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Wednesday, March 17th, 2010
The use of antidepressant medications by patients with fibromyalgia syndrome is associated with a reduction in pain, sleep disturbances and depressed mood and improvement of health-related quality of life, according to an analysis of previous studies, which is published in the January 14 issue of JAMA.
Fibromyalgia syndrome (FMS), which consists of chronic widespread pain and tenderness, with other symptoms including fatigue and sleep difficulties, has an estimated prevalence of 0.5 percent to 5.8 percent in North America and Europe. “Patients with FMS experience disability and reduced health-related quality of life (HRQOL). Fibromyalgia syndrome is also associated with high direct and indirect disease-related costs. Effective treatment of FMS is therefore necessary for medical and economic reasons,” the authors write.
Winfried Häuser, M.D., of Klinikum Saarbrücken, Saarbrücken, Germany, and colleagues conducted a meta-analysis to evaluate the effects of treatment with antidepressants on FMS-related symptoms. The researchers identified 18 randomized controlled trials, involving 1,427 participants, for inclusion in the study.
Overall, there was strong evidence for a reduction of pain, fatigue and depressed mood and improved sleep and HRQOL with the use of antidepressants by patients with FMS.
The researchers found large effect sizes of tricyclic and tetracyclic antidepressants (TCAs) for reducing pain, fatigue, and sleep disturbances; small effect sizes of selective serotonin reuptake inhibitors (SSRIs) for reducing pain; small effect sizes of serotonin and noradrenaline reuptake inhibitors (SNRIs) for reducing pain, sleep disturbances, and depressed mood; and small effect sizes of monoamine oxidase inhibitors (MAOIs) for reducing pain.
“Before treatment is initiated, [accompanying] diseases related to potential adverse effects of the drugs and patients’ preferences should be considered. Goals of pharmacological therapy should be defined (no cure, but possible symptom reduction). Since evidence for a long-term effect of antidepressants in FMS is still lacking, their effects should be re-evaluated at regular intervals to determine whether benefits outweigh adverse effects,” the authors write. “The identification of patient characteristics associated with positive and negative therapeutic outcomes are needed to better target antidepressant therapy for FMS.”
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Monday, March 15th, 2010
Taking a popular type of antidepressant during pregnancy may increase the risk for preterm birth, the need for treatment in a neonatal intensive care unit and lower overall health for the baby, according to a new study.
Researchers compared birth outcomes among babies born to 329 women who took selective serotonin reuptake inhibitors (SSRIs) during pregnancy, 4,902 women who had a history of psychiatric illness but did not take SSRIs during pregnancy and 51,770 women with no history of mental illness.
Compared with women who had no history of mental illness, those who took SSRIs during pregnancy gave birth an average of five days earlier and had double the risk for preterm delivery. Babies of mothers who took SSRIs during pregnancy were significantly more likely than infants in the other two groups to have a five-minute Apgar score of seven or lower (seven is the general indicator of good infant health) or to be admitted to the neonatal intensive care unit. Exposure to SSRIs did not affect birth weight or head circumference.
The researchers also found that SSRI-exposed infants admitted to the neonatal intensive care unit had symptoms including seizures, jitteriness, infections, respiratory problems and jaundice that may have been caused by withdrawal from SSRIs or adverse effects from them.
The findings appear in the October issue of Archives of Pediatrics & Adolescent Medicine.
“The study justifies increased awareness to the possible effects of intrauterine exposure to antidepressants,” the researchers concluded. “However, treatment of depression during pregnancy may be warranted, and future studies need to distinguish between individual SSRIs to find the safest medication.”
It’s estimated that more than 10 percent of pregnant women have depression. The authors noted that SSRIs have been shown to cross the placenta and be present in the umbilical cord blood of infants whose mothers took the drugs during pregnancy.
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Friday, March 12th, 2010
People taking prescription antidepressants appear to drive worse than people who aren’t taking such drugs, and depressed people on antidepressants have even more trouble concentrating and reacting behind the wheel.
These were the conclusions of a study recently released at the Annual Convention of the American Psychological Association.
University of North Dakota psychologists Holly Dannewitz. PhD, and Tom Petros, PhD, recruited 60 people to participate in a driving simulation in which participants had to make a series of common driving decisions, such as reacting to brake lights, stop signs or traffic signals while being distracted by speed limit signs, pylons, animals, other cars, helicopters or bicyclists. The simulation tested steering, concentration and scanning. Thirty-one of the participants were taking at least one type of antidepressant while 29 control group members were taking no medications with the exception of oral contraceptives in some cases.
The group taking antidepressants was further divided into those who scored higher and lower on a test of depression. The group taking antidepressants who reported a high number of symptoms of depression performed significantly worse than the control group on several of the driving performance tasks. But participants who were taking antidepressants and scored in the normal range on a test to measure depression performed no differently than the non-medicated individuals.
“Individuals taking antidepressants should be aware of the possible cognitive effects as [they] may affect performance in social, academic and work settings, as well as driving abilities,” the researchers wrote. “However, it appears that mood is correlated with cognitive performance, more so than medication use.”
This research is important in light of the rapid increase in the number of Americans taking antidepressants. Americans’ use of antidepressant drugs such as Prozac, Paxil or Zoloft, nearly tripled in a decade, according to the 2004 Health United States report, issued by the National Center for Health Statistics. Among women, one in 10 takes an antidepressant drug, according to the government.
Presentation: “The Effects of Antidepressants on Cognitive and Driving Performance,” Holly J. Dannewitz, PhD, and Thomas Petros, PhD, University of North Dakota; Poster Session 4110, Aug. 17, Boston Convention and Exhibition Center.
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Wednesday, March 10th, 2010
Having both depression and type 2 diabetes increases the risk of death for heart patients. Each factor had been known to increase the risk of heart disease deaths by itself, but together they’re even more deadly.
In an analysis of more than 900 patients with established coronary artery disease, Duke University Medical Center psychologists found that those with both type 2 diabetes and symptoms of depression were more likely to die than heart patients without those conditions.
The study showed that among type 2 diabetes patients, having high depression scores increased the risk of dying by 20 to 30 percent compared to patients with similar depression scores but no type 2 diabetes.
“We found a trend showing that the probability of death increases as the level of depression increases in diabetic patients with coronary artery disease,” said Duke researcher Anastasia Georgiades, Ph.D. “Our data appear to show an important interaction between type 2 diabetes and depression, meaning that physicians should closely monitor their heart patients who have both of these disorders.”
“There is some sort of synergistic effect between type 2 diabetes and depression that we don’t fully understand,” Georgiades said. “In our analysis, we controlled for factors that could influence mortality, such as heart disease severity and age. For whatever reasons, these patients were still at higher risk of dying, and future research will aim to investigate the mechanisms for this association.” The research was supported by the National Heart, Lung, Blood Institute.
The researchers followed 933 heart patients for more than four years and correlated the 135 deaths that occurred during that period with the presence of type 2 diabetes and depression alone and together.
Georgiades said there are some possible explanations for the link between depression and diabetes.
“Patients with type 2 diabetes typically have an extensive self-care regimen involving special diet, medications, exercise and numerous appointments with their doctor,” she said. “It may be that such patients who are depressed might not be as motivated to carry out all these activities, thereby putting them at higher risk.”
Depression has also been linked to other cardiovascular risk factors such as insulin resistance, hypertension, obesity, increased cigarette smoking, alcohol abuse and physical inactivity.
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Friday, March 5th, 2010
Antidepressants Account For Only 10% Of Fall In Suicide Rates Among Older People.
The use of antidepressants is likely to account for only 10 per cent of the fall in suicide rates among middle aged and older people, suggests a large study in the Journal of Epidemiology and Community Health.
Globally, more than 800, 000 people commit suicide every year. Rates have been falling in many countries, a factor that has been associated with better recognition of depression and the increasing use of antidepressants, particularly the newer selective serotonin reuptake inhibitors (SSRIs).
But research involving more than 2 million Danes aged 50 and above and living in Denmark between 1996 and 2000, throws this into question.
The researchers assessed changes in the numbers of middle aged and older people committing suicide during this period and the types of antidepressant drugs they had been prescribed.
Only one in five of those committing suicide was actually taking antidepressants at the time of death.
Suicide rates in older men fell by almost 10 per 100, 000 of the population during this timeframe, but among recipients of antidepressants, the fall was less than one. For older women, only 0.4 of the 3.3 fall per 100, 000 of the population was accounted for by those being treated with antidepressants.
Overall, treatment type made little difference, although rates among men taking SSRIs were slightly higher than among those taking tricyclics.
Suicide rates were five to six times higher among those taking antidepressants than those who were not.
Previous Scandinavian and US research has suggested that a fivefold increase in the use of antidepressants could lead to a 25% decrease in suicide rates, with SSRIs having saved as many as upwards of 33, 000 lives, say the authors.
Sales of antidepressants in Denmark have soared from 8.4 per 1000 of the population in 1990 to 52.2 in 2000.
And suicide rates among older people have more than halved from 52.2 in 1980 to 22.1 per 100, 000 of the population in 2000.
The authors conclude that current antidepressant treatment accounts for only a fraction of the falls in suicide rates among older people.
But they nevertheless suggest that more should be done to pick up and treat depression among older people.
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Wednesday, March 3rd, 2010
One of the most common reasons for noncompliance and discontinued use of antipsychotic medication is weight gain. The agent believed to be responsible for the increased food intake of patients taking antipsychotics is the serotonin blocker.
Conventional anti-psychotics include the following:
* Haloperidol (Haldol®, Peridol®)
* Molindone (Moban®)
* Thioridazine (Apo-Thioridazine®, Mellaril®, Novo-Ridazine®, PMS-Thioridazine®)
* Newer antipsychotics, classified as atypical antipsychotics, include the following:
* Clozapine (Clozaril®)
* Olanzapine (Zyprexa®)
* Quetiapine (Seroquel®)
* Risperidone (Risperdal®)
* Sertindole (Serlect®)
* Ziprasidone (Seldox®)
Haloperidol (Haldol®, Peridol®) is a conventional antipsychotic with a lower incidence of weight gain than the newer agents clozapine (Clozaril®), olanzapine (Zyprexa®), and sertindole (Serlect®).
A retrospective study showed that clozapine (Clozaril®) and olanzapine (Zyprexa®) had the greatest associated weight gain, followed by intermediate weight gain with risperidone (Risperdal®).
Patients treated with sertindole (Serlect®) had less weight gain than those treated with haloperidol. Another study linked clozapine (Clozaril®) to significant weight gain and lipid abnormalities, suggesting increased risk for diabetes.
Among the conventional antipsychotics, thioridazine and chlorpromazine have greater potential for weight gain, while molindone (Moban®) is the only antipsychotic shown not to increase weight on a consistent basis.
Studies show that antipsychotic agents have an effect on the reproductive hormones. Women receiving antipsychotics tended to display hyperprlactinemia and tended to be hypoestrogenic. Women with primary obesity did not have hyperprolactinemia and tended to have normal or elevated estradiol serum levels. These differences have pathogenic and therapeutic implications besides the effects on gonadal and adrenal steroids. Prolactin alone promotes appetite and insulin resistance that may underlie the excessive body weight observed in hyperprolactinemic conditions detected in both animal and clinical studies.
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Monday, March 1st, 2010
These drugs were initially used only for seizure disorders. The following anticonvulsants are now prescribed frequently in the treatment of bipolar disorder and other selected forms of depression:
* Carbamazepine (Tegretol®)
* Divalproex (Depakote®)
* Gabapentin (Neurontin®)
* Lamotrigine (Lamictal®)
* Topiramate (Topamax®)
Anticonvulsants tend to cause hyperinsulinemia (elevated insulin in the blood) and increased appetite leading to weight gain. Hyperinsulinemia also results in increased testosterone, which causes a risk to women on these medications for development of Polycystic Ovary Syndrome (POS). Polycystic ovary syndrome can cause weight gain, male pattern baldness, increased facial hair, skin tags, acne, infertility, high blood pressure, abnormal lipid levels, and heart disease.
Seizure disorder studies showed that patients taking anticonvulsants who had either a normal or below normal body mass index had the most severe weight gain.
Conventional Mood Stabilizers
Mood stabilizers were commonly used before anticonvulsants were developed for the treatment of bipolar disorder. Mood stabilizers commonly prescribed consisted primarily of the following:
* Lithium (Cibalith-S®, Duralith®,
* Ekalith®, Eskalith CR®, Lithane®,
* Lithobid®, Lithonate®, Lithotabs®)
Typically, one-third to two-thirds of the patients treated with Lithium gain weight. Of those, 25 percent gain enough weight to be classified as obese. Weight gain is dose dependent, but low doses of lithium (less than .8 mm/L) are often not therapeutic: therefore, low-dose lithium is usually not an alternative.
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Friday, February 26th, 2010
Other antidepressants that do not fall strictly under the classifications of SSRIs, TCAs, or MAOIs include the following:
* Buproprion HCL (Wellbutrin®)
* Mitrazapine (Remeron®)
* Nefazadone (Serzone®)
* Trazadone (Desyrel®)
* Venlafaxine (Effexor®)
Venlafaxine (Effexor®) has been shown to cause weight gain but not as severe as has been reported with the SSRIs paroxetine (Paxil®), fuoxetine (Prozac®), and sertraline (Zoloft®).
Mitrazapine (Remeron®) has been associated with significant weight gain, possibly secondary to interactions with the histamine (H1) receptor. It is not associated with gastrointestinal symptoms, sexual dysfunction, or increased heart rate, as seen with the SSRIs.
Trazadone (Desyrel®) is an antidepressant with sedative properties that is frequently used as a sleep aid as well as treatment for depression. It appears to cause less weight gain than amitriptyline (Elavil®) but more than buproprion HCL (Wellbutrin®).
There is currently no information available relating Nefazadone (Serzone®) to increased appetite or weight gain.
Buproprion HCL (Wellbutrin®) has not been associated with weight gain and is commonly used with some success in smoking cessation.
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Friday, February 19th, 2010
There are two categories of MAOIs: nonselective, irreversible MAOIs and reversible inhibitors of monoamine oxidase type A (RIMAs). The nonselective irreversible MAOIs cause weight gain similar to TCAs while the newer, selective MAOIs do not appear to have any effect on body weight.
There is not much information available on the current use of MAOIs in clinical practice because they have some dangerous side effects and are used less frequently than other antidepressants.
Nonselective, irreversible MAOIs include the following:
* Isocarboxazid (Marplan®)
* Phenelzine (Nardil®)
* Tranylcypromine (Parnate®)
* Selective reversible RIMAs include the following:
* Moclobemide (Manerix®)
* Toloxatone (Humoryl®)
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Wednesday, February 17th, 2010
TCAs were the most commonly prescribed antidepressants before SSRIs became widely available. Tricyclic antidepressants are often used to treat sleep disorders and to help patients manage pain. Most physicians are aware that TCAs can contribute significantly to weight gain.
Weight gain and other side effects vary from one TCA to another as well as from one patient to another. Many drugs in this class induce slowing of the metabolism and carbohydrate cravings. Factors more clearly understood involve histamine and alpha 1 receptor blocking actions. Appetite stimulation and weight gain make it extremely difficult for the diabetic using a TCA to control blood sugar.
TCAs include the following:
* Amitriptyline (Elavil®)
* Amoxapine (Asendin®)
* Clomipramine (Anafranil®)
* Desipramine (Norepramine®, Pertofrane®)
* Doxepin (Adapin®, Sinequan®)
* Imipramine (Janimine®, Tofranil®)
* Nortriptyline (Aventyl®, Pamelor®)
* Protriptyline (Vivactil®)
* Trimipramine (Rhotramine®, Surmontil®)
Weight gain with TCAs is dose dependent and relative to the length of therapy.
The greatest weight gain among TCA patients has been observed with those using either amitriptyline (Elavil®) or imipramine (Janimine®, Tofranil ®).
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