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Progress in Neuro-psychopharmacology &... Apr 2021Data regarding the ability of antidepressants to enter fetal, newborn and infant fluids have become gradually available, but mechanisms of antidepressant transfer remain... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Data regarding the ability of antidepressants to enter fetal, newborn and infant fluids have become gradually available, but mechanisms of antidepressant transfer remain poorly understood. Here we calculated penetration ratios in an array of matrices from combined samples of pregnant/breastfeeding women taking antidepressants.
METHOD
We performed a systematic literature search of PubMed and EMBASE to identify studies with concentrations of antidepressants from maternal blood, amniotic fluid, umbilical cord blood and/or breast milk. Penetration ratios were calculated by dividing the concentrations in amniotic fluid, umbilical cord plasma or breast milk by the maternal plasma concentration. When data from multiple studies were available, we calculated combined penetration ratios, weighting the study mean by study size.
RESULTS
Eighty-five eligible studies were identified. For amniotic fluid, the highest penetration ratios were estimated for venlafaxine (mean 2.77, range 0.43-4.70 for the active moiety) and citalopram (mean 2.03, range 0.35-6.97), while the lowest ratios were for fluvoxamine (mean 0.10) and fluoxetine (mean 0.11, range 0.02-0.20 for the active moiety). For umbilical cord plasma, nortriptyline had the highest ratio (mean 2.97, range 0.25-26.43) followed by bupropion (mean 1.14, range 0.3-5.08). For breast milk, the highest ratios were observed for venlafaxine (mean 2.59, range 0.85-4.85), mianserin (mean 2.22, range 0.80-3.64) and escitalopram (mean 2.19, range 1.68-3.00).
CONCLUSION
We observed considerable variability across antidepressants regarding their ability to enter fetal, newborn and infant fluids. Measuring antidepressant concentrations in a maternal blood sample can provide a reliable estimate of fetal/infant exposure, although further evidence for concentration-dependent effects is required.
Topics: Amniotic Fluid; Antidepressive Agents; Breast Feeding; Female; Fetal Blood; Humans; Infant; Milk, Human; Pregnancy; Pregnancy Complications
PubMed: 33358964
DOI: 10.1016/j.pnpbp.2020.110228 -
Depression and Anxiety Sep 2016Current clinical practice guidelines (CPGs) for posttraumatic stress disorder (PTSD) offer contradictory recommendations regarding use of medications or psychotherapy as... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Current clinical practice guidelines (CPGs) for posttraumatic stress disorder (PTSD) offer contradictory recommendations regarding use of medications or psychotherapy as first-line treatment. Direct head-to-head comparisons are lacking.
METHODS
Systemic review of Medline, EMBASE, PILOTS, Cochrane Central Register of Controlled Trials, PsycINFO, and Global Health Library was conducted without language restrictions. Randomized clinical trials ≥8 weeks in duration using structured clinical interview-based outcome measures, active-control conditions (e.g. supportive psychotherapy), and intent-to-treat analysis were selected for analyses. Independent review, data abstraction, and bias assessment were performed using standardized processes. Study outcomes were grouped around conventional follow-up time periods (3, 6, and 9 months). Combined effect sizes were computed using meta-analyses for medication versus control, medication pre-/posttreatment, psychotherapy versus control, and psychotherapy pre-/posttreatment.
RESULTS
Effect sizes for trauma-focused psychotherapies (TFPs) versus active control conditions were greater than medications versus placebo and other psychotherapies versus active controls. TFPs resulted in greater sustained benefit over time than medications. Sertraline, venlafaxine, and nefazodone outperformed other medications, although potential for methodological biases were high. Improvement following paroxetine and fluoxetine treatment was small. Venlafaxine and stress inoculation training (SIT) demonstrated large initial effects that decreased over time. Bupropion, citalopram, divalproex, mirtazapine, tiagabine, and topiramate failed to differentiate from placebo. Aripiprazole, divalproex, guanfacine, and olanzapine failed to differentiate from placebo when combined with an antidepressant.
CONCLUSIONS
Study findings support use of TFPs over nontrauma-focused psychotherapy or medication as first-line interventions. Second-line interventions include SIT, and potentially sertraline or venlafaxine, rather than entire classes of medication, such as SSRIs. Future revisions of CPGs should prioritize studies that utilize active controls over waitlist or treatment-as-usual conditions. Direct head-to-head trials of TFPs versus sertraline or venlafaxine are needed.
Topics: Antidepressive Agents; Combined Modality Therapy; Humans; Piperazines; Psychotherapy; Randomized Controlled Trials as Topic; Selective Serotonin Reuptake Inhibitors; Sertraline; Stress Disorders, Post-Traumatic; Treatment Outcome; Triazoles; Venlafaxine Hydrochloride
PubMed: 27126398
DOI: 10.1002/da.22511 -
Annals of Family Medicine 2015The purpose of this study was to investigate whether antidepressants are more effective than placebo in the primary care setting, and whether there are differences... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The purpose of this study was to investigate whether antidepressants are more effective than placebo in the primary care setting, and whether there are differences between substance classes regarding efficacy and acceptability.
METHODS
We conducted literature searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and PsycINFO up to December 2013. Randomized trials in depressed adults treated by primary care physicians were included in the review. We performed both conventional pairwise meta-analysis and network meta-analysis combining direct and indirect evidence. Main outcome measures were response and study discontinuation due to adverse effects.
RESULTS
A total of 66 studies with 15,161 patients met the inclusion criteria. In network meta-analysis, tricyclic and tetracyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), a serotonin-noradrenaline reuptake inhibitor (SNRI; venlafaxine), a low-dose serotonin antagonist and reuptake inhibitor (SARI; trazodone) and hypericum extracts were found to be significantly superior to placebo, with estimated odds ratios between 1.69 and 2.03. There were no statistically significant differences between these drug classes. Reversible inhibitors of monoaminoxidase A (rMAO-As) and hypericum extracts were associated with significantly fewer dropouts because of adverse effects compared with TCAs, SSRIs, the SNRI, a noradrenaline reuptake inhibitor (NRI), and noradrenergic and specific serotonergic antidepressant agents (NaSSAs).
CONCLUSIONS
Compared with other drugs, TCAs and SSRIs have the most solid evidence base for being effective in the primary care setting, but the effect size compared with placebo is relatively small. Further agents (hypericum, rMAO-As, SNRI, NRI, NaSSAs, SARI) showed some positive results, but limitations of the currently available evidence makes a clear recommendation on their place in clinical practice difficult.
Topics: Antidepressive Agents; Depressive Disorder; Humans; Patient Acceptance of Health Care; Primary Health Care; Treatment Outcome
PubMed: 25583895
DOI: 10.1370/afm.1687 -
Movement Disorders : Official Journal... Oct 2014Depressive symptoms are common in Huntington's disease (HD), profoundly affect quality of life, and predict suicidal ideation. However, no recent review of... (Review)
Review
BACKGROUND
Depressive symptoms are common in Huntington's disease (HD), profoundly affect quality of life, and predict suicidal ideation. However, no recent review of antidepressant treatment in HD has been published.
METHODS
We performed a PRISMA systematic review of HD studies, which used a recognized antidepressant and measured change in depressive symptoms using a validated psychiatric scale. Controlled trials, uncontrolled trials, observational studies, and case series were included.
RESULTS
Eleven studies were included, totalling 190 patients. One study examined venlafaxine, one fluoxetine, one citalopram, one atomoxetine, one modafinil, one lithium, and five antipsychotics. No studies were of adequate duration, size, or outcome, and no controlled trial in a depressed population produced a positive result.
CONCLUSIONS
Inadequate evidence exists to guide antidepressant treatment in HD. Further research is needed to assess antidepressant efficacy and to examine whether treatment of depression represents a modifiable target for the high suicide rate in HD.
Topics: Antidepressive Agents; Depression; Humans; Huntington Disease
PubMed: 25111961
DOI: 10.1002/mds.25980 -
Pharmacopsychiatry Sep 2015Desvenlafaxine, the active metabolite of venlafaxine, was approved in 2008 by the FDA for the treatment of depression. The aim of the present review is to provide an... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Desvenlafaxine, the active metabolite of venlafaxine, was approved in 2008 by the FDA for the treatment of depression. The aim of the present review is to provide an overview of the existing trials with desvenlafaxine and assess its overall efficacy and tolerability.
METHODS
We searched in PubMed, EMBASE and the Cochrane Library for eligible studies (double-blind randomized control trials). A random effects model was used for the estimation of effect sizes.
RESULTS
17 trials were found in total. In the placebo-controlled trials the overall risk ratio for response was 1.24 (1.16-1.32, p<0.001), for remission 1.29 (1.16-1.43, p<0.001), for dropouts 1.16 (0.99-1.35, p=0.066) and for dropouts due to adverse events 1.98 (1.45-2.69, p<0.001). There were no differences between the various doses that were used (i. e., 50 mg, 100 mg, 200 mg, 400 mg). The mean risk ratio for response in the head-to-head trials was 0.90 (0.82-0.98, p=0.014) and for remission 0.82 (0.71-0.95, p=0.009).
DISCUSSION
The risk ratios for response and remission were moderate. We further provide some evidence that desvenlafaxine might not be as efficacious as other antidepressants.
Topics: Antidepressive Agents; Depression; Desvenlafaxine Succinate; Humans
PubMed: 26205685
DOI: 10.1055/s-0035-1555879 -
Frontiers in Pharmacology 2024Amidst rising global burden of depression and the associated challenges with conventional antidepressant therapies, there is a growing interest in exploring the...
Amidst rising global burden of depression and the associated challenges with conventional antidepressant therapies, there is a growing interest in exploring the efficacy and safety of alternative treatments. This study uses a Bayesian network meta-analysis to rigorously evaluate the therapeutic potential of Chinese herbal medicines in the treatment of depression, focusing on their comparative efficacy and safety against standard pharmacological interventions. Five databases (PubMed, Wanfang Data, EMBASE, CNKI, and the Cochrane Library) and grey literature were searched from inception to end of July 2023 to identify studies that assessed the efficacy and safety of Chinese herbal medicines in treating depression. The response rate, Hamilton Depression Scale (HAMD) scores, and rates of adverse events were assessed through both direct and indirect comparisons. Data extraction and risk of bias assessment were meticulously performed. Statistical analysis used Markov chain Monte Carlo methods, with effect size estimates provided as odd ratios and their 95% confidence intervals. A total of 198 RCTs involving 8,923 patients were analyzed, assessing 17 Chinese herbal medicines. Surface Under the Cumulative Ranking results indicated that the top three treatments with the best response rate were possibly , , and ; the top three treatments on the reduction of HAMD scores were , , and ; and the top three treatments with the lowest adverse effects rates were , , and . Interestingly, commonly used synthetic drugs such as , , , , , and , not only appeared to be less effective than specific Chinese herbal medicines (, , , , and ), but they were also related to substantially higher risk of adverse events. Our findings elucidate the promising therapeutic potential of Chinese herbal medicines as viable alternatives in the treatment of depression, with certain herbs demonstrating enhanced efficacy and safety profiles. The outcomes of this study advocate for the integration of these alternative modalities into contemporary depression management paradigms. However, it underscores the necessity for larger, methodologically robust trials to further validate and refine these preliminary findings. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023452109.
PubMed: 38633609
DOI: 10.3389/fphar.2024.1295564 -
Pharmacopsychiatry Sep 2017This review provides an update of experimental and clinical studies on the effects of antidepressants on driving performance. A systematic literature search on the... (Review)
Review
This review provides an update of experimental and clinical studies on the effects of antidepressants on driving performance. A systematic literature search on the PubMed database (1980-2016) was performed. Twenty-eight studies could be included in this review, whereas only 5 studies investigated driving performance under antidepressants in patients. Most tri- and tetracyclics have acute deleterious effects on driving performance that, except for mianserin, attenuate after subchronic use. Selective serotonin reuptake inhibitors and the serotonin norepinephrine reuptake inhibitor's venlafaxine and milnacipran did not affect driving ability. Trazodone appears to have dose-related acute effects on driving skills. Acute use of mirtazapine does produce impairments that diminish when given as a nocturnal dose and cannot be seen in healthy subjects when initially given as a low dose or after repeated dosing. Additive effects with alcohol were most pronounced with sedating antidepressants. Most patients definitely benefit from treatment with newer antidepressants with respect to driving skills. Much more patient studies are needed to elucidate a crucial question: from which antidepressant treatment do patients benefit most with respect to driving performance?
Topics: Alcohol Drinking; Antidepressive Agents; Driving Under the Influence; Drug Synergism; Humans
PubMed: 28718182
DOI: 10.1055/s-0043-113572 -
Breast Cancer Research and Treatment Jul 2015Toxicity due to treatment causes a negative impact on quality of life in breast cancer survivors. Hot flash symptoms, described as intense sensations of heat, sweating... (Meta-Analysis)
Meta-Analysis Review
Toxicity due to treatment causes a negative impact on quality of life in breast cancer survivors. Hot flash symptoms, described as intense sensations of heat, sweating and flushing occur in more than 50 % of breast cancer patients taking tamoxifen. We hypothesized that venlafaxine, a selective-norepinephrine reuptake inhibitor drug, was effective for reducing patient-reported hot flash scores among women treated for breast cancer compared to other non-hormonal treatments. We searched Medline, Scopus, and Cochrane Central Register of Controlled Trials from inception till May 2015 for venlafaxine (75 mg once daily or greater) with non-hormonal comparators for the treatment of hot flashes in female breast cancer patients. The primary outcome was hot flash score (derived from patient-reported hot flash severity and frequency) in randomized controlled trials. Standardized mean differences (SMD) were calculated for each study due to variation in the outcome measures. Heterogeneity was determined using I (2) statistics, and publication bias was assessed using a contour funnel plot and Egger's tests. Pooled analyses demonstrated that venlafaxine significantly reduced hot flash scores compared to the trial comparators (overall SMD 2.06; 95% confidence interval (CI) [0.40, 3.72]). There was significant heterogeneity among these studies (I (2) = 98.7%, P < 0.001). Asymmetry in the contour funnel plot suggests the presence of publication bias and a trend towards small study effects (Egger's test, P = 0.096). Venlafaxine is efficacious in managing hot flashes among women with breast cancer. This review highlights methodological issues that arise from eligible trials and recommends a collaborative approach in survivorship studies.
Topics: Breast Neoplasms; Disease Management; Female; Hot Flashes; Humans; Serotonin and Noradrenaline Reuptake Inhibitors; Treatment Outcome; Venlafaxine Hydrochloride
PubMed: 26067931
DOI: 10.1007/s10549-015-3465-5 -
Iranian Journal of Medical Sciences May 2022Hot flashes (HF) are a common symptom during the menopausal transition. It is therefore important to identify effective drugs that can alleviate HF. This study aimed to... (Review)
Review
The Efficacy and Safety of Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitors in the Treatment of Menopausal Hot Flashes: A Systematic Review of Clinical Trials.
BACKGROUND
Hot flashes (HF) are a common symptom during the menopausal transition. It is therefore important to identify effective drugs that can alleviate HF. This study aimed to systematically review published clinical trials on the efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in the treatment of HF in healthy menopausal women.
METHODS
In this systematic review, articles published during 2003-2019 in PubMed, MEDLINE, Web of Science, Scopus, Science Direct, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, and Google Scholar as well as Iranian databases such as SID, and Magiran were searched. The quality of the selected articles was assessed using the Jadad score calculation.
RESULTS
Thirty-six articles on randomized controlled trials were included in this study, out of which 27 articles had acceptable, and nine had weak methodological quality. Findings on SSRIs class of drugs indicated that escitalopram, paroxetine, and fluoxetine have higher efficacy and safety in the treatment of menopausal HF than other drugs. Studies on the effectiveness of sertraline, citalopram, and fluvoxamine are limited in number or show inconsistent results. Therefore, further high-quality studies are required to confirm their effectiveness in alleviating HF. Within the SNRIs class, venlafaxine and desvenlafaxine showed significant efficacy in the treatment of menopausal HF. However, studies on the effectiveness of duloxetine are also limited, which requires further research.
CONCLUSION
Most studies have indicated the efficacy and safety of some antidepressants, such as SSRIs and SNRIs, in decreasing the frequency and severity of HF. These drugs are therefore recommended for the treatment of menopausal HF.
Topics: Female; Hot Flashes; Humans; Iran; Menopause; Norepinephrine; Randomized Controlled Trials as Topic; Serotonin; Selective Serotonin Reuptake Inhibitors; Serotonin and Noradrenaline Reuptake Inhibitors
PubMed: 35634530
DOI: 10.30476/ijms.2020.87687.1817 -
Archives of Physical Medicine and... Aug 2016To update a systematic review of published research on pharmacotherapy for pain post-spinal cord injury (SCI). (Review)
Review
OBJECTIVE
To update a systematic review of published research on pharmacotherapy for pain post-spinal cord injury (SCI).
DATA SOURCES
PubMed/MEDLINE, CINAHL, Embase, and PsycINFO databases were searched for articles from 2009 to September 2015 examining treatment of pain post-SCI.
STUDY SELECTION
Studies were included for analysis if they met the following 4 a priori criteria: (1) written in the English language; (2) ≥50% of subjects had an SCI, unless results were stratified by population type; (3) participants included ≥3 subjects with an SCI; and (4) any intervention involving pharmacologic treatment for the improvement of pain.
DATA EXTRACTION
Randomized controlled trials were assessed for methodologic quality using the Physiotherapy Evidence Database scoring system. All research designs were given a level of evidence according to a modified Sackett Scale.
DATA SYNTHESIS
Seven new studies met our inclusion criteria. The new studies fell into the following categories: analgesics (n=1), anticonvulsants (n=2), antidepressants (n=2), antispastics (n=1), and cannabinoids (n=1). There was evidence for 5 new pharmacotherapies among the SCI population; these included the following: oxycodone, duloxetine, venlafaxine, phenol block, and dronabinol. Levels of evidence for all therapy modalities were updated based on the new evidence.
CONCLUSIONS
Anticonvulsants remain the most studied and supported pharmacotherapy for neuropathic pain post-SCI. Antidepressants showed reduction in pain only among those with comorbid depression. Botulinum toxin and phenol blocks were supported for the reduction of mixed pain post-SCI.
Topics: Analgesics; Anticonvulsants; Antidepressive Agents; Cannabinoids; Humans; Neuralgia; Randomized Controlled Trials as Topic; Spinal Cord Injuries
PubMed: 26797114
DOI: 10.1016/j.apmr.2015.12.023