History Of Antidepressant Use Research Articles

The Effect of Anti-Depressants on Dental Implant Failure: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis is to analyze the risk of dental implant failure for patients who had a history of anti-depressant use. An electronic search was performed up to June 2023 in three databases, including PubMed/MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials with data on comparison of implant failure rate for patients with and without the use of antidepressants were included. Meta-analyses for the risk ratio of implant failure rate at the patient level and implant level were performed. Eleven clinical studies were selected for inclusion in this review. The meta-analyses showed a risk ratio of 2.44 (95% confidence interval= 1.75 to 3.39, p< 0.0001) and 2.44 (95% CI= 1.73 to 3.46, p< 0.0001) for the implant failure at the patient level and implant level, respectively. The comparisons presented a low heterogeneity for the patient-level analysis and a moderate heterogeneity for the implant-level analysis among the pooled studies. Subgroup analyses also revealed that patients who received only selective serotonin reuptake inhibitors (SSRIs) or SSRIs with other type of anti-depressants had a higher risk of implant failure than those who were not on any anti-depressants. The current review demonstrates the use of anti-depressants, such as SSRIs, may increase the risk of dental implant failure at both patient level and implant level. Although limited evidence suggests that a certain type of SSRI (sertraline) may have more influence on implant failure than other SSRIs, future studies are needed to warrant this finding.

An investigation of knowledge and attitudes towards antidepressants: a cross-sectional survey of Jordan’s six medical schools

ObjectiveDepression is Jordan’s most ravaging mental illness. Despite the growth of antidepressant use, only a handful of studies examine the factors affecting antidepressant knowledge among healthcare workers or medical students. Therefore, we aimed to explore the knowledge and attitudes towards antidepressants across Jordan’s six medical schools.MethodsUsing a cross-sectional design, we investigated the knowledge and attitudes towards antidepressants through the Drug Attitude Inventory and a literature-validated knowledge domain. Clinical students from Jordan’s six medical schools were recruited. Differences in knowledge and attitudes scores were examined by year of study, medical school among other factors. A multivariate linear regression model was utilized to assess predictors of knowledge.ResultsWe included a total of 1,234 participants representing Jordan’s six major schools of medicine. About 14.9% of participants had a personal history of antidepressant use while 20.5% reported family history of psychiatric disease. The majority of students demonstrated favorable attitudes towards antidepressants (74.1%). Students demonstrated an average understanding of antidepressants’ mechanism of action, side effects, but not indications in special populations. Senior medical students, higher GPA, higher family income, personal history of antidepressants, and family history of psychiatric illnesses were associated with significantly higher knowledge scores (all p-values < 0.001). In addition to attitudes scores, the aforementioned were positive predictors of knowledge scores in the multivariate model.ConclusionMedical students’ knowledge towards antidepressants leaves room for significant improvement. Yet, it is evident that significant differences for both attitudes and knowledge exist across medical schools which may indicate a gap in either training or teaching methodology.

Risk factors for new antidepressant use after surgery in Sweden: a nationwide, observational cohort study

BackgroundWhilst somatic complications after major surgery are being increasingly investigated, the research field has scarce data on psychiatric outcomes such as postoperative depression. This study evaluates the impact of patient and surgical factors on the risk of depression after surgery using the proxy measure of prescribed and collected antidepressants. MethodsAn observational, registry-based, national multicentre cohort study of individuals ≥18 yr of age who underwent noncardiac surgery between 2007 and 2014. Exclusion criteria included history of antidepressant use defined by collection of a prescription within 5 yr before surgery. Participants were identified using a surgical database from 23 Swedish hospitals and data were linked to National Board of Health and Welfare registers for collection of prescribed antidepressants. Descriptive statistics were used for baseline data and logistic regression for predictive factors. ResultsOf 223 617 patients, 4.9% had a new prescription of antidepressants collected 31–365 days after surgery. Antidepressant prescription was associated with increasing age, female sex, and more comorbidities. The incidence of antidepressant prescription was highest after neurosurgery, vascular, and thoracic surgery. Affective and anxiety disorders were risk factors. In the whole cohort and within the aforementioned surgical subtypes, acute and cancer surgery increased the risk of antidepressant prescription. ConclusionsThis study brings novel insights to the epidemiology of postoperative antidepressant treatment in antidepressant-naive patients. One in 20 postoperative patients are prescribed antidepressants but with knowledge of risk factors, interventional strategies can be tested.

Antidepressant adherence trajectory before cancer diagnosis and risk of antidepressant discontinuation after cancer diagnosis among middle-aged US adults.

e18890 Background: For middle-aged adults taking antidepressants before cancer diagnosis, concerns exist about drug-drug interactions between antidepressants and antineoplastics. Clinical guidelines recommend detailed assessment of the new cancer survivor's past history of antidepressant use before considering antidepressant discontinuation. We aimed to determine whether, in real-world settings, the risk of antidepressant discontinuation after cancer diagnosis is associated with survivors’ past antidepressant adherence trajectories. Methods: A retrospective cohort of 45 to 64-year old individuals with incident cancer diagnosis (index date) and ≥2 antidepressant fills in the 9 months before index date, IQVIA PharMetrics Plus for Academics claims, 2006-2020. Antidepressant adherence in the 9-month baseline was measured as monthly proportion of days covered (PDC) before tamoxifen initiation. Group-based trajectory modeling (GBTM) was used to identify clusters of survivors with distinct antidepressant adherence trajectories pre-index date i.e., we calculated polynomial functions of monthly PDCs and compared 2 to 6-group finite mixture models to determine which model best fit the data, based on the Bayesian Information Criterion, expert-adjudged parsimony and ≥10% of the sample in each trajectory group. Antidepressant discontinuation after cancer diagnosis was defined as a 45-day gap in antidepressant supply. Survivors were censored at first of either antidepressant discontinuation, loss of enrollment or 1 year post-index date. Cox regression compared the hazard of antidepressant discontinuation by trajectory group, adjusted for demographics, mental disorder and cancer type. Results: We identified 7,293 middle-aged cancer survivors with prior antidepressant use; females 72%, mean age (SD) 56 (7) years. GBTM identified 4 adherence trajectory groups (consistently high, steady increase, declining, and recent start); metastatic cancer being characteristic of the latter 3 groups relative to the consistently high group. Antidepressant discontinuation was lowest in the consistently high group (26% [mean months-to-discontinuation: 9]) and highest in the declining (68% [5]) and recent start (51% [6]) groups, p &lt; .01. Hazard ratios [95% CI] of discontinuation were significantly higher in the declining (2.7 [2.3 – 3.2]), recent start (1.9 [1.7 – 2.0]) and steady increase (1.5 [1.4 – 1.6]) groups, relative to the consistently high group. Conclusions: Middle-aged cancer survivors with past trajectories of consistently high adherence to antidepressants experience lower risk of antidepressant discontinuation after cancer diagnosis in real-world practice. However, concern remains about the unintended health outcomes of relatively higher antidepressant discontinuation among survivors diagnosed with metastatic cancer.

0714 Machine learning model for Predicting phenoconversion in patients with Rem behavior disorder using clinical markers

Abstract Introduction Idiopathic Rapid eye movement (REM) sleep behavior disorder is a condition that can be an early sign of alpha-synuclein-mediated neurodegenerative diseases, and the course of the disease can vary greatly from patient to patient. It is important to identify patients who are at risk of developing neurodegenerative diseases in the future for the purpose of future clinical trials and for patients to plan their lives accordingly. Previous research has identified various risk factors for phenoconversion in RBD patients, but these studies are not practical for use in clinical settings due to resource availability or the rarity of certain features. Additionally, most of these studies have been conducted on non-Asian populations, which may have different genetic backgrounds than Asian populations. This study aimed to develop a machine learning model to predict survival in RBD patients using clinical features commonly available in routine clinical settings. Methods This study recruited patients diagnosed with RBD based on polysomnography results and collected 34 features for each patient. Missing data were imputed and various models were applied to the data to improve performance. The model's predictive performance was evaluated using an integrated Brier score and the concordance index. Mean performance indicators were calculated from 5-fold cross-validation results. A web application hosting the final prediction model was developed and deployed on a server for use by physicians or patients. Results 173 patients were included in the study. We used the likelihood ratio test to calculate the p-values of all variables and selected the following 8 variables with p-values less than 0.1: UPDRS part III, age, history of antidepressant use, history of alcohol use, MoCA (Montreal Cognitive Assessment), PSQI-TST (Pittsburgh Sleep Quality Index - total sleep time), AHI-REM (apnea-hypopnea index - REM sleep), and education level. The random survival forest model had the best mean IBS of 0.07 and the best C-index of 0.93 Conclusion We showed that it is possible for a machine learning model to predict phenoconversion in patients with RBD using features that are commonly available in routine clinical settings Support (if any)

Baseline characteristics of the North American prodromal Synucleinopathy cohort.

Rapid eye movement (REM) sleep behavior disorder (RBD) is widely considered a prodromal synucleinopathy, as most with RBD develop overt synucleinopathy within ~10 years. Accordingly, RBD offers an opportunity to test potential treatments at the earliest stages of synucleinopathy. The North American Prodromal Synucleinopathy (NAPS) Consortium has created a multisite RBD participant, primarily clinic-based cohort to better understand characteristics at diagnosis, and in future work, identify predictors of phenoconversion, develop synucleinopathy biomarkers, and enable early stage clinical trial enrollment. Participants ≥18 years of age with overnight polysomnogram-confirmed RBD without Parkinson's disease, dementia, multiple system atrophy, or narcolepsy were enrolled from nine sites across North America (8/2018 to 4/2021). Data collection included family/personal history of RBD and standardized assessments of cognitive, motor, sensory, and autonomic function. Outcomes are primarily reported based on sex (361 total: n=295 male, n=66 female), and secondarily based on history of antidepressant use (n=200 with, n=154 without; with correction for sex differences) and based on extent of synucleinopathy burden (n=56 defined as isolated RBD, n=305 defined as RBD+ [i.e., exhibiting ≥1 abnormality]). Overall, these participants commonly demonstrated abnormalities in global cognition (MoCA; 38%), motor function (alternate tap test; 48%), sensory (BSIT; 57%), autonomic function (orthostatic hypotension, 38.8%), and anxiety/depression (BAI and PHQ-9; 39.3% and 31%, respectively). These RBD participants, assessed with extensive history, demographic, cognitive, motor, sensory, and autonomic function demonstrated a lack of sex differences and high frequency of concomitant neurological abnormalities. These participants will be valuable for future longitudinal study and neuroprotective clinical trials.

42-LB: Distress in Living with Diabetes Links to Age, Sex, Weight, and Good Glycaemic Control

Diabetes impacts on mental health. We investigated patient characteristics of those most at risk and consequences for glycaemic control. Depression (PHQ-9) , Diabetes Distress Screening Scale (DDSS) and Quality of Life (EQ5D) on-line questionnaires were completed by people with diabetes and linked to data extracted data from responders’ clinical records. Sources of distress were also considered through evaluating sub-scales Emotional, Physician, Regimen and Interpersonal DDSS scores. 130 responses with 34% T1DM, 56% women, median age 59 (IQR47-67) years were recorded. The median scores were EQ5D=0.74 (IQR 0.64 - 0.85) UK median 0.83; DDSS=1.9 (IQR1.3-2.7) (≥2 indicates moderate distress) and PHQ9=5 (IQR2-11) (≥5 indicates depression) . Higher DDSS/lower EQ5D5L/higher PHQ-9 within the response group were linked to female sex (DDSS 0.5/25% above median) , younger age (&amp;lt;50years DDSS 0.7/35% above median) , fewer years after diagnosis (&amp;lt;10years DDSS 0.8/40% above median) , and obesity (BMI&amp;gt;35 DDSS 0.6/30% above median) . 33 people with good (HbA1c≤48mmol/mol) or improving glycaemic control (HbA1c reduced by 2mmol/mol since previous reading) had higher DDSS = 2.4 versus the others = 1.9. The link between individual DDSS and PHQ-9 scores was significant r2=0.4, while the association to EQ5D was less r2=0.11. For 30 people with history of anti-depressant medication use, DDSS was 0.9/45% above median, showing medical diagnosis confirmed self-reported distress. DDSS scores did not significantly link to diabetes type or insulin use. Physician related DDSS higher scores came from women, younger age, overweight, early years after diagnosis, plus history of antidepressant use. This is potentially remediable. Level of distress is associated/maybe required in achieving and maintaining lower HbA1c. The impact on mental health of younger women/people with shorter diabetes duration should be noted when considering psychosocial intervention/behaviour change messaging. Disclosure A. H. Heald: None. U. Waheed: None. M. Stedman: None. A. N. Paisley: None. E. Solomon: None.

0640 North American Prodromal Synucleinopathy Consortium: Baseline characteristics in 251 patients with REM Sleep Behavior Disorder

Abstract Introduction Introduction: Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is characterized by a lack of muscle atonia during REM sleep with dream enactment. RBD is regarded as a prodromal synucleinopathy as a high proportion of patients eventually phenoconvert to Parkinson’s Disease and related synucleinopathies, suggesting RBD may be an early non-motor symptom of disease. Accordingly, patients with RBD are ideally situated to test potential therapeutic interventions to prevent phenoconversion to synucleinopathy. However, RBD itself, and associated patient registries, are rare. The North American Prodromal Synucleinopathy Consortium (NAPS) establishes a multisite registry of RBD patients with standardized neurological, neuropsychiatric, and neuropsychological assessments and biomarker collection. The present work reports baseline characteristics of this RBD patient database at its current state. Methods Methods: Participants &amp;gt;18 years of age with overnight polysomnogram-confirmed RBD by ICSD-3 criteria who did not meet criteria for the diagnosis of PD, dementia, MSA, or narcolepsy were enrolled from 10 sites across North America (8/2018 to 4/2021). Data collection included family and personal history of RBD and related symptoms, as well as standardized assessments related to cognitive, motor, sensory and autonomic function. Additionally, all subjects have contributed blood, and a subset of subjects have contributed cerebrospinal fluid samples to the National Centralized Repository for Alzheimer's Disease and Related Dementias for future analysis. Results Results: A total of n=251 participants were enrolled. Outcomes are reported based on sex (n=202 male, n=49 female). Data were further examined based on participants’ history of antidepressant use (n=142 with, n=103 without) and based on participants’ extent of synucleinopathy burden (n=70 defined as isolated RBD, n=181 defined as RBD+ [i.e., exhibiting ≥1 abnormality]). Any observed sex differences among the data did not persist after correction for antidepressant use. Conclusion Conclusions: This prospective, cross-sectional data on history, demographic, cognitive, motor, sensory, and autonomic function in n=251 participants with RBD highlight the lack of sex differences and the high preponderance of concomitant neurological abnormalities with RBD, and provide a valuable registry for future longitudinal studies and neuroprotective clinical trials. Support (If Any) NIH NIA R34 AG056639 (YJ, BB)

Abstract 5769: Opioid prescription characteristics associated with frequent emergency department use among hospitalized cancer patients: a comparative cohort study

Abstract Background: Opioid use is associated with greater health resource utilization, namely unplanned emergency department (ED) visits. The purpose of this study was to characterize ED visit patterns by patients hospitalized for cancer based on their use of prescription opioids in the community. Design &amp; Methods: A prospective cohort study of cancer patients discharged from medical and surgical units at an academic health center in Montreal (Canada) between October 2014 and November 2016 was assembled. The main outcome was frequent ED use (≥4 ED visits) in the year following hospital discharge. Clinical information linked to health administrative claims from the provincial universal health care program (RAMQ) was used in multivariable logistic regression to model patient and opioid prescription characteristics, comparing frequent ED users to non-frequent ED users. Potential predictors included history of chronic pain condition, mental health diagnoses, type of cancer, receipt of radiotherapy/chemotherapy, medication history (previous use of opioids, history of antidepressant use, benzodiazepines), receipt of surgery during the hospitalization as well as characteristics of the discharge prescription (e.g: receipt of an opioid, presence of a multi-modal pain regimen). Results: A cohort of 1253 cancer patients discharged from the medical and surgical units was assembled. The mean age for these patients was 70.9 (11.8) and the most frequent cancers included 488 (38.9%) respiratory and 309 (24.6%) upper digestive cancer. Overall, 54% of cancer patients (n =654) had at least one ED visit in the year post-discharge. Of these, all had filled at least one opioid prescription during the follow-up period. Of patients with at least one ED visit in the one year post-discharge, 29% (n = 188) became frequent ED users. In adjusted multivariable logistic model, the strongest associations of frequent ED use were receipt of chemotherapy one year before their index hospitalization (odds ratio (OR) 1.67; 95% CI: 1.08 - 2.61) and respiratory cancer diagnoses (OR 1.69; 95% CI: 1.07 - 2.67). With respect to opioid prescribing, most the dispensations were for oxycodone (51.4%) and hydromorphone (33.6%). Patients receiving a daily dose &amp;gt;90 MME (morphine milligram equivalents) had an odds ratio of 2.24 (95% CI: 1.14- 4.40) of becoming frequent ED users. Those who filled more than one type of opioid during the follow-up were 1.81 times more likely to become repeated ED users (95% CI: 1.23 - 2.70). Conclusions: Cancer patients with higher opioid use after hospital discharge and active use of more than two different type of opioids within one year time of discharge are at higher risk of encoring unplanned health visits in the ER. A new approach to care planning and coordination is recommended to better monitor opioid prescribing practices and improve outcomes. Citation Format: Siyana Kurteva, Robyn Tamblyn, Ari Meguerditchian. Opioid prescription characteristics associated with frequent emergency department use among hospitalized cancer patients: a comparative cohort study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5769.

190 Anti-Depressant Use Does Not Predict Development of Microscopic Colitis: A Retrospective Case-Controlled Study

INTRODUCTION: Microscopic Colitis (MC) is a chronic inflammatory disease of the colon that presents with chronic, non-bloody, watery diarrhea and is diagnosed with colonoscopy (CSPY). Literature is mixed on the association of Anti-Depressant (AD) use and their association with MC. We investigated the association of AD's with MC among patients with clinically significant diarrhea. METHODS: We performed a retrospective case-control study of all patients with clinically significant chronic diarrhea whom underwent CSPY to rule out MC from 1/2012–12/2016 at the University of Virginia Hospital. 127 patients diagnosed with MC were propensity score matched to 127 patients with normal biopsies based on age and gender. Patients were excluded if they were &lt;18 years old, inpatients, or had FMT. The primary outcome was history of AD use. The secondary outcome was use of NSAIDs or PPI's. OR was calculated for the primary outcome and binomial logistic regression modeling was used to control for other medication use. Statistical analysis and propensity score matching were performed in R using the MatchIt Package. RESULTS: 55/127 patients with MC and 45/127 patients with normal biopsies used AD's (OR 1.4; 95% CI (0.65–3.04). No differences were observed among the case and control groups with respect to age, gender, celiac disease, or PPI use. No statistical difference was seen in the lymphocytic (LC) vs. collagenous colitis (CC) subtypes among MC patients with AD use. More patients with AD use had LC than CC but this difference was not clinically or statistically significant. Logistic regression revealed that only NSAID use was a predictor of the development of MC (P &lt; 0.001). Anti-depressant use was not a predictor of MC development. Neither combination of AD and NSAID (P = 0.7385) nor AD and PPI use (P = 0.6892) together was predictive of development of MC. CONCLUSION: In this study, a history of AD did not predict a pathologic diagnosis of MC in an at risk population. It remains unclear if PPI's or AD's are associated with the development of MC suggesting that MC development may be iatrogenic. Despite studies on the gut-brain axis and gut microbiota dysbiosis associated with AD's, our series showed no association between AD use and MC. Further studies may prove beneficial in relating the development of MC with long-term AD use and their influence on the microbiome, Based on our data, the diagnosis of MC does not warrant discontinuing AD's especially since depression itself may lead to worsened clinical stability of MC.

Risk of adverse perinatal outcomes among women with pharmacologically treated and untreated depression during pregnancy: A retrospective cohort study.

The association between antidepressant use during pregnancy and adverse perinatal outcomes is unclear. The association without taking into consideration the independent effect of depression leads to a confounding of the effects of antidepressants with those of the underlying reason for the use of those medications. Additionally, a history of depression and antidepressant use may also influence this association. This study examined the risks of adverse perinatal outcomes associated with antidepressant use during pregnancy. This retrospective cohort study used population-based data in Alberta, Canada, for women who delivered between 2012 and 2015 (n=158486). Women with depression were identified using a validated case definition, and the receipt of antidepressants was identified using Anatomical Therapeutic Chemical codes. Adverse perinatal outcomes such as severe maternal/neonatal morbidity, preterm birth, and neonatal intensive care unit admission were assessed. Multivariable log-binomial regression was used to estimate the risk of adverse perinatal outcomes associated with antidepressants, adjusting for age and parity. In total, 9.1% women had depression and 2.5% women received antidepressants during pregnancy. The relative risk of severe neonatal morbidity/mortality was 1.25 (95% confidence interval 1.17, 1.33) times higher for women with depression alone compared to women without depression. The risk of severe neonatal morbidity/mortality was 1.51 (95% confidence interval 1.36, 1.66) times higher for women who used antidepressants compared to women with depression alone-however, the risk differed between the women with and without a history of antidepressant use. A similar risk pattern was observed for preterm birth and neonatal intensive care unit admission. Both depression and antidepressant use were independently associated with the risk of adverse perinatal outcomes; however, the risk associated with antidepressants was higher over and above the risk associated with depression. This may reflect the biological effects of antidepressants, greater severity of depression in those treated, or both.

Quantifying the use of opioids in the immediate postoperative period after endoscopic sinus surgery.

The opioid crisis is a public health emergency. There is limited evidence regarding how much opioid medication is necessary and which patients will require additional pain medication following endoscopic sinus surgery (ESS). The objective of this study was to quantify the use of opioids in the first 24 hours following ESS and determine the risk factors associated with increased need for opioid analgesia. Retrospective chart review. A review of opioid-naïve patients routinely admitted to the hospital following ESS between June 2016 and August 2018 was performed. Opioid consumption was quantified for each patient and converted to a morphine milligram equivalents (MME) dose. Pain intensity scores were also recorded throughout the postoperative period. Sociodemographic characteristics as well as surgical procedures performed were evaluated for impact on MME. A total of 130 patients (45.4% female) were included for analysis. The mean opioid dose consumed per patient in the first 24 hours following ESS was 24.1 MME, and the mean pain intensity was 2.4/10. Increasing pain scores were strongly associated with increasing MME (R = 0.78, P < .001). Multiple linear regression identified that patients taking antidepressants required an additional 17.2 MME (95% confidence interval [CI]: 5.5-28.9, P = .004) in the first 24 hours following ESS, whereas patients undergoing papilloma resection required an additional 16.9 MME (95% CI: 2.5-31.4, P = .022). Patients undergoing ESS require different amounts of opioids for pain control in the immediate postoperative period. A history of antidepressant use and inverted papilloma resection during ESS were associated with increased opioid consumption postoperatively. 4 Laryngoscope, 130:1122-1127, 2020.

Is depression a real risk factor for acute myocardial infarction mortality? A retrospective cohort study

BackgroundDepression has been associated with a higher risk of cardiovascular events and a higher mortality in patients with one or more comorbidities. This study investigated whether continuative use of antidepressants (ADs), considered as a proxy of a state of depression, prior to acute myocardial infarction (AMI) is associated with a higher mortality afterwards. The outcome to assess was mortality by AD use.MethodsA retrospective cohort study was conducted in the Veneto Region on hospital discharge records with a primary diagnosis of AMI in 2002–2015. Subsequent deaths were ascertained from mortality records. Drug purchases were used to identify AD users. A descriptive analysis was conducted on patients’ demographics and clinical data. Survival after discharge was assessed with a Kaplan-Meier survival analysis and Cox’s multiple regression model.ResultsAmong 3985 hospital discharge records considered, 349 (8.8%) patients were classified as ‘AD users’. The mean AMI-related hospitalization rate was 164.8/100,000 population/year, and declined significantly from 204.9 in 2002 to 130.0 in 2015, but only for AD users (− 40.4%). The mean overall follow-up was 4.6 ± 4.1 years. Overall, 523 patients (13.1%) died within 30 days of their AMI. The remainder survived a mean 5.3 ± 4.0 years. After adjusting for potential confounders, use of antidepressants was independently associated with mortality (adj OR = 1.75, 95% CI: 1.40–2.19).ConclusionsOur findings show that AD users hospitalized for AMI have a worse prognosis in terms of mortality. The use of routinely-available records can prove an efficient way to monitor trends in the state of health of specific subpopulations, enabling the early identification of AMI survivors with a history of antidepressant use.

The relationship between childhood maltreatment and psychopathology in adults undergoing bariatric surgery

BackgroundA history of childhood maltreatment and psychopathology are common in adults with obesity. ObjectivesTo report childhood maltreatment and to evaluate associations between severity and type of childhood maltreatment and lifetime history of psychopathology among adults with severe obesity awaiting bariatric surgery. SettingFour clinical centers of the Longitudinal Assessment of Bariatric Surgery Research Consortium. MethodsThe Childhood Trauma Questionnaire, which assesses presence/severity (i.e., none, mild, moderate, severe) of physical abuse, mental abuse, physical neglect, mental neglect, and sexual abuse, was completed by 302 female and 66 male bariatric surgery patients. Presurgery lifetime history of psychopathology and suicidal ideation/behavior were assessed with the Structured Clinical Interview for DSM-IV and the Suicidal Behavioral Questionnaire-Revised, respectively. Presurgery lifetime history of antidepressant use was self-reported. ResultsTwo thirds (66.6%) of females and 47.0% of males reported at least 1 form of childhood trauma; 42.4% and 24.2%, respectively, at greater than or equal to moderate severity. Among women, presence/greater severity of childhood mental or physical abuse or neglect was associated with a higher risk of history of psychopathology (i.e., major depressive disorder, posttraumatic stress disorder, other anxiety disorder, alcohol use disorder, binge eating disorder), suicidal ideation/behavior and antidepressant use (P for all ≤ .02). These associations were independent of age, race, education, body mass index, and childhood sexual abuse. Childhood sexual abuse was independently associated with a history of suicidal ideation/behavior and antidepressant use only (P for both ≤ .05). Statistical power was limited to evaluate these associations among men. ConclusionAmong women with obesity, presence/severity of childhood trauma was positively associated with relatively common psychiatric disorders.

A role of Yueju in fast-onset antidepressant action on major depressive disorder and serum BDNF expression: a randomly double-blind, fluoxetine-adjunct, placebo-controlled, pilot clinical study.

IntroductionConventional antidepressants, including fluoxetine, have a major disadvantage in delayed onset of efficacy. Yueju, an herbal medicine used to treat mood disorders was recently found to exhibit rapid antidepressant effects. The present study was conducted to evaluate the role of Yueju in rapidly acting on major depressive disorder (MDD).MethodsParticipants were MDD patients with scores of 24-item Hamilton Depression Rating Scale (HDRS-24) ≥20 and without history of antidepressant use. They randomly received daily oral doses of Yueju (23 g/day) plus fluoxetine (20 mg/day) (experimental group) or placebo plus fluoxetine (control group) for 7 days. HDRS-24 was used as the primary outcome measurement at baseline, and on days 1, 3, 5, and 7. Concentrations of serum brain-derived neurotrophic factor (BDNF) were assessed at baseline and on days 1 and 7.ResultsIn all, 18 participants met the criteria for data analysis. Compared to baseline level, only experimental group showed significant decrease of HDRS-24 score from day 3 to day 7 (P<0.05). Experimental group also showed significant improvement compared with control group from day 3 to day 7 (P<0.05). No correlation between treatment outcomes with serum BDNF levels was observed. However, experimental group showed significant correlation for serum BDNF level on day 1 with day 7 (r=0.721, P=0.028), whereas the control group did not.ConclusionYueju likely contributes to fast-onset antidepressant effects on MDD. Further investigation is necessary to firmly establish the ancient formula as a safe, efficacious, and rapidly acting alternative medicine for MDD treatment.

Tricyclic Antidepressants Amitriptyline and Desipramine Induced Neurotoxicity Associated with Parkinson's Disease.

Recent studies report that a history of antidepressant use is strongly correlated with the occurrence of Parkinson’s disease (PD). However, it remains unclear whether antidepressant use can be a causative factor for PD. In the present study, we examined whether tricyclic antidepressants amitriptyline and desipramine can induce dopaminergic cell damage, both in vitro and in vivo. We found that amitriptyline and desipramine induced mitochondria-mediated neurotoxicity and oxidative stress in SH-SY5Y cells. When injected into mice on a subchronic schedule, amitriptyline induced movement deficits in the pole test, which is known to detect nigrostriatal dysfunction. In addition, the number of tyrosine hydroxylase-positive neurons in the substantia nigra pars compacta was reduced in amitriptyline-injected mice. Our results suggest that amitriptyline and desipramine may induce PD-associated neurotoxicity.

All doctors are jackasses.

All doctors are jackasses.

History of Antidepressant use Among Primary Care Depressed Patients Switching Treatments in the United Kingdom.

History of Antidepressant use Among Primary Care Depressed Patients Switching Treatments in the United Kingdom.

Antidepressant Reduces Amyloid Load, Study Finds

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessAntidepressant Reduces Amyloid Load, Study FindsJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:3 Jul 2014https://doi.org/10.1176/appi.pn.2014.7a15AbstractAntidepressants have lowered levels of beta-amyloid in laboratory animals and some human volunteers, but future studies will have to determine whether the drugs can help prevent Alzheimer’s disease.The notion that antidepressants can prevent Alzheimer’s disease sounds almost too good to be true. Yet some animal work and human pilot research suggest that this is a possibility.In research headed by Yvette Sheline, M.D., a professor of psychiatry at the University of Pennsylvania, tiny probes were implanted in the brain memory centers—the hippocampi—of mice modeled to have Alzheimer’s. Some of the mice were given the SSRI antidepressant citalopram in 2.5 mg/kg doses, others in 5 mg/kg doses, and still others in 10 mg/kg doses. Fluid from their hippocampi was drawn before antidepressant administration and 24 hours after to measure the levels of beta-amyloid—a hallmark of Alzheimer’s disease—in that brain region. The results were published May 14 in Science Translational Medicine.Lower levels of beta-amyloid, a hallmark of Alzheimer’s disease, were found after administration of certain doses of the antidepressant citalopram.Molekuul.be/Shutterstock.comThere was no change in the levels of beta-amyloid in the mice that had been given the 2.5 mg/kg doses. But there were significantly lower levels in the mice that had been given the 5 mg/kg or the 10 mg/kg doses. The 10 mg dose is comparable to 50 mg/day in humans—a “common, though high, dose of citalopram prescribed to treat depression,” the researchers noted.The researchers then gave mice modeled to have Alzheimer’s either 10 mg/kg of citalopram or a placebo for 28 days. The animals’ brains were imaged before and after antidepressant or placebo administration to determine the number of beta-amyloid plaques present.Antidepressant treatment reduced the number of newly appearing plaques significantly more than placebo treatment did. Moreover, the rate of growth in existing plaques was significantly less in the antidepressant group than in the placebo group. Finally, the researchers gave 23 human volunteers aged 18 to 50 with no medical disease or history of antidepressant use either a 50 mg dose of citalopram or a placebo, then took cerebrospinal fluid samples from each volunteer before, during, and up to 45 hours after treatment to assess levels of beta-amyloid in the two groups. Beta-amyloid production in the cerebrospinal fluid was slowed by 37 percent in the citalopram group compared with the placebo group. This change was associated with a 38 percent decrease in total cerebrospinal fluid concentration in the antidepressant group.“The ability to decrease central nervous system beta-amyloid concentrations is thus potentially important as a preventive strategy for Alzheimer’s disease,” Sheline and her colleagues said in their report.“It has to be emphasized that these were not clinical studies and that no treatment recommendations can be based on these preliminary reports,” Joel Yager, M.D., a professor of psychiatry at the University of Colorado and chair of the APA Council on Quality Care, said in an interview with Psychiatric News. “Additional studies will be required to see whether reductions in beta-amyloid production in fact persist with long-term SSRI treatment in humans, and whether reduced production might actually result in clinically meaningful reductions in plaque formation and cognitive impairment. In addition, studies will have to consider potential adverse effects of long-term chronic SSRI treatments in the elderly. All that said, these results might suggest preventive strategies for future practice,” particularly in those at high risk for Alzheimer’s disease, he noted.The study was funded by the National Institutes of Health, the Washington University Hope Center for Neurological Diseases, and the Washington University Biomedical Mass Spectrometry Resource. ■An abstract of “An Antidepressant Decreases CSF Beta-Amyloid Production in Healthy Individuals and in Transgenic Alzheimer’s Mice” can be accessed here. ISSUES NewArchived

Associations between anxiety, depression, antidepressant medication, obesity and weight gain among Canadian women.

PurposeSome mental illnesses have been suggested to be associated with obesity, although results are somewhat inconsistent and research has focused mainly on depression.MethodsAssociations between anxiety, depression, medications for these illnesses, and obesity were investigated cross-sectionally among women aged 25–74 (n = 3004) who participated as population controls in a cancer case-control study. Participants self-reported information on anxiety, depression, height, current weight and weight at age 25.ResultsNo association was observed between either anxiety or depression and either current overweight or obesity status. However, depressed women taking antidepressants were more likely to be obese [OR = 1.71 (95%CI = 1.16–2.52) daily antidepressant use; OR = 1.89 (95%CI = 1.21–2.96) ever tricyclic antidepressant use]. In the full study sample consistent positive associations between anxiety, depression and obesity among women with a history of antidepressant use, and generally negative associations among women without, were suggested. Finally, weight gain was associated with history of anxiety [5–19 kg OR = 1.29 (95% CI = 1.06–1.57); ≥20 kg OR = 1.43 (95% CI = 1.08–1.88)] and depression [≥20 kg OR = 1.28 (95% CI = 0.99–1.65)].ConclusionsThese results suggest depression and anxiety may be associated with weight gain and antidepressant use may be associated with obesity.