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Journal of Stroke and Cerebrovascular... May 2020The purpose of our study is to evaluate the efficacy of paroxetine in poststroke depression (PSD) patients by conducting a meta-analysis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The purpose of our study is to evaluate the efficacy of paroxetine in poststroke depression (PSD) patients by conducting a meta-analysis.
METHODS
We searched Web of Science (science and social science citation index), PubMed, the Cochrane Central Register of Controlled Trials, Embase up to August 2019. Randomized controlled trials that paroxetine compared to other antidepressants or control treatments as monotherapy for patients with PSD.
RESULTS
This review identified a total of 4 studies including 212 patients. This meta-analysis presented that paroxetine exhibits beneficial efficacy than routine treatment in PSD patients in terms of the reducing score of Hamilton Depression Scale (HAMD). Control treatment is more effective than paroxetine. No significant advantage was found with paroxetine.
CONCLUSIONS
The efficacy of paroxetine maybe not very significant compared to other pharmacological and nonpharmacological interventions. Further high quality and large sample size studies are needed to evaluate the efficacy and safety of paroxetine in treating PSD in future.
Topics: Affect; Antidepressive Agents, Second-Generation; Depression; Humans; Paroxetine; Randomized Controlled Trials as Topic; Selective Serotonin Reuptake Inhibitors; Stroke; Time Factors; Treatment Outcome
PubMed: 32093988
DOI: 10.1016/j.jstrokecerebrovasdis.2020.104664 -
American Family Physician Sep 2023Peripartum depression is one of the most common disorders of pregnancy. It has a higher morbidity and mortality risk than any other condition affecting pregnant people....
Peripartum depression is one of the most common disorders of pregnancy. It has a higher morbidity and mortality risk than any other condition affecting pregnant people. The American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the U.S. Preventive Services Task Force recommend that pregnant patients be screened for depression with one of several validated tools and offered treatment with psychotherapy and medication. There are no validated tools available to identify who is at increased risk of peripartum depression. Risk factors for peripartum depression include a history of depression, a history of physical or sexual abuse, carrying an unplanned or unwanted pregnancy, and traumatic birth. The U.S. Preventive Services Task Force recommends offering psychotherapy to patients at increased risk of depression because it can decrease the development of peripartum depression by up to 39%. Untreated peripartum depression increases the risk of adverse pregnancy outcomes and mortality for the patient, as well as negative outcomes for the newborn, including growth faltering, developmental delay, and attachment disorder. Cognitive behavior therapy and interpersonal psychotherapy are the mainstay of treatment for peripartum depression; physicians should consider selective serotonin reuptake inhibitors for those with moderate to severe depression. The benefits of selective serotonin reuptake inhibitors generally outweigh the risks; however, fluoxetine and paroxetine should be avoided during pregnancy because they can cause an increased risk of birth defects.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Child; Selective Serotonin Reuptake Inhibitors; Depression; Peripartum Period; Psychotherapy; Advisory Committees
PubMed: 37725459
DOI: No ID Found -
The Medical Letter on Drugs and... Feb 2020
Topics: Antidepressive Agents; Depressive Disorder, Major; Drug Interactions; Humans
PubMed: 32320387
DOI: No ID Found -
Expert Review of Neurotherapeutics 2023Recommendations for treating panic disorder (PD) in older patients are scarce. The authors have systematically reviewed whether several recommended medications are... (Review)
Review
INTRODUCTION
Recommendations for treating panic disorder (PD) in older patients are scarce. The authors have systematically reviewed whether several recommended medications are superior to others and their optimal doses in this age group.
METHODS
A database search of studies involving patients with PD with/without agoraphobia aged ≥ 60 years was carried out using PubMed, PsycINFO, Embase, and Clinical Trials.gov, from their inception dates to 1 March 2023. Only four (published from 2002 to 2010) of the 1292 records screened were included. A risk of bias assessment was provided. This systematic review was performed using The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).
RESULTS
Two studies were randomized clinical trials, whereas two were open-label, including paroxetine, citalopram, escitalopram, and sertraline; three studies reported short-term evaluations, whereas one study included a 26-week follow-up. Medications provided benefits, with good tolerability. Preliminary results suggested greater benefits of paroxetine in reducing panic attacks vs. cognitive - behavioral therapy, and an earlier decrease in PAs with escitalopram vs. citalopram. Risk of bias was considerable.
CONCLUSIONS
The pharmacological management of PD in older patients has received no attention. Findings are scant, dated, and affected by methodological flaws; thus, they do not provide significant advances.
Topics: Humans; Aged; Panic Disorder; Paroxetine; Citalopram; Selective Serotonin Reuptake Inhibitors; Escitalopram; Randomized Controlled Trials as Topic
PubMed: 37676054
DOI: 10.1080/14737175.2023.2254938 -
European Neuropsychopharmacology : the... Jan 2023Antidepressant drugs are prescribed to patients with depressive, anxiety disorders, and other conditions. Evidence about antidepressant discontinuation syndrome (ADS)... (Review)
Review
Antidepressant drugs are prescribed to patients with depressive, anxiety disorders, and other conditions. Evidence about antidepressant discontinuation syndrome (ADS) and related outcomes is sparse, although potentially burdensome in some patients. The present state-of-the-art review aims to appraise the most current evidence about ADS critically. ADS has been documented for most antidepressant drugs, although most literature focuses on selective serotonin reuptake inhibitors prescribed for depression. While down-titration cannot exclude the chance of ADS, it is nonetheless warranted in the clinical setting, especially for short half-life and sedative compounds such as paroxetine. Integrative management with concurrent pharmacotherapy and psychotherapy may minimize the eventual unpleasant effects arising within the discontinuation process. In addition, patient-tailored interventions and education should be part of the discontinuation strategy. Future research must rely on broadly accepted definitions for ADS and related phenomena such as antidepressant withdrawal and shed further light on the underpinning neurobiology. Discriminating between ADS-related phenomena and relapse of depression is likewise warranted, along with a neuroscience-based nomenclature instead of a class one.
Topics: Humans; Antidepressive Agents; Selective Serotonin Reuptake Inhibitors; Paroxetine; Anxiety Disorders; Anxiety; Substance Withdrawal Syndrome
PubMed: 36345093
DOI: 10.1016/j.euroneuro.2022.10.005 -
Drug Design, Development and Therapy 2023Osteoarthritis (OA), a common chronic joint disease, is characterized by cartilage degeneration and subchondral bone reconstruction. NF-κB signaling pathway-activated...
BACKGROUND
Osteoarthritis (OA), a common chronic joint disease, is characterized by cartilage degeneration and subchondral bone reconstruction. NF-κB signaling pathway-activated inflammation and NLRP3-induced pyroptosis play essential roles in the development of OA. In this study, we examine whether paroxetine can inhibit pyroptosis and reduce osteoclast formation, thereby delaying the destruction of knee joints.
METHODS
We employed high-density cultures, along with quantitative polymerase chain reactions and Western blotting techniques, to investigate the effects of paroxetine on extracellular matrix synthesis and degradation. The expression levels of NF-κB and pyroptosis-related signaling pathway proteins were examined by Western blotting and immunofluorescence. Furthermore, the impact of paroxetine on RANKL-induced osteoclast formation was evaluated through TRAP staining and F-actin ring fluorescence detection. To investigate the role of paroxetine in vivo, we constructed a mouse model with destabilization of the medial meniscus (DMM) surgery. Safranin O-Fast Green staining, Hematoxylin-Eosin staining, and immunohistochemistry were conducted to observe the extent of knee joint cartilage deformation. In addition, TRAP staining was used to observe the formation of osteoclasts in the subchondral bone.
RESULTS
In the in vitro experiments with ATDC5, paroxetine treatment attenuated IL-1β-induced activation of the pyroptosis-related pathway and suppressed extracellular matrix catabolism by inhibiting the NF-kB signaling pathway. In addition, paroxetine treatment decreased the expression of RANKL-induced osteoclast marker genes and reduced osteoclast formation. In animal experiments conducted in vivo, mice treated with paroxetine exhibited thicker knee cartilage with a smoother surface compared to the DMM group. Additionally, the formation of osteoclasts in the subchondral bone was reduced in the paroxetine-treated mice. Further analysis revealed that paroxetine treatment played a role in preserving the balance of the extracellular matrix and delaying knee joint degeneration.
CONCLUSION
Paroxetine can inhibit pyroptosis and reduce osteoclast formation via inhibiting the NF-κB signaling pathway, suggesting that it may have therapeutic effects in patients with OA.
Topics: Animals; Mice; NF-kappa B; Chondrocytes; Osteoclasts; Paroxetine; Pyroptosis; Signal Transduction; Osteoarthritis, Knee
PubMed: 37605762
DOI: 10.2147/DDDT.S417598 -
Climacteric : the Journal of the... Dec 2019Women with estrogen-sensitive cancer or survivors of these neoplasms are generally not candidates for systemic menopausal hormone therapy or tibolone for the treatment... (Review)
Review
Women with estrogen-sensitive cancer or survivors of these neoplasms are generally not candidates for systemic menopausal hormone therapy or tibolone for the treatment of bothersome vasomotor symptoms (hot flashes or night sweats). However, menopausal symptoms negatively affect quality of life and need to be addressed by clinicians. For mild vasomotor symptoms, optimizing lifestyle changes or mind-brain behavior may be sufficient. For women with moderate to severe vasomotor symptoms unresponsive to these measures, non-hormone pharmacologic therapy may be needed. Randomized controlled trials have shown efficacy for vasomotor symptoms with selective serotonin reuptake inhibitors (paroxetine, citalopram, and escitalopram) and serotonin-norepinephrine reuptake inhibitors (venlafaxine and desvenlafaxine), as well as gabapentin, pregabalin, and clonidine. Therapies in development include neurokinin B inhibitors (neurokinin 3 receptor), stellate ganglion blockade, and a natural estrogen, estetrol. Individualizing therapy is important. As the physiology of menopausal hot flashes becomes better understood, it will drive development of future non-hormone pharmacotherapies.
Topics: Cancer Survivors; Female; Hot Flashes; Humans; Menopause; Randomized Controlled Trials as Topic; Selective Serotonin Reuptake Inhibitors
PubMed: 31081391
DOI: 10.1080/13697137.2019.1600501 -
Therapeutic Advances in... 2023In patients attempting to discontinue their antidepressant medication, there have been no prospective studies on patterns of withdrawal as a function of the rate of...
BACKGROUND
In patients attempting to discontinue their antidepressant medication, there have been no prospective studies on patterns of withdrawal as a function of the rate of antidepressant reduction during the tapering trajectory, and moderators thereof.
OBJECTIVE
To investigate withdrawal as a function of gradual dose reduction.
DESIGN
Prospective cohort study.
METHODS
The sampling frame consisted of 3956 individuals in the Netherlands who received an antidepressant tapering strip between 19 May 2019 and 22 March 2022 in routine clinical practice. Of these, 608 patients, majorly with previous unsuccessful attempts to stop, provided daily ratings of withdrawal in the context of reducing their antidepressant medications (mostly venlafaxine or paroxetine), using hyperbolic tapering strips offering daily tiny reductions in dose.
RESULTS
Withdrawal in daily-step hyperbolic tapering trajectories was limited, and inverse to the rate of taper. Female sex, younger age, presence of one or more risk factors and faster rate of reduction over shorter tapering trajectories were associated with more withdrawal and differential course over time. Thus, sex and age differences were less marked early in the course of the trajectory, whereas differences associated with risk factors and shorter trajectories tended to peak early in the trajectory. There was evidence that tapering in weekly larger steps (mean per-week dose reduction: 33.4% of previous dose), in comparison with daily tiny steps (mean per-day dose reduction: 4.5% of previous dose or 25.3% per week), was associated with more withdrawal in trajectories of 1, 2 or 3 months, particularly for paroxetine and the group of other (non-paroxetine, non-venlafaxine) antidepressants.
CONCLUSION
Antidepressant hyperbolic tapering is associated with limited, rate-dependent withdrawal that is inverse to the rate of taper. The demonstration of multiple demographic, risk and complex temporal moderators in time series of withdrawal data indicates that antidepressant tapering in clinical practice requires a personalised process of shared decision making over the entire course of the tapering period.
PubMed: 37200818
DOI: 10.1177/20451253231171518 -
The Medical Letter on Drugs and... Aug 2020
Review
Topics: Animals; Cimicifuga; Dehydroepiandrosterone; Estrogens; Female; Flax; Hot Flashes; Humans; Menopause; Progestins; Tamoxifen
PubMed: 32960867
DOI: No ID Found -
Ecotoxicology and Environmental Safety Jul 2023Paroxetine (PRX) is a common antidepressant drug which widely existence in natural environment. Numerous studies in the past few decades have focused on the beneficial...
Paroxetine (PRX) is a common antidepressant drug which widely existence in natural environment. Numerous studies in the past few decades have focused on the beneficial effects of PRX on depression, however, the toxic properties and the potential mechanisms remain unclear. In this study, zebrafish embryos were exposed to 1.0, 5.0, 10 and 20 mg/L of PRX from 4 to 120-hour-post-fertilization (hpf), and it showed that PRX exposure caused adverse effects in zebrafish embryos, including decreased body length, blood flow velocity, cardiac frequency, cardiac output and increased burst activity and atria area. Meanwhile, the Tg (myl7: EGFP) and Tg (lyz: DsRed) transgenic zebrafish were used to detect the cardiotoxicity and inflammation response of PRX. Moreover, the heart development associated genes (vmhc, amhc, hand2, nkx2.5, ta, tbx6, tbx16 and tbx20) and inflammatory genes (IL-10, IL-1β, IL-8 and TNF-α) were up-regulated after PRX challenge. In addition, Aspirin was used to alleviate the PRX-induced heart development disorder. In conclusion, our study verified the PRX induced inflammatory related cardiotoxicity in larva zebrafish. Meanwhile, the current study shown the toxic effects of PRX in aquatic organism, and provide for the environmental safety of PRX.
Topics: Animals; Zebrafish; Cardiotoxicity; Paroxetine; Larva; Embryo, Nonmammalian; Inflammation; Water Pollutants, Chemical; T-Box Domain Proteins; Zebrafish Proteins
PubMed: 37269614
DOI: 10.1016/j.ecoenv.2023.115096