Selective Serotonin Reuptake Inhibitors and Poststroke Epilepsy: A Population-Based Nationwide Study

Objective

To investigate the effects of selective serotonin reuptake inhibitors (SSRIs) on poststroke epilepsy in a population-based nationwide study.

The Use of Selective Serotonin Reuptake Inhibitors in Children and Adolescents with Major Depression

TOPIC: Recent warnings about suicidal thoughts and self-injurious behavior in youth treated with selective serotonin reuptake inhibitors raise fundamental questions about the risk-benefit ratio of this class of medications. METHODS: Data from placebo-controlled trials are used to elucidate the potential risks and benefits of the selective serotonin reuptake inhibitors (SSRIs) in children and adolescent with major depression. This analysis forms the basis of clinical recommendations. SOURCES: The review includes the six large-scale, placebo-controlled trials that have been published over the past decade. These data were augmented by information from regulatory hearings in 2003-2004 and selected open-label reports. CONCLUSIONS: Emerging data from several clinical trials show that the SSRIs have modest effects on childhood depression. In addition, SSRI treatment may be associated with behavioral activation, self-harm, and suicidal ideation. Appropriate use of SSRIs in children and adolescents requires careful diagnostic assessment, evaluation of co-occurring conditions, and diligent monitoring, especially within the first weeks of treatment.     

The FDA Alert on Serotonin Syndrome With Use of Triptans Combined With Selective Serotonin Reuptake Inhibitors or Selective Serotonin‐Norepinephrine Reuptake Inhibitors: American Headache Society Position Paper

(Headache 2010;50:1089‐1099) Background.— In 2006, a US Food and Drug Administration (FDA) alert warned about the potential life‐threatening risk of serotonin syndrome when triptans are used in combination with selective serotonin reuptake inhibitors (SSRIs) or selective serotonin/norepinephrine reuptake inhibitors (SNRIs). This American Headache Society Position Paper further reviews the available evidence of the potential risk of combining triptans with other serotonergic agents. Methods.— Using the Sternbach Criteria or the Hunter Serotonin Toxicity Criteria, the 29 cases used as the basis for the FDA alert were assessed in addition to a more recently published clinical review of 11 case reports of serotonin syndrome resulting from monotherapy, and one report of combination serotonergic agents. Evidence was evaluated according to the American Academy of Neurology Clinical Practice Guideline Process Manual. Results.— Collectively, 40 case reports are available in the literature for subjects receiving either combination or monotherapy of serotonin agonists, all of which are limited to Class IV level of evidence. Of the 29 cases used as the basis for the FDA alert, 10 cases actually met the Sternbach Criteria for diagnosing serotonin syndrome. No cases fulfilled the Hunter Criteria for serotonin toxicity. One case published since the original report does not meet either criteria, and subsequently reported cases involving triptan monotherapy include insufficient details to confirm a diagnosis of serotonin syndrome. Recommendations.— With only Class IV evidence available in the literature and available through the FDA registration of adverse events, inadequate data are available to determine the risk of serotonin syndrome with the addition of a triptan to SSRIs/SNRIs or with triptan monotherapy. The currently available evidence does not support limiting the use of triptans with SSRIs or SNRIs, or the use of triptan monotherapy, due to concerns for serotonin syndrome (Level U). However, given the seriousness of serotonin syndrome, caution is certainly warranted and clinicians should be vigilant to serotonin toxicity symptoms and signs to insure prompt treatment. Health care providers should report potential cases to MedWatch and consider submitting them for publication.     

Association Between Cataract and Risk of Incident Atrial Fibrillation: A Nationwide Population-Based Retrospective Cohort Study

Objective

To identify the association between cataract and the subsequent atrial fibrillation (AF) risk.

Review of the Evidence for Treatment of Children with Autism with Selective Serotonin Reuptake Inhibitors

PURPOSE.  To review the potential role of serotonin dysregulation in autism and the efficacy of selective serotonin reuptake inhibitors (SSRIs) in treating core deficits and associated symptoms of autism in children. The literature was searched for reports of SSRI use in children with autism. Data are presented from prospective clinical trials that evaluated treatment outcomes.
CONCLUSIONS.  Some SSRIs show moderate success in managing specific behaviors. Only fluoxetine shows evidence of decreasing global autism severity.
PRACTICE IMPLICATION.  Definitive conclusions concerning selection criteria, dosage, safety, and efficacy cannot be drawn given the current state of evidence.     

Selective Serotonin Reuptake Inhibitors Versus Tricyclic Antidepressants in Young Patients: A Meta-analysis of Efficacy and Acceptability

Purpose

A meta-analysis comparing the efficacy and acceptability of selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants (TCAs) in depressed children, adolescents, and young adults was performed.

Methods

A comprehensive literature search of the PubMed, Cochrane, Embase, Web of Science, and PsycINFO databases was conducted from 1970 to December 2013. Only clinical trials that randomly assigned one SSRI or TCA to patients aged 7 to 25 years who met the diagnostic criteria for unipolar depressive disorder were included. Primary efficacy was determined by the pooling of standardized mean differences (SMDs) calculated from the difference in the reduction in mean depression rating scale scores for the 2 antidepressants. Acceptability was determined by pooling the risk ratios (RRs) of dropouts for all reasons and for adverse effects as well as the suicide-risk outcome.

Findings

Five trials with a total of 422 patients were considered to be eligible for inclusion. SSRIs were significantly more effective than TCAs in primary efficacy (SMD = −0.52; 95% CI, −0.81 to −0.24; P = 0.0003). Patients taking SSRIs had a significantly greater response to depressive symptoms than patients taking TCAs (RR = 1.55; 95% CI, 1.04 to 2.29; P = 0.03). On an individual SSRI basis, fluoxetine had a significantly greater efficacy than TCAs (SMD = −0.82; 95% CI, −1.34 to −0.29; P = 0.003). On an individual TCA basis, only imipramine was not significantly worse than SSRIs (SMD = −0.27; 95% CI, −0.56 to 0.02; P = 0.06). Significantly more patients taking TCAs discontinued treatment than patients taking SSRIs (35.8% vs 25.1%; RR = 0.70; 95% CI, 0.52 to 0.93; P = 0.02).

Implications

SSRI therapy has a superior efficacy and is better tolerated compared with TCA therapy in young patients.     

Case Report: The Effects of Selective Serotonergic Reuptake Inhibitors Combined with Behavioral Treatment on Self-Injury Associated with Lesch-Nyhan Syndrome

A 6-year-old African-American male child with Lesch-Nyhan syndrome participated. Because of the occurrence of unmanageable self-injurious behavior (SIB) in a group home, James at the age of 3.5 years was admitted to a large residential facility for persons with mental retardation. A behavior treatment program was implemented soon after admission and produced a large decrease in SIB; however, rates of SIB remained clinically unacceptable and a danger to him. The program consisted of differential reinforcement, extinction, and noncontingent protective restraint. Because SIB may be caused by decreased serotonergic activity, open trials of serotonergic drugs in combination with a serotonergic diet were conducted. The use of a serotonergic diet alone resulted in no change in SIB. Dose-dependent reductions in SIB occurred during paroxetine and sertraline phases, suggesting some benefit in the use of serotonergic drugs.     

Treatment of bulimia nervosa with fluvoxamine: A randomized controlled trial

Bulimia nervosa (BN) is one of the most common eating disorders in industrialized societies. It has been suggested that reduced serotonin activity triggers some of the cognitive and mood disturbances associated with BN. For this reason, the pharmacologic treatment of BN consists mainly of selective serotonin reuptake inhibitors (SSRIs), which have been proven effective. At present, the physiologic bases of this disorder are not yet completely understood. We conducted a randomized controlled trial to verify the efficacy of the SSRI fluvoxamine in patients with a diagnosis of BN. Twelve female outpatients aged 21 to 34 years with a diagnosis of BN-binge purging (as defined by the fourth edition of theDiagnostic and Statistical Manual of Mental Disorders [DSM IV]) were randomly assigned to 2 treatment groups: the fluvoxamine 200 mg/day group and the placebo group. The patients underwent weekly clinical assessments for 12 weeks. At the end of the observation period, there was a statistically significant reduction in the number of binge-eating crises and purging episodes in the fluvoxamine group compared with placebo. In no case was treatment interrupted because of emergent side effects. These findings support the hypothesis that fluvoxamine is well tolerated and effective in reducing binge-eating crises and purging episodes in patients with BN.     

The effects of Selective Serotonin Reuptake Inhibitors on newborn adaptation and withdrawal symptoms: A scoping review

BackgroundSince becoming the most frequently prescribed antidepressants in pregnancy, the effects of Selective Serotonin Reuptake Inhibitors on newborns is hotly debated. The aims of this review were to examine terminology and adaptation, withdrawal, and toxicity risks for newborns.MethodScoping review methodology guided the search of electronic databases EBSCOhost, PubMed Central and Springer Online Journals.ResultsOut of 90 articles screened, 23 were eligible for inclusion in the synthesis. Terminology is used interchangeably with poor delineation. Poor Neonatal Abstinence Syndrome is usually mild and transient with newborns experiencing neuro-behaviour and/or respiratory symptoms, initial lowered Apgar score, inhibited respiratory regulation, and hypoglycaemia. Limited studies examined Serotonin toxicity.ConclusionsNewborns exposed to Selective Serotonin Reuptake Inhibitors in-utero are affected, however the evidence is limited due to a lack of high-quality, robust studies to accurately make generalisations regarding Poor Neonatal Adaptation Syndrome or to support the diagnosis over withdrawals. Further research is needed to adequately differentiate between the conditions.     

Osteoporosis and Fractures After Solid Organ Transplantation: A Nationwide Population-Based Cohort Study

ObjectiveTo investigate the incidence of bone disorders after solid organ transplantation (SOT).Participants and MethodsWe used Taiwan's National Health Insurance Research Database to identify 9428 recipients of SOT and 38,140 sex- and age- matched control subjects between January 1, 1997, and December 31, 2010, to compare the incidence and risk of bone disorders between groups.ResultsRecipients of SOT had a significantly higher incidence of osteoporosis and related fractures compared with the non-SOT group. The overall hazard ratio (HR) of osteoporosis after SOT was 5.14 (95% CI, 3.13-8.43), and the HR of related fractures was 5.76 (95% CI, 3.80-8.74). The highest HRs were observed in male patients (HR, 7.09; 95% CI, 3.09-16.3) and in those aged 50 years or younger (HR, 7.38; 95% CI, 2.46-22.1). In addition, SOT patients without any comorbidities had a 9.03-fold higher risk of osteoporosis than non-SOT participants (HR, 9.03; 95% CI, 5.29-15.4). To compare the risk of osteoporosis and related fractures in different recipients of SOT, the highest risk of osteoporosis and fractures was noted in patients receiving lung transplantation, followed by other types of SOT.ConclusionWe report high rates of metabolic bone disorders after SOT in chronic transplant patients over a long follow-up. Both underlying bone disorders before transplantation and use of immunosuppressant agents may contribute to bone disorders after transplantation.     

Treatment of the paraphilic disorders: A review of the role of the selective serotonin reuptake inhibitors

Alternative psychopharmacological interventions in the treatment of paraphilic disorders have previously been limited. This article briefly reviews previous psychopharmacological treatment as well as more recent therapeutic advances. During the past 5 years there have been 14 case reports or open trials documenting the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of paraphilics. The authors discuss the hypothetical role of serotonin in human sexual behavior and review the results of the efficacy of SSRIs in the treatment of these disorders. The limitations and possible indications of these medications are discussed. Although no double-blind placebo-controlled studies have been completed, the results seem to hold new promise for these alternative medications in the treatment of the paraphilic disorders and, possibly, in individuals with an inappropriately high sexual drive.     

Body Mass Index Variability and Long-term Risk of New-Onset Atrial Fibrillation in the General Population: A Korean Nationwide Cohort Study

Objective

To assess the effects of body mass index (BMI) variability on the incidence of new-onset atrial fibrillation (AF), stroke, cardiovascular (CV) risk factors, and CV outcomes in a general Asian population.

Association of Statin Use With Mortality After Dialysis-Requiring Acute Kidney Injury: A Population-Based Cohort Study

Objective

To investigate the association between statin use and mortality in patients with dialysis-requiring acute kidney injury (AKI-D).

Serum 25-Hydroxyvitamin D Values and Risk of All-Cause and Cause-Specific Mortality: A Population-Based Cohort Study

Objective

To determine the relationship between 25-hydroxyvitamin D (25[OH]D) values and all-cause and cause-specific mortality.

Statin Use and Risk of Community-Acquired Staphylococcus aureus Bacteremia: A Population-Based Case-Control Study

Objective

To ascertain whether persons treated with statins experience a decreased risk of community-acquired Staphylococcus aureus bacteremia (CA-SAB) as compared with nonusers.

Integrating Chinese and Western medicines reduced the incidence of hepatocellular carcinoma in patients with diabetes mellitus: A Taiwanese population-based cohort study

ObjectivesMuch epidemiological evidence links diabetes mellitus (DM) to the development of multiple cancers and, in particular, the development of hepatocellular carcinoma (HCC). The aim of this study was to investigate whether Chinese herbal medicine (CHM) reduces the incidence of HCC in patients receiving Western antidiabetic drugs.Interventions and main outcome measuresThis retrospective cohort study used data from the National Health Insurance Research Database involving 81,105 diabetic patients, including 5122 CHM users and 25,966 non-CHM users. Analyses of treatment effects were adjusted for covariates including gender, age, comorbidities, antidiabetic drugs and liver medications. NodeXL software performed a network analysis to identify the 50 most commonly used CHM herbs and formulas.ResultsIn Cox proportional hazards models adjusted for demographic and clinical characteristics, DM patients exposed to adjuvant CHM therapy were significantly less likely to develop HCC compared with non-CHM users (adjusted hazard ratio [aHR] 0.59; 95 % confidence interval [CI], 0.41-0.87; p = 0.01). Kaplan-Meier analysis revealed a lower 10-year cumulative risk of HCC among CHM users compared with non-CHM users. Amongst the 10 individual CHM herbs and herbal formulas most commonly prescribed for DM, the most frequent were Salvia miltiorrhiza (Dan Shen) and Liu Wei Di Huang Wan, respectively.ConclusionThis nationwide retrospective cohort study from Taiwan provides some valuable insights into the prescribing characteristics of CHM treatment in patients with DM. Compared with use of Western antidiabetic medications alone, use of adjuvant CHM effectively reduces the incidence of HCC in patients with DM.