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Acta Gastro-enterologica Belgica 2023Functional dyspepsia is a common chronic condition with upper abdominal symptoms in the absence of an organic cause. The first line treatment consists of protonpomp... (Review)
Review
BACKGROUND AND STUDY AIMS
Functional dyspepsia is a common chronic condition with upper abdominal symptoms in the absence of an organic cause. The first line treatment consists of protonpomp inhibition or Helicobacter pylori eradication. However, this approach often does not provide enough symptom relief. Neuromodulating agents are commonly used in clinical practice but only tricyclic antidepressant (TCAs) are mentioned in European and American and Canadian guidelines.
METHODS
We performed a comprehensive review of the literature in Pubmed for full-text randomized controlled trials in English with adult participants (>18 years) who met the Rome II, III or IV criteria or were diagnosed by a physician with a negative upper endoscopy and that compared a neuromodulating agent with placebo.
RESULTS
The search strategy identified 386 articles of which 14 articles met the eligibility criteria. TCAs like amitriptyline and imipramine have been shown to be effective in the treatment of functional dyspepsia whereas other neuromodulating agents like tetracyclic antidepressants, levosulpiride and anxiolytics might be beneficial but conclusive evidence is lacking. serotonin and noradrenaline reuptake inhibitors (SNRI) and selective serotonin reuptake inhibitors (SSRI) have not shown benefit in patients with functional dyspepsia.
CONCLUSION
Selected neuromodulators have an established efficacy in functional dyspepsia. The best supporting evidence is available for TCAs with a potential role for tetracyclic antidepressants, levosulpiride and anxiolytics.
Topics: Adult; Humans; Anti-Anxiety Agents; Antidepressive Agents; Antidepressive Agents, Tricyclic; Canada; Dyspepsia; Selective Serotonin Reuptake Inhibitors; Randomized Controlled Trials as Topic
PubMed: 36842175
DOI: 10.51821/86.1.10998 -
PloS One 2014Preterm birth is a major contributor to neonatal morbidity and mortality and its rate has been increasing over the past two decades. Antidepressant medication use during... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Preterm birth is a major contributor to neonatal morbidity and mortality and its rate has been increasing over the past two decades. Antidepressant medication use during pregnancy has also been rising, with rates up to 7.5% in the US. The objective was to systematically review the literature to determine the strength of the available evidence relating to a possible association between antidepressant use during pregnancy and preterm birth.
METHODS
We conducted a computerized search in PUBMED, MEDLINE and PsycINFO through September 2012, supplemented with a manual search of reference lists, to identify original published research on preterm birth rates in women taking antidepressants during pregnancy. Data were independently extracted by two reviewers, and absolute and relative risks abstracted or calculated. Our a priori design was to group studies by level of confounding adjustment and by timing of antidepressant use during pregnancy; we used random-effects models to calculate summary measures of effect.
RESULTS
Forty-one studies met inclusion criteria. Pooled adjusted odds ratios (95% CI) were 1.53 (1.40-1.66) for antidepressant use at any time and 1.96 (1.62-2.38) for 3rd trimester use. Controlling for a diagnosis of depression did not eliminate the effect. There was no increased risk [1.16 (0.92-1.45)] in studies that identified patients based on 1st trimester exposure. Sensitivity analyses demonstrated unmeasured confounding would have to be strong to account for the observed association.
DISCUSSION
Published evidence is consistent with an increased risk of preterm birth in women taking antidepressants during the 2nd and 3rd trimesters, although the possibility of residual confounding cannot be completely ruled out.
Topics: Antidepressive Agents; Confidence Intervals; Confounding Factors, Epidemiologic; Female; Humans; Infant, Newborn; Mental Disorders; Odds Ratio; Pregnancy; Premature Birth
PubMed: 24671232
DOI: 10.1371/journal.pone.0092778 -
International Journal of Molecular... Nov 2022Conventional antidepressants are widely employed in several psychiatric and neurologic disorders, yet the mechanisms underlying their delayed and partial therapeutic... (Review)
Review
Conventional antidepressants are widely employed in several psychiatric and neurologic disorders, yet the mechanisms underlying their delayed and partial therapeutic effects are only gradually being understood. This narrative review provides an up-to-date overview of the interplay between antidepressant treatment and Brain-Derived Neurotrophic Factor (BDNF) signaling. In addition, the impact of nutritional, environmental and physiological factors on BDNF and the antidepressant response is outlined. This review underlines the necessity to include information on lifestyle choices in testing and developing antidepressant treatments in the future.
Topics: Brain-Derived Neurotrophic Factor; Antidepressive Agents; Signal Transduction
PubMed: 36430921
DOI: 10.3390/ijms232214445 -
Neurotoxicity Research Jul 2016The co-morbidity of neuropsychiatric disorders, particularly major depressive disorder (MDD) with neurodegenerative diseases, in particular Parkinson's disease (PD) is... (Review)
Review
The co-morbidity of neuropsychiatric disorders, particularly major depressive disorder (MDD) with neurodegenerative diseases, in particular Parkinson's disease (PD) is now well recognized. Indeed, it is suggested that depressive disorders, especially in late life, may be an indication of latent neurodegeneration. Thus, it is not unreasonable to expect that deterrents of MDD may also deter the onset and/or progression of the neurodegenerative diseases including PD. In this review, examples of neuroprotective efficacy of established as well as prospective antidepressants are provided. Conversely, mood-regulating effects of some neuroprotective drugs are also presented. Thus, in addition to currently used antidepressants, ketamine, nicotine, curcumin, and resveratrol are discussed for their dual efficacy. In addition, potential neurobiological substrates for their actions are presented. It is concluded that pharmacological developments of mood-regulating or neuroprotective drugs can have cross benefit in co-morbid conditions of neuropsychiatric and neurodegenerative disorders and that inflammatory and neurotrophic factors play important roles in both conditions.
Topics: Animals; Antidepressive Agents; Comorbidity; Depressive Disorder, Major; Humans; Inflammation Mediators; Nerve Growth Factors; Neurodegenerative Diseases; Neuroprotective Agents
PubMed: 26613895
DOI: 10.1007/s12640-015-9577-1 -
Dialogues in Clinical Neuroscience Sep 2018Minor/subthreshold depression is associated with functional impairment, reduced quality of life, and the risk of developing into major depression. Therefore, it should... (Review)
Review
Minor/subthreshold depression is associated with functional impairment, reduced quality of life, and the risk of developing into major depression. Therefore, it should be treated. Watchful waiting should be an option only for patients who, despite adequate information, are not interested in any kind of treatment. Psychotherapy has been found to be effective, but due to methodological problems (control group, blinding), efficacy derived from randomized trials might be over-estimated. Studies on the efficacy of antidepressants in the treatment of minor depression have found clinically relevant benefits over placebo, particularly the newer, better-controlled trials. One major advantage of antidepressants over psychotherapy is their immediate availability and the short period required to evaluate efficacy. Aside from the severity of depression, the patient's attitude towards psychotherapy or antidepressant treatment is of major relevance and should be explored. In a shared decision-making process, the patient should receive appropriate information on treatment options, state her or his preferences, and then receive the treatment of choice.
Topics: Antidepressive Agents; Depression; Humans; Psychotherapy; Quality of Life; Selective Serotonin Reuptake Inhibitors
PubMed: 30581292
DOI: 10.31887/DCNS.2018.20.3/dnaber -
Annual Review of Clinical Psychology 2014Women in their reproductive years are at risk of experiencing depressive and anxiety disorders. As such, it is likely that pregnant women will undergo treatment with... (Review)
Review
Women in their reproductive years are at risk of experiencing depressive and anxiety disorders. As such, it is likely that pregnant women will undergo treatment with antidepressants. We review the risk of adverse birth outcomes and neonatal complications subsequent to antidepressant use in pregnancy. An inconsistent literature shows that antidepressant exposure is associated with shortened gestations and diminished fetal growth; these effects are small. Transitory neonatal signs are seen in some neonates after exposure to antidepressants in utero. No specific pattern of malformations has been consistently associated with antidepressants, with the possible exception of paroxetine and cardiac malformations. There is inconclusive evidence of a link between antidepressants in late pregnancy and persistent pulmonary hypertension in the newborn. Extensive study finds that antidepressants cannot be considered major teratogens. It is likely that confounding factors contribute to a number of the adverse effects found to be associated with antidepressant use in pregnancy.
Topics: Antidepressive Agents; Depression, Postpartum; Depressive Disorder; Female; Heart Defects, Congenital; Humans; Infant, Newborn; Paroxetine; Persistent Fetal Circulation Syndrome; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects
PubMed: 24313569
DOI: 10.1146/annurev-clinpsy-032813-153626 -
BMJ (Clinical Research Ed.) Mar 2008Treatment is probably too sporadic to affect overall suicide rates
Treatment is probably too sporadic to affect overall suicide rates
Topics: Antidepressive Agents; Depressive Disorder; Humans; Suicide
PubMed: 18276665
DOI: 10.1136/bmj.39482.666366.80 -
Scientific Reports May 2023It is currently difficult to successfully choose the correct type of antidepressant for individual patients. To discover patterns in patient characteristics, treatment...
It is currently difficult to successfully choose the correct type of antidepressant for individual patients. To discover patterns in patient characteristics, treatment choices and outcomes, we performed retrospective Bayesian network analysis combined with natural language processing (NLP). This study was conducted at two mental healthcare facilities in the Netherlands. Adult patients admitted and treated with antidepressants between 2014 and 2020 were included. Outcome measures were antidepressant continuation, prescription duration and four treatment outcome topics: core complaints, social functioning, general well-being and patient experience, extracted through NLP of clinical notes. Combined with patient and treatment characteristics, Bayesian networks were constructed at both facilities and compared. Antidepressant choices were continued in 66% and 89% of antidepressant trajectories. Score-based network analysis revealed 28 dependencies between treatment choices, patient characteristics and outcomes. Treatment outcomes and prescription duration were tightly intertwined and interacted with antipsychotics and benzodiazepine co-medication. Tricyclic antidepressant prescription and depressive disorder were important predictors for antidepressant continuation. We show a feasible way of pattern discovery in psychiatry data, through combining network analysis with NLP. Further research should explore the found patterns in patient characteristics, treatment choices and outcomes prospectively, and the possibility of translating these into a tool for clinical decision support.
Topics: Adult; Humans; Bayes Theorem; Retrospective Studies; Antidepressive Agents; Antidepressive Agents, Tricyclic; Psychiatry
PubMed: 37225783
DOI: 10.1038/s41598-023-35508-7 -
European Neuropsychopharmacology : the... Apr 2018Major depressive disorder (MDD) is a severe psychiatric syndrome with high prevalence and socioeconomic impact. Current antidepressant treatments are based on the... (Review)
Review
Major depressive disorder (MDD) is a severe psychiatric syndrome with high prevalence and socioeconomic impact. Current antidepressant treatments are based on the blockade of serotonin (5-hydroxytryptamine, 5-HT) and/or noradrenaline transporters. These drugs show slow onset of clinical action and limited efficacy, partly due to the activation of physiological negative feed-back mechanisms operating through autoreceptors (5-HT, 5-HT, α-adrenoceptors) and postsynaptic receptors (e.g., 5-HT). As a result, clinically-relevant doses of reuptake inhibitors increase extracellular (active) 5-HT concentrations in the midbrain raphe nuclei but not in forebrain, as indicated by rodent microdialysis studies and by PET-scan studies in primate/human brain. The prevention of these self-inhibitory mechanisms by antagonists of the above receptors augments preclinical and clinical antidepressant effects. Hence, the mixed ß-adrenoceptor/5-HT antagonist pindolol accelerated, and in some cases enhanced, the clinical action of selective serotonin reuptake inhibitors (SSRI). This strategy has been incorporated into two new multi-target antidepressant drugs, vilazodone and vortioxetine, which combine 5-HT reuptake inhibition and partial agonism at 5-HT receptors. Vortioxetine shows also high affinity for other 5-HT receptors, including excitatory 5-HT receptors located in cortical and hippocampal GABA interneurons. 5-HT receptor blockade by vortioxetine enhances pyramidal neuron activity in prefrontal cortex as well as cortical and hippocampal 5-HT release. It is still too soon to know whether these new antidepressants will represent a real advance over existing drugs in the real world. However, their development opened the way to future antidepressant drugs based on the prevention of local and distal self-inhibitory mechanisms attenuating monoamine activity.
Topics: Animals; Antidepressive Agents; Biogenic Monoamines; Depressive Disorder, Major; Humans; Neurotransmitter Agents
PubMed: 29174531
DOI: 10.1016/j.euroneuro.2017.10.032 -
Clinical Epigenetics 2016Epigenetic mechanisms are important for the regulation of gene expression and differentiation in the fetus and the newborn child. Symptoms of maternal depression and... (Review)
Review
INTRODUCTION
Epigenetic mechanisms are important for the regulation of gene expression and differentiation in the fetus and the newborn child. Symptoms of maternal depression and antidepressant use affects up to 20 % of pregnant women, and may lead to epigenetic changes with life-long impact on child health. The aim of this review is to investigate whether there is an association between exposure to maternal antidepressants during pregnancy and epigenetic changes in the newborn.
MATERIAL AND METHODS
Systematic literature searches were performed in MEDLINE and EMBASE combining MeSH terms covering epigenetic changes, use of antidepressant medication, pregnancy and newborns. A keyword search was also performed. We included studies on pregnant women and their children where there was a history of maternal depressed mood or anxiety, a reported use of antidepressant medication, and measurements of epigenetic changes in umbilical cord blood. Studies using genome-wide or candidate-based epigenetic analyses were included. Citations and references from the included articles were investigated to locate further relevant articles. The completeness of reporting as well as the risk of bias and confounding was assessed.
RESULTS
Six studies were included. They all investigated methylation changes. Genome-wide methylation changes were examined in 184 children and methylation status in specific genes was examined in 96 children exposed to antidepressant medication. Three of the studies found an association between use of antidepressant medication during pregnancy and methylation status at various CpG sites measured in cord blood of the newborn. One of these studies found an association in African-Americans, but not Caucasians. The remaining three studies found associations between maternal mood and epigenetic changes in umbilical cord blood but no association between epigenetic changes and maternal use of antidepressant medication.
CONCLUSION
The included studies have not established a clear association between use of antidepressant medication during pregnancy and epigenetic changes in the cord blood. Future studies using newer, more wide-ranging epigenetic methods could discover possible new differentially methylated sites. Larger sample sizes and good validity of exposures are warranted in order to adjust for level of maternal depression, other maternal illness, maternal use of other types of medication, and maternal ethnicity. PROSPERO registration number: CRD42015026575.
Topics: Antidepressive Agents; DNA Methylation; Depression; Epigenesis, Genetic; Female; Fetal Blood; Humans; Maternal Exposure; Pregnancy; Pregnancy Complications
PubMed: 27610205
DOI: 10.1186/s13148-016-0262-x