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BMC Psychiatry Jun 2020Antidepressants-induced movement disorders are rare and imperfectly known adverse drug reactions. The risk may differ between different antidepressants and... (Observational Study)
Observational Study
BACKGROUND
Antidepressants-induced movement disorders are rare and imperfectly known adverse drug reactions. The risk may differ between different antidepressants and antidepressants' classes. The objective of this study was to assess the putative association of each antidepressant and antidepressants' classes with movement disorders.
METHODS
Using VigiBase®, the WHO Pharmacovigilance database, disproportionality of movement disorders' reporting was assessed among adverse drug reactions related to any antidepressant, from January 1967 to February 2017, through a case/non-case design. The association between nine subtypes of movement disorders (akathisia, bruxism, dystonia, myoclonus, parkinsonism, restless legs syndrome, tardive dyskinesia, tics, tremor) and antidepressants was estimated through the calculation first of crude Reporting Odds Ratio (ROR), then adjusted ROR on four potential confounding factors: age, sex, drugs described as able to induce movement disorders, and drugs used to treat movement disorders.
RESULTS
Out of the 14,270,446 reports included in VigiBase®, 1,027,405 (7.2%) contained at least one antidepressant, among whom 29,253 (2.8%) reported movement disorders. The female/male sex ratio was 2.15 and the mean age 50.9 ± 18.0 years. We found a significant increased ROR for antidepressants in general for all subtypes of movement disorders, with the highest association with bruxism (ROR 10.37, 95% CI 9.62-11.17) and the lowest with tics (ROR 1.49, 95% CI 1.38-1.60). When comparing each of the classes of antidepressants with the others, a significant association was observed for all subtypes of movement disorders except restless legs syndrome with serotonin reuptake inhibitors (SRIs) only. Among antidepressants, mirtazapine, vortioxetine, amoxapine, phenelzine, tryptophan and fluvoxamine were associated with the highest level to movement disorders and citalopram, paroxetine, duloxetine and mirtazapine were the most frequently associated with movement disorders. An association was also found with eight other antidepressants.
CONCLUSIONS
A potential harmful association was found between movement disorders and use of the antidepressants mirtazapine, vortioxetine, amoxapine, phenelzine, tryptophan, fluvoxamine, citalopram, paroxetine, duloxetine, bupropion, clomipramine, escitalopram, fluoxetine, mianserin, sertraline, venlafaxine and vilazodone. Clinicians should beware of these adverse effects and monitor early warning signs carefully. However, this observational study must be interpreted as an exploratory analysis, and these results should be refined by future epidemiological studies.
Topics: Adult; Aged; Antidepressive Agents; Female; Humans; Male; Middle Aged; Movement Disorders; Pharmacovigilance; Selective Serotonin Reuptake Inhibitors; Sertraline
PubMed: 32546134
DOI: 10.1186/s12888-020-02711-z -
Pathogens (Basel, Switzerland) Apr 2021Non-typhoidal ingeniously scavenges energy for growth from tyramine (TYR) and d-glucuronic acid (DGA), both of which occur in the host as the metabolic byproducts of...
Non-typhoidal ingeniously scavenges energy for growth from tyramine (TYR) and d-glucuronic acid (DGA), both of which occur in the host as the metabolic byproducts of the gut microbial metabolism. A critical first step in energy scavenging from TYR and DGA in involves TYR-oxidation via TYR-oxidoreductase and production of free-DGA via β-glucuronidase (GUS)-mediated hydrolysis of d-glucuronides (conjugated form of DGA), respectively. Here, we report that utilizes TYR and DGA as sole sources of energy in a serotype-independent manner. Using colorimetric and radiometric approaches, we report that genes , , and encode TYR-oxidoreductases. Some serotypes produce GUS, thus can also scavenge energy from d-glucuronides. We repurposed phenelzine (monoaminoxidase-inhibitor) and amoxapine (GUS-inhibitor) to inhibit the TYR-oxidoreductases and GUS encoded by , respectively. We show that phenelzine significantly inhibits the growth of by inhibiting TYR-oxidoreductases SEN2971, SEN3065, and SEN2426. Similarly, amoxapine significantly inhibits the growth of by inhibiting GUS-mediated hydrolysis of d-glucuronides. Because TYR and DGA serve as potential energy sources for growth in vivo, the data and the novel approaches used here provides a better understanding of the role of TYR and DGA in pathogenesis and nutritional virulence.
PubMed: 33924374
DOI: 10.3390/pathogens10040469 -
British Journal of Pharmacology Feb 1986The effects of amoxapine (10(-7)-10(-4) M) have been studied in rat atrial fibres obtained from untreated animals and animals pretreated for 28 days with amoxapine (10...
The effects of amoxapine (10(-7)-10(-4) M) have been studied in rat atrial fibres obtained from untreated animals and animals pretreated for 28 days with amoxapine (10 mg kg-1, i.p.). In untreated atria amoxapine reduced atrial rate, contractile force and df/dtmax, prolonged the sinus node recovery time and decreased atrial excitability. Amoxapine also decreased amplitude and Vmax of the upstroke, prolonged the duration of the action potential (APD) and effective refractory period (ERP) and reduced the resting membrane potential. During the treatment with amoxapine behavioural and cardiovascular adverse effects, including hypotension, tachycardia and prolongation of the Q-Tc, were observed. However, with the exception of the ERP which was significantly prolonged in pretreated atria, pretreatment with amoxapine did not modify the control values of the measured parameters compared to those obtained in untreated atria. Further addition of amoxapine produced similar changes in both pretreated and untreated atria. However, in contrast to untreated atria, in pretreated atria the prolongation of the ERP produced by amoxapine exceeded the prolongation of the APD and thus, the ERP/APD ratio increased. The decrease in atrial excitability was also more marked in pretreated than in untreated atria. Amoxapine inhibited the slow action potentials and contractions induced by isoprenaline in K-depolarized atria. It is concluded that the electrophysiological effects of amoxapine on rat atrial fibres are similar to those described for other tricyclic antidepressants. Possible explanations for the lower cardiodepressant activity of amoxapine are discussed.
Topics: Action Potentials; Amoxapine; Animals; Behavior, Animal; Dibenzoxazepines; Electrocardiography; Heart; Heart Atria; Hypotension; In Vitro Techniques; Isoproterenol; Membrane Potentials; Myocardial Contraction; Rats; Rats, Inbred Strains; Time Factors
PubMed: 3955303
DOI: 10.1111/j.1476-5381.1986.tb10820.x -
Canadian Family Physician Medecin de... Mar 1986There are now 15 effective antidepressant medicines marketed in Canada (eight tricyclic antidepressants, three monoamine oxidase inhibitors, and four medicines with...
There are now 15 effective antidepressant medicines marketed in Canada (eight tricyclic antidepressants, three monoamine oxidase inhibitors, and four medicines with novel chemical structures). The tricyclics remain the drug of first choice for major depressions, because of their proven efficacy over three decades, their known side effect profiles, and the cheaper cost of imipramine and amitriptyline compared to other tricyclics and the new antidepressants. The monoamine oxidase inhibitors are an excellent alternative, and are far safer than earlier reports suggested. Maprotiline offers few advantages over the tricyclics and costs significantly more. Trazodone may be a second- or third-line drug with the advantage of minimal anticholinergic properties. Adequate clinical evaluation of nomifensine has not yet occurred. Neuroleptic and cardiotoxic properties of amoxapine suggest other medicines should be tried first.
PubMed: 21267155
DOI: No ID Found -
Revista de NeurologiaTo review the literature on the frequency, aetiology, risk factors, diagnosis and treatment of depression in epileptic illness with a view to clarifying certain... (Review)
Review
AIMS
To review the literature on the frequency, aetiology, risk factors, diagnosis and treatment of depression in epileptic illness with a view to clarifying certain controversial issues in a clinically relevant subject.
METHOD
Work published on this subject over the last three years was analysed and the data combined in order to achieve a scientific approach to the clinical handling of these patients. We analyse papers, especially reviews of literature on the subject, we compare postures and attempt to highlight the most popular. We point out the aspects that are still in need of study and the gaps to be filled in handling protocols, and we propose characteristics required for future research.
CONCLUSIONS
Interictal depression is frequent, and appears in some moment in the evolution in one out of every three epileptics, especially in cases of severe epilepsy with frequent seizures. There are aetiological factors and risk indicators, both of a biological and a psychosocial nature, that point to a more likely appearance of depression. Treatment includes the control of epileptic seizures with a reappraisal of the established pharmacological antiepileptic treatment; the use of antidepressants is, however, nearly always necessary. Choice of the antidepressant must be based on knowledge of pharmacological interactions, the side effects, possible effects on the convulsion threshold and efficiency. Among all the antidepressants, the new ones, especially citalopram and some other SSRIs, seem to offer less convulsant risk and maprotiline, amoxapine and bupropion are clearly unadvisable. Electroconvulsive therapy can be a good therapeutic option.
Topics: Anticonvulsants; Antidepressive Agents; Depression; Epilepsy; Humans; Psychopathology; Suicide
PubMed: 12389176
DOI: No ID Found -
MBio Mar 2020Frequent and excessive use of antibiotics primes patients to infection (CDI), which leads to fatal pseudomembranous colitis, with limited treatment options. In earlier...
Frequent and excessive use of antibiotics primes patients to infection (CDI), which leads to fatal pseudomembranous colitis, with limited treatment options. In earlier reports, we used a drug repurposing strategy and identified amoxapine (an antidepressant), doxapram (a breathing stimulant), and trifluoperazine (an antipsychotic), which provided significant protection to mice against lethal infections with several pathogens, including However, the mechanisms of action of these drugs were not known. Here, we provide evidence that all three drugs offered protection against experimental CDI by reducing bacterial burden and toxin levels, although the drugs were neither bacteriostatic nor bactericidal in nature and had minimal impact on the composition of the microbiota. Drug-mediated protection was dependent on the presence of the microbiota, implicating its role in evoking host defenses that promoted protective immunity. By utilizing transcriptome sequencing (RNA-seq), we identified that each drug increased expression of several innate immune response-related genes, including those involved in the recruitment of neutrophils, the production of interleukin 33 (IL-33), and the IL-22 signaling pathway. The RNA-seq data on selected genes were confirmed by quantitative real-time PCR (qRT-PCR) and protein assays. Focusing on amoxapine, which had the best anti-CDI outcome, we demonstrated that neutralization of IL-33 or depletion of neutrophils resulted in loss of drug efficacy. Overall, our lead drugs promote disease alleviation and survival in the murine model through activation of IL-33 and by clearing the pathogen through host defense mechanisms that critically include an early influx of neutrophils. is a spore-forming anaerobic bacterium and the leading cause of antibiotic-associated colitis. With few therapeutic options and high rates of disease recurrence, the need to develop new treatment options is urgent. Prior studies utilizing a repurposing approach identified three nonantibiotic Food and Drug Administration-approved drugs, amoxapine, doxapram, and trifluoperazine, with efficacy against a broad range of human pathogens; however, the protective mechanisms remained unknown. Here, we identified mechanisms leading to drug efficacy in a murine model of lethal infection (CDI), advancing our understanding of the role of these drugs in infectious disease pathogenesis that center on host immune responses to Overall, these studies highlight the crucial involvement of innate immune responses, as well as the importance of immunomodulation as a potential therapeutic option to combat CDI.
Topics: Amoxapine; Animals; Clostridioides difficile; Clostridium Infections; Doxapram; Drug Repositioning; Female; Immunity, Innate; Immunomodulation; Male; Mice; Mice, Inbred C57BL; Microbiota; RNA-Seq; Specific Pathogen-Free Organisms; Trifluoperazine
PubMed: 32156806
DOI: 10.1128/mBio.00053-20