Suicidal bupropion ingestions in adolescents: increased morbidity compared with other antidepressants

Objective: Bupropion is often categorized as a newer generation antidepressant and assessed with serotonin reuptake inhibitors as a lower risk than older tricyclic antidepressants (TCAs). The objective of this study was to compare outcomes in adolescent suicide from ingestions between bupropion and TCA medications.

Study design: An analysis of the National Poison Data System for exposures coded “suspected suicide” in adolescents (age: 13–19) was undertaken for the years 2013–2016 and included TCAs or bupropion. We compared clinical effects, therapies and medical outcomes.

Results: Over the four-year period there were 2253 bupropion and 1496 TCA adolescent suspected suicide calls. There was a significant linear increase in bupropion ingestions over the four years. Across all years, there were on average 189.2 (95% CI: 58.1–320.4; p?=?.01) more ingestions of bupropion than TCA. When comparing bupropion to a TCA, ingestions of bupropion were significantly more likely to be accompanied by seizure (30.7% vs 3.9%; p?p?p?p?p?Conclusions: Adolescents who overdose on a single medication in a suicide attempt with bupropion have a statistically significant higher incidence of major outcomes and seizures. The risks of bupropion as a potential means of suicidal gesture by overdose must be considered, and weighed against its benefits and side effect profile when choosing an appropriate agent for the treatment of depression in adolescents.     

Electrical and contractile consequences of Na+ or Ca2+ gradient reduction in cultured heart cells

The normal electrical and contractile activity of cultured neonatal rat ventricular cells is characterized and compared to activity seen in low [Ca²⁺]₀ and low [Na⁺]₀ solutions. In 0 Ca²⁺/0.5 mm EGTA solutions electrical activity is altered: the maximum diastolic potential (m.d.p.), maximum rate of rise ($\text{+}\text{V}\text{?}{}_{\mathrm{<mtext>max</mtext>}}$), and overshoot (o.s.) are reduced, while duration is increased. Low [Ca²⁺]₀ activity is insensitive to TTX and blocked by La³⁺. In low [Na⁺]₀ solutions electrical activity is generally absent; when present $\text{+}\text{V}\text{?}{}_{\mathrm{<mtext>max</mtext>}}$ and o.s. are decreased while duration is increased. Low [Na⁺]₀ activity is blocked by La³⁺. These data suggest the presence of one La³⁺-sensitive slow inward current channel. The absence of spontaneous electrical activity in low [Na⁺]₀ solutions suggests an inhibition of automaticity. To determine if this inhibition is due to a reduction of the Na⁺ gradient, drugs which raise [Na⁺]_i were examined. Both monensin (a Na⁺ ionophore) and ouabain inhibit the occurrence of spontaneous action potentials (cells respond to stimulation) indicating a dependence of pacemaker activity on a normal Na⁺ gradient. During Na⁺ gradient reduction, asynchronous subcellular contractile activity occurs independent of membrane potential fluctuation. This asynchronous activity is inhibited by La³⁺ or when Ca²⁺₀ is absent, but continues in the presence of verapamil (normal activity is blocked by all three conditions). The Na⁺Ca²⁺ exchange system is unaffected by verapamil but blocked by La³⁺, while both these drugs block the slow inward current. These data indicate that the Na⁺Ca²⁺ exchange system can directly supply Ca²⁺ (independent of electrical activity at the membrane) to intracellular sites that support contractile activity.     

Risk of Second Cancers in Patients with Colorectal Carcinoids

INTRODUCTION: It is often stated that patients with colorectal carcinoid tumors have an increased risk of developing other malignancies. However, this risk has not been conclusively documented. A comprehensive evaluation is needed to more thoroughly assess the risk of second cancers in patients with colorectal carcinoids. METHODS: A search of the National Cancer Institute Surveillance, Epidemiology, and End Result database from 1973 to 1996 revealed 2,086 patients with colorectal carcinoids. This subset of patients was examined for occurrence of second cancers. The observed incidence of cancer for each site was compared with the expected incidence based on the gender-adjusted and age-adjusted cancer rates in the remaining Surveillance, Epidemiology, and End Result file. A Poisson distribution probability was used to determine the significance of these comparisons. RESULTS: Patients with colorectal carcinoids had an increased rate of cancer in the colon and rectum (P < 0.001), small bowel (P < 0.001), esophagus/stomach (P = 0.02), lung/bronchus (P < 0.001), urinary tract (P = 0.005), and prostate (P < 0.001), when compared with a control population. Most of the gastrointestinal tract cancers were synchronous cancers, whereas lesions outside the gastrointestinal tract were most commonly metachronous tumors. CONCLUSIONS: A significantly increased risk of synchronous colorectal, small-bowel, gastric, and esophageal cancers and metachronous lung, prostate, and urinary tract neoplasms is clearly demonstrated. After the diagnosis of colorectal carcinoid tumors, patients should undergo appropriate screening and surveillance for cancer at these sites.