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British Journal of Nursing (Mark Allen... Jul 2023Depression and anxiety are common, with one in six people experiencing symptoms in any given week. Of these people, 8.32 million are prescribed antidepressants. People... (Review)
Review
Depression and anxiety are common, with one in six people experiencing symptoms in any given week. Of these people, 8.32 million are prescribed antidepressants. People living with HIV are likely to experience psychiatric disorder, with one in three experiencing depression and anxiety, and being at greater risk of developing post-traumatic stress disorder. Sexual side-effects of psychotropic medication are very common, cause distress, and can persist even after the medication has been withdrawn. Antidepressants are powerful drugs and can have severe interactions with many other substances. This article seeks to raise awareness of sexual side-effects of psychotropic medications and draw attention to ethical issues related to post selective serotonin reuptake inhibitor sexual dysfunction (PSSD). Additional risk factors and interactions between psychotropic medications and recreational drugs are identified. Recommendations are made to improve care and clinical outcomes through the development of therapeutic alliances.
Topics: Humans; Serotonin Syndrome; Antidepressive Agents; Sexual Behavior; Sexual Dysfunction, Physiological; Selective Serotonin Reuptake Inhibitors; Drug-Related Side Effects and Adverse Reactions
PubMed: 37495413
DOI: 10.12968/bjon.2023.32.14.678 -
The Veterinary Clinics of North... Jan 2024The stress response affects the central nervous system and multiple other systems in the body. Chronic mental and behavioral pathologies are associated with... (Review)
Review
The stress response affects the central nervous system and multiple other systems in the body. Chronic mental and behavioral pathologies are associated with inflammation, dysfunctions in the immune response and an increased risk for other chronic inflammatory and metabolic diseases. Psychiatric treatments alleviate fear, stress and anxiety, increase the qualify of life and lifespan for dogs and cats. Multiple safe psychoactive medications that can be used in association are available to help veterinary patients. Clinicians should understand the function of neurotransmitters and hormones on emotional processing, cognition and behavior, and drug mechanism of action so medication selection is appropriate for each individual patient.
Topics: Humans; Cats; Animals; Dogs; Psychopharmacology; Cat Diseases; Dog Diseases; Psychotropic Drugs; Fear
PubMed: 37648610
DOI: 10.1016/j.cvsm.2023.07.003 -
Current Neuropharmacology 2024This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four... (Review)
Review
This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of PTSD treatment includes a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to good treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame, often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.
Topics: Humans; Stress Disorders, Post-Traumatic; Psychotropic Drugs; Treatment Outcome; Substance-Related Disorders; Brain
PubMed: 37132142
DOI: 10.2174/1570159X21666230428091433 -
Expert Opinion on Drug Metabolism &... Dec 2023The coronavirus (COVID-19) pandemic has led to as well as exacerbated mental health disorders, leading to increased use of psychotropic medications. Co-administration of... (Review)
Review
INTRODUCTION
The coronavirus (COVID-19) pandemic has led to as well as exacerbated mental health disorders, leading to increased use of psychotropic medications. Co-administration of COVID-19 and psychotropic medications may result in drug-drug interactions (DDIs), that may compromise both the safety and efficacy of both medications.
AREAS COVERED
This review provides an update of the current evidence on DDIs between COVID-19 and psychotropic medications. The interactions are categorized into pharmacokinetic, pharmacodynamic, and other relevant types. A thorough literature search was conducted using electronic databases to identify relevant studies, and extract data to highlight potential DDIs, clinical implications, and management strategies.
EXPERT OPINION
Understanding and managing potential DDIs between COVID-19 and psychotropic medications is paramount to ensuring safe and effective treatment of patients with COVID-19 and mental illness. Awareness of the diverse spectrum of DDIs, vigilant monitoring, and judicious dose modifications, while choosing pharmacotherapeutic options with low risk of interaction whenever possible, are necessary. Ongoing and future investigations should continue to review the dynamic landscape of COVID-19 therapeutic modalities and their interactions with psychotropic medications.
Topics: Humans; COVID-19; Drug Interactions; Psychotropic Drugs; Pharmaceutical Preparations; Mental Disorders
PubMed: 38032183
DOI: 10.1080/17425255.2023.2288681 -
Ugeskrift For Laeger Nov 2023This review offers a summary of the current knowledge of pshychotropic drugs and glaucoma. If exposed to psychotropic drugs, some patients may develop angle-closure... (Review)
Review
This review offers a summary of the current knowledge of pshychotropic drugs and glaucoma. If exposed to psychotropic drugs, some patients may develop angle-closure glaucoma. Although rarely contraindicated, exposed predisposed and diagnosed patients should be followed-up by an ophthalmologist. It is still unclear if serotonin reuptake inhibitors increase the risk of angle-closure glaucoma. Tricyclic antidepressants and benzodiazepines should be used with caution in predisposed patients. The same applies to antipsychotic drugs, where first-generation antipsychotic drugs might have a smaller impact on the intraocular pressure than second-generation antipsychotic drugs.
Topics: Humans; Antipsychotic Agents; Glaucoma, Angle-Closure; Psychotropic Drugs; Glaucoma; Selective Serotonin Reuptake Inhibitors
PubMed: 38018726
DOI: No ID Found -
JAMA Psychiatry Jan 2024Antidepressants are increasingly prescribed to pediatric patients with unipolar depression, but little is known about the risk of treatment-emergent mania. Previous...
IMPORTANCE
Antidepressants are increasingly prescribed to pediatric patients with unipolar depression, but little is known about the risk of treatment-emergent mania. Previous research suggests pediatric patients may be particularly vulnerable to this adverse outcome.
OBJECTIVE
To estimate whether pediatric patients treated with antidepressants have an increased incidence of mania/hypomania compared with patients not treated with antidepressants and to identify patient characteristics associated with the risk of mania/hypomania.
DESIGN, SETTING, AND PARTICIPANTS
In a cohort study applying the target trial emulation framework, nationwide inpatient and outpatient care in Sweden from July 1, 2006, to December 31, 2019, was evaluated. Follow-up was conducted for 12 and 52 weeks after treatment initiation, with administrative follow-up ending December 31, 2020. Data were analyzed between May 1, 2022, and June 28, 2023. Individuals aged 4 to 17 years with a diagnosis of depression, but without a prior diagnosis of mania/hypomania, bipolar disorder, or psychosis or treatment with mood stabilizer (lithium, valproate, or carbamazepine), prescriptions were included.
EXPOSURES
The treatment group included patients who initiated any antidepressant medication within 90 days of diagnosis. The control group included patients who did not initiate antidepressants within 90 days.
MAIN OUTCOMES AND MEASURES
Diagnosis of mania/hypomania or initiation of mood stabilizer therapy. Incidences were estimated with Kaplan-Meier estimator, and inverse probability of treatment weighting was used to adjust for group differences at baseline.
RESULTS
The cohort included 43 677 patients (28 885 [66%] girls); 24 573 in the treatment group and 19 104 in the control group. The median age was 15 (IQR, 14-16) years. The outcome occurred in 96 individuals by 12 weeks and in 291 by 52 weeks. The cumulative incidence of mania was 0.26% (95% CI, 0.19%-0.33%) in the treatment group and 0.20% (95% CI, 0.13%-0.27%) in the control group at 12 weeks, with a risk difference of 0.06% (95% CI, -0.04% to 0.16%). At 52 weeks, the cumulative incidence was 0.79% (95% CI, 0.68%-0.91%) in the treatment group and 0.52% (95% CI, 0.40%-0.63%) in the control group (risk difference, 0.28%; 95% CI, 0.12%-0.44%). Hospitalizations, parental bipolar disorder, and use of antipsychotics and antiepileptics were the most important predictors of mania/hypomania by 12 weeks.
CONCLUSION
This cohort study found no evidence of treatment-emergent mania/hypomania by 12 weeks in children and adolescents. This corresponds to the time frame for antidepressants to exert their psychotropic effect. A small risk difference was found only with longer follow-up. Certain patient characteristics were associated with mania/hypomania, which warrants clinical attention.
Topics: Female; Humans; Adolescent; Child; Male; Mania; Cohort Studies; Depression; Antidepressive Agents; Depressive Disorder; Antipsychotic Agents
PubMed: 37755835
DOI: 10.1001/jamapsychiatry.2023.3555 -
Science (New York, N.Y.) Sep 2023As states relax their laws on cannabis, neuroscientist Yasmin Hurd is warning about the drug's dangers for the developing brain.
As states relax their laws on cannabis, neuroscientist Yasmin Hurd is warning about the drug's dangers for the developing brain.
Topics: Child; Female; Humans; Pregnancy; Brain; Cannabis; Child Development; Dronabinol; Psychotropic Drugs; Pregnant Women; Marijuana Smoking
PubMed: 37651516
DOI: 10.1126/science.adk5505 -
Journal of Psychopharmacology (Oxford,... Jul 2023Evidence suggests that serotonergic psychedelics (e.g. psilocybin), have rapid-acting and long-lasting antidepressant effects after a single dose. However, the mechanism... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Evidence suggests that serotonergic psychedelics (e.g. psilocybin), have rapid-acting and long-lasting antidepressant effects after a single dose. However, the mechanism underlying these effects remain unclear. One proposed mechanism is that these drugs promote neuroplasticity. However, this has not been conclusively demonstrated in humans.
AIMS
We hypothesized that relative to placebo, psilocybin would: (1) increase electroencephalographic (EEG) correlates of neuroplasticity, (2) reduce depression symptoms, and (3) changes in EEG would correlate with improvements in depression.
METHODS
In this double-blind, placebo-controlled, within-subject study, individuals with major depressive disorder (MDD; = 19) were administered placebo followed by psilocybin (0.3 mg/kg) in a fixed order (placebo, followed by psilocybin 4 weeks later). EEG indices of neuroplasticity (tetanus-induced long-term potentiation) as assessed via auditory evoked theta (4-8 Hz) power and measures of depression (GRID Hamilton Rating Scale for Depression-17 (GRID-HAM-D-17)) were measured at several time-points after placebo and psilocybin (24 h and 2 weeks after each session).
RESULTS
EEG theta power doubled in amplitude 2 weeks after a single psychedelic dose of psilocybin but not after placebo. Further, improvements in depression symptoms 2 weeks after psilocybin were correlated with increases in theta power.
CONCLUSIONS
The increased theta power observed represents evidence of sustained changes in the brain following psilocybin. Given the correlation with enhancement in depressive symptoms, changes in theta may represent an EEG biomarker of the sustained effects of psilocybin, and may shed light on potential mechanisms of psilocybin's antidepressant effect. Taken together, these results complement the emerging notion that psilocybin, and perhaps other psychedelics, can produce long-term alterations in neuroplasticity.
Topics: Humans; Psilocybin; Depressive Disorder, Major; Hallucinogens; Depression; Electroencephalography; Antidepressive Agents; Neuronal Plasticity
PubMed: 37392016
DOI: 10.1177/02698811231179800 -
Neuron Apr 2024Physical exercise is known to reduce anxiety, but the underlying brain mechanisms remain unclear. Here, we explore a hypothalamo-cerebello-amygdalar circuit that may...
Physical exercise is known to reduce anxiety, but the underlying brain mechanisms remain unclear. Here, we explore a hypothalamo-cerebello-amygdalar circuit that may mediate motor-dependent alleviation of anxiety. This three-neuron loop, in which the cerebellar dentate nucleus takes center stage, bridges the motor system with the emotional system. Subjecting animals to a constant rotarod engages glutamatergic cerebellar dentate neurons that drive PKCδ amygdalar neurons to elicit an anxiolytic effect. Moreover, challenging animals on an accelerated rather than a constant rotarod engages hypothalamic neurons that provide a superimposed anxiolytic effect via an orexinergic projection to the dentate neurons that activate the amygdala. Our findings reveal a cerebello-limbic pathway that may contribute to motor-triggered alleviation of anxiety and that may be optimally exploited during challenging physical exercise.
Topics: Animals; Anti-Anxiety Agents; Anxiety; Hypothalamus; Cerebellum; Anxiety Disorders
PubMed: 38301648
DOI: 10.1016/j.neuron.2024.01.007 -
Asian Journal of Psychiatry Sep 2023As of June 2023, (US) FDA has granted approval for a number of psychotropic drugs on market that might usher an innovative sparkle in psychopharmacotherapy. This is a...
As of June 2023, (US) FDA has granted approval for a number of psychotropic drugs on market that might usher an innovative sparkle in psychopharmacotherapy. This is a recap to update busy clinicians.
Topics: United States; Humans; Psychotropic Drugs; United States Food and Drug Administration; Drug Approval
PubMed: 37379646
DOI: 10.1016/j.ajp.2023.103684