• 【689妇女的妊娠结果暴露于治疗剂量的抗抑郁药。欧洲畸系信息服务网络 (ENTIS) 的合作研究。】 复制标题 收藏 收藏
    DOI:10.1016/0890-6238(96)00057-3 复制DOI
    作者列表:McElhatton PR,Garbis HM,Eléfant E,Vial T,Bellemin B,Mastroiacovo P,Arnon J,Rodríguez-Pinilla E,Schaefer C,Pexieder T,Merlob P,Dal Verme S
    BACKGROUND & AIMS: The European Network of the Teratology Information Services (ENTIS) has collected and evaluated data on 689 pregnancies in which exposure to tricyclic and nontricyclic antidepressants occurred. Data were collected prospectively from the time of in utero exposure and all the cases were followed up to the first few weeks of postnatal life using standardized procedures. In most cases, no longer term follow-up data were available. Approximately two-thirds of the mothers were on multidrug therapy, and of those, half took a benzodiazepine. About 95% of the patients were exposed during the first trimester. The most striking feature of the pregnancy outcomes is that 97% of live-born babies were morphologically normal. The incidence of spontaneous abortion and late fetal/neonatal deaths were within the normal range. Fourteen live-born babies and one fetus had either major or minor malformations, and six had minor anomalies. However, there was no increase in either a particular type of malformation or a specific pattern of defects. Another 31 infants without malformations had neonatal problems; these were usually associated with chronic multidrug therapy, especially near term. Elective termination of pregnancy occurred more frequently in the multidrug groups (86 out of 488) than in the monotherapy groups (20 out of 201), but data concerning the condition of the fetus are not available in the majority of the cases. Overall, no causal relationship could be established between in utero exposure to antidepressants and adverse pregnancy outcome.

    背景与目标: 欧洲畸胎学信息服务网络 (ENTIS) 收集并评估了689怀孕发生三环和非三环抗抑郁药的数据。从子宫内暴露时开始前瞻性收集数据,并使用标准化程序对所有病例进行随访,直到出生后的前几周。在大多数情况下,不再提供长期随访数据。大约3分之2的母亲正在接受多药治疗,其中一半服用了苯二氮卓。大约95% 的患者在孕早期暴露。妊娠结局最显著的特征是97% 的活产婴儿在形态上是正常的。自然流产和晚期胎儿/新生儿死亡的发生率均在正常范围内。十四个活产婴儿和一个胎儿有严重或轻微畸形,六个有轻微异常。但是,特定类型的畸形或特定类型的缺陷都没有增加。另外31名没有畸形的婴儿有新生儿问题; 这些通常与慢性多药治疗有关,尤其是近期。多药组 (86个,488个) 的选择性终止妊娠发生率高于单药组 (20个,201个),但大多数情况下无法获得有关胎儿状况的数据。总体而言,子宫内暴露于抗抑郁药与不良妊娠结局之间没有因果关系。
  • 【人血清中6种三环类抗抑郁药的毛细管电泳筛选方法。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Madej K,Woźniakiewicz M,Karabinowska K
    BACKGROUND & AIMS: :A capillary electrophoretic (CE) method for screening of six tricyclic antidepressants: amitriptyline, nortriptyline, imipramine, desipramine, doxepin and nordoxepin, in human serum, has been developed. The drugs were separated in a bare fused silica capillary (50 microm i.d.) using the background electrolyte: 50 mM CAPSO (pH 9.54) in methanol/water with KCI addition. For increasing the method sensitivity, the sample concentration in the capillary (sample stacking) using pressure and electrokinetic injection has been applied. The standard addition method was used for calibration of the developed analytical procedure. The precision of the identification parameter (the relative migration time) and the quantitative parameter (the relative peak area) was within the range of 0.05-1.65 and 0.73-6.7 (RSD %), respectively. The detection limits were found to be 30 ng/mL for desipramine, 62.5 ng/mL for nortriptyline, and 50 ng/mL for remaining analytes.
    背景与目标: : 已开发出一种毛细管电泳 (CE) 方法,用于筛选人血清中的六种三环抗抑郁药: 阿米替林,去甲替林,丙咪嗪,地昔帕明,多塞平和去甲氧磷。使用背景电解质: 50 mmcapso (pH 9.54) 在甲醇/水中添加KCI,在裸露的熔融石英毛细管 (50微米内径) 中分离药物。为了提高方法的灵敏度,已经应用了使用压力和电动注射的毛细管中的样品浓度 (样品堆叠)。标准添加方法用于校准所开发的分析程序。识别参数 (相对迁移时间) 和定量参数 (相对峰面积) 的精度分别在0.05-1.65和0.73-6.7 (RSD %) 的范围内。发现地昔帕明的检出限为30 ng/mL,去甲替林的检出限为62.5 ng/mL,其余分析物的检出限为50 ng/mL。
  • 【抗抑郁药引发的早期改善是否能预测反应/缓解?来自自然主义研究的数据分析,该研究对大样本的重度抑郁症住院患者进行了分析。】 复制标题 收藏 收藏
    DOI:10.1016/j.jad.2008.10.011 复制DOI
    作者列表:Henkel V,Seemüller F,Obermeier M,Adli M,Bauer M,Mundt C,Brieger P,Laux G,Bender W,Heuser I,Zeiler J,Gaebel W,Mayr A,Möller HJ,Riedel M
    BACKGROUND & AIMS: BACKGROUND:Delayed onset of efficacy of antidepressants and a high proportion of depressed patients being poor or non-responders to antidepressants are well known clinical challenges. Therefore, it seems to be necessary to identify predictors for response and - even more important - for remission. It has been suggested that reduction of depressive symptoms at an early stage of antidepressant treatment may predict treatment outcome. Our objective was to test, if this hypothesis derived from randomized controlled studies (RCTs) in outpatients, would be confirmed in a large naturalistic study in a cohort of inpatients with major depression. Patients were treated with various antidepressants and co-medication according to the protocol based on evidence-based clinical guidelines. METHODS:This was a large naturalistic prospective study. All patients (N=795) were hospitalized and met DSM-IV criteria for major depression according to a structured clinical interview (SCID). Assessments were conducted biweekly. Several definitions of early improvement (20%, 25% and 30% reduction in HAMD-21 baseline total scores) at two different visits were tested. Sensitivity, specificity and predictive values were calculated for the different definitions of early improvement. ROC-analyses as well as logistic regression models have been performed. Response was defined as 50% improvement of the total baseline HAMD-21 score and remission as a score of
    背景与目标:
  • 【使用第二代抗抑郁药治疗抑郁症: 美国医师学会的临床实践指南。】 复制标题 收藏 收藏
    DOI:10.7326/0003-4819-149-10-200811180-00007 复制DOI
    作者列表:Qaseem A,Snow V,Denberg TD,Forciea MA,Owens DK,Clinical Efficacy Assessment Subcommittee of American College of Physicians.
    BACKGROUND & AIMS: DESCRIPTION:The American College of Physicians developed this guideline to present the available evidence on the pharmacologic management of the acute, continuation, and maintenance phases of major depressive disorder; dysthymia; subsyndromal depression; and accompanying symptoms, such as anxiety, insomnia, or neurovegetative symptoms, by using second-generation antidepressants. METHODS:Published literature on this topic was identified by using MEDLINE, EMBASE, PsychLit, the Cochrane Central Register of Controlled Trials, and International Pharmaceutical Abstracts from 1980 to April 2007. Searches were limited to English-language studies in adults older than 19 years of age. Keywords for search included terms for depressive disorders and 12 specific second-generation antidepressants-bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine-and their specific trade names. This guideline grades the evidence and recommendations by using the American College of Physicians clinical practice guidelines grading system. RECOMMENDATION 1: The American College of Physicians recommends that when clinicians choose pharmacologic therapy to treat patients with acute major depression, they select second-generation antidepressants on the basis of adverse effect profiles, cost, and patient preferences (Grade: strong recommendation; moderate-quality evidence). RECOMMENDATION 2: The American College of Physicians recommends that clinicians assess patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis beginning within 1 to 2 weeks of initiation of therapy (Grade: strong recommendation; moderate-quality evidence). RECOMMENDATION 3: The American College of Physicians recommends that clinicians modify treatment if the patient does not have an adequate response to pharmacotherapy within 6 to 8 weeks of the initiation of therapy for major depressive disorder (Grade: strong recommendation; moderate-quality evidence). RECOMMENDATION 4: The American College of Physicians recommends that clinicians continue treatment for 4 to 9 months after a satisfactory response in patients with a first episode of major depressive disorder. For patients who have had 2 or more episodes of depression, an even longer duration of therapy may be beneficial (Grade: strong recommendation; moderate-quality evidence).
    背景与目标:
  • 【错误信息、错误行为、错误指导和错误陈述的荟萃分析。在重度抑郁症 (MDD) 中使用抗抑郁药 (AD)。】 复制标题 收藏 收藏
    DOI:10.1111/bdi.12893 复制DOI
    作者列表:Vinberg M
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【抗抑郁药是缺血性心脏病的危险因素: 初级保健中的病例对照研究。】 复制标题 收藏 收藏
    影响因子 :
    发表时间:2001-09-22
    来源期刊:BMJ
    DOI:10.1136/bmj.323.7314.666 复制DOI
    作者列表:Hippisley-Cox J,Pringle M,Hammersley V,Crown N,Wynn A,Meal A,Coupland C
    BACKGROUND & AIMS: OBJECTIVES:To determine whether antidepressants are a risk factor for ischaemic heart disease and to compare the risk for different subgroups of antidepressants and individual antidepressants. DESIGN:Case-control study. SETTING:Nine general practices recruited from the Trent Focus Collaborative Research Network. PARTICIPANTS:933 men and women with ischaemic heart disease matched by age, sex, and practice to 5516 controls. MAIN OUTCOME MEASURE:Adjusted odds ratio for ischaemic heart disease calculated by logistic regression. RESULTS:Odds ratios for ischaemic heart disease were significantly raised for patients who had ever received a prescription for tricyclic antidepressants even after diabetes, hypertension, smoking, body mass index, and use of selective serotonin reuptake inhibitors had been adjusted for (1.56; 95% confidence interval 1.18 to 2.05). Patients who had ever taken dosulepin (dothiepin) had a significantly raised odds ratio for ischaemic heart disease after adjustment for confounding factors and use of other antidepressants (1.67, 1.17 to 2.36). There was no significant increase in the odds ratios for amitriptyline, lofepramine, and selective serotonin reuptake inhibitors in multivariate analysis. Increasing maximum doses of dosulepin were associated with increasing odds ratios for ischaemic heart disease. Similarly, there was a significant positive trend associated with increasing numbers of prescriptions of dosulepin (adjusted odds ratio 1.52 for 1 prescription, 1.39 for 2-3, and 1.96 for >/=4, P<0.002). CONCLUSION:There is good evidence for an association between dosulepin and subsequent ischaemic heart disease and for a dose-response relation.
    背景与目标:
  • 【三环胺抗抑郁药通过抑制关键耐药基因的mRNA水平来抑制耐甲氧西林金黄色葡萄球菌 (MRSA) 中的 β-内酰胺耐药性。】 复制标题 收藏 收藏
    DOI:10.1111/cbdd.13361 复制DOI
    作者列表:Gillard K,Miller HB,Blackledge MS
    BACKGROUND & AIMS: :Methicillin-resistant Staphylococcus aureus (MRSA) is the leading cause of recurrent infections in humans including endocarditis, pneumonia, and toxic shock syndrome. Novel therapeutics to treat MRSA and other resistant bacteria are urgently needed. Adjuvant therapy, which uses a non-toxic compound to repotentiate the toxic effects of an existing antibiotic, is an attractive response to the growing resistance crisis. Herein, we describe the evaluation of structurally related, FDA-approved tricyclic amine antidepressants that selectively repotentiate MRSA to β-lactam antibiotics. Our results identify important structural features of the tricyclic amine class for β-lactam adjuvant activity. Furthermore, we describe the mechanism of action for our lead compound, amoxapine, and illustrate that it represses the mRNA levels of key β-lactam resistance genes in response to β-lactam treatment. This work is novel in that it highlights an important class of small molecules with the ability to simultaneously inhibit production of both β-lactamase and penicillin binding protein 2a.
    背景与目标: : 耐甲氧西林金黄色葡萄球菌 (MRSA) 是人类反复感染的主要原因,包括心内膜炎,肺炎和中毒休克综合征。迫切需要治疗MRSA和其他耐药细菌的新型疗法。辅助疗法使用无毒化合物来增强现有抗生素的毒性作用,是对日益增长的耐药性危机的一种有吸引力的反应。在本文中,我们描述了结构相关的,FDA批准的三环胺抗抑郁药的评估,可选择性地将MRSA转化为 β-内酰胺类抗生素。我们的结果确定了三环胺类对 β-内酰胺佐剂活性的重要结构特征。此外,我们描述了我们的铅化合物阿莫沙平的作用机理,并说明了它在响应 β-内酰胺治疗时抑制关键的 β-内酰胺抗性基因的mRNA水平。这项工作是新颖的,因为它突出了一类重要的小分子,具有同时抑制 β-内酰胺酶和青霉素结合蛋白2a产生的能力。
  • 【抗抑郁药的心血管作用: 识别和控制。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Chutka DS
    BACKGROUND & AIMS: :The elderly frequently receive antidepressant medications that can affect cardiac conduction and rhythm, heart rate, and blood pressure. Because coexistent cardiovascular disease is common in the elderly, these medications must be used with caution, remembering that different antidepressants produce different cardiovascular effects. Fortunately, a variety of antidepressant medications are available, facilitating the selection of a safe agent for elderly patients who are at risk for cardiovascular side effects.
    背景与目标: : 老年人经常接受抗抑郁药物治疗,这些药物会影响心脏传导和节律,心率和血压。由于并存的心血管疾病在老年人中很常见,因此必须谨慎使用这些药物,并记住不同的抗抑郁药会产生不同的心血管作用。幸运的是,多种抗抑郁药物可供选择,有助于为有心血管副作用风险的老年患者选择安全的药物。
  • 【诊断后使用三环抗抑郁药的神经胶质瘤和结直肠癌患者的生存。】 复制标题 收藏 收藏
    DOI:10.1007/s10552-012-0073-0 复制DOI
    作者列表:Walker AJ,Grainge M,Bates TE,Card TR
    BACKGROUND & AIMS: BACKGROUND:Tricyclic antidepressants have been demonstrated in the laboratory to have anticancer properties. A recent study by our group also suggested a protective effect against development of colorectal cancer and glioma. This study aims to determine whether the anticancer action of tricyclics translates to improved survival in these cancers post-diagnosis. METHODS:A study using the General Practice Research Database examined whether tricyclic antidepressant exposure in the months following diagnosis of glioma or colorectal cancer would affect longer term all-cause mortality. Cox proportional hazards modelling adjusted for age, gender, smoking, body mass index, comorbidity, and diagnosed depression. RESULTS:A cohort of 1,364 glioma and 16,519 colorectal cancer patients were identified. There was a non-significant reduction in the hazard for glioma patients treated with tricyclics (HR = 0.83, CI = 0.53-1.30). This was mainly found in patients who were not previously exposed to tricyclics (HR = 0.56, CI = 0.26-1.18). In contrast, a significant increase in hazard was found for colorectal cancer (HR = 1.37, CI = 1.21-1.54). This was mostly in patients prescribed low-dose tricyclics (HR = 1.57, CI = 1.33-1.86). CONCLUSIONS:We have shown no significant mortality reduction in colorectal cancer or glioma patients treated with tricyclics. An apparent detrimental effect observed in colorectal cancer may be related to prescription of low-dose tricyclics in the management of pain related to disseminated cancer. We cannot rule out small effects or an effect that occurs exclusively at higher doses. Blinded clinical studies may therefore be the only method of determining efficacy in glioma patients.
    背景与目标:
  • 【神经性贪食症患者的抗抑郁药与安慰剂比较。】 复制标题 收藏 收藏
    DOI:10.1002/14651858.CD003391 复制DOI
    作者列表:Bacaltchuk J,Hay P
    BACKGROUND & AIMS: BACKGROUND:Bulimia Nervosa (BN) represents an important public health problem and is related to serious morbidity and even mortality. This review attempted to systematically evaluate the use of antidepressant medications compared with placebo for the treatment of bulimia nervosa. OBJECTIVES:The primary objective of this review was to determine whether using antidepressant medications was clinically effective for the treatment of bulimia nervosa. The secondary objectives were:(i) to examine whether there was a differential effect for the various classes/types of antidepressants with regard to effectiveness and tolerability(ii) to test the hypothesis that the effect of antidepressants on bulimic symptoms was independent of its effect on depressive symptoms SEARCH STRATEGY:(1) electronic searches of MEDLINE (1966 to December 2002), EMBASE (1980-December 2002), PsycINFO (to December 2002), LILACS & SCISEARCH (to 2002)(2) the Cochrane Register of Controlled Trials and the Cochrane Depression, Anxiety and Neurosis Group Register - ongoing(3) inspection of the references of all identified trials(4) contact with the pharmaceutical companies and the principal investigator of included trials(5) inspection of the International Journal of Eating Disorders - ongoing SELECTION CRITERIA: INCLUSION CRITERIA:every randomised, placebo-controlled trial in which antidepressant medications were compared to placebo to reduce the symptoms of bulimia nervosa in patients of any age or gender.Quality criteria: reports were considered adequate if they were classified as A or B according to the Cochrane Manual. The Jadad scale, with a cut off of 2 points, was applied to check the validity of the above referred criterion but was not used as an inclusion criterion. DATA COLLECTION AND ANALYSIS:Data were extracted independently by two reviewers for each included trial. Dichotomous data were evaluated by the relative risk with 95% confidence intervals (CI) around this measure, based on the random effects model; continuous data were evaluated by the standardised mean difference with the 95% CI. NNT was calculated using the inverse of the absolute risk reduction. MAIN RESULTS:Currently the review includes 19 trials comparing antidepressants with placebo: 6 trials with TCAs (imipramine, desipramine and amitriptyline), 5 with SSRIs (fluoxetine), 5 with MAOIs (phenelzine, isocarboxazid, moclobemide and brofaromine) and 3 with other classes of drugs (mianserin, trazodone and bupropion). Similar results were obtained in terms of efficacy for these different groups of drugs. The pooled RR for remission of binge episodes was 0.87 (95% CI 0.81-0.93; p<0,001) favouring drugs. The NNT for a mean treatment duration of 8 weeks, taking the non-remission rate in the placebo controls of 92% as a measure of the baseline risk was 9 (95% CI 6 - 16). The RR for clinical improvement, defined as a reduction of 50% or more in binge episodes was 0.63 (95% CI 0.55-0.74) and the NNT for a mean treatment duration of 9 weeks was 4 (95% CI 3 - 6), with a non-improvement rate of 67% in the placebo group. Patients treated with antidepressants were more likely to interrupt prematurely the treatment due to adverse events. Patients treated with TCAs dropped out due to any cause more frequently that patients treated with placebo. The opposite was found for those treated with fluoxetine, suggesting it may be a more acceptable treatment. Independence between antidepressant and anti-bulimic effects could not be evaluated due to incomplete published data. REVIEWER'S CONCLUSIONS:The use of a single antidepressant agent was clinically effective for the treatment of bulimia nervosa when compared to placebo, with an overall greater remission rate but a higher rate of dropouts. No differential effect regarding efficacy and tolerability among the various classes of antidepressants could be demonstrated.
    背景与目标:
  • 11 Fatal poisoning by cyclic antidepressants. 复制标题 收藏 收藏

    【循环抗抑郁药致命中毒。】 复制标题 收藏 收藏
    DOI:10.1055/s-2007-1014523 复制DOI
    作者列表:Worm K,Steentoft A
    BACKGROUND & AIMS: :In a seven-year period (1979-1985), 151 fatal cases of poisoning by cyclic antidepressants were registered at the Institute of Forensic Chemistry in Copenhagen. Amitriptyline was by far the most frequently occurring compound. An increase in the number of fatal poisonings by cyclic antidepressants was seen over the seven years, also compared to the total number of fatal poisonings registered at the Institute in the same period. The increase was seen mostly in men, the number of women remaining fairly constant over the period. Altogether there were 91 women and 60 men. Most cases were found in the 30-39 age group closely followed by the 40-49 age group, both groups including twice as many women as men. Men dominated only in the 20-29 age group. One hundred and twenty-one of the cases were found to be suicides, while thirteen of the cases were more dubious and were registered as "accident/suicide?" Seventeen of the cases were apparent accidents; of these, thirteen (76%) had a mention of alcohol abuse in their case histories.
    背景与目标: : 在七年内 (1979-1985年),哥本哈根法医化学研究所登记了151例致命的循环抗抑郁药中毒病例。阿米替林是迄今为止最常见的化合物。与同期研究所登记的致命中毒总数相比,在过去的七年中,循环抗抑郁药致命中毒的数量有所增加。这一增长主要发生在男性,在此期间,女性人数保持相当稳定。总共有91名女性和60名男性。大多数病例是在30-39岁年龄组中发现的,紧随其后的是40-49岁年龄组,这两个组的女性人数是男性的两倍。男性仅在20-29岁年龄段占主导地位。发现其中有21例是自杀,而其中13例更为可疑,被登记为 “事故/自杀”?其中17例是明显的事故; 其中13例 (76% 例) 在其病历中提到了酗酒。
  • 【抗抑郁药的六种戒断效果和成瘾程度有多普遍和严重?大量国际患者样本的经历。】 复制标题 收藏 收藏
    DOI:10.1016/j.addbeh.2019.106157 复制DOI
    作者列表:Read J
    BACKGROUND & AIMS: INTRODUCTION:The incidence and severity of withdrawal effects when coming off antidepressants (ADs) have recently received considerable attention. National guidelines on the topic have proven to be inaccurate. This paper reports the largest direct-to-patient international survey on these issues. METHODS:Data generated by an online survey from 867 people from 31 countries, who had taken ADs continuously for at least one month, and had tried to come off (successfully or not) was analysed. RESULTS:The majority (59%) had taken ADs for more than three years. Of those who were still taking them, 29% had been doing so for at least 20 years. 61% reported some degree of withdrawal effects, and 44% of these described the effects as 'severe'. The most common of six listed withdrawal effects were anxiety/panic (66%) and irritability (62%). The most common spontaneously reported 'other' withdrawal effect was suicidality (2%). 40% reported that they felt addicted, with 39% of these describing their addiction as 'severe'. Over half (55%) reported some degree of difficulty coming off, with 27% ticking 'very difficult', and 11% 'very easy'. Duration of treatment was related to withdrawal, addiction and difficulty coming off. Younger people experienced more frequent withdrawal effects. Only six people (0.7%) recalled being told anything about withdrawal, dependence or addiction by the initial prescriber. CONCLUSIONS:These findings confirm previous studies, using a range of methodologies, finding high incidences of withdrawal effects, frequently at severe levels. National guidelines, and those of professional organisations, urgently need to be updated to reflect this evidence.
    背景与目标:
  • 【在中国被误诊为重度抑郁症的双相情感障碍患者中抗抑郁药,抗精神病药和情绪稳定剂的处方模式。】 复制标题 收藏 收藏
    DOI:10.1002/hup.2262 复制DOI
    作者列表:Xiang YT,Hu C,Wang G,Zheng QW,Fang YR,Ungvari GS,Kilbourne AM,Lai KY,Si TM,Chen DF,Lu Z,Yang HC,Hu J,Chen ZY,Huang Y,Sun J,Wang XP,Li HC,Zhang JB,Chiu HF
    BACKGROUND & AIMS: OBJECTIVE:Bipolar disorder (BD) is frequently misdiagnosed as major depressive disorder (MDD), which may lead to inappropriate treatment and poor outcomes. This study aimed to examine prescribing patterns of antidepressants, antipsychotics and mood stabilizers in BD patients misdiagnosed with MDD in China. METHODS:A total of 1487 patients originally diagnosed with MDD were consecutively screened for diagnostic revision in 13 psychiatric hospitals or psychiatric units of general hospitals in China nationwide. The patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. The Mini International Neuropsychiatric Interview (MINI) was used to establish DSM-IV diagnoses. Data on psychotropic prescriptions were collected by a review of medical records. RESULTS:Three hundred and nine of the 1487 patients (20.8%) fulfilled DSM-IV criteria for BD; 118 (7.9%) for BD-I and 191 (12.8%) for BD-II on the MINI. Of the BD patients (n = 309), 227 (73.5%) received any use of antidepressants, 73 (23.6%) antipsychotics and 33 (10.7%) mood stabilizers. In multiple logistic regression analyses, compared with those with MDD, patients with BD-I were more likely to receive antidepressants (OR 1.7, 95% CI 1.1-2.8, p = 0.02), antipsychotics (OR 1.6, 95% CI 1.04-2.5, p = 0.04) and mood stabilizers (OR 3.9, 95% CI 2.1-7.2, p < 0.001), whereas patients with BD-II were more likely to receive mood stabilizers (OR 2.4, 95% CI 1.3-4.4, p = 0.003). There was no difference in the use of antidepressants (OR 1.1, 95% CI 0.8-1.5, p = 0.7) and antipsychotics (OR 1.3, 95% CI 0.9-1.9, p = 0.2) between BD-II and MDD. In addition, there was no difference between BD-I and BD-II in any use of antidepressants, antipsychotics and mood stabilizers. CONCLUSIONS:The prescription of antidepressants for BD patients misdiagnosed with MDD is very common, and only a very small proportion of patients received guideline-concordant treatment. Considering the potentially hazardous effects of inappropriate pharmacotherapy in this population, continuing education and training addressing the correct diagnosis of BD and rational use of psychotropic medications are needed in China.
    背景与目标:
  • 【抑郁症患者对抗抑郁药临床反应的预测: 临床实践中的神经生理学。】 复制标题 收藏 收藏
    DOI:10.1177/155005940703800208 复制DOI
    作者列表:Pogarell O,Juckel G,Norra C,Leicht G,Karch S,Schaaff N,Folkerts M,Ibrahim A,Mulert C,Hegerl U
    BACKGROUND & AIMS: :Brain monoaminergic neurotransmission is involved in the pathophysiology of various psychiatric disorders including depression. Reliable indicators of central monoaminergic activity might be helpful to specifically identify and differentiate dysfunctions in individual patients in order to selectively adjust medication and predict clinical response. In patients with depression, predictors of treatment response to serotonergic versus non-serotonergic (e.g., noradrenergic) antidepressants could be of considerable clinical relevance by avoiding unfavorable factors such as a prolonged duration of the disorder, risk of suicidality and therapy-resistance. Consequently, these tools might help to decrease direct and indirect costs of treatment. The loudness dependence of the N1/P2 component of auditory evoked potentials (LD) has been proposed as a noninvasive neurophysiological indicator of central serotonergic function. This review focuses on recent studies providing evidence for the validity of LD as an indirect serotonergic marker and highlights data on the clinical application in terms of prediction of treatment response in patients with depression.
    背景与目标: : 脑单胺能神经传递参与包括抑郁症在内的各种精神疾病的病理生理。中枢单胺能活性的可靠指标可能有助于特异性识别和区分个别患者的功能障碍,以便选择性地调整药物治疗和预测临床反应。在抑郁症患者中,通过避免不利因素,例如疾病的持续时间延长,自杀倾向的风险和治疗耐药性,对血清素能与非血清素能 (例如去甲肾上腺素能) 抗抑郁药的治疗反应的预测指标可能具有相当大的临床意义。因此,这些工具可能有助于降低治疗的直接和间接成本。听觉诱发电位 (LD) 的N1/P2分量的响度依赖性已被提出作为中枢血清素能功能的非侵入性神经生理学指标。这篇综述着重于最近的研究,为LD作为间接血清素能标志物的有效性提供了证据,并着重介绍了在预测抑郁症患者治疗反应方面的临床应用数据。
  • 【MDD和中度至重度疼痛患者中抗抑郁药的早期与常规转换: 一项双盲随机研究。】 复制标题 收藏 收藏
    DOI:10.1016/j.jad.2012.05.024 复制DOI
    作者列表:Romera I,Pérez V,Menchón JM,Schacht A,Papen R,Neuhauser D,Abbar M,Picard H,Gilaberte I
    BACKGROUND & AIMS: BACKGROUND:Concomitant painful physical symptoms in depressive patients frequently impair functioning and failure to treat these symptoms may adversely impact treatment outcomes of depression. Early vs. conventional switch of antidepressants were compared in patients with major depressive disorder (MDD) and moderate to severe pain. METHOD:Pre-specified subgroup analysis of a 16-week, randomized, double-blind clinical study on MDD patients with >30 mm overall pain visual analog scale (VAS). Patients not achieving 30% reduction Hamilton Depression Rating Scale (HAM-D) after 4 weeks escitalopram (10 mg/day) were randomized to duloxetine 60-120 mg/day (early switch) or continued on escitalopram (conventional switch) with non-responders at week 8 switching to duloxetine. Endpoints were time to confirmed response and remission, VAS pain severity, and Sheehan disability scale (SDS). Switch strategies were compared using Kaplan-Meier, logistic regression, and repeated measures analyses. RESULTS:No differences between early and conventional switching were found in time to confirmed response after randomization (3.9 vs. 4.1 weeks, p=0.511) or remission (6.0 vs. 8.0 weeks, p=0.238). Significantly lower VAS mean pain levels at for overall pain, headache, back pain, shoulder pain, interference with daily activities, and time being awake in pain were found for patients in the early switching group. Time to achieving normal functioning (SDS total score <6) was shorter in the early switching group (p=0.042). Safety results were comparable between switch strategies. CONCLUSIONS:In MDD patients with moderate to severe painful physical symptoms not improving after 4 weeks of treatment with escitalopram, an earlier switch to duloxetine may lead to better pain and functional outcomes.
    背景与目标:

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