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"ANTIDEPRESSANTS"
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Unhappiness, sadness and 'depression' : antidepressants and the mental disorder epidemic
This book examines existing treatments, legislation and research methodology of depression and exposes their limitations, championing psycho-social support as an alternative. Depression, affecting 350 million people according to the World Health Organisation, is almost invariably diagnosed by the criteria of the American Psychiatric Association, a definition which encompasses those with normal emotional responses to stressful life events. Tullio Giraldi discusses recent developments in popular and academic dialogue related to the use of antidepressants and recent increases in depression diagnosis and laments the rise in prescribing antidepressants despite their links to suicide and unfulfilled promises of efficacy and safety. He argues that psychotherapy is a cost effective treatment devoid of drugs' adverse effects. This work presents psycho-social support as an alternative to antidepressants, particularly for less severe cases, and as a more effective strategy for coping with the emotional challenges of today's global reality. Patients, students of medicine and psychology, and professionals of mental health will find this work valuable.
BOOK
The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs
Newer generation antidepressant drugs (ADs) are widely used as the first line of treatment for major depressive disorders and are considered to be safer than tricyclic agents. In this critical review, we evaluated the literature on adverse events, tolerability and safety of selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, bupropion, mirtazapine, trazodone, agomelatine, vilazodone, levomilnacipran and vortioxetine. Several side effects are transient and may disappear after a few weeks following treatment initiation, but potentially serious adverse events may persist or ensue later. They encompass gastrointestinal symptoms (nausea, diarrhea, gastric bleeding, dyspepsia), hepatotoxicity, weight gain and metabolic abnormalities, cardiovascular disturbances (heart rate, QT interval prolongation, hypertension, orthostatic hypotension), genitourinary symptoms (urinary retention, incontinence), sexual dysfunction, hyponatremia, osteoporosis and risk of fractures, bleeding, central nervous system disturbances (lowering of seizure threshold, extrapyramidal side effects, cognitive disturbances), sweating, sleep disturbances, affective disturbances (apathy, switches, paradoxical effects), ophthalmic manifestations (glaucoma, cataract) and hyperprolactinemia. At times, such adverse events may persist after drug discontinuation, yielding iatrogenic comorbidity. Other areas of concern involve suicidality, safety in overdose, discontinuation syndromes, risks during pregnancy and breast feeding, as well as risk of malignancies. Thus, the rational selection of ADs should consider the potential benefits and risks, likelihood of responsiveness to the treatment option and vulnerability to adverse events. The findings of this review should alert the physician to carefully review the appropriateness of AD prescription on an individual basis and to consider alternative treatments if available.
Journal Article
Serotonin
\"Dissatisfied and discontent, Florent-Claude Labrouste begrudgingly works as an engineer for the Ministry of Agriculture, and is in a self-imposed dysfunctional relationship with a younger woman. When he discovers her ongoing infidelity, he decides to abandon his life in Paris and return to the Normandy countryside of his youth. There he contemplates lost loves and past happiness as he struggles to embed himself in a world that no longer holds any joy for him. His only relief comes in the form of a pill - white, oval, small. Captorix is a new brand of anti-depressant, recently released for public consumption, which works by altering the brain's release of serotonin. With social unrest intensifying around him, and his own depression deepening, Florent-Claude turns to this new medication in the hope that he will find something to live for. Written by one of the most provocative and prophetic novelists of his generation, Serotonin is at once a devastating story of solitude, longing and individual suffering, and a powerful criticism of modern life.\"--Publisher.
Book
A Comprehensive Algorithm for Management of Neuropathic Pain
Abstract
Background
The objective of this review was to merge current treatment guidelines and best practice recommendations for management of neuropathic pain into a comprehensive algorithm for primary physicians. The algorithm covers assessment, multidisciplinary conservative care, nonopioid pharmacological management, interventional therapies, neurostimulation, low-dose opioid treatment, and targeted drug delivery therapy.
Methods
Available literature was identified through a search of the US National Library of Medicine’s Medline database, PubMed.gov. References from identified published articles also were reviewed for relevant citations.
Results
The algorithm provides a comprehensive treatment pathway from assessment to the provision of first- through sixth-line therapies for primary care physicians. Clear indicators for progression of therapy from firstline to sixth-line are provided. Multidisciplinary conservative care and nonopioid medications (tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, gabapentanoids, topicals, and transdermal substances) are recommended as firstline therapy; combination therapy (firstline medications) and tramadol and tapentadol are recommended as secondline; serotonin-specific reuptake inhibitors/anticonvulsants/NMDA antagonists and interventional therapies as third-line; neurostimulation as a fourth-line treatment; low-dose opioids (no greater than 90 morphine equivalent units) are fifth-line; and finally, targeted drug delivery is the last-line therapy for patients with refractory pain.
Conclusions
The presented treatment algorithm provides clear-cut tools for the assessment and treatment of neuropathic pain based on international guidelines, published data, and best practice recommendations. It defines the benefits and limitations of the current treatments at our disposal. Additionally, it provides an easy-to-follow visual guide of the recommended steps in the algorithm for primary care and family practitioners to utilize.
Journal Article
Cognitive impairment in depression: recent advances and novel treatments
In the past, little or no attention was paid to cognitive disorders associated with depression (a condition sometimes termed pseudodementia). However, recent years have seen a growing interest in these changes, not only because of their high frequency in acute-stage depression, but also because they have been found to persist, as residual symptoms (in addition to affective and psychomotor ones), in many patients who respond well to antidepressant treatment. These cognitive symptoms seem to impact significantly not only on patients' functioning and quality of life, but also on the risk of recurrence of depression. Therefore, over the past decade, pharmacological research in this field has focused on the development of new agents able to counteract not only depressive symptoms, but also cognitive and functional ones. In this context, novel antidepressants with multimodal activity have emerged. This review considers the different issues, in terms of disease evolution, raised by the presence of cognitive disorders associated with depression and considers, particularly from the neurologist's perspective, the ways in which the clinical approach to cognitive symptoms, and their interpretation to diagnostic and therapeutic ends, have changed in recent years. Finally, after outlining the pharmacodynamics and pharmacokinetics of the first multimodal antidepressant, vortioxetine, it reports the main results obtained with the drug in depressed patients, also in consideration of the ever-increasing evidence on its different mechanisms of action in animal models.
Journal Article
PO070 Treatment effect in visual snow
Patients with visual snow suffer from pan-field, dynamic visual disturbance. Proposed diagnostic criteria require at least two additional visual symptoms from: palinopsia, entoptic phenomena, photophobia and nyctalopia. Little is known regarding useful pharmacological treatments for patients. The aim of this study was to gain knowledge on the effect of a number of commonly used medications on visual snow. A questionnaire was prepared in collaboration with the patient group Eye-on-Vision and sent to subjects who had expressed an interest in research. It required to select from a list of drugs, including antiepileptics, antidepressants and benzodiazepines, the treatments that caused a change in symptoms, with either an improvement or a worsening. The study was approved by KCL Research Ethics Panel. For a total of n=182 patients, the effect of ninety-six drugs was recorded in 514 reports. Antidepressants and antiepileptics were the most commonly used drugs; they showed no effect on visual snow in 53% of reports. Visual snow is a highly disabling syndrome, for which there is no widely accepted treatment. More effort needs to be made in understanding its pathophysiology to allow focused treatment strategies.
Journal Article