Interferon-induced depressive illness in hep C patients responds to SSRI antidepressant treatments

This paper examines the role of selective serotonin reuptake inhibitors (SSRIs) in the treatment of hepatitis-C virus (HCV) patients who have developed interferon-α induced depression. A 2-year data analysis of HCV psychiatric liaison clinic has been undertaken. The diagnosis, treatment, and progress of those patients who were treated with interferon-α (INF-α) are reported. 53 of the 78 patients enrolled at the HCV Clinic and treated with INF-α were referred for psychiatric consultation. Six patients developed major depressive illness following INF therapy. They were all treated with SSRIs and they made full recovery. This is a significant observation and is concordant with other studies. Its biochemical ramifications are presented. It is concluded that INF-induced depression is fully reversible. A hypothesis is proposed that SSRIs modulate the neuro-protective neurotoxic ratio by possibly inhibiting the indole-2,3-dioxygenase induction of the kynurenine pathway.     

米氮平治疗神经性厌食症的疗效对照研究

目的：观察米氮平对神经性厌食症的疗效。方法：42例符合CCMD-3神经性厌食症患者被随机分成2组，分别给予米氮平和5-羟色胺再摄取抑制剂（SSRIs）治疗12周，而后随访12周。比较患者治疗前后的体重变化、汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评分及药物不良反应。结果：共38例患者完成治疗全过程，其中米氮平组20例，SSRIs组18例。在治疗6周时，米氮平组的体重增加大于SSRIs组，差异有显著性（P〈0．01）；治疗12周时，两组体重增加值差异没有显著性。治疗后两组HAMD和HAMA评分均明显减低（P〈0．01），但两组间差异无显著性（P〉0．05）。两组均未出现严重的药物不良反应，主要不良反应SSRIs组为胃肠道不适，米氮平有嗜睡、体重增加等。结论：米氮平能明显提高神经性厌食症患者的食欲和体重，改善焦虑抑郁情绪，依从性好，起效时间早于SSRIs，值得在临床上选用。     

Can acupuncture combined with SSRIs improve clinical symptoms and quality of life in patients with depression? Secondary outcomes of a pragmatic randomized controlled trial

ObjectivesTo explore the effects of acupuncture (manual acupuncture or electroacupuncture) combined with SSRIs for moderate to severe depression improving major clinical symptoms and life quality of the patients on secondary outcomes.DesignPragmatic, parallel, randomized controlled trial.Setting6 hospitals in China.Interventions6 weeks of manual acupuncture (MA)+selective serotonin reuptake inhibitors (SSRIs), electroacupuncture (EA)+SSRIs, and SSRIs alone.Main outcome measuresThe primary outcome was response rate of 17-item Hamilton Depression Scale (HAMD-17) total score at 6^th week. The secondary outcomes reported in this analysis were HAMD-17 factor scores at 1^st, 2^nd, 4^th, 6^th, 10^th week and WHO Quality of Life-BREF (WHOQOL-BREF) scores at 6^th week.Results477 patients were randomly assigned into MA + SSRIs (n = 161), EA + SSRIs (n = 160), or SSRIs alone (n = 156) groups. For HAMD-17 (at 6^th week), the MA + SSRIs group was significantly better than the SSRIs alone group in retardation factor (p = 0.008), while the EA+SSRIs group was significantly better than the SSRIs alone group in anxiety/somatization factor (p<0.001) and sleep disturbance factor (p = 0.002). For WHOQOL-BREF (at 6^th week), the EA + SSRIs group, compared with the SSRIs alone group, produced a more significant improvement in the overall quality of life, general health, physical health, and psychological health (p<0.05). While, the MA + SSRIs group, compared to the SSRIs alone group, showed significant advantage only in psychological health (p = 0.023).ConclusionsEither MA or EA combined SSRIs treatment could improve symptoms and quality of life for patients with moderate to severe depression. The main limitation of this trial was not using a sham control therefore the placebo effect could not be excluded.     

Are the antiplatelet and profibrinolytic properties of selective serotonin-reuptake inhibitors relevant to their brain effects?

The serotonin transporter (SERT) is found in neuron and platelet membranes. Selective serotonin-reuptake inhibitors (SSRIs) are widely prescribed for severe depression. They may at least partly counteract the effects of serotonin on the vascular biology system, can lower agonists-induced platelet activation, aggregation and procoagulant activity in vitro, thus modulating platelet thrombogenicity. Other effects, such as those mediated through PAI-1 modulation, may indirectly influence neurobiology-relevant mechanisms involved in depression. Patients receiving SSRIs are at increased bleeding risk and decreased risk of arterial occlusive events, such as myocardial infarction, compared to those using non-SSRI antidepressants. The objectives of this review were to highlight antiplatelet and profibrinolytic properties of SSRIs and discuss the potential role of these activities in the context of SSRI brain effects.     

Efficacy and safety of phosphodiesterase type 5 inhibitors on primary premature ejaculation in men receiving selective serotonin reuptake inhibitors therapy: a systematic review and meta‐analysis

We performed a systematic review and meta‐analysis to assess whether selective serotonin reuptake inhibitors (SSRIs) and phosphodiesterase type 5 inhibitors ( PDE5‐Is ) may have an additive therapeutic effect. A literature review was performed to identify all published randomised controlled trials (RCT) that used SSRIs combined with PDE5‐Is therapy for the treatment of primary PE. The search included the following databases: EMBASE, MEDLINE and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated. Five publications involving a total of 419 patients were used in the analysis, including 5 RCTs that compared PDE5‐Is plus SSRIs with SSRIs treating primary PE. Primary efficacy endpoints: IELT (the standardised mean difference (SMD) = 1.07, 95% confidence interval (CI) = 1.00 to 1.14, P < 0.00001) indicated that utilisation of PDE5‐Is and SSRIs was more effective than the SSRIs alone for a long time in patients with primary PE. Safety assessments included headache (odds ratio (OR) = 3.16, 95% CI = 1.63 to 6.11, P = 0.0006), and flushing indicated that PDE5‐Is plus SSRIs were well tolerated. This meta‐analysis indicates that PDE5‐Is combined with SSRIs seem to provide significantly better ejaculatory latency time as compared with SSRIs alone in patients with primary PE.     

Are there advances in pharmacotherapy for panic disorder? A systematic review of the past five years

Introduction: Several effective medications are available for treating panic disorder (PD). However, outcomes are unsatisfactory in a number of patients, suggesting the usefulness of expanding the array of antipanic drugs and improving the quality of response to current recommended treatments.

Areas covered: The authors have performed an updated systematic review of pharmacological studies (phase III onwards) to examine whether advances have been made in the last five years. Only four studies were included. D-cycloserine no longer seemed promising as a cognitive-behavioral therapy (CBT) enhancer. Some preliminary findings concerning the optimization of recommended medications deserved consideration, including: the possibility that SSRIs are more effective than CBT alone in treating panic attacks, combined therapy is preferable when agoraphobia is present, and clonazepam is more potent than paroxetine in decreasing panic relapse.

Expert opinion: Given the lack of novel treatments, expanding a personalized approach to the existing medications seems to be the most feasible strategy to improve pharmacotherapy outcomes regarding PD. Recent technological progress, including wearable devices collecting real-time data, ‘big data’ platforms, and application of machine learning techniques might help make outcome prediction more reliable. Further research on previously promising novel treatments is also recommended.     

Antidepressant‐Induced Suicidality: An Update

Evidence suggests that antidepressant treatment may in some cases result in worsening depression and increased risk of suicidality in pediatric and adolescent patients. The United States Food and Drug Administration requires that antidepressants carry a black box warning regarding such a risk in patients up to age 24. Many studies of antidepressant‐induced suicidality among adults have also reported an increased risk, while several other investigations involving that population have not supported such a finding. This article provides an update of the controversy surrounding antidepressants as a potential cause of suicidal ideations or behavior. Antidepressant‐induced suicidality appears to be an uncommon occurrence but also a legitimate phenomenon. Close monitoring and a follow‐up care should be provided for patients after initiation of a new antidepressant.     

我院2003～2005年抗抑郁药用药分析

目的:了解某院抗抑郁药物的使用情况,为临床合理用药提供参考.方法:采用世界卫生组织推荐的限定日剂量(DDD)、用药频度(DDDs)为指标,分析某院2003～2005年抗抑郁药的利用情况.结果:2003～2005年某院应用抗抑郁药的年消耗金额增加明显,DDDs呈上升趋势.结论:某院抗抑郁药的应用基本合理,5-羟色胺再摄取抑制剂等新型抗抑郁药已成为临床应用的一线药物,三环类药物应用减少.     

抑郁症对冠心病的影响及治疗策略

抑郁症和冠心病（CHD）作为影响人类身心健康的两大疾病已引起全社会尤其是医务工作者的广泛关注，目前已有很多文献报道了抑郁症作为CHD的独立危险因素不但增加CHD的发病率，而且对CHD的预后产生不良影响^[1,2]，且与传统的危险因素如：吸烟，高胆固醇血症等对CHD的影响程度相同^[3]；