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Obesity (Silver Spring, Md.) Nov 2020Antidepressant medications are the first-line treatment option for moderate to severe major depressive disorder. However, most antidepressants have numerous documented... (Review)
Review
Antidepressant medications are the first-line treatment option for moderate to severe major depressive disorder. However, most antidepressants have numerous documented adverse events, including cardiometabolic effects and weight gain, which are major public health concerns. Antidepressant agents provide varying risk of associated weight gain, including significant within-class differences. Some agents, such as mirtazapine, show significant levels of weight gain, while others, such as bupropion, demonstrate weight-loss effects. Current findings suggest the role of histamine and serotonin off-target appetite-promoting pathways in adverse weight-gain effects. Therefore, controlling for undesired weight effects is an important consideration for the selection of antidepressants.
Topics: Antidepressive Agents; Humans; Weight Gain
PubMed: 33022115
DOI: 10.1002/oby.22969 -
The American Journal of Nursing Sep 2018: Depression is one of the most common mental health conditions. Many nurses will care for patients who have depression and may be receiving treatment. Treatment often... (Review)
Review
: Depression is one of the most common mental health conditions. Many nurses will care for patients who have depression and may be receiving treatment. Treatment often includes the use of medications that affect mood. This article provides a brief overview of the history, indications for use, adverse effects, and nursing considerations regarding antidepressants. This is the second in a series of articles about medications used in the treatment of mental health disorders. For the first article in this series, see "Antipsychotic Medications," June 2017.
Topics: Age Factors; Antidepressive Agents; Depression; Depressive Disorder; Evidence-Based Medicine; Humans
PubMed: 30138204
DOI: 10.1097/01.NAJ.0000544978.56301.f6 -
The Consultant Pharmacist : the Journal... Mar 2016To describe the prevalence of hyponatremia in older adults related to antidepressive agents and identify potential alternative options in older adults with a... (Review)
Review
OBJECTIVE
To describe the prevalence of hyponatremia in older adults related to antidepressive agents and identify potential alternative options in older adults with a low-baseline serum sodium concentration and/or when a patient has experienced hyponatremia as a result of taking an antidepressant.
DATA SOURCES
A PubMed search was conducted on November 10, 2015. Search terms included: antidepressive agents, antidepressive agents second-generation, bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, hyponatremia, milnacipran, mirtazapine, paroxetine, reboxetine, syndrome of inappropriate antidiuretic hormone, sertraline, trazodone, venlafaxine, and vilazodone. Filters included English language. A search of product labeling was also conducted.
STUDY SELECTION
Out of 363 results, 124 publications were identified and reviewed along with 11 additional references. Publications were chosen based on relevance to the review: case reports of patients 60 years of age or older or clinical investigations of the association between hyponatremia and antidepressants in older adults.
DATA EXTRACTION
Hyponatremia was counted as an adverse effect if an antidepressant was the likely cause of hyponatremia, and hyponatremia was resolved after withdrawal.
DATA SYNTHESIS
Antidepressant-induced hyponatremia in older adults is fairly common. Selective serotonin reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, and mirtazapine were implicated in the majority of the case reports and clinical studies evaluating older adults. Bupropion, trazodone, and tricyclic antidepressants were implicated less often in the same literature.
CONCLUSION
Given its unique mechanism of action, bupropion may be the most appropriate antidepressant for older adults at risk for antidepressant-induced hyponatremia.
Topics: Aged; Antidepressive Agents; Bupropion; Humans; Hyponatremia; Middle Aged; Prevalence; Sodium
PubMed: 26975593
DOI: 10.4140/TCP.n.2016.139 -
Deutsches Arzteblatt International May 2019Antidepressants are among the most commonly prescribed drugs worldwide. They are often discontinued, frequently without the knowledge of the prescribing physician. It... (Review)
Review
BACKGROUND
Antidepressants are among the most commonly prescribed drugs worldwide. They are often discontinued, frequently without the knowledge of the prescribing physician. It is, therefore, important for physicians to be aware of the withdrawal and rebound phenomena that may arise, in order to prevent these phenomena, treat them when necessary, and counsel patients appropriately.
METHODS
This review is based on a comprehensive, structured literature search on antidepressant withdrawal phenomena that we carried out in the CENTRAL, PubMed (Medline), and Embase databases. We classified the relevant publications and reports by their methodological quality.
RESULTS
Out of a total of 2287 hits, there were 40 controlled trials, 38 cohort studies and retrospective analyses, and 271 case reports that met the inclusion criteria. Withdrawal manifestations are usually mild and self-limiting; common ones include dizziness, headache, sleep disturbances, and mood swings. More serious or pro- longed manifestations rarely arise. There is an increased risk with MAO inhibitors, tricyclic antidepressants, venlafaxine, and paroxetine; on the other hand, for agome- latine and fluoxetine, abrupt discontinuation seems to be unproblematic. There is also some evidence of rebound phenomena, i.e., of higher relapse rates or especially severe relapses of depression after the discontinuation of an anti- depressant.
CONCLUSION
A robust evidence base now indicates that there can be acute with- drawal phenomena when antidepressants are discontinued. Putative rebound phenomena have not been adequately studied to date. It is recommended that antidepressants should be tapered off over a period of more than four weeks.
Topics: Antidepressive Agents; Fluoxetine; Humans; Paroxetine; Retrospective Studies; Selective Serotonin Reuptake Inhibitors; Substance Withdrawal Syndrome
PubMed: 31288917
DOI: 10.3238/arztebl.2019.0355 -
L'Encephale Dec 2016Antidepressant therapy aims to reach remission of depressive symptoms while reducing the complications and risks of relapse. Even though they have proven their efficacy,... (Review)
Review
Antidepressant therapy aims to reach remission of depressive symptoms while reducing the complications and risks of relapse. Even though they have proven their efficacy, it takes several weeks for antidepressants to demonstrate full effectiveness, and adverse effects occur more quickly or (quicker) which can be a source of poor compliance. This latest aspect often leads to dose reduction and/or change of molecule that have the effect of delaying remission. This review attempts to present, from the pharmacological properties of the major classes of antidepressants (monoamine oxidase inhibitor [MAOI], tricyclic antidepressants [TCA], selective serotonin reuptake inhibitor [SSRI] and serotonin and noradrenaline reuptake inhibitor [SNRI]), to the pharmacological mechanisms involved in adverse effects by focusing on sexual dysfunction, nausea/vomiting, and weight changes and sleep disruption. If the activation of dopamine D or norepinephrine receptors through the autonomic nervous system controls and facilitates sexual desire, increasing serotoninergic transmission through 5-HT receptors activation inhibits this process. The pharmacological properties of drugs inducing nausea/vomiting activate opiate receptors μ, increase dopaminergic and serotoninergic transmission activating the dopamine D and serotonin 5-HT receptors, respectively. Among the causes responsible for weight gain under antidepressant therapy, monoamine neurotransmission still plays an important role. The blockade of serotonin 5-HT or histamine H receptors is directly responsible for weight gain. Finally, the activation of 5-HT serotoninergique receptors modulates wakefulness, raid eyes movement or sleep duration. In conclusion, if antidepressant activity of SERT or MAO inhibitors is an indirect consequence of postsynaptic 5-HT, DA, NA receptor activation, it is also responsible for side effects, causes of poor compliance and hence therapeutic failures. Finally, we need to take into account the key role of the nocebo effect in the occurrence of adverse effects. The next generation of antidepressant would aim to have a rapid efficacy in patients unresponsive or resistant to drugs currently available while improving certain effects of tolerance through an optimization of their psychopharmacological properties leading to a reduction of their side effects.
Topics: Antidepressive Agents; Antidepressive Agents, Tricyclic; Depressive Disorder; Humans; Monoamine Oxidase Inhibitors; Selective Serotonin Reuptake Inhibitors
PubMed: 27423475
DOI: 10.1016/j.encep.2016.05.006 -
The Psychiatric Clinics of North America Jun 2013Treating patients with psychiatric problems can present numerous challenges for clinicians. The deliberate self-ingestion of antidepressants is one such challenge... (Review)
Review
Treating patients with psychiatric problems can present numerous challenges for clinicians. The deliberate self-ingestion of antidepressants is one such challenge frequently encountered in hospitals throughout the United States. This review focuses on 1) the classes of antidepressants, their pharmacologic properties, and some of the proposed mechanism(s) for antidepressant overdose-induced seizures; 2) the evidence for seizures caused by antidepressants in overdose; 3) management strategies for patients who have intentionally or unintentionally overdosed on an antidepressant, or who have experienced an antidepressant overdose-induced seizure.
Topics: Antidepressive Agents; Brain; Disease Management; Drug Overdose; Humans; Incidence; Risk Factors; Seizures
PubMed: 23688690
DOI: 10.1016/j.psc.2013.02.004 -
International Journal of Molecular... Sep 2020This review analyzes the current scientific literature on the role of the Sigma1R chaperone in the pathogenesis of depressive disorders and pharmacodynamics of... (Review)
Review
This review analyzes the current scientific literature on the role of the Sigma1R chaperone in the pathogenesis of depressive disorders and pharmacodynamics of antidepressants. As a result of ligand activation, Sigma1R is capable of intracellular translocation from the endoplasmic reticulum (ER) into the region of nuclear and cellular membranes, where it interacts with resident proteins. This unique property of Sigma1R provides regulation of various receptors, ion channels, enzymes, and transcriptional factors. The current review demonstrates the contribution of the Sigma1R chaperone to the regulation of molecular mechanisms involved in the antidepressant effect.
Topics: Animals; Antidepressive Agents; Depressive Disorder; Humans; Receptors, sigma; Sigma-1 Receptor
PubMed: 32992988
DOI: 10.3390/ijms21197088 -
Psychological Medicine Feb 2023Depression in dementia is common, disabling and causes significant distress to patients and carers. Despite widespread use of antidepressants for depression in dementia,... (Review)
Review
Depression in dementia is common, disabling and causes significant distress to patients and carers. Despite widespread use of antidepressants for depression in dementia, there is no evidence of therapeutic efficacy, and their use is potentially harmful in this patient group. Depression in dementia has poor outcomes and effective treatments are urgently needed. Understanding why antidepressants are ineffective in depression in dementia could provide insight into their mechanism of action and aid identification of new therapeutic targets. In this review we discuss why depression in dementia may be a distinct entity, current theories of how antidepressants work and how these mechanisms of action may be affected by disease processes in dementia. We also consider why clinicians continue to prescribe antidepressants in dementia, and novel approaches to understand and identify effective treatments for patients living with depression and dementia.
Topics: Humans; Antidepressive Agents; Treatment Outcome; Dementia
PubMed: 36621964
DOI: 10.1017/S003329172200397X -
Molecules (Basel, Switzerland) Mar 2020Increasing prevalence and burden of major depressive disorder presents an unavoidable problem for psychiatry. Existing antidepressants exert their effect only after... (Review)
Review
Increasing prevalence and burden of major depressive disorder presents an unavoidable problem for psychiatry. Existing antidepressants exert their effect only after several weeks of continuous treatment. In addition, their serious side effects and ineffectiveness in one-third of patients call for urgent action. Recent advances have given rise to the concept of psychoplastogens. These compounds are capable of fast structural and functional rearrangement of neural networks by targeting mechanisms previously implicated in the development of depression. Furthermore, evidence shows that they exert a potent acute and long-term positive effects, reaching beyond the treatment of psychiatric diseases. Several of them are naturally occurring compounds, such as psilocybin, ,-dimethyltryptamine, and 7,8-dihydroxyflavone. Their pharmacology and effects in animal and human studies were discussed in this article.
Topics: Animals; Antidepressive Agents; Biological Products; Clinical Studies as Topic; Depression; Drug Evaluation, Preclinical; Humans; Structure-Activity Relationship; Treatment Outcome
PubMed: 32150976
DOI: 10.3390/molecules25051172 -
The Journal of Clinical Psychiatry 2018A large number of antidepressant drugs are available across the world. All have been compared against placebo, and many have been compared with some but not all other...
A large number of antidepressant drugs are available across the world. All have been compared against placebo, and many have been compared with some but not all other antidepressants. There is therefore little information about a hierarchy of the efficacy and acceptability of these drugs. About 9 years ago, a network meta-analysis attempted to rank the efficacy and acceptability of 12 newer antidepressant drugs in adults with major depressive disorder. Very recently, this network meta-analysis was updated to include 21 antidepressant drugs, most of which were introduced during the 1980s and afterward. The present article explains what meta-analysis and network meta-analysis do, summarizes the important findings of the 21-antidepressant network meta-analysis, and offers comments on the findings. In general, it appears that antidepressant drugs are associated with clinically significant superiority over placebo with regard to response and remission rates; that almost all antidepressants do not differ from placebo with regard to all-cause discontinuation; that escitalopram, mirtazapine, amitriptyline, venlafaxine, and paroxetine are associated with better response rates than certain other antidepressants; that reboxetine, trazodone, and fluoxetine are associated with poorer response rates than certain other antidepressants; that agomelatine, escitalopram, and vortioxetine are associated with lower all-cause discontinuation than certain other antidepressants; and that clomipramine, reboxetine, and duloxetine are associated with higher all-cause discontinuation than certain other antidepressants. Whereas this conclusion is necessarily subjective, escitalopram could be a first choice in the balance of efficacy and acceptability, and reboxetine, the last choice. The strengths and limitations of the network meta-analysis are examined, and some comments on the findings are offered.
Topics: Antidepressive Agents; Depressive Disorder, Major; Health Services Accessibility; Humans; Meta-Analysis as Topic; Network Meta-Analysis; Treatment Outcome
PubMed: 29718600
DOI: 10.4088/JCP.18f12254