Trimipramine (Surmontil®): Guidance on Withdrawal
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Stopping Antidepressants
Stopping antidepressants This information is for anyone who wants to know more about stopping antidepressants. It describes: symptoms that you may get when stopping an antidepressant some ways to reduce or avoid these symptoms. This patient information accurately reflects recommendations in the NICE guidance on depression in adults Disclaimer This resource provides information, not advice. The content in this resource is provided for general information only. It is not intended to, and does not, amount to advice which you should rely on. It is not in any way an alternative to specific advice. You must therefore obtain the relevant professional or specialist advice before taking, or refraining from, any action based on the information in this resource. If you have questions about any medical matter, you should consult your doctor or other professional healthcare provider without delay. If you think you are experiencing any medical condition, you should seek immediate medical attention from a doctor or other professional healthcare provider. Although we make reasonable efforts to compile accurate information in our resources and to update the information in our resources, we make no representations, warranties or guarantees, whether express or implied, that the content in this resource is accurate, complete or up to date. What are antidepressants? They are medications prescribed for depressive illness, anxiety disorder or obsessive- compulsive disorder (OCD). You can find out more about how they work, why they are prescribed, their effects and side-effects, and alternative treatments in our separate resource on antidepressants. Usually, you don’t need to take antidepressants for more than 6 to 12 months. -
Dose Equivalents of Antidepressants Evidence-Based Recommendations
Journal of Affective Disorders 180 (2015) 179–184 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad Research report Dose equivalents of antidepressants: Evidence-based recommendations from randomized controlled trials Yu Hayasaka a,n, Marianna Purgato b, Laura R Magni c, Yusuke Ogawa a, Nozomi Takeshima a, Andrea Cipriani b,d, Corrado Barbui b, Stefan Leucht e, Toshi A Furukawa a a Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo- ku, Kyoto 606-8501, Japan b Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico “G.B.Rossi”, Pzz.le L.A. Scuro, 10, Verona 37134, Italy c Psychiatric Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy d Department of Psychiatry, University of Oxford, Oxford, UK e Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany article info abstract Article history: Background: Dose equivalence of antidepressants is critically important for clinical practice and for Received 4 February 2015 research. There are several methods to define and calculate dose equivalence but for antidepressants, Received in revised form only daily defined dose and consensus methods have been applied to date. The purpose of the present 10 March 2015 study is to examine dose equivalence of antidepressants by a less arbitrary and more systematic method. Accepted 12 March 2015 Methods: We used data from all randomized, double-blind, flexible-dose trials comparing fluoxetine or Available online 31 March 2015 paroxetine as standard drugs with any other active antidepressants as monotherapy in the acute phase Keywords: treatment of unipolar depression. -
Drugs Inducing Insomnia As an Adverse Effect
2 Drugs Inducing Insomnia as an Adverse Effect Ntambwe Malangu University of Limpopo, Medunsa Campus, School of Public Health, South Africa 1. Introduction Insomnia is a symptom, not a stand-alone disease. By definition, insomnia is "difficulty initiating or maintaining sleep, or both" or the perception of poor quality sleep (APA, 1994). As an adverse effect of medicines, it has been documented for several drugs. This chapter describes some drugs whose safety profile includes insomnia. In doing so, it discusses the mechanisms through which drug-induced insomnia occurs, the risk factors associated with its occurrence, and ends with some guidance on strategies to prevent and manage drug- induced insomnia. 2. How drugs induce insomnia There are several mechanisms involved in the induction of insomnia by drugs. Some drugs affects sleep negatively when being used, while others affect sleep and lead to insomnia when they are withdrawn. Drugs belonging to the first category include anticonvulsants, some antidepressants, steroids and central nervous stimulant drugs such amphetamine and caffeine. With regard to caffeine, the mechanism by which caffeine is able to promote wakefulness and insomnia has not been fully elucidated (Lieberman, 1992). However, it seems that, at the levels reached during normal consumption, caffeine exerts its action through antagonism of central adenosine receptors; thereby, it reduces physiologic sleepiness and enhances vigilance (Benington et al., 1993; Walsh et al., 1990; Rosenthal et al., 1991; Bonnet and Arand, 1994; Lorist et al., 1994). In contrast to caffeine, methamphetamine and methylphenidate produce wakefulness by increasing dopaminergic and noradrenergic neurotransmission (Gillman and Goodman, 1985). With regard to withdrawal, it may occur in 40% to 100% of patients treated chronically with benzodiazepines, and can persist for days or weeks following discontinuation. -
Cambridgeshire and Peterborough Joint Prescribing Group MEDICINE REVIEW
Cambridgeshire and Peterborough Joint Prescribing Group MEDICINE REVIEW Name of Medicine / Trimipramine (Surmontil®) Class (generic and brand) Licensed indication(s) Treatment of depressive illness, especially where sleep disturbance, anxiety or agitation are presenting symptoms. Sleep disturbance is controlled within 24 hours and true antidepressant action follows within 7 to 10 days. Licensed dose(s) Adults: For depression 50-75 mg/day initially increasing to 150-300 mg/day in divided doses or one dose at night. The maintenance dose is 75-150 mg/day. Elderly: 10-25 mg three times a day initially. The initial dose should be increased with caution under close supervision. Half the normal maintenance dose may be sufficient to produce a satisfactory clinical response. Children: Not recommended. Purpose of Document To review information currently available on this class of medicines, give guidance on potential use and assign a prescribing classification http://www.cambsphn.nhs.uk/CJPG/CurrentDrugClassificationTable.aspx Annual cost (FP10) 10mg three times daily: £6,991 25mg three times daily: £7,819 150mg daily: £7,410 300mg daily: £14,820 Alternative Treatment Options within Class Tricyclic Annual Cost CPCCG Formulary Classification Antidepressant (FP10) Amitriptyline (75mg) Formulary £36 Lofepramine (140mg) Formulary £146 Imipramine (75mg) Non-formulary £37 Clomipramine (75mg) Non-formulary £63 Trimipramine (75mg). TBC £7,819 Nortriptyline (75mg) Not Recommended (pain) £276 Doxepin (150mg) TBC £6,006 Dosulepin (75mg) Not Recommended (NICE DO NOT DO) £19 Dosages are based on possible maintenance dose and are not equivalent between medications Recommendation It is recommended to Cambridgeshire and Peterborough CCG JPG members and through them to local NHS organisations that the arrangements for use of trimipramine are in line with restrictions agreed locally for drugs designated as NOT RECOMMENDED:. -
THE USE of MIRTAZAPINE AS a HYPNOTIC O Uso Da Mirtazapina Como Hipnótico Francisca Magalhães Scoralicka, Einstein Francisco Camargosa, Otávio Toledo Nóbregaa
ARTIGO ESPECIAL THE USE OF MIRTAZAPINE AS A HYPNOTIC O uso da mirtazapina como hipnótico Francisca Magalhães Scoralicka, Einstein Francisco Camargosa, Otávio Toledo Nóbregaa Prescription of approved hypnotics for insomnia decreased by more than 50%, whereas of antidepressive agents outstripped that of hypnotics. However, there is little data on their efficacy to treat insomnia, and many of these medications may be associated with known side effects. Antidepressants are associated with various effects on sleep patterns, depending on the intrinsic pharmacological properties of the active agent, such as degree of inhibition of serotonin or noradrenaline reuptake, effects on 5-HT1A and 5-HT2 receptors, action(s) at alpha-adrenoceptors, and/or histamine H1 sites. Mirtazapine is a noradrenergic and specific serotonergic antidepressive agent that acts by antagonizing alpha-2 adrenergic receptors and blocking 5-HT2 and 5-HT3 receptors. It has high affinity for histamine H1 receptors, low affinity for dopaminergic receptors, and lacks anticholinergic activity. In spite of these potential beneficial effects of mirtazapine on sleep, no placebo-controlled randomized clinical trials of ABSTRACT mirtazapine in primary insomniacs have been conducted. Mirtazapine was associated with improvements in sleep on normal sleepers and depressed patients. The most common side effects of mirtazapine, i.e. dry mouth, drowsiness, increased appetite and increased body weight, were mostly mild and transient. Considering its use in elderly people, this paper provides a revision about studies regarding mirtazapine for sleep disorders. KEYWORDS: sleep; antidepressive agents; sleep disorders; treatment� A prescrição de hipnóticos aprovados para insônia diminuiu em mais de 50%, enquanto de antidepressivos ultrapassou a dos primeiros. -
Mirtazapine (Remeron)
What is most important to remember? If you have questions: Strong Internal Medicine • It may take a few weeks for you to see the benefits of taking this Ask your doctor, nurse or pharmacist for medicine more information about mirtazapine (Remeron®). • Do not suddenly stop taking mirtazapine; you could have unpleasant withdrawal symptoms. Talk with your doctor about how to slowly discontinue this medicine • Seek help from a doctor or pharmacist if you have thoughts of suicide or hurting yourself • This medication may impair your thinking or reactions. Be careful if Strong Internal Medicine you drive or do anything that 601 Elmwood Avenue requires you to be alert. Ambulatory Care Facility, 5th Floor Rochester, NY 14642 • Do not start any new medications, Phone: (585) 275 -7424 over-the-counter drugs or herbal Mirtazapine (Remeron®): remedies without talking to your Visit our website at: Important Patient Information www.urmc.rochester.edu/medicine/ - doctor general-medicine/patientcare/ • If you think there has been an overdose, call your poison control center or get medical care right away What does mirtazapine (Remeron®) do? What side effects could occur with mirtazapine What are some things that I need to be aware of when • It is in a class of medications called antidepressants. It (Remeron®)? taking mirtazapine (Remeron®)? works by increasing certain types of activity in the brain • Lightheaded, dizzy, or sleepy • Tell your doctor or pharmacist if you are allergic to mirtazapine, any other medicines, foods, or substances to maintain mental balance • Blurred eyesight or a change in thinking clearly • It may take a few weeks for you to see the benefits of taking • It is used to treat depression (low mood) • Constipation, dry mouth, and weight gain this medicine. -
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. -
Psychotropic Medications Judicial Reference Guide
PSYCHOTROPIC MEDICATIONS JUDICIAL REFERENCE GUIDE (Revised Edition 7/15/10) PSYCHOTROPIC MEDICATIONS JUDICIAL REFERENCE GUIDE FIRST EDITION THE STEERING COMMITTEE ON FAMILIES AND CHILDREN IN THE COURT Distributed by Florida Supreme Court 500 South Duval Street Tallahassee, FL 32399-1900 (850) 488-0125 INTRODUCTION One of the toughest challenges facing our dependency courts is the mental health of our children. “In July 2003, the Florida Statewide Advocacy Council published a Red Item Report finding 55% of foster children…in the state of Florida had been put on powerful mind altering psychotropic drugs.”1 In order to assist in this regard, the Psychotherapeutic Medication Subcommittee of the Steering Committee on Families and Children in the Court of the Supreme Court of Florida compiled this resource guide to help judges have a better understanding of psychotropic medications and their interaction with other drugs and with mental health disorders. Recently, the tragic case of Gabriel Myers in 2009 highlighted the fact that a number of child deaths were linked to the off label use of anti-psychotic medications. This is of special concern to Dependency Judges who are ultimately responsible for children in Florida’s Foster Care system. The researchers used publically available data from the internet, FDA manufactures’ published guidelines, publically available non-copyrighted articles and Dr. Brenda Thompson graciously prepared the Psychotropic Medication Chart. Special thanks to Dr. Brenda Thompson, the Honorable Herbert J. Baumann, the Honorable Ralph C. Stoddard, General Magistrate Tracy Ellis, Avron Bernstein, Selena Schoonover, Daniel Ringhoff, Jovasha Lang and to the Members of the Psychotherapeutic Medication Subcommittee. -
Decomposition Profile Data Analysis of Multiple Drug Effects Identifies
www.nature.com/scientificreports OPEN Decomposition profle data analysis of multiple drug efects identifes endoplasmic reticulum stress‑inducing ability as an unrecognized factor Katsuhisa Morita1,2, Tadahaya Mizuno1,2* & Hiroyuki Kusuhara1* Chemicals have multiple efects in biological systems. Because their on‑target efects dominate the output, their of‑target efects are often overlooked and can sometimes cause dangerous adverse events. Recently, we developed a novel decomposition profle data analysis method, orthogonal linear separation analysis (OLSA), to analyse multiple efects. In this study, we tested whether OLSA identifed the ability of drugs to induce endoplasmic reticulum (ER) stress as a previously unrecognized factor. After analysing the transcriptome profles of MCF7 cells treated with diferent chemicals, we focused on a vector characterized by well‑known ER stress inducers, such as ciclosporin A. We selected fve drugs predicted to be unrecognized ER stress inducers, based on their inducing ability scores derived from OLSA. These drugs actually induced X‑box binding protein 1 splicing, an indicator of ER stress, in MCF7 cells in a concentration‑dependent manner. Two structurally diferent representatives of the fve test compounds exhibited similar results in HepG2 and HuH7 cells, but not in PXB primary hepatocytes derived from human‑liver chimeric mice. These results indicate that our decomposition strategy using OLSA uncovered the ER stress‑inducing ability of drugs as an unrecognized efect, the manifestation of which depended on the background of the cells. Small compounds have the capacity to interact with multiple cellular proteins, thereby mediating multiple efects depending on their exposure to interacting proteins. It is quite difcult to identify the full range of efects of a new chemical, even for its developers, and some factors may be unrecognized. -
Herbal Remedies and Sleep
HERBAL REMEDIES AND SLEEP • Some people use herbal remedies to treat sleep problems. They may choose this in preference to sleeping pills. • There have been studies on some of these herbs. However, not all of them have been conducted properly. For some herbs, there is virtually no evidence to show whether they are effective or not. • The most frequently studied herbs are Valerian, Kava, Hops, Chamomile, and Passionflower. However, there is little convincing evidence to suggest that they work well for improving sleep. • Some herbal remedies have been associated with adverse health effects. Note: All words that are underlined relate to topics in the Sleep Health Foundation Information Library at www.sleephealthfoundation.org.au 1. Why try herbs to help your sold by a specific manufacturer for a certain time-period. Trials testing effectiveness are expensive, and without a patent, companies may not sleep? be able to recover their costs through guaranteed sales, even if the herb has potential. However, there have been studies of some herbs About 40% of people use alternative or complementary medicines at used for insomnia and anxiety. Here we focus on herbs where least occasionally, and 4.5% use them to treat sleep problem. Some reasonable information exists from clinical research trials. people who are concerned about using sleeping pills will turn to herbal remedies to help them sleep (see our page on Sleeping Tablets). Melatonin is not a herbal remedy (for more information see Melatonin). 3. What does the evidence say about herbs helping sleep? 2. Has the effectiveness of herbs In the table below, we look at the effectiveness of eight herbal remedies in treating sleep problems as treatments of insomnia. -
Association of Selective Serotonin Reuptake Inhibitors with the Risk for Spontaneous Intracranial Hemorrhage
Supplementary Online Content Renoux C, Vahey S, Dell’Aniello S, Boivin J-F. Association of selective serotonin reuptake inhibitors with the risk for spontaneous intracranial hemorrhage. JAMA Neurol. Published online December 5, 2016. doi:10.1001/jamaneurol.2016.4529 eMethods 1. List of Antidepressants for Cohort Entry eMethods 2. List of Antidepressants According to the Degree of Serotonin Reuptake Inhibition eMethods 3. Potential Confounding Variables Included in Multivariate Models eMethods 4. Sensitivity Analyses eFigure. Flowchart of Incident Antidepressant (AD) Cohort Definition and Case- Control Selection eTable 1. Crude and Adjusted Rate Ratios of Intracerebral Hemorrhage Associated With Current Use of SSRIs Relative to TCAs eTable 2. Crude and Adjusted Rate Ratios of Subarachnoid Hemorrhage Associated With Current Use of SSRIs Relative to TCAs eTable 3. Crude and Adjusted Rate Ratios of Intracranial Extracerebral Hemorrhage Associated With Current Use of SSRIs Relative to TCAs. eTable 4. Crude and Adjusted Rate Ratios of Intracerebral Hemorrhage Associated With Current Use of Antidepressants With Strong Degree of Inhibition of Serotonin Reuptake Relative to Weak eTable 5. Crude and Adjusted Rate Ratios of Subarachnoid Hemorrhage Associated With Current Use of Antidepressants With Strong Degree of Inhibition of Serotonin Reuptake Relative to Weak eTable 6. Crude and Adjusted Rate Ratios of Intracranial Extracerebral Hemorrhage Associated With Current Use of Antidepressants With Strong Degree of Inhibition of Serotonin Reuptake Relative to Weak This supplementary material has been provided by the authors to give readers additional information about their work. © 2016 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/02/2021 eMethods 1. -
Current and Experimental Therapeutics of Insomnia
133 CURRENT AND EXPERIMENTAL THERAPEUTICS OF INSOMNIA DANIEL J. BUYSSE CYNTHIA M. DORSEY 15% (4,5). Epidemiologic studies point to a consistent set of risk factors for insomnia. These include a previous history INSOMNIA: DEFINITIONS, IMPACT, AND of insomnia, increasing age, female gender, psychiatric DIAGNOSIS symptoms and disorders, medical symptoms and disorders, impaired activities of daily living, anxiolytic and hypnotic Definition of Insomnia Symptoms and medication use, and low socioeconomic status. The increas- Disorders ing prevalence of insomnia with age may be explained in large part by increasing comorbidity with medical and psy- Insomnia can refer to either a symptom or clinical disorder. chiatric disorders and medication use. The incidence of in- The symptom of insomnia is the subjective complaint of somnia also increases with age and is greater in women than difficulty falling or staying asleep, poor quality sleep, or men. On the other hand, remission of insomnia decreases inadequate sleep duration, despite having an adequate op- with age and is less common in women. Together, preva- portunity for sleep. Two points in this definition deserve lence, incidence, and remission data indicate that insomnia specific attention. First, insomnia is a subjective complaint is often a chronic condition. Between 50% and 80% of not currently defined by laboratory test results or a specific individuals with insomnia at baseline have a persistent com- duration of sleep or wakefulness. Second, the insomnia plaint after follow-up intervals of 1 to 3.5 years (1,6–8). symptom occurs despite the individual having adequate op- portunity to sleep. This distinguishes insomnia from sleep deprivation, which has different causes, consequences, and Impact of Insomnia clinical presentations.