptor. Moreover, our results indicate that adrenaline release is related to imipramine-induced hyperglycemia.
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MESH Headings
- Adrenalectomy
- Animals
- Antidepressive Agents, Tricyclic
- Blood Glucose/metabolism
- Dose-Response Relationship, Drug
- Drug Interactions
- Epinephrine/metabolism
- Hyperglycemia/chemically induced
- Hyperglycemia/metabolism
- Imipramine
- Injections, Intraperitoneal
- Injections, Intraventricular
- Male
- Mice
- Mice, Inbred Strains
- Receptors, Serotonin, 5-HT2/classification
- Receptors, Serotonin, 5-HT2/drug effects
- Receptors, Serotonin, 5-HT2/metabolism
- Serotonin Antagonists/pharmacology
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Affiliation(s)
- Y Sugimoto
- Department of Pharmacology, Kobe Pharmaceutical University, Motoyamakita-machi, Higashinada-ku, Kobe, Japan.
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48
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van Dyk JC, Duvenhage F, Coetzee LJE, Segone AM, Fockema M, Smart D, Haffejee M, Lefakane SBI, Roos J, Stellmacher G, McGillevray D, Bereczky Z. South African guidelines for the management of nocturnal enuresis. S Afr Med J 2003; 93:338-40. [PMID: 12830593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
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49
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Nomura S. [Problems of current antidepressant drugs]. Nihon Shinkei Seishin Yakurigaku Zasshi 2003; 23:61-5. [PMID: 12762217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Currently, 17 antidepressant drugs are available in Japan. They are certainly evaluated as effective drugs based on abundant clinical evidence. However, treatment outcome of mood disorders does not seem to tremendously advance despite the growing number of antidepressant drugs available in clinical practice. The current antidepressant drugs, including SSRIs and SNRI, have common shortcomings from several clinical standpoints, such as 1) efficacy rate remains at 60-70%, 2) lack of immediate onset of efficacy, 3) side effects, 4) no pleasant effect, and 5) difficult prediction of efficacy for each drug. These problems are largely due to a fact that their prototypes are common. New strategy for development of antidepressants is expected.
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Affiliation(s)
- Soichiro Nomura
- Department of Psychiatry, National Defense Medical College, 3-2, Namiki, Tokorozawa, 359-8513 Japan
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50
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Abstract
Syndrome X (SX) is usually diagnosed in the presence of angina and normal coronary arteriograms. It is an heterogeneous syndrome which encompasses different pathogenic mechanisms. Whether myocardial ischaemia is responsible for the condition remains controversial. The term "microvascular angina" has been used to define the syndrome of chest pain and normal coronary arteries with heightened sensitivity of the coronary microcirculation to vasoconstrictor stimuli. It has been suggested that the abnormal vasodilator response of the coronary circulation in patients with SX is due to impaired endothelial function. Plasma levels of endothelin in patients with chest pain and normal coronary arteries were found to be significantly raised compared to normal controls. Endothelial dysfunction in SX is likely to be multifactorial and many cardiac risk factors, such as hypertension, hypercholesterolemia, oestrogen deficiency and smoking, can contribute to its development. As the majority of SX patients are women and most are post-menopausal, oestrogen deficiency has been proposed as a pathogenic factor. A large proportion of patients satisfying the stated criteria for SX have one or more coronary risk factors. Additional factors, such as abnormal pain perception, may contribute to the evolution of chest pain in patients with normal coronaries and endothelial dysfunction. Combined alteration of pain perception and microvascular dysfunction are likely to explain a proportion of all cases of SX. The treatment of this syndrome represents a major challenge for the cardiologist. Beta-blockers and calcium channel blockers are effective in controlling chest pain in SX patients. A very important therapeutic intervention in microvascular angina is the control of risk factors that can lead to endothelial dysfunction. Different approaches, including spinal cord stimulation and psychological treatment, have been proposed especially for those patients in whom a cardiac origin of pain is unlikely.
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Affiliation(s)
- J C Kaski
- Coronary Artery Disease Research Group, Cardiological Sciences, St. George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.
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