Chronic Use Of Antidepressants Research Articles

Antidepressant Treatment Preserves Microvascular Endothelium-Dependent Dilation in Women Who Have Had Preeclampsia

Women with a history of preeclampsia (hxPE) demonstrate persistent microvascular endothelial dysfunction which may contribute to the progression of cardiovascular disease. Women with hxPE also have higher rates of depression compared to women with a history of healthy pregnancy. Interestingly, accumulating evidence indicates that antidepressant treatment may have vasculoprotective effects and attenuate preeclampsia risk. However, whether antidepressant treatment impacts microvascular function in these women remains unknown. Therefore, we examined the effect of chronic antidepressant use on microvascular function in women with hxPE. We hypothesized that antidepressant-treated women with hxPE would have greater endothelium-mediated microvascular vasodilation than unmedicated women with hxPE. Five women with hxPE who were currently treated with an antidepressant (hxPE+AD; 36±3 years; 26±7 months postpartum), six who were not (hxPE-AD; 34±2 years; 26±5 months postpartum), and six unmedicated women with a history of uncomplicated pregnancy (HC; 37±1 years; 35±7 months postpartum) participated in one study visit. We measured cutaneous vascular conductance (CVC=laser doppler flowmetry flux/MAP) responses to graded perfusion of acetylcholine (10−10-10−1 mM) via microdialysis in a control (lactated Ringer's) site and a site treated with 15 mM NG-nitro-L-arginine methyl ester [L-NAME; nitric oxide (NO) synthase inhibitor]. hxPE-AD had reduced endothelium-dependent dilation compared to HC (acetylcholine ³10−3 mM; P<0.03). hxPE+AD had greater endothelium-dependent dilation compared to hxPE-AD (acetylcholine 10−2 and 10−3 mM; P<0.02) and there were no differences between hxPE+AD and HC (all P>0.05). L-NAME reduced endothelium-dependent dilation in all groups (all P<0.001), and there was no difference between groups in NO-dependent dilation [area under the curve (AUC) at a control site − AUC at a L-NAME treated site; P=0.522]. These data suggest that microvascular endothelium-dependent dilation is preserved in women with a history of preeclampsia treated with an antidepressant, potentially mediated through non-NO-dependent mechanisms. Funding: American Heart Association CDA 937990. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Role of Pharmacokinetics and Pharmacogenetics of Antidepressant-Induced Prolongation of the QT Interval and Torsade de Pointes in Patients with Mental Disorders

Antidepressants (ADs) include drugs of various pharmacological groups, which are mainly used for the treatment of mental disorders (major depressive disorder, obsessive-compulsive disorder, social phobia, panic disorder, generalized anxiety disorder, post-traumatic stress disorder), chronic pain and addiction diseases. Chronic use of ADs can lead to the development of cardiotoxic adverse drug reactions (ADRs). The most important cardiotoxic AD-induced ADRs are prolongation of the QT interval, ventricular tachycardia of the "pirouette" type (Torsades de Pointes - TdP). This narrative review analyzes and summarizes the results of studies on pharmacokinecis and pharmacogenetics of ADs on QT interval prolongation and updates physicians' knowledge of the risk of developing AD-induced TdP in patients with psychiatric disorders.

Chronic Antidepressant Use

Background: Chronic use of antidepressant drugs often results in drug-induced organ damage, which is mostly undetected and under-reported. The study aimed at evaluating the effect of selected antidepressants on organs and blood cell counts in adult albino rats. Materials and Methods: Adult rats were divided into four groups (n = 5): Group 1 (5 mL/kg of body weight/day normal saline), Group 2 (1 mg/kg of body weight/day risperidone), Group 3 (5 mg/kg of body weight/day fluoxetine), and Group 4 (15 mg/kg of body weight/day imipramine) for 14 days. The animals experienced different stressors during the treatment period to simulate physiological state of depression. On the 14th day, the animals were exposed to the forced swimming test 1 h after the respective treatments. On the 15th day, the animals were sacrificed under halothane anesthesia. Blood sample was collected. Liver and kidney were excised for histological examination. Results were analyzed using one-way analysis of variance. Results: Kidney histology was normal for all groups. Risperidone-exposed rats presented with hepatotoxicity with areas of zonal necrosis and partial central vein congestion. Neutrophil (%) was significantly reduced (P < 0.01) in all treatment groups when compared with controls. White blood cell count was significantly increased (P < 0.01) in the imipramine and risperidone treatment groups but significantly reduced (P < 0.01) in the fluoxetine treatment group when compared with controls. Also, the platelet count was significantly increased (P < 0.01) in the fluoxetine group but decreased in imipramine-and risperidone-treated groups. Conclusion: Chronic antidepressant use can cause changes in blood cell counts and drug-induced organ damage; hence, frequent organ function tests and blood count are required in patients undergoing chronic antidepressant therapy.

Chronic prescription of antidepressant medication in patients with chronic kidney disease with and without kidney replacement therapy compared with matched controls in the Dutch general population.

ABSTRACTBackgroundChronic kidney disease (CKD) is associated with a higher prevalence of depression, neuropathic pain and insomnia. These conditions are often treated pharmaceutically. In this study we aimed to determine the prevalence of chronic antidepressant use among CKD patients with and without kidney replacement therapy (KRT).MethodsBy using the Dutch health claims database, we were able to determine the prevalence, type and dosage of chronic antidepressant prescriptions in patients with CKD Stage G4/G5 without KRT (n = 14 905), patients on dialysis (n = 3872) and patients living on a functioning graft (n = 8796) and compared these to age-, sex- and socio-economic status (SES)-matched controls from the general population.ResultsOur data show that the prevalence of chronic antidepressant prescription is 5.6%, 5.3% and 4.2% in CKD Stage G4/G5, dialysis and kidney transplant patients, respectively, which is significantly higher than in matched controls. Although our data revealed more prescriptions in female patients and in the age category 45–64 years, our data did not show any association between antidepressant prescriptions and SES. Selective serotonin reuptake inhibitors were the most prescribed drugs in all patient groups and controls. Tricyclic antidepressants were more often used in patients compared with controls.ConclusionThis nationwide analysis revealed that chronic antidepressant prescription in the Netherlands is higher in CKD patients with and without KRT than in controls, higher in middle-aged patients and women, unrelated to socio-economic status and lower than chronic use reported in other countries.

Rehospitalization for pneumonia after first pneumonia admission: Incidence and predictors in a population-based cohort study.

Hospital readmissions are a frequent complication of pneumonia. Most data regarding readmissions are obtained from the United States, whereas few data are available from the European healthcare utilization (HCU) systems. In a large cohort of Italian patients with a previous hospitalization for pneumonia, our aim was to evaluate the incidence and predictors of early readmissions due to pneumonia. This is a observational retrospective, population based, cohort study. Data were retrieved from the HCU databases of the Italian Lombardy region. 203,768 patients were hospitalized for pneumonia between 2003 and 2012. The outcome was the first rehospitalization for pneumonia. The patients were followed up after the index hospital admission to estimate the hazard ratio, and relative 95% confidence interval, of the outcome associated with the risk factors that we had identified. 7,275 patients (3.6%) had an early pneumonia readmission. Male gender, age ≥70 years, length of stay of the first admission and a higher burden of comorbidities were significantly associated with the outcome. Chronic use of antidepressants, antiarrhythmics, glucocorticoids and drugs for obstructive airway diseases were also more frequently prescribed in patients requiring rehospitalization. Previous use of inhaled broncodilators, including both beta2-agonists and anticholinergics, but not inhaled steroids, were associated with an increased risk of hospital readmission. Frail elderly patients with multiple comorbidities and complex drug regimens were at higher risk of early rehospitalization and, thus, may require closer follow-up and prevention strategies.

Trends in Antidepressants Use in Spain between 2015 and 2018: Analyses from a Population-Based Registry Study with Reference to Driving.

Antidepressants are considered driving-impairing medicines (DIM). This is a population-based registry study that shows the trend in the use of antidepressants in Castile and León, Spain, from 2015 to 2018. Data on antidepressant dispensations at pharmacies and the adjusted use of these medicines by the driver population are presented. For the purposes of analysis, population distribution by age and gender has been taken into account, as well as the three Driving Under the Influence of Drugs, alcohol, and medicines (DRUID) categories. Antidepressants were used by 8.56% of the general population and 5.66% of drivers. Antidepressants were used more commonly by females than by males (12.12% vs. 4.87%, χ² = 1325.124, p = 0.001), and users increased as the age increased, even if women who drive used less antidepressants after turning 60 years of age. Chronic use of antidepressants was relevant (8.28%) in the same way as daily use (3.15%). Most of the consumption included SSRIs (4.99%), which are also known as “other antidepressants” (3.71%). Regardless of antidepressants consumed, users took 2.75 ± 1.19 DIMs, which are mainly anxiolytics (58.80%) and opioids (26.43%). Lastly, regarding consumption of antidepressants according to the DRUID classification, category I predominated over categories II and III. Our findings should serve as a starting point for health and traffic authorities to raise awareness of the risk for traffic accidents, especially involving SSRIs.

Predictors of dental erosions in patients evaluated with upper digestive endoscopy: a cross-sectional study.

The most studied medical condition related with dental erosions is gastroesophageal reflux disease (GERD). The aim of this study was to assess other predictors of dental erosions besides GERD in outpatients referred for upper digestive endoscopy. In a cross-sectional study, we prospectively evaluated 235 patients who underwent upper digestive endoscopy. Patients were interviewed and examined by a trained dentist before the endoscopies, addressing dental health as well as clinical information and food intake. Dental erosion was classified using Basic Erosive Wear Examination score. Potential predictors for dental erosions were: gender, age, chronic use of antidepressants and proton pump inhibitors (PPI), diabetes mellitus, body mass index, heartburn and acid regurgitation scores, chocolate intake, reflux esophagitis and hiatal hernia. Overall prevalence of dental erosions was 23.4%. The most parsimonious Poisson regression model for dental erosions considered age, chocolate intake and acid regurgitation as predictors. Dental erosions were associated with acid regurgitation in patients younger than 50years [adjusted prevalence ratio (PR) = 1.8 (95% CI 1.1-2.9)] and with chocolate intake in patients older than 50years [PR = 2.1 (95% CI 1.2-3.9]. The surfaces most eroded were palatine/lingual (n = 25) and occlusal (n = 25), followed by vestibular (n = 5). In outpatients evaluated with upper digestive endoscopy, the variables associated with dental erosions were age younger than 50years, acid regurgitation and chocolate intake. Referral for dental evaluation should be considered for young patients with GERD and frequent acid regurgitation.

Effects of chronic antidepressant use on neurophysiological responses to tDCS post-stroke

BackgroundTranscranial direct current stimulation (tDCS) induces neuroplastic changes in the motor cortex of healthy individuals and has become a candidate intervention to promote recovery post-stroke. However, neurophysiological effects of tDCS in stroke are poorly understood. Antidepressant medications, which are commonly prescribed post-stroke, have the potential to significantly affect cortical excitability and alter responsiveness to tDCS interventions, yet these effects have not previously been examined. Objective/HypothesisTo examine the effects of chronic antidepressant use, tDCS, and the interaction of the two on motor cortical excitability in people with chronic stroke. Based on previous literature in nondisabled adults, we hypothesized that post-stroke, antidepressant-takers would show decreased baseline motor cortical excitability but enhanced responsiveness to anodal tDCS. MethodsTwenty-six participants with chronic stroke (17 control, 9 antidepressant) received real and sham anodal tDCS during separate sessions at least a week apart. Motor cortical excitability was measured before and after tDCS was applied to the lesioned hemisphere primary motor cortex. We compared baseline cortical excitability and neurophysiological responses to tDCS between groups and sessions. ResultsBaseline motor cortical excitability was not different between control and antidepressant groups. Following anodal tDCS over the ipsilesional primary motor cortex, cortical excitability in the non-lesioned hemisphere decreased in controls, but, surprisingly, increased in antidepressant-takers. ConclusionsChronic antidepressant use may not affect motor cortical excitability post-stroke, however it appears to reverse some of the expected effects of tDCS. Therefore future utilization of tDCS in post-stroke neurorehabilitation research should take antidepressant medication status into account.

Therapeutic implications of the serotonin transporter gene in depression

Abstract Background A natural variant of the serotonin transporter gene has been studied in mood disorders and its treatment with serotonin transporter inhibitors. It is now available on gene testing profiles to help guide treatment. But the actual interpretation of the data regarding clinical actionable items is controversial. Methods A review is undertaken to understand the role of the short form in the biology of the brain and its effect on depression and response to serotoninergic antidepressants. Results There are naturally occurring variants of the serotonin reuptake transporter (SERT) gene that express approximately 50 % fewer SERT units in the synapse. People with these low-expressing variants (frequently referred to as the ‘short form’) are more likely to: 1) develop depression in the setting of adversity; 2) attempt or re-attempt suicide; 3) respond inadequately to an antidepressant; 4) develop side effects when taking an antidepressant; or 5) develop rapid cycling if they have bipolar illness. Emerging data suggest that due to the similarity between these natural variants and the mechanism of action of most antidepressants, chronic use of antidepressants may significantly worsen these consequences in patients with the low-expressing variants or induce similar outcomes in people that do not have the short form variants. Conclusions Greater caution is required regarding exposure to serotonin reuptake inhibitors (or serotonin/norepinephrine reuptake inhibitors) for people that have the low expressing short form variants of SERT.

SERUM S100B MEDIATES DEPRESSION’S EFFECT ON COGNITION

The latent variable “δ” (for “dementia”) appears to be uniquely responsible for the dementing aspects of cognitive impairment. Age, depression, and the apolipoprotein E (APOE) e4 allele are independently associated with δ. S100b is a calcium- binding protein that is secreted mainly by astrocytes. S100b has been identified as a biomarker for mood/ depressive disorders. In addition, Brain level of S100b is altered in response to chronic use of anti-depressants. In this analysis, we combine SEM (Structural Equation Model) with longitudinal data from the Texas Alzheimer's Research and Care Consortium (TARCC) to explore whether S100b is a mediator of depression's specific effect on δ. We employed structural equation models (SEM) to examine the mediation effect of S100b on depression's association with δ in a well characterized cohort (TARCC). Subjects included n= 3385 TARCC participants [1240 cases of Alzheimer's Disease (AD), 688 “Mild Cognitive Impairment “(MCI) cases, and 1384 normal controls (NC)]. Serum S100b levels were determined at baseline by Luminex assay (Rules Based Medicine /Austin, TX). All observed measures were adjusted for education, ethnicity, gender, Geriatric Depression Scale (GDS) scores, Hb1Ac, apoE4 and HCY. S100b was additionally adjusted for batch effects. We used an ethnicity equivalent δ homolog (i.e., “dEQ”). Wave 2 dEQ scores were used. Thus, the model is longitudinal and arguable causal. Furthermore, we randomly divided the cohort into 2 groups. Group A (n = 1691) was used to construct the model, while Group B (n=1694) was used to replicate and verify the parameters of interest. Analyses were conducted in Analysis of Moment Structures (AMOS). Model fit was excellent [c2 = 519.912(49), p =0.0; CFI = 0.89; RMSEA = 0.053]. Serum S100b was found to mediate 18.3% of depression's association with Wave 2 dEQ scores (p<0.001). The effect generalized across random subsets of TARCC's sample. S100B plays a role in mediating depression's independent effects on dementia severity. High levels of serum S100B are dementing. S100B is a possible serum biomarker of depression in the elderly. S100B is a target for rational anti-dementia intervention, and may be amenable to modulation by SSRI.

A Case of Major Depressive Disorder With Mixed Features: Diagnostic and Treatment Issues.

A Case of Major Depressive Disorder With Mixed Features: Diagnostic and Treatment Issues.

Obesity and Fractures: Between Black and White Aspects

Obesity, a worldwide medical problem, associates a large panel of disorders but traditionally osteoporosis was not considered one of them. This mini-review targets human and animal studies related to this topic. DXA is the golden standard of fracture risk assessment by providing Bone Mineral Density (BMD) which is directly correlated to Body Mass Index (BMI). Recent studies found that the correlation become weaker at BMI >30 kg/sqm while associating a higher mechanical load. The obesity-related fracture risk includes a blunt bone turnover markers status and a proinflammatory environment as IL-6, TNF-a¾³. Common pathogenic pathways involve both the skeleton and the metabolic complications of obesity as growth hormone, insulin-like growth factor-1, angiotensin II and ghrelin. On the contrary, estrogens are fat-derived by aromatase conversion being bone protective as androgens or insulin resistance. Leptin and adiponectin are produced by adipose tissue playing multiple roles including on bone cells. The overlapping factors in obese persons that elevate the fracture risk are the vitamin D deficiency and sarcopenia with increased risk of fall and diabetic bone disease cause by the type 2 diabetes mellitus which is very frequent among obese subjects. Increased cortical porosity as well as alteration of bone matrix quality to the advanced glycation products is correlated to diabetic fracture risk while BMD remain inadequately normal. The correlation between obesity and fall also associates with prior diagnosis of chronic heart disease, severe depression/anxiety, chronic use of anti-depressants or sleeping pills, and sedentary lifestyle. A new map of fractures is drawn since obesity involves a higher risk of ankle (most frequent site in obesity) and humerus fractures and a lower risk of vertebral and hip fractures. The fracture healing is difficult in obese subjects due to inflammation and co-morbidities especially diabetes. Obesity has a rapidly rising prevalence so are the associated conditions; among them fragility fractures at specific sites represents an alarming new issue despite the traditional theories that obesity protects against osteoporosis.

Tardive dysphoria: The role of long term antidepressant use in-inducing chronic depression

Background Treatment-resistant and chronic depression appear to be increasing. The recent identification of antidepressant tachyphylaxis, the loss of antidepressant efficacy over time, is only a partial explanation. This is an emerging evidence that, in some individuals, persistent use of antidepressants may be prodepressant. Methods A literature search of PubMed utilizing the terms: antidepressant tachyphylaxis, treatment-resistant depression, chronic depression, and antidepressant tolerance was performed, and relevant articles were used. Results Depressed patients who ultimately become treatment resistant frequently have had a positive initial response to antidepressants and invariably have received these agents for prolonged time periods at high doses. Parallels between this course and tardive dyskinesia are noted. It is proposed that neuroplastic processes related to dendritic arborization may underlie the treatment resistant depression that occurs in the setting of chronic antidepressant use. Since the prodepressant effect is seen after prolonged antidepressant use, the term tardive dysphoria is proposed. Conclusions Tardive dysphoria, needs to be considered in studies of treatment resistant depression, and should be examined in blinded, randomized antidepressant discontinuation trials.

Cognitive performance in depressed patients after chronic use of antidepressants

Depressive disorders are conditions that often require continuous treatment, and it is therefore important to evaluate the consequences of prolonged administration. There are few studies assessing cognitive functions of depressed patients after long-term use of antidepressants. This study evaluated the cognitive performance of depressed patients treated with antidepressants for at least 6 months. Patients with major depression (DSM-IV) using imipramine for 2.4+/-0.6 years (mean+/-SE), clomipramine for 2.8+/-1.2 years, fluoxetine for 1.8+/-0.3 years and sertraline for 1.5+/-0.3 years were compared to matched controls (sex, age and educational level) without any psychiatric diagnosis. Memory evaluation consisted of episodic, implicit and working memory tests as well as metamemory assessment. (a) Psychomotor performance of patients taking imipramine was worse than that of controls in inserting pins and a visual reaction time task; on the performance of tapping the difference from controls varied according to dose/weight for patients taking clomipramine and fluoxetine. (b) For memory tests, differences between patients taking sertraline and controls were observed in the number of digits and words recalled; the difference between patients and controls varied according to dose/weight on the number of familiar words correctly completed for patients taking clomipramine and on digit span backward for those taking sertraline. (c) Metamemory was worse in all patient groups irrespective of patients' clinical state. The impairment in psychomotor and memory performances associated with these antidepressants seems to be of low intensity and of questionable clinical relevance.

Anaesthesia for patients with mood disorders

Treatment of patients with mood disorders has changed over the past few years. It is not always clear how the anaesthesiologist has to incorporate these antidepressants and mood stabilizers in premedication or even how to anticipate any interaction with anaesthetic technique. The older generation of antidepressants (tricyclic antidepressants, monoamine oxidase inhibitors) is seldom used nowadays. Actually, treatment with selective serotonin-reuptake inhibitors, serotonin noradrenaline-reuptake inhibitors, noradrenaline-reuptake inhibitor, noradrenergic and specific serotonin antidepressants, or noradrenaline- and dopamine-reuptake inhibitors is common practice. Combination with atypical antipsychotics and newer antiepileptics is suggested as an add-on therapy or as monotherapy, while lithium and valproate therapy is still the first choice in bipolar mood stabilization. Electroconvulsive therapy is still used in therapy-resistant forms of depression; however, the anaesthesia technique herein has been increasingly well described in the last years. Electroencephalogram-derived monitoring such as bispectral index (BIS) can be used as a tool to predict seizure duration. Intoxications with these newer agents are not infrequent and deserve specific attention. In particular, serotonin syndrome is a life-threatening condition that requires great care by the anaesthesiologist. The chronic use of antidepressants does affect the anaesthetized patient: hypotension, arrhythmias, changed thermoregulation, altered postoperative pain, differences in surgical stress response and postoperative confusion. However, it is advised to continue these drugs in the perioperative period. Discontinuation of treatment with the new antidepressants in the perioperative period is not advised. Intoxication with the newer drugs appears to be safer. The anaesthesiologist must pay attention to serotonin syndrome. Electroconculsive therapy has gained renewed attention.

Continued use of antidepressants among patients in ambulatory care

Depression and depressive symptoms have a relatively poor prognosis. Prophylactic maintenance treatment with antidepressants has only been recommended recently. Most studies of chronicity and relapses have been carried out with initially hospitalized patients or with patients attending psychiatric treatment facilities. All incident ambulatory antidepressant-treated patients (n=456) in a Swedish community during 1980–84 were identified. They were followed up for 8 years after the index date. Survival analysis was used to study chronic antidepressant use. Concomitant use of other prescription drugs was studied using generalized estimating equations regression analysis. More than half of the patients had one or several periods of antidepressant treatment after the index year. The relapse rate was between 23% and 33% for each year after the index year. Eleven per cent had continuous use every year after the index year. Patients with one or more relapses had a significantly higher number of other prescription ...

The antidepressant effect of beta-adrenoreceptor subsensitivity: a brief review and clinical implications.

This paper reviews briefly the very common finding in chronic antidepressant use, of subsensitivity of the beta-adrenoreceptor-linked cyclic AMP system. This subsensitivity is observed with a number of different antidepressant treatments, including pharmacological, electrical and sleep deprivation. The subsensitivity requires intact noradrenergic and serotonergic systems, functionally linking the two neurotransmitters most often implicated in depression. Thyroid hormones and estrogens also cause subsensitivity, while the opposite effect is seen with Reserpine and Propranolol. A modified conditioning/sensitization model is proposed, implicating psychosocial stressors with a biological inability to down-regulate beta-adrenoreceptors.

Effects of Psychotropic Drugs on Human Sperm Motility

Imipramine has been shown to have a potent inhibitory effect on sperm motility in vitro. Because of the frequent chronic use of antidepressants in treatment of depression, we investigated the in vivo effects of desmethylimipramine and lithium carbonate on sperm function in patients suffering from clinical depression. We also studied the in vitro effects of a series of neurotropic agents on sperm motility. There were no significant differences in sperm count, viability, or motility between a group of patients diagnosed as having clinical depression and a group of semen donors with normal sperm characteristics. Three weeks of continuous therapy with desmethylimipramine or lithium carbonate resulted in a significant decrease in sperm viability but no significant change in sperm count or motility. The in vitro drug studies demonstrated that imipramine hydrochloride, desmethylimipramine, chlorpromazine, trifluoperazine, and nortriptyline hydrochloride were all potent inhibitors of sperm motility, whereas lithium carbonate had no effect on motility.

Effects of psychotropic drugs on human sperm motility

Imipramine has been shown to have a potent inhibitory effect on sperm motility in vitro. Because of the frequent chronic use of antidepressants in treatment of depression, we investigated the in vivo effects of desmethylimipramine and lithium carbonate on sperm function in patients suffering from clinical depression. We also studied the in vitro effects of a series of neurotrophic agents on sperm motility. There were no significant differences in sperm count, viability, or motility between a group of patients diagnosed as having clinical depression and a group of semen donors with normal sperm characteristics. Three weeks of continuous therapy with desmethylimipramine or lithium carbonate resulted in a significant decrease in sperm viability but no significant change in sperm count or motility. The in vitro drug studies demonstrated that imipramine hydrochloride, desmethylimipramine, chlorpromazine, trifluoperazine, and nortriptyline hydrochloride were all potent inhibitors of sperm motility, whereas lithium carbonate had no effect on motility.