Antidepressant-associated mania: a study of anxiety disorders patients

Antidepressants are related to the emergence of manic and hypomanic episodes in mood disorder patients. This study examined whether antidepressant-associated manic states are also present in anxiety disorder patients, so that this phenomenon may be defined as a side-effect. A total of 167 consecutive patients at a specialized outpatient clinic, suffering from anxiety disorders and treated by antidepressants, were assessed in a blind, retrospective chart review. Five patients (2.99%) were identified as having suffered an episode of antidepressant-associated mania within 3 months of initiation of treatment. All were females and all had an axis II diagnosis of a cluster B personality disorder. Antidepressant-associated mania appears to be related to risk factors such as personality disorder, even in non-mood disorder patients, tentatively suggesting that it is not simply an adverse event but rather a reflection of an underlying psychopathology. Received: 27 May 1997/Final version: 10 October 1997     

Alprazolam in the treatment of generalized anxiety and panic disorders: A double-blind placebo-controlled study

In a double-blind controlled study lasting 8 weeks, 50 anxious psychoneurotic outpatients with a primary diagnosis of generalized anxiety or panic disorder were randomly assigned to alprazolam (n=30), a new benzodiazepine, or placebo (n=20), after a washout period of 1 week. Alprazolam at dosages between 0.25 and 3 mg/day was found to be significantly better than placebo in the treatment of either disorder. The finding that alprazolam was effective in the treatment of panic disorder is of interest as this diagnostic category is usually treated with tricyclic antidepressants or MAO inhibitors.     

Efficacy of pregabalin in depressive symptoms associated with generalized anxiety disorder: A pooled analysis of 6 studies

Epidemiological evidence supports comorbidity of generalized anxiety disorder (GAD) and major depressive disorder (MDD) or dysthymia, and its association with significant disability. As pregabalin, a new ₂-δ anxiolytic treatment for GAD, unlike most other licensed treatments for GAD has not undergone investigation in patients with MDD, we examined its efficacy in depressive symptoms associated with GAD, through a post-hoc analysis of the existing clinical trial database. The results provide consistent evidence that in patients with GAD pregabalin reduced associated symptoms of depression. This was seen in the 150 mg/day, 300–450 mg/day and 600 mg/day dosing groups. Even in subjects with more prominent depressive symptoms, pregabalin remained effective for both sub-syndromal depression and GAD symptoms, with pregabalin 300–450 mg/day demonstrating the most beneficial response. In conclusion, pregabalin, an alternative treatment option for GAD with a novel mechanism of action, also demonstrated efficacy in treating depressive symptoms typically encountered in GAD patients.     

Validating a human model for anxiety using startle potentiated by cue and context: the effects of alprazolam,pregabalin, and diphenhydramine

Background  Fear-potentiated startle has been suggested as a translational model for evaluating efficacy of anxiolytic compounds in humans. Several known anxiolytic compounds have been tested as well as several putative anxiolytics. Because results of these studies have been equivocal, the aim of the present study was to examine another pharmacological permutation of the human potentiated startle model by comparing two anxiolytic agents to a non-anxiolytic sedative and placebo. Methods  Twenty healthy volunteers participated in a double-blind, placebo-controlled, cross-over study with four sessions in which they received single doses of the anxiolytics alprazolam (1 mg) and pregabalin (200 mg), as well as diphenhydramine (50 mg) as a non-anxiolytic sedative control and placebo. The design included a cued shock condition that presumably evokes fear and an unpredictable shock context condition presumably evoking anxiety. Results  None of the treatments reliably reduced either fear- or anxiety-potentiated startle. Alprazolam and diphenhydramine reduced overall baseline startle. Alprazolam was found to only affect contextual anxiety in a statistical significant way after two subjects who failed to show a contextual anxiety effect in the placebo condition were excluded from the analysis. Pregabalin did not significantly affect any of the physiological measures. Discussion  The negative findings from this study are discussed in terms of methodological differences between designs and in variability of startle both between and within study participants. Conclusion  Even though fear-potentiated startle may be used to translate preclinical evidence to human populations, methodological issues still hamper the application of this model to early screening of putative anxiolytic drugs.     

丁螺环酮联合奋乃静治疗焦虑症70例疗效观察

目的观察丁螺环酮联合奋乃静用于焦虑症的临床价值。方法丁螺环酮联合奋乃静,治疗符合CCMD-3焦虑症诊断标准的患者,以HAMA、SAS作为主要疗效评价指标,以不良事件,评价安全性。结果经8周治疗后,临床痊愈60%,显进10%,进步30%,总显效率（痊愈＋显进）70%,有效率100%。结论丁螺环酮联合奋乃静治疗焦虑症效果好,不良反应小,患者依从性好。     

Deramciclane in the treatment of generalized anxiety disorder: A placebo-controlled, double-blind, dose-finding study

Deramciclane, a camphor derivative, is a novel anxiolytic agent with a unique mechanism of action. It acts as a potent and specific antagonist at serotonin 5-HT_2A/2C receptors, and exhibits anxiolytic efficacy in animal models. The aim of this double-blind, placebo-controlled, parallel-group study was to evaluate the efficacy, safety, and tolerability of a range of doses of deramciclane in patients with generalized anxiety disorder (GAD). Adult patients with a diagnosis of GAD (DSM-IV) and a Hamilton Anxiety Rating Scale (HAM-A) total score ≥ 18; a score ≥ 2 for the HAM-A items ‘Anxious Mood’ and ‘Tension’; a score ≥ 4 on the Clinical Global Impression of Severity of Illness (CGI-S) Scale; and a score ≤ 20 on the Montgomery–Åsberg Depression Rating Scale (MADRS) were enrolled in the study. Following a 1–2 week placebo run-in period, patients were randomized to receive deramciclane (10, 30, or 60 mg/day in two divided doses) or placebo for 8 weeks, followed by a 2-week placebo wash-out period. The primary efficacy measure was change in HAM-A score from baseline to week 8. Adverse events were monitored throughout the study. Withdrawal reactions were assessed at the end of the study (week 8) and during the placebo wash-out period using the Physician's Withdrawal Checklist (34 items). In the intent-to-treat population (n = 208), both the deramciclane 30 mg/day and 60 mg/day doses provided clinically relevant improvements in HAM-A total score after 8 weeks of treatment, reaching statistical significance compared with placebo in the 60 mg/day dose group (p = 0.024) and a clear trend in the 30 mg/day group (p = 0.059). On the HAM-A psychic anxiety factor, significant improvements were seen in patients in the deramciclane 30 mg/day and 60 mg/day treatment groups compared with those in the placebo group (p < 0.05). Adverse events were reported at a similar frequency across all four treatment groups; the most commonly reported adverse event was headache. No withdrawal reactions were observed on abrupt discontinuation of deramciclane. In conclusion, deramciclane 60 mg/day showed significant evidence of efficacy for the treatment of GAD in adult patients. The efficacy for the 30 mg/day dose was close to the larger dose although not significant in the primary analysis, and there was no significant evidence of efficacy for the 10 mg/day dose. Deramciclane was safe and well-tolerated up to the 60 mg/day dose over an 8-week period.     

普瑞巴林联合强的松治疗带状疱疹后神经痛的疗效及安全性

目的 探讨普瑞巴林与强的松联合应用治疗带状疱疹神经痛患者的临床疗效及安全性.方法 选取2010年3月至2013年3月我院收治的带状疱疹后神经痛患者64例,按其就诊顺序均分为对照组及观察组,每组32例.对照组给予口服普瑞巴林,观察组给予普瑞巴林联合强的松治疗.比较两组的临床疗效及安全性.结果 治疗后3周,对照组疼痛发生率、疼痛程度评分、精神状况评分、不良反应发生率分别为56.25％、5.8±0.5、5.3±1.6、9.4％,观察组分别为28.12％、3.6±1.1、4.8±1.8、3.1％,两组比较,差异均具有统计学意义（P均＜ 0.05）;治疗9周后,对照组患者疼痛发生率、疼痛程度、精神状况、不良反应发生率为50.0％、2.8±0.9、3.1±0.9、12.5％,观察组为9.38％、0.9±0.06、2.3±0.6、6.25％,两组比较差异均具有统计学意义（P＜0.01或P＜0.05）.结论 普瑞巴林联合强的松治疗带状疱疹后神经痛疗效显著优于单用普瑞巴林,且不良反应发生率低于单用普瑞巴林,值得临床推广.     

Efficacy and safety of pregabalin in patients with spinal cord injury: a pooled analysis

Abstract

Objective:

To summarize the efficacy and examine the safety and tolerability of pregabalin in patients with central neuropathic pain due to spinal cord injury (SCI).     

坦度螺酮与丁螺环酮治疗广泛性焦虑症的疗效和安全性比较研究

目的评价坦度螺酮治疗广泛性焦虑症的有效性和安全性。方法用随机化、双盲、双模拟、多中心、阳性药平行对照研究方法。共入组符合研究方案的病例236例,坦度螺酮组117例,丁螺环酮组119例。试验药的剂量为每日30-60mg,对照药的剂量为每日15-30 mg。结果两组病人的主要疗效指标HAMA评分在治疗结束时与基线比较均显著减低(P相似文献   

原发性头痛与焦虑抑郁的关系及抗焦虑抑郁治疗的效果

目的 探讨原发性头痛与焦虑抑郁的关系及抗焦虑抑郁治疗的效果。方法 选取2012年1月~2014年1月本院收治的100例原发性头痛患者,依据随机数字表法将患者分为观察组、对照组,每组各50例。对照组患者给予盐酸氟桂利嗪胶囊治疗,观察组患者在对照组基础上给予氟哌噻吨美利曲辛片治疗。结果 治疗前,两组患者的HADS、NRS评分比较,差异均无统计学意义（P〉0.05）;治疗后2、4周,观察组患者的HADS、NRS评分均明显比对照组低（P〈0.05）。治疗后2周,观察组、对照组患者的头痛减轻有效率分别为32%（16/50）、20%（10/50）,两组比较,差异无统计学意义（P〉0.05）;治疗后4周,观察组患者的头痛减轻有效率为66%（33/50）,明显高于对照组的36%（18/50）（P〈0.05）。结论 原发性头痛与焦虑抑郁密切相关,抗焦虑抑郁治疗的效果显著。     

Comparative efficacy and acceptability of pharmacotherapeutic agents for anxiety disorders in children and adolescents: a mixed treatment comparison meta-analysis

Abstract

Objective:

to compare efficacy and acceptability of different pharmacotherapeutic agents for treating anxiety disorders in children and adolescents     

利培酮联合氟西汀对焦虑抑郁共病患者的治疗观察

目的观察利培酮联合氟西汀对焦虑抑郁共病的疗效和安全性。方法71例焦虑抑郁共病患者随机分为研究组(利培酮+氟西汀)38例、对照组(氟西汀)33例,治疗8周。于治疗前、治疗后每2周测评汉密尔顿抑郁量表(HAMD)24项、汉密尔顿焦虑量表(HAMA)、治疗中需处理的不良反应量表(TESS)。疗效评价以HAMD减分率为标准,不良反应以TESS评分为标准。结果两组HAMD、HAMA评分组间比较从第2周末开始差异有统计学意义(P<0.05、P<0.01),两组疗效比较差异有统计学意义(P<0.05),各时期TESS评分比较差异无统计学意义(P>0.05)。结论利培酮联合氟西汀治疗焦虑抑郁共病的疗效和安全性较好。     

Metabotropic and ionotropic glutamate receptors as neurobiological targets in anxiety and stress-related disorders: focus on pharmacology and preclinical translational models

Anxiety disorders are amongst the most common and disabling of psychiatric illnesses and have severe health and socio-economic implications. Despite the availability of a number of treatment options there is still a strong medical need for novel and improved pharmacological approaches in treating these disorders. New developments at the forefront of preclinical research have begun to identify the therapeutic potential of molecular entities integral to the biological response to adversity, particularly molecules and processes that may pre-determine vulnerability or resilience, and those that may act to switch off or “unlearn” a response to an aversive event. The glutamate system is an interesting target in this respect, especially given the impact anxiety disorders have on neuroplasticity, cognition and affective function. These areas of research demonstrate expanding and improved evidence-based options for treating disorders where stress in various guises plays an important etiological role. The current review will discuss how these pathways are involved in fear circuitry of the brain and compare the strength of therapeutic rationale as well as progress towards pharmacological validation of the glutamate pathway towards the treatment of anxiety disorders, with a particular focus on metabotropic and ionotropic glutamate receptors. Specific reference to their anxiolytic actions and efficacy in translational disease models of posttraumatic stress disorder, obsessive-compulsive disorder, panic disorder and phobia will be made. In addition, the availability of ligands necessary to assist clinical proof of concept studies will be discussed.     

The pharmacological management of childhood anxiety disorders: a review

Rationale Pediatric anxiety is a prevalent psychiatric disorder that may have important implications for school, social, and academic function. Psychopharmacological approaches to the treatment of pediatric anxiety have expanded over the past 20 years and increasing empirical evidence helps guide current clinical practice. Objective To review studies which examine the pharmacological treatment of pediatric anxiety disorders, including obsessive–compulsive disorder and to summarize treatment implications. Methods All relevant studies were searched using MEDLINE and PsycINFO search engines, supplemented by a manual bibliographical search; studies published between 1985 and 2006 that met inclusion criteria were examined. Results This article provides a systematic review of the psychopharmacological treatment of pediatric anxiety disorders based on available empirical evidence, with a focus on randomized controlled trials. General treatment principles and pharmacological management of specific pediatric anxiety disorders are also reviewed. Conclusion There is good evidence to support the efficacy of several pharmacological agents including the selective serotonin reuptake inhibitors to treat pediatric anxiety and obsessive–compulsive disorder, although there are still many unanswered questions.     

西酞普兰与阿普唑仑治疗广泛性焦虑症对照研究

目的：探讨西酞普兰治疗广泛性焦虑症的临床疗效。方法：将66例广泛性焦虑症患者随机分为两组,西酞普兰组34例,阿普唑仑组32例。西酞普兰组治疗剂量40～60 mg/d,阿普唑仑组为2.4～3.6 mg/d,观察时间均为6周。治疗前与治疗第1、2、4、6周末采用HAMA、SAS、TESS评定临床疗效和副反应。结果：两组疗效相当,差异无统计学意义（P〉0.05）;阿普唑仑组起效时间快,但远期疗效差于西酞普兰组;西酞普兰组副反应明显少于阿普唑仑组（P〈0.05）。结论：西酞普兰治疗广泛性焦虑疗效肯定,依从性好。     

度洛西汀联合普瑞巴林治疗阴部神经痛的临床观察

目的观察度洛西汀联合普瑞巴林治疗阴部神经痛的临床疗效和安全性。方法筛选2018年2月至2019年8月来我院疼痛科诊治的阴部神经痛患者共42例,随机分为对照组与试验组(各21例)。对照组单用普瑞巴林治疗,试验组联合应用普瑞巴林与度洛西汀。观察两组患者治疗前和治疗后第4、8及12周视觉模拟评分(VAS)、匹兹堡睡眠质量指数(PSQI)和健康问卷抑郁量表(PHQ-9),并记录两组患者不良反应发生情况。结果两组患者治疗后VAS、PSQI和PHQ-9评分均明显降低(P<0.01);试验组治疗后各时间点VAS和PHQ-9评分明显低于对照组(P<0.05),试验组治疗后8、12周PSQI评分明显低于对照组(P<0.05)。两组不良反应发生情况比较,差异无统计学意义(P>0.05)。结论度洛西汀联合普瑞巴林可以有效缓解阴部神经痛,改善睡眠质量,缓解患者抑郁状态,可安全应用于临床。     

Adjunctive topiramate in the maintenance treatment of bipolar disorders: an open-label study

SUMMARY

Objective: A considerable number of patients with bipolar disorder fail to respond completely to mood stabilizers. The anti-epileptic topiramate shares some pharmacological actions with carbamazepine and valproate. We therefore explored the efficacy and tolerability of topiramate in the prophylaxis of bipolar disorder.

Methods: Fifty-six patients receiving outpatient treatment for bipolar affective disorder who had been on mood stabilizers, and had relapsed at least once in the past 12?months, were treated with topiramate in an add-on design and were evaluated for 1?year. Patients were assessed biweekly for the first 3?months and every month thereafter.

Results: Fifty out of 56 patients completed the 1-year study, which indicated that adjunctive topiramate was associated with a significant reduction of new manic and depressive episodes compared to the past 12?months. The most common adverse effects were reduced appetite, fatigue and somnolence.

Conclusions: This was an open-label, uncontrolled study involving retrospective evaluation of episodes prior to the initiation of treatment, and the use of more than one mood stabilizer in a few patients. However, these preliminary observations of adjunctive topiramate as a maintenance treatment encourage further investigations, especially with controlled trials, for its long-term effect.     

盐酸羟考酮控释片联合普瑞巴林治疗带状疱疹后神经痛的临床应用

目的探讨盐酸羟考酮控释片联合普瑞巴林治疗带状疱疹后神经痛的疗效和安全性。方法将52例带状疱疹后神经痛患者随机分成2组,每组26例。A组使用盐酸羟考酮控释片治疗,B组联合使用普瑞巴林,观察比较两组疼痛缓解程度、用药量、生活质量及不良反应情况。结果两组患者疼痛均明显缓解,B组患者14～28 d的疼痛缓解率明显优于A组,盐酸羟考酮控释片使用量低;B组患者的生活质量及SF-36评分优于A组;B组患者除了头晕、口干及嗜睡发生率略高之外,其他不良反应与A组比较差异无统计学意义。结论盐酸羟考酮控释片联合普瑞巴林治疗中重度带状疱疹后神经痛疗效确切,安全可行。     

普瑞巴林治疗广泛性焦虑障碍的疗效与安全性的系统评价

目的系统评价普瑞巴林治疗广泛性焦虑障碍(GAD)的临床疗效和安全性。方法电子检索CENTRAL、Pubmed、EMbase和中国生物文献数据库文献(CBM),全面收集普瑞巴林治疗GAD的随机对照试验(RCTs),采用Cochrane系统评价方法评价纳入RCTs的方法学质量后,采用RevMan 5.1.4软件对提取的数据进行分析。结果纳入7个RCTs,共2 410例患者。与安慰剂相比,普瑞巴林150 mg·d~(-1)治疗GAD有效率无统计学差异[RR=1.32,95%CI(0.98,1.79),P=0.07],普瑞巴林固定剂量200～450 mg·d~(-1)[RR=1.60,95%CI(1.34,1.93),P<0.01]、600 mg·d~(-1)[RR=1.42,95%CI(1.18,1.70),P=0.000 2]以及可变剂量组[RR=1.25,95%CI(1.06,1.49),P=0.01]有效率差异均有统计学意义。与安慰剂组相比,普瑞巴林固定剂量组150～450 mg·d~(-1)以及可变剂量组因不良反应退出试验人数差异无统计学意义(分别为P=0.26,P=0.12);而普瑞巴林600 mg·d~(-1)组因不良反应退出试验人数差异有统计学意义[RR=1.76,95%CI(1.16,2.68),P=0.008]。结论普瑞巴林200～450 mg·d~(-1)治疗GAD有效且安全性好。