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Evidence-based Mental Health Nov 2022Predictors of antidepressant response in older patients with major depressive disorder (MDD) need to be confirmed before they can guide treatment.
BACKGROUND
Predictors of antidepressant response in older patients with major depressive disorder (MDD) need to be confirmed before they can guide treatment.
OBJECTIVE
To create decision trees for early identification of older patients with MDD who are unlikely to respond to 12 weeks of antidepressant treatment, we analysed data from 454 older participants treated with venlafaxine XR (150-300 mg/day) for up to 12 weeks in the Incomplete Response in Late-Life Depression: Getting to Remission study.
METHODS
We selected the earliest decision point when we could detect participants who had not yet responded (defined as >50% symptom improvement) but would do so after 12 weeks of treatment. Using receiver operating characteristic models, we created two decision trees to minimise either false identification of future responders (false positives) or false identification of future non-responders (false negatives). These decision trees integrated baseline characteristics and treatment response at the early decision point as predictors.
FINDING
We selected week 4 as the optimal early decision point. Both decision trees shared minimal symptom reduction at week 4, longer episode duration and not having responded to an antidepressant previously as predictors of non-response. Test negative predictive values of the leftmost terminal node of the two trees were 77.4% and 76.6%, respectively.
CONCLUSION
Our decision trees have the potential to guide treatment in older patients with MDD but they require to be validated in other larger samples.
CLINICAL IMPLICATIONS
Once confirmed, our findings may be used to guide changes in antidepressant treatment in older patients with poor early response.
Topics: Humans; Aged; Venlafaxine Hydrochloride; Depressive Disorder, Major; Decision Trees; Treatment Outcome; Antidepressive Agents
PubMed: 36100357
DOI: 10.1136/ebmental-2022-300479 -
Neurology India 2022
Topics: Anti-Inflammatory Agents, Non-Steroidal; Headache; Humans; Indomethacin; Venlafaxine Hydrochloride
PubMed: 36076682
DOI: 10.4103/0028-3886.355083 -
Revista Brasileira de Ginecologia E... Sep 2022To evaluate the effect of neuromodulatory drugs on the intensity of chronic pelvic pain (CPP) in women.
OBJECTIVE
To evaluate the effect of neuromodulatory drugs on the intensity of chronic pelvic pain (CPP) in women.
DATA SOURCES
Searches were carried out in the PubMed, Cochrane Central, Embase, Lilacs, OpenGrey, and Clinical Trials databases.
SELECTION OF STUDIES
The searches were carried out by two of the authors, not delimiting publication date or original language. The following descriptors were used: OR , associated with MESH/ENTREE/DeCS: , , , , , , , , , , , , , , , , and , with the Boolean operator . Case reports and systematic reviews were excluded.
DATA COLLECTION
The following data were extracted: author, year of publication, setting, type of study, sample size, intervention details, follow-up time, and results.
DATA SYNTHESIS
A total of 218 articles were found, with 79 being excluded because they were repeated, leaving 139 articles for analysis: 90 were excluded in the analysis of the titles, 37 after reading the abstract, and 4 after reading the articles in full, and 1 could not be found, therefore, leaving 7 articles that were included in the review.
CONCLUSION
Most of the studies analyzed have shown pain improvement with the help of neuromodulators for chronic pain. However, no improvement was found in the study with the highest statistical power. There is still not enough evidence that neuromodulatory drugs reduce the intensity of pain in women with CPP.
Topics: Amitriptyline; Anticonvulsants; Antidepressive Agents; Antidepressive Agents, Tricyclic; Chronic Pain; Citalopram; Duloxetine Hydrochloride; Female; Gabapentin; Humans; Imipramine; Norepinephrine; Nortriptyline; Pelvic Pain; Pregabalin; Serotonin; Sertraline; Venlafaxine Hydrochloride
PubMed: 36044916
DOI: 10.1055/s-0042-1755459 -
The Science of the Total Environment Dec 2022Microplastics have been investigated over the last decade as potential transport vectors for other pollutants. However, the specific role of plastic aging, in which...
Microplastics have been investigated over the last decade as potential transport vectors for other pollutants. However, the specific role of plastic aging, in which plastics change their characteristics over time when exposed to environmental agents, has been overlooked. Therefore, sorption experiments were herein conducted using virgin and aged (by ozone treatment or rooftop weathering) microplastic particles of LDPE - low-density polyethylene, PET - poly(ethylene terephthalate), or uPVC - unplasticized poly(vinyl chloride). The organic micropollutants (OMPs) selected as sorbates comprise a diversified group of priority substances and contaminants of emerging concern, including pharmaceutical substances (florfenicol, trimethoprim, diclofenac, tramadol, citalopram, venlafaxine) and pesticides (alachlor, clofibric acid, diuron, pentachlorophenol), analyzed at trace concentrations (each ≤100 μg L). Sorption kinetics and equilibrium isotherms were obtained, as well as the confirmation that the aging degree of microplastics plays a major role in their sorption capacities. The results show an increased sorption of several OMPs on aged microplastics when compared to pristine samples, i.e. the sorption capacity increasing from one or two sorbed substances (maximum 3 μg g per sorbate) up to nine after aging (maximum 10 μg g per sorbate). The extent of sorption depends on the OMP, polymer and the effectiveness of the aging treatment. The modifications (e.g. in the chemical structure) between virgin and aged microplastics were linked to the increased sorption capacity of certain OMPs, allowing to better understand the different affinities observed. Additionally, phytotoxicity tests were performed to evaluate the mobility of the OMPs sorbed on the microplastics and the potential effects (on germination and early growth) of the combo on two species of plants (Lepidium sativum and Sinapis alba). These tests suggest low or no phytotoxicity effect under the conditions tested but indicate a need for further research on the behavior of microplastics on soil-plant systems.
Topics: Adsorption; Citalopram; Clofibric Acid; Diclofenac; Diuron; Environmental Pollutants; Ethylenes; Microplastics; Ozone; Pentachlorophenol; Pesticides; Pharmaceutical Preparations; Plastics; Polyethylene; Polymers; Soil; Tramadol; Trimethoprim; Venlafaxine Hydrochloride; Vinyl Chloride; Water Pollutants, Chemical
PubMed: 35981591
DOI: 10.1016/j.scitotenv.2022.158073 -
Journal of Clinical Psychopharmacology
Topics: Cyclohexanols; Humans; Vascular Diseases; Venlafaxine Hydrochloride
PubMed: 35976990
DOI: 10.1097/JCP.0000000000001598 -
Analytical and Bioanalytical Chemistry Oct 2022The effect of LC mobile phase composition and flow rate (2-50 µL/min) on mobility behavior in vacuum differential mobility spectrometry (vDMS) was investigated for...
The effect of LC mobile phase composition and flow rate (2-50 µL/min) on mobility behavior in vacuum differential mobility spectrometry (vDMS) was investigated for electrosprayed isobaric antidepressant drugs (AD); amitriptyline, maprotiline, venlafaxine; and structurally related antidepressants nortriptyline, imipramine, and desipramine. While at 2 µL/min, no difference in compensation voltage was observed with methanol and acetonitrile, at 50 µL/min, acetonitrile used for LC elution of analytes enabled the selectivity of the mobility separation to be improved. An accurate and sensitive method could be developed for the quantification of six AD drugs in human plasma using trap/elute micro-LC setup hyphenated to vDMS with mass spectrometric detection in the selected ion monitoring mode. The assay was found to be linear over three orders of magnitude, and the limit of quantification was of 25 ng/mL for all analytes. The LC-vDMS-SIM/MS method was compared to a LC-MRM/MS method, and in both cases, inter-assay precisions were lower than 12.5 and accuracies were in the range 91.5-110%, but with a four times reduced analysis time (2 min) for the LC-vDMS-SIM/MS method. This work illustrates that with vDMS, the LC mobile phase composition can be used to tune the ion mobility separation and to improve assay selectivity without additional hardware.
Topics: Acetonitriles; Amitriptyline; Antidepressive Agents; Desipramine; Humans; Imipramine; Maprotiline; Mass Spectrometry; Methanol; Nortriptyline; Reproducibility of Results; Spectrum Analysis; Vacuum; Venlafaxine Hydrochloride
PubMed: 35976423
DOI: 10.1007/s00216-022-04276-0 -
The Primary Care Companion For CNS... Aug 2022
Topics: Antidepressive Agents, Second-Generation; Heart Failure; Humans; Venlafaxine Hydrochloride
PubMed: 35960894
DOI: 10.4088/PCC.21cr02908 -
Pharmacopsychiatry Sep 2022Pharmacogenetic testing is proposed to minimize adverse effects when considered in combination with pharmacological knowledge of the drug. As yet, limited studies in...
INTRODUCTION
Pharmacogenetic testing is proposed to minimize adverse effects when considered in combination with pharmacological knowledge of the drug. As yet, limited studies in clinical settings have investigated the predictive value of pharmacokinetic (pk) gene variation on therapeutic drug levels as a probable mechanism of adverse effects, nor considered the combined effect of pk gene variation and drug level on antidepressant treatment response.
METHODS
Two depression cohorts were investigated for the relationship between pk gene variation and antidepressant serum concentrations of amitriptyline, venlafaxine, mirtazapine and quetiapine, as well as treatment response. For the analysis, 519 patients (49% females; 46.6±14.1 years) were included.
RESULTS
Serum concentration of amitriptyline was associated with (higher concentrations in poor metabolizers compared to normal metabolizers), of venlafaxine with (higher concentrations in intermediate metabolizers compared to rapid/ultrarapid metabolizers) and (lower metabolite-to-parent ratio in poor compared to intermediate and normal metabolizers, and intermediate compared to normal and ultrarapid metabolizers). Pk gene variation did not affect treatment response.
DISCUSSION
The present data support previous recommendations to reduce starting doses of amitriptyline and to guide dose-adjustments via therapeutic drug monitoring in CYP2D6 poor metabolizers. In addition, we propose including in routine testing in venlafaxine-treated patients to improve therapy by raising awareness of the risk of low serum concentrations in CYP2C19 rapid/ultrarapid metabolizers. In summary, pk gene variation can predict serum concentrations, and thus the combination of pharmacogenetic testing and therapeutic drug monitoring is a useful tool in a personalized therapy approach for depression.
Topics: Amitriptyline; Antidepressive Agents; Cytochrome P-450 CYP2C19; Cytochrome P-450 CYP2D6; Female; Genotype; Humans; Male; Venlafaxine Hydrochloride
PubMed: 35839823
DOI: 10.1055/a-1872-0613 -
The Science of the Total Environment Nov 2022Ozonation has been used to effectively remove micropollutants from the secondary effluent in several wastewater treatment plants. It is known that ozonation transforms...
Ozonation has been used to effectively remove micropollutants from the secondary effluent in several wastewater treatment plants. It is known that ozonation transforms tertiary amine compounds into their respective N-oxides, however in an earlier study a mass balance could not be closed at elevated ozone concentrations, leading to the assumption that more ozonation products are possible. This study was conducted to elucidate which (hitherto unknown) ozonation products can be formed from venlafaxine and tramadol when ozonating wastewater. Ozonation experiments were performed with tramadol and venlafaxine N-oxide in two different set-ups. Both tramadol- and venlafaxine N-oxide degraded during ozonation in pure (deionized) water in both semi-continuous and batch mode ozonation set-ups. 13 and 17 new transformation products were detected from tramadol- and venlafaxine N-oxide respectively, using high resolution mass spectrometry with ESI(+) ionization. Empirical chemical formulas were proposed based on the determination of the exact masses and interpretation of the product ion spectra. These transformation products result from the addition of one to three oxygen atoms and removal of C, -CH, CH, CH, etc., from the parent molecule, respectively. Quenching experiments suggested that most of the transformation products originated from the direct reaction with ozone (eight for tramadol N-oxide and ten for venlafaxine N-oxide), whereas fewer products originated from the reaction with OH radicals (three for tramadol N-oxide and three for venlafaxine N-oxide). Reaction mechanisms and chemical structures of products are proposed, based on the available active sites and past literature on ozone reaction mechanisms. The experimental results are compared to theory and literature on ozone reactive sites and ozone reaction mechanisms. All in all this shows that there can be multiple ozonation products, and ozonation pathways can be complex, even if initially only one ozonation product is formed.
Topics: Organic Chemicals; Oxides; Ozone; Tramadol; Venlafaxine Hydrochloride; Waste Disposal, Fluid; Wastewater; Water Pollutants, Chemical; Water Purification
PubMed: 35817117
DOI: 10.1016/j.scitotenv.2022.157259 -
Acta Psychiatrica Scandinavica Oct 2022Rapid cycling is a common and disabling phenomenon in individuals with bipolar disorders. In the absence of a recent literature examination, this systematic review and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Rapid cycling is a common and disabling phenomenon in individuals with bipolar disorders. In the absence of a recent literature examination, this systematic review and meta-analysis aimed to synthesise the evidence of efficacy, acceptability and tolerability of treatments for individuals with rapid cycling bipolar disorder (RCBD).
METHOD
A systematic search was conducted to identify randomised controlled trials assigning participants with RCBD to pharmacological and/or non-pharmacological interventions. Study inclusion and data extraction were undertaken by two reviewers independently. The primary outcome was continuous within-subject RCBD illness severity before and after treatment. Pre-post random effects meta-analyses were conducted for each outcome/intervention arm studied, generating a standardised effect size (hedge's g) and 95% confidence interval (CI).
RESULTS
A total of 34 articles describing 30 studies were included. A total of 16 separate pharmacological treatments were examined in contrast to 1 psychological therapy study. Only quetiapine and lamotrigine were assessed in >5 studies. By assessing 95% CI overlap of within-subject efficacy effects compared to placebo, the only interventions suggesting significant depression benefits (placebo g = 0.60) were olanzapine (with/without fluoxetine; g = 1.01), citalopram (g = 1.10) and venlafaxine (g = 2.48). For mania, benefits were indicated for quetiapine (g = 1.01), olanzapine (g = 1.19) and aripiprazole (g = 1.09), versus placebo (g = 0.33). Most of these effect sizes were from only one trial per treatment. Heterogeneity between studies was variable, and 20% were rated to have a high risk of bias.
CONCLUSIONS
While many interventions appeared efficacious, there was a lack of robust evidence for most treatments. Given the limited and heterogeneous evidence base, the optimal treatment strategies for people with RCBD are yet to be established.
Topics: Aripiprazole; Bipolar Disorder; Citalopram; Fluoxetine; Humans; Lamotrigine; Olanzapine; Quetiapine Fumarate; Venlafaxine Hydrochloride
PubMed: 35778967
DOI: 10.1111/acps.13471