Screening/Spot/Colour Test of Anti-Depressants
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Fatal Toxicity of Antidepressant Drugs in Overdose
BRITISH MEDICAL JOURNAL VOLUME 295 24 OCTOBER 1987 1021 Br Med J (Clin Res Ed): first published as 10.1136/bmj.295.6605.1021 on 24 October 1987. Downloaded from PAPERS AND SHORT REPORTS Fatal toxicity of antidepressant drugs in overdose SIMON CASSIDY, JOHN HENRY Abstract dangerous in overdose, thus meriting investigation of their toxic properties and closer consideration of the circumstances in which A fatal toxicity index (deaths per million National Health Service they are prescribed. Recommendations may thus be made that prescriptions) was calculated for antidepressant drugs on sale might reduce the number offatalities. during the years 1975-84 in England, Wales, and Scotland. The We used national mortality statistics and prescription data tricyclic drugs introduced before 1970 had a higher index than the to compile fatal toxicity indices for the currently available anti- mean for all the drugs studied (p<0-001). In this group the depressant drugs to assess the comparative safety of the different toxicity ofamitriptyline, dibenzepin, desipramine, and dothiepin antidepressant drugs from an epidemiological standpoint. Owing to was significantly higher, while that ofclomipramine, imipramine, the nature of the disease these drugs are particularly likely to be iprindole, protriptyline, and trimipramine was lower. The mono- taken in overdose and often cause death. amine oxidase inhibitors had intermediate toxicity, and the antidepressants introduced since 1973, considered as a group, had significantly lower toxicity than the mean (p<0-001). Ofthese newer drugs, maprotiline had a fatal toxicity index similar to that Sources ofinformation and methods of the older tricyclic antidepressants, while the other newly The statistical sources used list drugs under their generic and proprietary http://www.bmj.com/ introduced drugs had lower toxicity indices, with those for names. -
1 Supplemental Figure 1: Illustration of Time-Varying
Supplemental Material Table of Contents Supplemental Table 1: List of classes and medications. Supplemental Table 2: Association between benzodiazepines and mortality in patients initiating hemodialysis (n=69,368) between 2013‐2014 stratified by age, sex, race, and opioid co‐dispensing. Supplemental Figure 1: Illustration of time‐varying exposure to benzodiazepine or opioid claims for one person. Several sensitivity analyses were performed wherein person‐day exposure was extended to +7 days, +14 days, and +28 days beyond the outlined periods above. 1 Supplemental Table 1: List of classes and medications. Class Medications Short‐acting benzodiazepines Alprazolam, estazolam, lorazepam, midazolam, oxazepam, temazepam, and triazolam Long‐acting benzodiazepines chlordiazepoxide, clobazam, clonazepam, clorazepate, diazepam, flurazepam Opioids alfentanil, buprenorphine, butorphanol, codeine, dihydrocodeine, fentanyl, hydrocodone, hydromorphine, meperidine, methadone, morphine, nalbuphine, nucynta, oxycodone, oxymorphone, pentazocine, propoxyphene, remifentanil, sufentanil, tapentadol, talwin, tramadol, carfentanil, pethidine, and etorphine Antidepressants citalopram, escitalopram, fluoxetine, fluvozamine, paroxetine, sertraline; desvenlafaxine, duloxetine, levomilnacipran, milnacipran, venlafaxine; vilazodone, vortioxetine; nefazodone, trazodone; atomoxetine, reboxetine, teniloxazine, viloxazine; bupropion; amitriptyline, amitriptylinoxide, clomipramine, desipramine, dibenzepin, dimetacrine, dosulepin, doxepin, imipramine, lofepramine, melitracen, -
Tricyclic Antidepressants Versus
Jørgensen et al. Syst Rev (2021) 10:227 https://doi.org/10.1186/s13643-021-01789-0 PROTOCOL Open Access Tricyclic antidepressants versus ‘active placebo’, placebo or no intervention for adults with major depressive disorder: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis Caroline Kamp Jørgensen1* , Sophie Juul1,2,3, Faiza Siddiqui1, Marija Barbateskovic1, Klaus Munkholm4, Michael Pascal Hengartner5, Irving Kirsch6, Christian Gluud1 and Janus Christian Jakobsen1,7 Abstract Background: Major depressive disorder is a common psychiatric disorder causing great burden on patients and societies. Tricyclic antidepressants are frequently used worldwide to treat patients with major depressive disorder. It has repeatedly been shown that tricyclic antidepressants reduce depressive symptoms with a statistically signifcant efect, but the efect is small and of questionable clinical importance. Moreover, the benefcial and harmful efects of all types of tricyclic antidepressants have not previously been systematically assessed. Therefore, we aim to investigate the benefcial and harmful efects of tricyclic antidepressants versus ‘active placebo’, placebo or no intervention for adults with major depressive disorder. Methods: This is a protocol for a systematic review with meta-analysis that will be reported as recommended by Pre- ferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols, bias will be assessed with the Cochrane Risk of Bias tool—version 2, our eight-step procedure will be used to assess if the thresholds for clinical signifcance are crossed, Trial Sequential Analysis will be conducted to control random errors and the certainty of the evidence will be assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. -
Effect of Depression and Diabetes Mellitus on the Risk for Dementia: a National Population-Based Cohort Study
Supplementary Online Content Katon W, Pedersen HS, Ribe AR, et al. Effect of depression and diabetes mellitus on the risk for dementia: a national population-based cohort study. JAMA Psychiatry. Published online April 15, 2015. doi:10.1001/jamapsychiatry.2015.0082. eAppendix 1. Information on Depression Obtained From the Danish Psychiatric Central Research Register and the Danish National Prescription Registry eAppendix 2. Information on Severe Mental Illness Obtained From the Danish Psychiatric Central Research Register eAppendix 3. Information on Diabetes Mellitus Obtained From the Danish National Diabetes Register eAppendix 4. Information on Dementia Obtained From the Danish Psychiatric Central Research Register, the Danish National Patient Register, and the Danish National Prescription Registry eAppendix 5. Information on Marital Status Obtained From the Danish Civil Registration System eAppendix 6. Information on Chronic Diseases and Diabetic Complications Obtained From the Danish National Patient Register This supplementary material has been provided by the authors to give readers additional information about their work. © 2015 American Medical Association. All rights reserved. 1 Downloaded From: https://jamanetwork.com/ on 09/23/2021 eAppendix 1. Information on depression obtained from the Danish Psychiatric Central Research Register and the Danish National Prescription Registry A diagnosis of depression was identified if at least one of the following criteria applied: 1. Registration of a diagnosis of depression in the Danish -
CCDAN Search Strategies (All Antidepressants)
CCDAN search strategies (all antidepressants) 1. Cochrane Depression, Anxiety and Neurosis Review Group’s Specialized Register (CCDANCTR) #1 (antidepress* or anti-depress* or "anti depress*" or MAOI* or RIMA* or “monoamine oxidase inhibit*” or ((serotonin or norepinephrine or noradrenaline or neurotransmitter* or dopamin*) NEAR (uptake or reuptake or re-uptake or "re uptake")) or SSRI* or SNRI* or NARI* or SARI* or NDRI* or TCA* or tricyclic* or tetracyclic* or pharmacotherap* or psychotropic* or "drug therapy") #2 (Agomelatine or Alaproclate or Amoxapine or Amineptine or Amitriptylin* or Amitriptylinoxide or Atomoxetine or Befloxatone or Benactyzine or Binospirone or Brofaromine or (Buproprion or Amfebutamone) or Butriptyline or Caroxazone or Cianopramine or Cilobamine or Cimoxatone or Citalopram or (Chlorimipramin* or Clomipramin* or Chlomipramin* or Clomipramine) or Clorgyline or Clovoxamine or (CX157 or Tyrima) or Demexiptiline or Deprenyl or (Desipramine* or Pertofrane) or Desvenlafaxine or Dibenzepin or Diclofensine or Dimetacrin* or Dosulepin or Dothiepin or Doxepin or Duloxetine or Desvenlafaxine or DVS-233 or Escitalopram or Etoperidone or Femoxetine or Fluotracen or Fluoxetine or Fluvoxamine or (Hyperforin or Hypericum or “St John*”) or Imipramin* or Iprindole or Iproniazid* or Ipsapirone or Isocarboxazid* or Levomilnacipran or Lofepramine* or (“Lu AA21004” or Vortioxetine) or "Lu AA24530" or (LY2216684 or Edivoxetine) or Maprotiline or Melitracen or Metapramine or Mianserin or Milnacipran or Minaprine or Mirtazapine or Moclobemide -
Antidepressants for Insomnia in Adults (Review)
Cochrane Database of Systematic Reviews Antidepressants for insomnia in adults (Review) Everitt H, Baldwin DS, Stuart B, Lipinska G, Mayers A, Malizia AL, Manson CCF, Wilson S Everitt H, Baldwin DS, Stuart B, Lipinska G, Mayers A, Malizia AL, Manson CCF, Wilson S. Antidepressants for insomnia in adults. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD010753. DOI: 10.1002/14651858.CD010753.pub2. www.cochranelibrary.com Antidepressants for insomnia in adults (Review) Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . ..... 4 BACKGROUND .................................... 6 OBJECTIVES ..................................... 8 METHODS ...................................... 8 Figure1. ..................................... 10 RESULTS....................................... 12 Figure2. ..................................... 14 Figure3. ..................................... 15 Figure4. ..................................... 24 ADDITIONALSUMMARYOFFINDINGS . 27 DISCUSSION ..................................... 32 AUTHORS’CONCLUSIONS . 35 ACKNOWLEDGEMENTS . 35 REFERENCES ..................................... 36 CHARACTERISTICSOFSTUDIES . 41 DATAANDANALYSES. 95 Analysis 1.1. Comparison 1 Selective serotonin reuptake inhibitors (SSRI) versus other antidepressants, Outcome 1 Subjective measure of sleep quality. ...... 96 -
Antidepressant” a Review of the Evidence for on and Off Label Uses
9/25/2020 The Versatile “Antidepressant” A review of the evidence for on and off label uses Mark Aksamit MPAS, PA-C, PSY-CAQ Kelly Gassman MPAS, PA-C 1 Introductions • Mark Aksamit – Nothing to disclose • Assistant Professor UNMC PA Program • Co-Director Psychiatry Department Treatment Resistant Depression Subspecialty • Transplant Psychiatry • Kelly Gassman – Nothing to disclose • Addiction Psychiatry Subspecialty • Treatment Resistant Depression Subspecialty 2 1 9/25/2020 Objectives • Describe the hypothesized roles of specific neurotransmitters and receptors (antidepressants) in treating various psychiatric and medical conditions. • Explain hypothesized mechanisms of action for various psychotropic medications. • Evaluate the evidence for on and off-label usage of various psychotropic medications within the context of medical comorbidity. 3 Overview Today’s Topics 1. Introduction to “antidepressants” 2. Proposed MOAs of various antidepressants 3. Different conditions antidepressants are proposed to help with 4. Review of evidence for & against complementary use in comorbid conditions 4 2 9/25/2020 “Antidepressants” • Commonly known to help with various psychiatric conditions • What is depression? • Polypharmacy a growing problem 5 SSRIs & SNRIs Selective Serotonin Serotonin-Norepinephrine Reuptake Inhibitors Reuptake Inhibitors Citalopram Desvenlafaxine Escitalopram Duloxetine Fluoxetine Levomilnacipran Fluvoxamine Milnacipran Venlafaxine Paroxetine Sertraline 6 3 9/25/2020 TCAs Tricyclic Antidepressants • Amitriptyline • Lofepramine -
UPDATE on NEURO/PSYCH MEDICATIONS Steve Williams, Pharm.D
UPDATE ON NEURO/PSYCH MEDICATIONS Steve Williams, Pharm.D. - clinical pharmacist, clinical professor DEMENTIA Type of % of Symptoms Pathology Dementia Dementias Alzheimer’s Memory: names, recent Atrophy 55 events, language generalized, deficits (aphasia, esp. apraxia), Late: temporal, pit. mood/aggression Lewy Body Visual hallucinations, Atrophy, 20 cognition fluctuation Lewy bodies Parkinsonian: gait, cortex tremor, rigid tone, falls – sensitive to antipsychotics, PD meds Vascular Focal signs, stepwise Stroke, 15 decline diabetes Pseudo Mimics dementia Depression, * bipolar, Other Nutritional, trauma, Fe, B12, 10 AIDS, thyroid, folate, drugs/alcohol ADUCANUMAB • Sept 1 2016 Nature • MAB targeting amyloid plaque • Scientists may have ‘game changer’ drug to treat Alzheimer’s Type of % of Symptoms Pathology Dementia Dementias Alzheimer’s Memory: names, recent Atrophy 55 events, language generalized, deficits, aphasia, esp. apraxia, Late: temporal, pit. mood/aggression Lewy Body Visual hallucinations, Atrophy, 20 cognition fluctuation Lewy bodies Parkinsonian: gait, cortex tremor, rigid tone, falls – sensitive to antipsychotics, PD meds Vascular Focal signs, stepwise Stroke, 15 decline diabetes Pseudo Mimics dementia Depression, * bipolar, Other Nutritional, trauma, Fe, B12, 10 AIDS, thyroid, folate, drugs/alcohol NUPLAZID (PIMAVANSERIN) • Parkinson’s Disease - Psychosis • Caused by low dopamine • Medications increasing dopamine can cause hallucinations • Clozapine and Quetiapine used – mechanism is serotonin (5-HT2A) receptor blockade • -
The Problem of Tricyclic Antidepressant Poisoning PETER CROME BELINDA NEWMAN M.B., M.R.C.P
Postgrad Med J: first published as 10.1136/pgmj.55.646.528 on 1 September 1979. Downloaded from Postgraduate Medical Jouirnal (August 1979) 55, 528-532 The problem of tricyclic antidepressant poisoning PETER CROME BELINDA NEWMAN M.B., M.R.C.P. B.A., M.Sc. Poisons Unit, Guy's Hospital, London SE] 9RT Summary Edinburgh Poisons Treatment Centre. Their con- In the year May 1976 to April 1977, 489 enquiries clusions were that most of these patients were not about the management of tricyclic antidepressant severely affected and that recovery was usually poisoning received at the London Centre of the Nat- rapid and uneventful, supportive treatment being all ional Poisons Information Service were followed-up. that was necessary. In their study no patients re- One hundred and sixty-four patients (33-5%) were quired artificial ventilation and there were no deaths. unconscious, convulsions occurred in 62 (12-7y/), hy- It seemed possible to the present authors that those potension in 31 (6-3%), respiratory depression in 28 findings no longer held true, for since then both the (5-70%), tachydysrhythmias in 17 (3-5%) and cardiac number of different antidepressants and the number arrest in 12 patients (2-5%). Sixteen patients died of admissions to hospital have increased. Support (3.30%). No statistically significant differences were for this view comes in a study from the same unitProtected by copyright. found between individual antidepressants although which reported that the proportion of patients poisoning with amitriptyline-like drugs resulted in a admitted with poisoning from these drugs who were significantly higher proportion of unconscious patients in Grade IV coma had increased from 3-90 in the than poisoning with imipramine-like drugs (P< 0-01). -
Antidepressants and Movement Disorders
Revet et al. BMC Psychiatry (2020) 20:308 https://doi.org/10.1186/s12888-020-02711-z RESEARCH ARTICLE Open Access Antidepressants and movement disorders: a postmarketing study in the world pharmacovigilance database Alexis Revet1,2,3* , François Montastruc1,2,4, Anne Roussin1,2,4, Jean-Philippe Raynaud2,3, Maryse Lapeyre-Mestre1,2,4 and Thi Thu Ha Nguyen1,2 Abstract Background: Antidepressants-induced movement disorders are rare and imperfectly known adverse drug reactions. The risk may differ between different antidepressants and antidepressants’ classes. The objective of this study was to assess the putative association of each antidepressant and antidepressants’ classes with movement disorders. Methods: Using VigiBase®, the WHO Pharmacovigilance database, disproportionality of movement disorders’ reporting was assessed among adverse drug reactions related to any antidepressant, from January 1967 to February 2017, through a case/non-case design. The association between nine subtypes of movement disorders (akathisia, bruxism, dystonia, myoclonus, parkinsonism, restless legs syndrome, tardive dyskinesia, tics, tremor) and antidepressants was estimated through the calculation first of crude Reporting Odds Ratio (ROR), then adjusted ROR on four potential confounding factors: age, sex, drugs described as able to induce movement disorders, and drugs used to treat movement disorders. Results: Out of the 14,270,446 reports included in VigiBase®, 1,027,405 (7.2%) contained at least one antidepressant, among whom 29,253 (2.8%) reported movement disorders. The female/male sex ratio was 2.15 and the mean age 50.9 ± 18.0 years. We found a significant increased ROR for antidepressants in general for all subtypes of movement disorders, with the highest association with bruxism (ROR 10.37, 95% CI 9.62–11.17) and the lowest with tics (ROR 1.49, 95% CI 1.38–1.60). -
Appendix & Tables
Supplemental materials for: Maund E, Stuart B, Moore M, et al. Managing antidepressant discontinuation: a systematic review. Ann Fam Med. 2019;17(1):52-60. 1 Supplemental APPENDIX 1 - SEARCH STRATEGIES MEDLINE Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946 to 23 March 2017 Search Query Items ID# found 1 exp ANTIDEPRESSIVE AGENTS/ 133782 2 exp NEUROTRANSMITTER UPTAKE INHIBITORS/ 133192 3 (psychotropic* or antidepress* or anti depress* or ((serotonin or norepinephrine or 136112 noradrenaline or nor epinephrine or nor adrenaline or neurotransmitt* or dopamine*) and (uptake or reuptake or re-uptake)) or noradrenerg* or antiadrenergic or anti adrenergic or SSRI* or SNRI* or TCA* or tricyclic* or tetracyclic* or heterocyclic*).ti,kf,hw. 4 (Agomelatine or Alaproclate or Alnespirone or Amoxapine or Amersergide or 44215 Amfebutamone or Amiflamine or Amineptine or Amitriptylin* or Amitriptylinoxide or Amoxapine or Aripiprazole or Atomoxetine or Tomoxetine or Befloxatone or Benactyzine or Binospirone or Brofaromine or Bupropion or Butriptylin*or Caroxazone or Chlopoxiten or Cianopramine or Cilobamine or Cilosamine or Cimoxatone or Citalopram or (Chlorimipramin* or Clomipramin* or Chlomipramin* or Clorimipramine) or Clorgyline or Clovoxamine or Dapoxetine or Deanol or Dibenzepin or Demexiptilin* or Deprenyl or Desipramine or Desvenlafaxine or Dibenzepin or Diclofensin* or Dimetacrin* or (Dosulepin or Dothiepin) or Doxepin or Duloxetine or DVS 233 or Enilospirone or Eptapirone -
Table [1]: Definition of Reported Outcomes Study Outcome
Table [1]: Definition of reported outcomes Study outcome Definitions Adverse events Treatment side effect Depression severity and Change in depression symptoms from baseline using depression standardized treatment efficacy scale (PHQ-9 ,Beck Depression Inventory (BDI),BDI for primary care, Zung Self-Rating Depression Scale (SDS),Center for Epidemiologic Studies- Depression Scale (CES-D),Center for Epidemiologic Studies-Depression Scale (CES-D), Montgomery-Asberg Depression Rating Scale (MADRS), Minnesota Multiphasic Personality Inventory (MMPI), depression symptoms improvement. Dropout rate Percentage of patients who dropout from each treatment arm. Clinical Response ≥30%depression improvement (from baseline to endpoint). Remission Scores lower than 8 in the HAMD or more than 70% depression improvement. Relapse rate Return of symptoms to the full syndrome criteria for an episode during remission. Table[2]: Characteristics of the systematic reviews Author, year Studies Study Population/ country Interventions Comparison Outcome Alyson 201220 23 RCTs 211 patients / NR Group CBT Control -Depression severity measured by any standardized Scale Almeida 201521 11 RCTs Patients with depression Naturopathic Control -Depression (6 studies symptoms / NR severity measured included into by any our analysis) standardized Scale Amick 201522 11 RCTs Canada, Germany, England, AD CBT - Depression (6 studies Iran, Romania and United States severity measured included into by any our analysis) standardized scale -Response -Remission Arnberg 201423 40 RCTs 260 patients were included CCBT WL -Depression (only three Switzerland, Australia, Sweden severity measured studies were by any included to standardized our analysis) scale Berlim 201424 29 RCTS Subjects aged 18–75 years Biological Control -Response (only 17 with a diagnosis of primary MD/ intervention -Remission rates studies were NR -drop-out included to rates our analysis) Bower 201125 9 RCTS Participants (age 18+) with Psychotherapy -AD -Depression (only three depression.