RESUMEN
BACKGROUND: Although a large variety of antidepressants agents (AD) with different mechanisms of action are available, no significant differences in efficacy and safety have been shown. However, there have been few attempts to incorporate data on subjective experiences under different AD. METHOD: We conducted a qualitative and quantitative analysis of the posts from the website www.askapatient.com from different AD. We reviewed a random sample of 1000 posts. RESULT: After applying the inclusion and exclusion criteria, we included a final sample of 450 posts, 50 on each of the most used AD: sertraline, citalopram, paroxetine, escitalopram, fluoxetine, venlafaxine, duloxetine, mirtazapine, and bupropion. Bupropion, citalopram, and venlafaxine had the higher overall satisfaction ratings. Sertraline, paroxetine, and fluoxetine had high reports of emotional blunting, while bupropion very few. Overall satisfaction with AD treatment was inversely associated with the presence of the following side-effects: suicidality, irritability, emotional blunting, cognitive disturbances, and withdrawal symptoms. After adjusting for confounders, only emotional blunting was shown to be more frequently reported by users of serotonergic agents, as compared to non-serotoninergic agents. CONCLUSION: This research points out that the subjective experience of patients under treatment should be taken into consideration when selecting an AD as differences between agents were evident. In contrast to the more frequent treatment decisions, users might prefer receiving a non-serotoninergic agent over a serotonergic one due to their lower propensity to produce emotional blunting.
Asunto(s)
Citalopram , Paroxetina , Humanos , Clorhidrato de Venlafaxina/efectos adversos , Fluoxetina/efectos adversos , Bupropión/efectos adversos , Sertralina , Antidepresivos/efectos adversosRESUMEN
INTRODUCTION: Using fluoxetine is one of many weight loss strategies. A serotonin reuptake inhibitor indicated for depression believed to impact weight control by changing an individual's appetite; however, its benefit-risk ratio is unclear. The aim of this review was to assess the efficacy and safety of fluoxetine in reducing weight in adults with overweight or obesity. METHODS: We searched Cochrane Library, MEDLINE, Embase, and other databases without language restrictions. Cochrane Collaboration tool and GRADE instrument assessed the risk of bias of randomized controlled trials and certainty of their evidence. We conducted random-effects meta-analyses and calculated the risk ratio/mean difference with 95% confidence intervals for the outcomes. RESULTS: We included 19 trials (2,216 adults) and found that fluoxetine may reduce weight by -2.7 kg (95% CI -4 to -1.4; p < 0.001) and body mass index by -1.1 kg/m2 (95% CI -3.7 to 1.4), compared with placebo; however, it would cause approximately twice as many adverse events, such as dizziness, drowsiness, fatigue, insomnia, or nausea. CONCLUSIONS: Although low-certainty evidence suggests that off-label fluoxetine may reduce weight, high-certainty research is needed to be conducted in the future to determine its effects exclusively as well as whether it is useful when combined with other agents. This article is based on a Cochrane Review published in the Cochrane Database of Systematic Reviews 2019, Issue 10, DOI: 10.1002/14651858.CD011688.pub2. Cochrane Reviews are regularly updated as new evidence emerges, and in response to feedback, it should be consulted for the most recent version of the review.
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Fluoxetina , Sobrepeso , Adulto , Humanos , Índice de Masa Corporal , Fluoxetina/efectos adversos , Obesidad/tratamiento farmacológico , Sobrepeso/tratamiento farmacológico , Revisiones Sistemáticas como AsuntoRESUMEN
BACKGROUND: Epilepsy has neuropsychiatric comorbidities such as depression, bipolar disorder, and anxiety. Drugs that target epilepsy may also be useful for its neuropsychiatric comorbidities. OBJECTIVE: To investigate the effects of serotonergic modulation on pro-inflammatory cytokines and the seizures in pentylenetetrazole (PTZ)-induced seizure model in rats. METHODS: Male Wistar rats were injected intraperitoneally with serotonin, selective serotonin reuptake inhibitor fluoxetine, 5-HT1B/D receptor agonist sumatriptan, or saline 30 min prior to PTZ treatment. Behavioral seizures were assessed by the Racine's scale. Concentrations of IL-1ß, IL-6, and TNF-α in serum and brain tissue were determined by ELISA. RESULTS: Serotonin and fluoxetine, but not sumatriptan, alleviated PTZ-induced seizures by prolonging onset times of myoclonic-jerk and generalized tonic-clonic seizures. The anti-seizure effect of fluoxetine was greater than that of serotonin. Likewise, serotonin and fluoxetine, but not sumatriptan, reduced PTZ-induced increases in the levels of IL-1ß and IL-6 in both serum and brain tissue. None of the administered drugs including PTZ affected TNF-α concentrations. CONCLUSIONS: Our findings suggest that endogenous and exogenous serotonin exhibits anticonvulsant effects by suppressing the neuroinflammation. It seems that 5-HT1B/D receptors do not mediate anticonvulsant and anti-neuroinflammatory effects of serotonin.
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Epilepsia , Pentilenotetrazol , Animales , Anticonvulsivantes/efectos adversos , Epilepsia/tratamiento farmacológico , Fluoxetina/efectos adversos , Humanos , Interleucina-6 , Masculino , Enfermedades Neuroinflamatorias , Pentilenotetrazol/efectos adversos , Ratas , Ratas Wistar , Convulsiones/inducido químicamente , Convulsiones/tratamiento farmacológico , Serotonina/efectos adversos , Sumatriptán/efectos adversos , Factor de Necrosis Tumoral alfaRESUMEN
ABSTRACT Background: Epilepsy has neuropsychiatric comorbidities such as depression, bipolar disorder, and anxiety. Drugs that target epilepsy may also be useful for its neuropsychiatric comorbidities. Objective: To investigate the effects of serotonergic modulation on pro-inflammatory cytokines and the seizures in pentylenetetrazole (PTZ)-induced seizure model in rats. Methods: Male Wistar rats were injected intraperitoneally with serotonin, selective serotonin reuptake inhibitor fluoxetine, 5-HT1B/D receptor agonist sumatriptan, or saline 30 min prior to PTZ treatment. Behavioral seizures were assessed by the Racine's scale. Concentrations of IL-1β, IL-6, and TNF-α in serum and brain tissue were determined by ELISA. Results: Serotonin and fluoxetine, but not sumatriptan, alleviated PTZ-induced seizures by prolonging onset times of myoclonic-jerk and generalized tonic-clonic seizures. The anti-seizure effect of fluoxetine was greater than that of serotonin. Likewise, serotonin and fluoxetine, but not sumatriptan, reduced PTZ-induced increases in the levels of IL-1β and IL-6 in both serum and brain tissue. None of the administered drugs including PTZ affected TNF-α concentrations. Conclusions: Our findings suggest that endogenous and exogenous serotonin exhibits anticonvulsant effects by suppressing the neuroinflammation. It seems that 5-HT1B/D receptors do not mediate anticonvulsant and anti-neuroinflammatory effects of serotonin.
RESUMO Antecedentes: A epilepsia apresenta comorbidades neuropsiquiátricas como depressão, transtorno bipolar e ansiedade. Os medicamentos que visam o tratamento da epilepsia podem ser úteis para a epilepsia e suas comorbidades neuropsiquiátricas. Objetivo: Investigar os efeitos da modulação serotonérgica em citocinas pró-inflamatórias e as convulsões no modelo de convulsão induzida por pentilenotetrazol (PTZ) em ratos. Métodos: Ratos Wistar machos foram injetados intraperitonealmente com serotonina, inibidor seletivo da recaptação da serotonina fluoxetina, sumatriptano agonista do receptor 5-HT1B / D ou solução salina 30 min antes do tratamento com PTZ. As crises comportamentais foram avaliadas pela escala de Racine. As concentrações de IL-1β, IL-6 e TNF-α no soro e tecido cerebral foram determinadas por ELISA. Resultados: A serotonina e a fluoxetina, mas não o sumatriptano, aliviaram as convulsões induzidas por PTZ ao prolongar os tempos de início das convulsões mioclônicas e tônico-clônicas generalizadas. O efeito anticonvulsivo da fluoxetina foi maior do que o da serotonina. Da mesma forma, a serotonina e a fluoxetina, mas não o sumatriptano, reduziram os aumentos induzidos por PTZ nos níveis de IL-1β e IL-6 no soro e no tecido cerebral. Nenhum dos medicamentos administrados, incluindo PTZ, alterou as concentrações de TNF-α. Conclusões: Nossos achados sugerem que a serotonina endógena e exógena exibe efeitos anticonvulsivantes por suprimir a neuroinflamação. Aparentemente, os receptores 5-HT1B / D não medeiam os efeitos anticonvulsivantes e anti-neuroinflamatórios da serotonina.
Asunto(s)
Humanos , Animales , Masculino , Ratas , Pentilenotetrazol/efectos adversos , Epilepsia/tratamiento farmacológico , Convulsiones/inducido químicamente , Convulsiones/tratamiento farmacológico , Serotonina/efectos adversos , Fluoxetina/efectos adversos , Interleucina-6 , Factor de Necrosis Tumoral alfa , Ratas Wistar , Sumatriptán/efectos adversos , Anticonvulsivantes/efectos adversosRESUMEN
BACKGROUND AND OBJECTIVE: Fluoxetine, antidepressant widely-used during pregnancy, is a selective inhibitor for P-glycoprotein (P-gp). Fexofenadine, an in vivo P-gp probe, is an antihistamine drug for seasonal allergic rhinitis and chronic urticaria treatment during pregnancy and it is available as a racemic mixture. This study evaluated the chiral discrimination of P-gp investigating the effect of fluoxetine on maternal-fetal pharmacokinetics of fexofenadine. METHODS: Healthy parturient women received either a single oral dose of 60 mg racemic fexofenadine (Control group; n = 8) or a single oral dose of 40 mg racemic fluoxetine 3 h before a single oral dose of 60 mg racemic fexofenadine (Interaction group; n = 8). Maternal blood and urine samples were collected up to 48 h after fexofenadine administration. At delivery, maternal-placental-fetal blood samples were collected. RESULTS: The maternal pharmacokinetics of fexofenadine was enantioselective (AUC0-∞R-(+)/S-(-) ~ 1.5) in both control and interaction groups. Fluoxetine increased AUC0-∞ (267.7 vs 376.1 ng.h/mL) and decreased oral total clearance (105.1 vs 74.4 L/h) only of S-(-)-fexofenadine, whereas the renal clearance were reduced for both enantiomers, suggesting that the intestinal P-gp-mediated transport of S-(-)-fexofenadine is influenced by fluoxetine to a greater extent that the R-(+)-fexofenadine. However, the transplacental transfer of fexofenadine is low (~16%), non-enantioselective and non-influenced by fluoxetine. CONCLUSIONS: A single oral dose of 40 mg fluoxetine inhibited the intestinal P-gp mediated transport of S-(-)-fexofenadine to a greater extent than R-(+)-fexofenadine in parturient women. However, the placental P-gp did not discriminate fexofenadine enantiomers and was not inhibited by fluoxetine.
Asunto(s)
Antidepresivos de Segunda Generación/administración & dosificación , Fluoxetina/administración & dosificación , Antagonistas de los Receptores Histamínicos H1 no Sedantes/farmacocinética , Absorción Intestinal/efectos de los fármacos , Mucosa Intestinal/efectos de los fármacos , Parto , Terfenadina/análogos & derivados , Subfamilia B de Transportador de Casetes de Unión a ATP/antagonistas & inhibidores , Subfamilia B de Transportador de Casetes de Unión a ATP/metabolismo , Adulto , Antidepresivos de Segunda Generación/efectos adversos , Estudios de Casos y Controles , Interacciones Farmacológicas , Femenino , Sangre Fetal/metabolismo , Fluoxetina/efectos adversos , Antagonistas de los Receptores Histamínicos H1 no Sedantes/administración & dosificación , Antagonistas de los Receptores Histamínicos H1 no Sedantes/sangre , Humanos , Mucosa Intestinal/metabolismo , Intercambio Materno-Fetal , Circulación Placentaria , Embarazo , Terfenadina/administración & dosificación , Terfenadina/sangre , Terfenadina/farmacocinética , Adulto JovenRESUMEN
Asociada o no a una enfermedad orgánica, la depresión tiene gran prevalencia en la práctica médica pero es subdiagnosticada. El trastorno del ánimo suele coexistir con variadas quejas somáticas y dolores crónicos, configurando síndromes mixtos con un diagnóstico diferencial complejo. En este artículo se describen distintas presentaciones clínicas de la depresión en medicina general, con énfasis en los estados depresivos atípicos, depresiones enmascaradas muy relevantes por su frecuencia y consecuencias: depresión posquirúrgica, cuadros dolorosos crónicos como cefaleas o lumbago, la fatiga crónica y la fibromialgia. Solo el reconocimiento y diagnóstico de la depresión subyacente posibilitará la implementación de las adecuadas intervenciones terapéuticas. Se revisan también algunas recomendaciones para el uso de antidepresivos en atención primaria y la eventual consulta psiquiátrica. (AU)
Associated or not with an organic disease, depression has a high prevalence in medical practice but is underdiagnosed. The mood disorder usually coexists with varied somatic complaints and chronic pain, forming mixed syndromes with a complex differential diagnosis. This article describes different clinical presentations of depression in general medicine, with emphasis on atypical depressive states, masked depressions very relevant for their frequency and consequences: post-surgical depression, chronic painful conditions such as headaches or lumbago, chronic fatigue and fibromyalgia. Only the recognition and diagnosis of the underlying depression will enable the implementation of appropriate therapeutic interventions. Some recommendations for the use of antidepressant drugs in primary care and the eventual psychiatric consultation are also reviewed. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Atención Primaria de Salud/tendencias , Depresión/diagnóstico , Psiquiatría/tendencias , Signos y Síntomas , Trastornos Somatomorfos/diagnóstico , Citalopram/efectos adversos , Citalopram/uso terapéutico , Fibromialgia/complicaciones , Síndrome de Fatiga Crónica/complicaciones , Fluoxetina/efectos adversos , Fluoxetina/uso terapéutico , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Dolor de la Región Lumbar/complicaciones , Antagonistas Colinérgicos/efectos adversos , Errores Médicos , Sertralina/efectos adversos , Sertralina/uso terapéutico , Depresión/clasificación , Depresión/complicaciones , Depresión/terapia , Depresión/epidemiología , Medicina General , Dolor Crónico/complicaciones , Clorhidrato de Venlafaxina/efectos adversos , Clorhidrato de Venlafaxina/uso terapéutico , Clorhidrato de Duloxetina/efectos adversos , Clorhidrato de Duloxetina/uso terapéutico , Inhibidores de Captación de Serotonina y Norepinefrina/efectos adversos , Cefalea/complicaciones , Amitriptilina/efectos adversos , Amitriptilina/uso terapéutico , Antidepresivos/administración & dosificaciónRESUMEN
A wealth of evidence indicates that the lateral wings subnucleus of the dorsal raphe nucleus (lwDR) is implicated in the processing of panic-associated stimuli. Escape expression in the elevated T-maze, considered a panic-related defensive behavior, markedly and selectively recruits non-serotonergic cells within this DR subregion and in the dorsal periaqueductal gray (dPAG), another key panic-associated area. However, whether anti-panic drugs may interfere with this pattern of neuronal activation is still unknown. In the present study, the effects of acute (10 mg/kg) or chronic fluoxetine (10 mg/kg/daily/21 days) treatment on the number of serotonergic and non-serotonergic cells induced by escape expression within the rat DR and PAG subnuclei were investigated by immunochemistry. The results showed that chronic, but not acute, treatment with fluoxetine impaired escape expression, indicating a panicolytic-like effect, and markedly decreased the number of non-serotonergic cells that were recruited in the lwDR and dPAG. The same treatment selectively increased the number of serotonergic neurons within the lwDR. Our immunochemistry analyses also revealed that the non-serotonergic cells recruited in the lwDR and dPAG by the escape expression were not nitrergic. Overall, our findings suggest that the anti-panic effect of chronic treatment with fluoxetine is mediated by stimulation of the lwDR-dPAG pathway that controls the expression of panic-associated escape behaviors.
Asunto(s)
Núcleo Dorsal del Rafe/metabolismo , Fluoxetina/efectos adversos , Pánico/efectos de los fármacos , Neuronas Serotoninérgicas/metabolismo , Animales , Conducta Animal/efectos de los fármacos , Núcleo Dorsal del Rafe/efectos de los fármacos , Masculino , Óxido Nítrico Sintasa de Tipo I/metabolismo , Sustancia Gris Periacueductal/efectos de los fármacos , Sustancia Gris Periacueductal/metabolismo , Proteínas Proto-Oncogénicas c-fos/metabolismo , Ratas Wistar , Neuronas Serotoninérgicas/efectos de los fármacosRESUMEN
INTRODUCTION: Depression is the most common psychiatric morbidity in pregnancy, affecting more than 13% of pregnant women. Its diagnosis is based on the criteria established by the DSM-5 and the application of validated scales such as the Edinburgh Postnatal Depression Scale. However, there are still errors and shortcomings among healthcare professionals in the recognition, diagnosis and treatment of depression during pregnancy, with the resulting consequences and repercussions on the gestation itself or the foetus. OBJECTIVE: To present a review of depression in pregnancy, its risk factors, clinical characteristics, complications and treatment. METHODS: The PubMed and LILACS databases were used to search for manuscripts. Of the 223 articles found, 55 fulfilled the inclusion criteria. RESULTS: The prevalence of depression in pregnancy in South America is approximately 29% and the most significant risk factors are sexual abuse, pregnancy at an early age and intrafamily violence. Therefore, early diagnosis favours a reduction in risk behaviour, foetal neurodevelopmental disorders and obstetric outcomes. CONCLUSIONS: Depression in pregnancy is common condition but is underreported as its symptoms are often attributed to the pregnancy itself. The use of selective serotonin reuptake inhibitor antidepressants, particularly fluoxetine, which has not been associated with teratogenicity, is recommended, in addition to the implementation of non-pharmacological treatment such as psychotherapy, mindfulness and aerobic exercise. Educating healthcare professionals will facilitate the correct diagnosis and treatment of this condition.
Asunto(s)
Depresión/epidemiología , Complicaciones del Embarazo/psicología , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Depresión/diagnóstico , Depresión/terapia , Femenino , Fluoxetina/efectos adversos , Fluoxetina/uso terapéutico , Humanos , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/terapia , Prevalencia , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversosRESUMEN
Fluoxetine (FLX) is an antidepressant from the selective serotonin reuptake inhibitor class that has largely been used for the treatment of depression in pregnancy. However, increasing evidences have indicated the potential of early maternal exposure to FLX to induce molecular and neuro functional effects on the offspring. In the present study we evaluated possible long lasting impacts of the maternal exposure to FLX during gestation and lactation. Female Wistar rats were gavaged with 5 mg/kg of FLX during the period that comprehends the first day of pregnancy (PD0) and the last day of lactation (LD21) (Group FLX). Control group (CTL) received a proportional volume of water. On the postnatal day 75 (PND75), male rats were euthanized and hippocampus, cortex, hypothalamus, and periaqueductal gray area (PAG) were removed. Global DNA methylation was quantified using a high-throughput ELISA-based method. In order to address neuro functional changes animals (PND75) were evaluated in the elevated plus maze and social interaction tests as well as submitted to repeated restraint stress. An increase in the global DNA methylation profile of hippocampus (p = 0.0399) was associated with the early exposure to FLX, whereas no significant change was observed in the hypothalamus (p = 0.6556), cortex (p = 0.9402) or PAG (p = 0.3822). Furthermore, early exposure to FLX was also associated with a reduction in the social interaction time (p = 0.0084) and to a decreased in the plasma corticosterone level when animals were submitted to the restraint stress (p < 0.0001). No significant change in the elevated plus maze test was associated with the early exposure to FLX. In summary, our data demonstrate that maternal exposure to FLX during gestation and lactation results in a long lasting impact on the DNA methylation of hippocampus, and affects the social behavior and the corticosterone response to stress.
Asunto(s)
Encéfalo/efectos de los fármacos , Encéfalo/crecimiento & desarrollo , Metilación de ADN/efectos de los fármacos , Fluoxetina/efectos adversos , Efectos Tardíos de la Exposición Prenatal , Conducta Social , Animales , Animales Recién Nacidos , Conducta Animal/efectos de los fármacos , Epigénesis Genética/efectos de los fármacos , Femenino , Lactancia , Masculino , Exposición Materna , Embarazo , Ratas Wistar , Estrés Psicológico/metabolismoRESUMEN
This study aimed to investigate the antidepressant effect and the mechanism of action of Kai-Xin-San (KXS) in fluoxetine-resistant depressive (FRD) rats. Two hundred male Wistar rats weighing 200±10 g were exposed to chronic and unpredictable mild stresses (CUMS) for 4 weeks and given fluoxetine treatment simultaneously. The rats that did not show significant improvement in behavioral indexes were chosen as the FRD model rats. These rats were randomly divided into four groups: FRD model control; oral fluoxetine and aspirin; oral KXS at a dose of 338 mg·kg-1·day-1; and oral KXS at a dose of 676 mg·kg-1·day-1. Rats continued to be exposed to CUMS and underwent treatment once a day for 3 weeks, then cytokine (COX-2, IFN-γ, IL-1ß, IL-2, IL-4, IL-6, IL-10, TGF-ß, and TNF-α) levels in the hippocampus and serum, and organ coefficients were measured. Both doses of KXS improved the crossing and rearing frequencies, sucrose-preference index, and body weight in FRD rats. KXS at a dose of 338 mg·kg-1·day-1reduced COX-2, IL-2, IL-6, TNF-α levels, increased IL-10 level in the hippocampus, and reduced IL-2 and TNF-α levels in serum. KXS at a dose of 676 mg·kg-1·day-1reduced TNF-α level in the hippocampus, reduced IL-2 and TNF-α levels in serum, and increased IFN-γ and IL-10 levels in the hippocampus and serum. There were no significant differences in organ-coefficients of the spleen among and between groups. The results suggested that oral administration of KXS in FRD rats was effective in improving behavior disorders by influencing various inflammatory pathways.
Asunto(s)
Antidepresivos/uso terapéutico , Citocinas/metabolismo , Depresión/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Hipocampo/metabolismo , Animales , Citocinas/efectos de los fármacos , Depresión/metabolismo , Modelos Animales de Enfermedad , Resistencia a Medicamentos , Fluoxetina/efectos adversos , Hipocampo/efectos de los fármacos , Masculino , Distribución Aleatoria , Ratas , Ratas Wistar , Estrés Psicológico/psicologíaRESUMEN
This study aimed to investigate the antidepressant effect and the mechanism of action of Kai-Xin-San (KXS) in fluoxetine-resistant depressive (FRD) rats. Two hundred male Wistar rats weighing 200±10 g were exposed to chronic and unpredictable mild stresses (CUMS) for 4 weeks and given fluoxetine treatment simultaneously. The rats that did not show significant improvement in behavioral indexes were chosen as the FRD model rats. These rats were randomly divided into four groups: FRD model control; oral fluoxetine and aspirin; oral KXS at a dose of 338 mg·kg-1·day-1; and oral KXS at a dose of 676 mg·kg-1·day-1. Rats continued to be exposed to CUMS and underwent treatment once a day for 3 weeks, then cytokine (COX-2, IFN-γ, IL-1β, IL-2, IL-4, IL-6, IL-10, TGF-β, and TNF-α) levels in the hippocampus and serum, and organ coefficients were measured. Both doses of KXS improved the crossing and rearing frequencies, sucrose-preference index, and body weight in FRD rats. KXS at a dose of 338 mg·kg-1·day-1reduced COX-2, IL-2, IL-6, TNF-α levels, increased IL-10 level in the hippocampus, and reduced IL-2 and TNF-α levels in serum. KXS at a dose of 676 mg·kg-1·day-1reduced TNF-α level in the hippocampus, reduced IL-2 and TNF-α levels in serum, and increased IFN-γ and IL-10 levels in the hippocampus and serum. There were no significant differences in organ-coefficients of the spleen among and between groups. The results suggested that oral administration of KXS in FRD rats was effective in improving behavior disorders by influencing various inflammatory pathways.
Asunto(s)
Animales , Masculino , Ratas , Antidepresivos/uso terapéutico , Citocinas/metabolismo , Depresión/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Hipocampo/metabolismo , Citocinas/efectos de los fármacos , Depresión/metabolismo , Modelos Animales de Enfermedad , Resistencia a Medicamentos , Fluoxetina/efectos adversos , Hipocampo/efectos de los fármacos , Distribución Aleatoria , Ratas Wistar , Estrés Psicológico/psicologíaRESUMEN
OBJECTIVE: Debate has focused on the effects of the selective serotonin reuptake inhibitor (SSRI) antidepressants on heart rate (HR) and HR variability (HRV), both of which are predictors of adverse cardiovascular events. Here, we examine the associations between specific SSRI antidepressants and resting state HR (and HRV) after accounting for a host of potential confounding factors using propensity score techniques. METHODS: Participants included 10,466 not taking antidepressants, 46 participants taking escitalopram, 86 taking citalopram, 66 taking fluoxetine, 103 taking paroxetine, and 139 taking sertraline. HR and HRV (root mean square of successive squared differences, high frequency) were extracted from 10-minute resting-state ECGs. Analyses including propensity score weighting and matching were conducted using R-statistics to control for potentially confounding variables. RESULTS: Major findings indicated that users of all SSRI medications-except fluoxetine-displayed lower HRV relative to nonusers. Users of paroxetine also displayed significantly lower HRV relative to users of citalopram (Cohen's d = 0.42), fluoxetine (Cohen's d = 0.54), and sertraline (Cohen's d = 0.35), but not escitalopram. Although associations were also observed for HR, these were less robust than those for HRV. CONCLUSIONS: Although paroxetine is associated with decreases in HRV relative to nonusers, as well as users of other SSRI medications, fluoxetine was the only medication not to display significant alterations in HR or HRV. These conclusions are limited by the cross-sectional design and nonrandomized nature of medication prescriptions. Findings highlight the importance of focusing on specific medications, rather than more heterogeneous groupings according to antidepressant action, and may have implications for health and well-being for the longer term.
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Citalopram/efectos adversos , Electrocardiografía/efectos de los fármacos , Fluoxetina/efectos adversos , Frecuencia Cardíaca/efectos de los fármacos , Paroxetina/efectos adversos , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Sertralina/efectos adversos , Adulto , Anciano , Brasil , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Antidepresivos/efectos adversos , Aceites de Pescado/farmacología , Fluoxetina/efectos adversos , Ácido Fólico/farmacología , Exposición Materna/efectos adversos , Animales , Ansiedad , Factor Neurotrófico Derivado del Encéfalo/metabolismo , Femenino , Hipocampo/efectos de los fármacos , Lactancia , Embarazo , Efectos Tardíos de la Exposición Prenatal , Ratas , Ratas WistarRESUMEN
Depression is one of the most prevalent disorders in the world and may occur during pregnancy and postpartum periods. Fluoxetine (FLX) has been widely prescribed for use during depression in pregnancy and lactation. This study aimed to investigate if in utero and lactational exposure to FLX could compromise reproductive parameters in female offspring. Wistar rats received, by daily gavage, FLX 5mg/kg or 0.3ml of water (control group) from the first gestational day until weaning (21 days). Assessments in the female offspring included: body weight, anogenital distance, vaginal opening, first estrus, estrous cycle, reproductive organs weight, uterine morphometric analyses, ovarian follicle and corpora lutea counting, estradiol plasmatic concentration, sexual behavior, maternal behavior and fertility test. Exposure to FLX delayed the puberty onset in female pups. The present study demonstrated that developmental exposure to FLX can deregulate the neuroendocrine hormonal control of female offspring during prepubertal and pubertal periods.
Asunto(s)
Antidepresivos de Segunda Generación/efectos adversos , Fluoxetina/efectos adversos , Efectos Tardíos de la Exposición Prenatal , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Maduración Sexual/efectos de los fármacos , Animales , Estradiol/sangre , Ciclo Estral/efectos de los fármacos , Femenino , Fertilidad/efectos de los fármacos , Lactancia , Masculino , Conducta Materna/efectos de los fármacos , Intercambio Materno-Fetal , Ovario/anatomía & histología , Ovario/efectos de los fármacos , Embarazo , Ratas Wistar , Conducta Sexual Animal/efectos de los fármacos , Útero/anatomía & histología , Útero/efectos de los fármacosRESUMEN
High serotonin levels during pregnancy affect central nervous system development. Whether a commonly used antidepressant such as fluoxetine (a selective serotonin reuptake inhibitor) taken during pregnancy may adversely affect respiratory control in offspring has not been determined. The objective was to determine the effect of prenatal-perinatal fluoxetine exposure on the respiratory neural network in offspring, particularly on central chemoreception. Osmotic minipumps implanted into CF-1 mice on Days 5-7 of pregnancy delivered 7 milligrams per kilogram per day of fluoxetine, achieving plasma levels within the range found in patients. Ventilation was assessed in offspring at postnatal Days 0-40 using head-out body plethysmography. Neuronal activation was evaluated in the raphe nuclei and in the nucleus tractus solitarius by c-Fos immunohistochemistry during normoxic eucapnia and hypercapnia (10% CO2). Respiratory responses to acidosis were evaluated in brainstem slices. Prenatal-perinatal fluoxetine did not affect litter size, birth weight, or the postnatal growth curve. Ventilation under eucapnic normoxic conditions was similar to that of control offspring. Fluoxetine exposure reduced ventilatory responses to hypercapnia at P8-P40 (P < 0.001) but not at P0-P5. At P8, it reduced hypercapnia-induced neuronal activation in raphe nuclei (P < 0.05) and nucleus tractus solitarius (P < 0.01) and the acidosis-induced increase in the respiratory frequency in brainstem slices (P < 0.05). Fluoxetine applied acutely on control slices did not modify their respiratory response to acidosis. We concluded that prenatal-perinatal fluoxetine treatment impairs central respiratory chemoreception during postnatal life. These results are relevant in understanding the pathogenesis of respiratory failures, such as sudden infant death syndrome, associated with brainstem serotonin abnormalities and the failure of respiratory chemoreflexes.
Asunto(s)
Dióxido de Carbono/farmacología , Fluoxetina/efectos adversos , Reflejo/efectos de los fármacos , Muerte Súbita del Lactante/etiología , Animales , Animales Recién Nacidos , Tronco Encefálico/efectos de los fármacos , Tronco Encefálico/patología , Femenino , Humanos , Hipercapnia/patología , Hipercapnia/fisiopatología , Lactante , Ratones , Neuronas/efectos de los fármacos , Neuronas/patología , Embarazo , Ventilación Pulmonar/efectos de los fármacos , Factores de TiempoRESUMEN
Much recent research aims to identify evidence for Drug-Drug Interactions (DDI) and Adverse Drug reactions (ADR) from the biomedical scientific literature. In addition to this "Bibliome", the universe of social media provides a very promising source of large-scale data that can help identify DDI and ADR in ways that have not been hitherto possible. Given the large number of users, analysis of social media data may be useful to identify under-reported, population-level pathology associated with DDI, thus further contributing to improvements in population health. Moreover, tapping into this data allows us to infer drug interactions with natural products-including cannabis-which constitute an array of DDI very poorly explored by biomedical research thus far. Our goal is to determine the potential of Instagram for public health monitoring and surveillance for DDI, ADR, and behavioral pathology at large. Most social media analysis focuses on Twitter and Facebook, but Instagram is an increasingly important platform, especially among teens, with unrestricted access of public posts, high availability of posts with geolocation coordinates, and images to supplement textual analysis. Using drug, symptom, and natural product dictionaries for identification of the various types of DDI and ADR evidence, we have collected close to 7000 user timelines spanning from October 2010 to June 2015.We report on 1) the development of a monitoring tool to easily observe user-level timelines associated with drug and symptom terms of interest, and 2) population-level behavior via the analysis of co-occurrence networks computed from user timelines at three different scales: monthly, weekly, and daily occurrences. Analysis of these networks further reveals 3) drug and symptom direct and indirect associations with greater support in user timelines, as well as 4) clusters of symptoms and drugs revealed by the collective behavior of the observed population. This demonstrates that Instagram contains much drug- and pathology specific data for public health monitoring of DDI and ADR, and that complex network analysis provides an important toolbox to extract health-related associations and their support from large-scale social media data.
Asunto(s)
Interacciones Farmacológicas , Monitoreo de Drogas/métodos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Vigilancia en Salud Pública/métodos , Medios de Comunicación Sociales/estadística & datos numéricos , Antidepresivos de Segunda Generación/administración & dosificación , Antidepresivos de Segunda Generación/efectos adversos , Biología Computacional/métodos , Biología Computacional/estadística & datos numéricos , Monitoreo de Drogas/estadística & datos numéricos , Fluoxetina/administración & dosificación , Fluoxetina/efectos adversos , Humanos , Factores de TiempoRESUMEN
This review aimed to discuss the importance of the comprehensive treatment of depression among older adults in Brazil. The abuse of selective serotonin reuptake inhibitors, including fluoxetine hydrochloride, as antidepressants has been considered a serious public health problem, particularly among older adults. Despite the consensus on the need for a comprehensive treatment of depression in this population, Brazil is still unprepared. The interface between pharmacotherapy and psychotherapy is limited due to the lack of healthcare services, specialized professionals, and effective healthcare planning. Fluoxetine has been used among older adults as an all-purpose drug for the treatment of depressive disorders because of psychosocial adversities, lack of social support, and limited access to adequate healthcare services for the treatment of this disorder. Preparing health professionals is a sine qua non for the reversal of the age pyramid, but this is not happening yet.
Asunto(s)
Antidepresivos de Segunda Generación/efectos adversos , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Fluoxetina/efectos adversos , Anciano , Brasil , Terapia Combinada , Atención Integral de Salud , Costo de Enfermedad , Fluoxetina/economía , Humanos , PsicoterapiaRESUMEN
A síndrome do QT longo induzida por fármacos é uma condição potencialmente fatal, capaz decausar morte súbita como primeira manifestação clínica. Relatamos o caso de paciente jovem que evoluiu comparada cardiorrespiratória em fibrilação ventricular durante internação hospitalar, 24 horas após nefrolitotripsiaextracorpórea. Durante a avaliação foi observado intervalo QT corrigido aumentado de 580 ms e uso de fórmulapara emagrecer que continha fluoxetina 30 mg. Após suspensão da medicação houve normalização do QT,optando-se pelo uso de cardiodesfibrilador implantável pelo alto risco de recorrência da fibrilação ventricular.A síndrome do QT longo pode se manifestar após o uso de fármacos para o tratamento de outras afecções,ressaltando a importância da anamnese rigorosa em busca de antecedentes de morte súbita, assim como darealização de eletrocardiografia antes da introdução de fármacos específicos, de forma a identificar possíveis casosassintomáticos de síndrome do QT longo.
Drug-induced long QT syndrome is a potentially fatal condition that can cause sudden death as a firstclinical manifestation. We report the case of a young patient evolved with cardiorespiratory arrest in ventricularfibrillation during hospitalization, 24 hours after extracorporeal nephrolithotripsy. The patient had an increasedcorrected QT interval of 580 ms and was on weight loss medication containing fluoxetine 30 mg. The QT intervalnormalized after withdrawal of the medication and we chose to use an implantable cardioverter defibrillator dueto the high risk of reoccurrence of ventricular fibrillation. Long QT syndrome may manifest after drug therapyfor other diseases, highlighting the importance of obtaining a through family history of sudden death as well asan ECG before using specific drugs, to identify possible asymptomatic cases of long QT syndrome.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Estrés Psicológico/terapia , Síndrome de QT Prolongado/diagnóstico , Taquicardia Ventricular/complicaciones , Electrocardiografía Ambulatoria/enfermería , Fluoxetina/efectos adversos , Fluoxetina/farmacología , Lidocaína/administración & dosificación , Sulfato de Magnesio/administración & dosificaciónRESUMEN
This review aimed to discuss the importance of the comprehensive treatment of depression among older adults in Brazil. The abuse of selective serotonin reuptake inhibitors, including fluoxetine hydrochloride, as antidepressants has been considered a serious public health problem, particularly among older adults. Despite the consensus on the need for a comprehensive treatment of depression in this population, Brazil is still unprepared. The interface between pharmacotherapy and psychotherapy is limited due to the lack of healthcare services, specialized professionals, and effective healthcare planning. Fluoxetine has been used among older adults as an all-purpose drug for the treatment of depressive disorders because of psychosocial adversities, lack of social support, and limited access to adequate healthcare services for the treatment of this disorder. Preparing health professionals is a sine qua non for the reversal of the age pyramid, but this is not happening yet.
Esse comentário tem como objetivo discutir a importância da multidisciplinariedade do tratamento da depressão do idoso no Brasil. O abuso de prescrições de antidepressivos inibidores seletivos da receptação de serotonina, como o cloridrato de fluoxetina, já tem sido apontado como grave problema de saúde pública, especialmente entre idosos. Embora seja consenso a necessidade de multidisciplinariedade no tratamento da depressão nessa população, o Brasil ainda encontra-se despreparado. A interface entre farmacoterapia e psicoterapia encontra-se prejudicada por falta de serviços, de profissionais especializados e de planejamento assistencial efetivo. A fluoxetina tornou-se uma “muleta” para a cura de males causados pelas adversidades psicossociais, falta de suporte social e de acesso a serviços de saúde adequados para o tratamento desse transtorno em idosos. É condição sine qua non haver preparo para a inversão das pirâmides etárias, o que parece não acontecer atualmente.