Safety Of Antidepressants Research Articles

Antidepressants in Bipolar Depression: Still Controversial After All These Years

The use of antidepressants in the treatment of bipolar disorder (BD) has been one of the more enduring controversies in the field. Antidepressants continue to be one of the most widely used classes of psychotropic agents in BD and are still prominently featured in most treatment guidelines, despite the limited and inconsistent evidence supporting their safety and efficacy in the treatment and prevention of episodes of bipolar 1 depression. Herein, the authors review the clinical and meta-analytical evidence on the efficacy and safety of antidepressants in BD types 1 and 2. Clinicians should be aware of the potential risks and benefits of anti-depressants for patients with BD, as well as the scenarios and patients' characteristics that can affect treatment outcomes. [ Psychiatr Ann . 2023;53(2):63–67.]

Efficacy and tolerability of antidepressant drugs in treatment of depression in children and adolescents: a network meta-analysis.

To evaluate the efficacy and safety of antidepressants in treatment of depression disorder in children and adolescents by network meta-analysis. Databases of PubMed, Cochrane Library, EMBASE, Web of Science, PsycINFO, CBM, CNKI and Wanfang Data were searched for randomized controlled trials (RCT) related to antidepressants in treatment of children and adolescents with depression from inception to December 2021. Quality assessment and data extraction from the included RCTs were performed. Statistical analyses of efficacy and tolerability were conducted with Stata 15.1 software. Surface under the cumulative ranking (SUCAR) was used to rank the value of the antidepressants. A total of 33 RCTs were included in 32 articles, involving 6949 patients. There are 13 antidepressants used in total, including amitriptyline, vilazodone, fluoxetine, selegiline, paroxetine, imipramine, desipramine, sertraline, nortriptyline, escitalopram, citalopram, venlafaxine and duloxetine. The results of network meta-analysis showed that the efficacy of duloxetine ( OR=1.95, 95% CI: 1.41-2.69), fluoxetine ( OR=1.73, 95% CI: 1.40-2.14), venlafaxine ( OR=1.37, 95% CI: 1.04-1.80) and escitalopram ( OR=1.48, 95% CI: 1.12-1.95) were significantly higher than that of placebos (all P<0.05); the probability cumulative ranks were duloxetine (87.0%), amitriptyline (83.3%), fluoxetine (79.0%), escitalopram (62.7%), etc. The results showed that the intolerability of patients receiving imipramine ( OR=0.15, 95% CI: 0.08-0.27), sertraline ( OR=0.33, 95% CI: 0.16-0.71), venlafaxine ( OR=0.35, 95% CI: 0.17-0.72), duloxetine ( OR=0.35, 95% CI: 0.17-0.73) and paroxetine ( OR=0.52, 95% CI: 0.30-0.88) were significantly higher than that of placebos (all P<0.05), and the probability cumulative ranks were imipramine (95.7%), sertraline (69.6%), venlafaxine (68.6%), duloxetine (68.2%), etc. Conclusion: Among 13 antidepressants, duloxetine, fluoxetine, escitalopram and venlafaxine are significantly better than placebo in terms of efficacy, but duloxetine and venlafaxine are less well tolerated.

Effect of Maternal Antidepressant Use During the Pre-pregnancy/Early Pregnancy Period on Congenital Heart Disease: A Prospective Cohort Study in Central China.

BackgroundWith the increase in maternal antidepressant prescribing before/during pregnancy, concerns about the safety of antidepressants have come into focus. The purpose of this study was to explore the association between maternal antidepressant use before pregnancy/in early pregnancy and the risk of congenital heart disease (CHD) in children, and to provide a scientific basis for clinical safety of antidepressant use.MethodsThe prospective cohort study ultimately included 34,104 singleton pregnancies. Modified Poisson regression model with robust error variances was used to evaluate RRs and 95% confidence intervals (CIs) for the risk of CHD in offspring exposed to maternal antidepressant in the 3 months before pregnancy and early pregnancy. In addition, sensitivity analysis was further performed to explore the robustness of the results.ResultsIn this study, the maternal antidepressant exposure rate was 2.83% in the 3 months before pregnancy, 2.42% in early pregnancy, and the incidence of CHD was 8.973 per 1,000 live births. We found that maternal antidepressant use in the 3 months before pregnancy and early pregnancy were all associated with an increased risk of CHD, ~2.54 times and 2.87 times, respectively, of non-use of antidepressants after adjusting for potential confounders. This association was also found in CHD specific phenotypic analysis. Of these, offspring whose mothers were exposed to antidepressants in the 3 months before pregnancy had the highest risk of transposition of the great arteries (aOR = 5.50, 95% CI: 1.91–15.88). The offspring of mothers exposed to antidepressants in early pregnancy had the highest risk of developing ventricular septal defect (aOR = 4.80, 95% CI: 2.50–9.24). Sensitivity analysis verified the stability of the results.ConclusionsMaternal antidepressant use in the 3 months before pregnancy and early pregnancy were all associated with an increased risk of CHD in their offspring. In order to reduce the risk of teratogenesis, we recommend that pregnant women prepare for pregnancy after their condition improves or receive the minimum effective dose of medication.

Analyses of Pharmacokinetic, Pharmacogenetic and Psychometrics Correlates of Antidepressants Use during Pregnancy and the Post-Partum Period

IntroductionAbout 15% of women experience a depressive episode during pregnancy, and 19% during the postpartum. Studies on safety of Antidepressants use during pregnancy have given controversial results. Obstetric-gynecological changes of pregnancy determine modifications in the pharmacokinetics of medications, through an altered metabolism of the CYP enzymes. Patient’s therapeutic response might also be influenced by polymorphisms of the genes encoding CYP enzymes.ObjectivesIn this perspective, we evaluated the correlation between pharmacokinetics, pharmacogenetics and psychopathological measures, analyzing SSRIs or SNRIs concentrations during the three trimesters of pregnancy, at birth and at postpartum, in order to define efficacy, tolerability and safety of Antidepressants (ADs) in the treatment of affective and anxiety disorders during pregnancy.Methods87 patients were enrolled at the Depressive Disorders Treatment Centre (CTDD) of the Department of Psychiatry of Sacco University Hospital (Milano, Italy). Plasma concentrations of ADs were measured during first (T1), second (T2), third (T3) trimester, at birth (T4) and at postpartum (T5). Psychometric assessments were carried out. The genotype of hepatic CYP isoforms were also analysed.ResultsADs mainly metabolized by CYP2C19 (es. Sertraline) are less frequently below therapeutic range than ADs metabolized by CYP2D6. In fact, the metabolic activity of CYP2C19 is slowed down during pregnancy. The majority of ADs concentrations below therapeutic range were found in women with an accelerated metaboslism, carrier of a CYP polymorphism.ConclusionsOur results underline that the systematic use of pharmacokinetic and pharmacogenetic analyses during pregnancy could constitute a valid support in the management of therapy in the last phases of pregnancy.DisclosureNo significant relationships.

Accounting for publication bias using a bivariate trim and fill meta-analysis procedure.

In research synthesis, publication bias (PB) refers to the phenomenon that the publication of a study is associated with the direction and statistical significance of its results. Consequently, it may lead to biased (commonly optimistic) estimates of treatment effects. Visualization tools such as funnel plots have been widely used to investigate PB in univariate meta-analyses. The trim and fill procedure is a nonparametric method to identify and adjust for PB. It is popular among applied scientists due to its simplicity. However, most visualization tools and PB correction methods focus on univariate outcomes. For a meta-analysis with multiple outcomes, the conventional univariate trim and fill method can only account for different outcomes separately and thus may lead to inconsistent conclusions. In this article, we propose a bivariate trim and fill procedure to simultaneously account for PB in the presence of two outcomes that are possibly associated. Based on a recently developed galaxy plot for bivariate meta-analysis, the proposed procedure uses a data-driven imputation algorithm to detect and adjust PB. The method relies on the symmetry of the galaxy plot and assumes that some studies are suppressed based on a linear combination of outcomes. The method projects bivariate outcomes along a particular direction, uses the univariate trim and fill method to estimate the number of trimmed and filled studies, and yields consistent conclusions about PB. The proposed approach is validated using simulated data and is applied to a meta-analysis of the efficacy and safety of antidepressant drugs.

Pharmacogénétique des cytochromes appliquée à la prescription des antidépresseurs : mode d’emploi

CYP2D6 and CYP2C19 polymorphisms affect the exposure, efficacy, and safety of antidepressants. This article is an instruction manual and a guide for the deployment, in hospitals, of pharmacogenetics as an aid to the prescription of an antidepressant. It synthesizes the recommendations of two learned societies, the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Dutch Pharmacogenetics Working Group (DPWG), to produce a recommendation table adapted to a wide panel of antidepressants.

Combining cox regressions across a heterogeneous distributed research network facing small and zero counts.

Studies of the effects of medical interventions increasingly take place in distributed research settings using data from multiple clinical data sources including electronic health records and administrative claims. In such settings, privacy concerns typically prohibit sharing of individual patient data, and instead, cross-network analyses can only utilize summary statistics from the individual databases such as hazard ratios and standard errors. In the specific but very common context of the Cox proportional hazards model, we show that combining such per site summary statistics into a single network-wide estimate using standard meta-analysis methods leads to substantial bias when outcome counts are small. This bias derives primarily from the normal approximations of the per site likelihood that the methods utilized. Here we propose and evaluate methods that eschew normal approximations in favor of three more flexible approximations: a skew-normal, a one-dimensional grid, and a custom parametric function that mimics the behavior of the Cox likelihood function. In extensive simulation studies, we demonstrate how these approximations impact bias in the context of both fixed-effects and (Bayesian) random-effects models. We then apply these approaches to three real-world studies of the comparative safety of antidepressants, each using data from four observational health care databases.

Antidepressants and Circadian Rhythm: Exploring Their Bidirectional Interaction for the Treatment of Depression.

Scientific evidence that circadian rhythms affect pharmacokinetics and pharmacodynamics has highlighted the importance of drug dosing-time. Circadian oscillations alter drug absorption, distribution, metabolism, and excretion (ADME) as well as intracellular signaling systems, target molecules (e.g., receptors, transporters, and enzymes), and gene transcription. Although several antidepressant drugs are clinically available, less than 50% of depressed patients respond to first-line pharmacological treatments. Chronotherapeutic approaches to enhance the effectiveness of antidepressants are not completely known. Even so, experimental results found until this day suggest a positive influence of drug dosing-time on the efficacy of depression therapy. On the other hand, antidepressants have also demonstrated to modulate circadian rhythmicity and sleep–wake cycles. This review aims to evidence the potential of chronotherapy to improve the efficacy and/or safety of antidepressants. It includes pre-clinical and clinical studies that demonstrate the relevance of determining the most appropriate time of administration for antidepressant drugs. In parallel, their positive influence on the resynchronization of disrupted circadian rhythms is also herein discussed. It is expected that this review will promote the investigation of chronotherapy for the treatment of depression, contribute to a better understanding of the relationship between antidepressants and circadian rhythms, and consequently promote the development of new therapeutics.

Surveillance of Antidepressant Safety (SADS): Active Signal Detection of Serious Medical Events Following SSRI and SNRI Initiation Using Big Healthcare Data.

IntroductionThe current process for generating evidence in pharmacovigilance has several limitations, which often lead to delays in the evaluation of drug-associated risks.ObjectivesIn this study, we proposed and tested a near real-time epidemiological surveillance system using sequential, cumulative analyses focusing on the detection and preliminary risk quantification of potential safety signals following initiation of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).MethodsWe emulated an active surveillance system in an historical setting by conducting repeated annual cohort studies using nationwide Danish healthcare data (1996–2016). Outcomes were selected from the European Medicines Agency's Designated Medical Event list, summaries of product characteristics, and the literature. We followed patients for a maximum of 6 months from treatment initiation to the event of interest or censoring. We performed Cox regression analyses adjusted for standard sets of covariates. Potential safety signals were visualized using heat maps and cumulative hazard ratio (HR) plots over time.ResultsIn the total study population, 969,667 new users were included and followed for 461,506 person-years. We detected potential safety signals with incidence rates as low as 0.9 per 10,000 person-years. Having eight different exposure drugs and 51 medical events, we identified 31 unique combinations of potential safety signals with a positive association to the event of interest in the exposed group. We proposed that these signals were designated for further evaluation once they appeared in a prospective setting. In total, 21 (67.7%) of these were not present in the current summaries of product characteristics.ConclusionThe study demonstrated the feasibility of performing epidemiological surveillance using sequential, cumulative analyses. Larger populations are needed to evaluate rare events and infrequently used antidepressants.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40264-021-01110-x.

Antidepressants for people with epilepsy and depression.

Antidepressants for people with epilepsy and depression.

Antidepressants for pain management in adults with chronic pain: a network meta-analysis

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the comparative efficacy and safety of antidepressants for adults with chronic pain. We will achieve this by: assessing the efficacy of antidepressants by type, class and dose in improving pain, mood, patient global impression of change, physical functioning, sleep quality and quality of life; assessing the number of adverse events of antidepressants by type, class and dose; ranking antidepressants in the efficacy of treating pain, mood and adverse events.

Effectiveness of antidepressants in bipolar depression

IntroductionPrescribing antidepressants in the treatment of bipolar depression remains highly controversial due to the inconsistency between routine clinical practice and the results of controlled trials.ObjectivesTo assess the validity of antidepressants use in bipolar depression from the point of view of evidence-based medicine.MethodsDatabase search (Scopus and MEDLINE) followed by analysis of studies concerning the efficacy and safety of antidepressants in the bipolar depression treatment.ResultsThe search found 23 studies. There was a high degree of inconsistency in the results, apparently related to the methodology. Only two studies compared the effectiveness of antidepressants in monotherapy with placebo. No differences were found in the study with 740 participants but in the study with 70 participants with type 2 bipolar disorder antidepressants were found to be more effective than placebo. Nevertheless, both studies had significant methodological issues. In 6 studies comparing the effectiveness of the combination of antidepressants with mood stabilizers against the combination of mood stabilizers with placebo, only the effectiveness of fluoxetine in combination with olanzapine was confirmed, other antidepressants were ineffective. At the same time, studies where antidepressants were compared with each other in combination with mood stabilizers revealed a significant clinical response to therapy. Risk of the treatment emergency adverse events were relatively low for SSRI.ConclusionsDespite the contradictory literature data, the use of antidepressants in bipolar depression is justified from the point of view of evidence-based medicine for certain groups of patients with taking into account risk factors.

Journal Digest: Electrical Brain Stimulation and OC; Postpartum Depression Scale; Antidepressants and Sciatica Pain; Vitamin D and ADHD Risk in Children; Cannabidiol and Cocaine Relapse; Gender Differences and Suicide Attempt

Journal Digest: Electrical Brain Stimulation and OC; Postpartum Depression Scale; Antidepressants and Sciatica Pain; Vitamin D and ADHD Risk in Children; Cannabidiol and Cocaine Relapse; Gender Differences and Suicide Attempt

Efficacy, acceptability, and safety of antidepressants for low back pain: a systematic review and meta-analysis

BackgroundAntidepressant medicines are used to manage symptoms of low back pain. The efficacy, acceptability, and safety of antidepressant medicines for low back pain (LBP) are not clear. We aimed to evaluate the efficacy, acceptability, and safety of antidepressant medicines for LBP.MethodsWe searched CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, the EU Clinical Trials Register, and the WHO International Clinical Trial Registry Platform from inception to May 2020. We included published and trial registry reports of RCTs that allocated adult participants with LBP to receive an antidepressant medicine or a placebo medicine. Pairs of authors independently extracted data in duplicate. We extracted participant characteristics, study sample size, outcome values, and measures of variance for each outcome. We data using random-effects meta-analysis models and calculated estimates of effects and heterogeneity for each outcome. We formed judgments of confidence in the evidence in accordance with GRADE. We report our findings in accordance with the PRISMA statement. We prespecified all outcomes in a prospectively registered protocol. The primary outcomes were pain intensity and acceptability. We measured pain intensity at end-of-treatment on a 0–100 point scale and considered 10 points the minimal clinically important difference. We defined acceptability as the odds of stopping treatment for any reason.ResultsWe included 23 RCTs in this review. Data were available for pain in 17 trials and acceptability in 14 trials. Treatment with antidepressants decreased pain intensity by 4.33 points (95% CI − 6.15 to − 2.50) on a 0–100 scale, compared to placebo. Treatment with antidepressants increased the odds of stopping treatment for any reason (OR 1.27 [95% CI 1.03 to 1.56]), compared to placebo.ConclusionsTreatment of LBP with antidepressants is associated with small reductions in pain intensity and increased odds of stopping treatment for any reason, compared to placebo. The effect on pain is not clinically important. The effect on acceptability warrants consideration. These findings provide Level I evidence to guide clinicians in their use of antidepressants to treat LBP.Trial registrationWe prospectively registered the protocol for this systematic review on PROSPERO (CRD42020149275).

Antidepressant treatment for postnatal depression.

Depression is one of the most common morbidities of the postnatal period. It has been associated with adverse outcomes for women, children, the wider family and society as a whole. Treatment is with psychosocial interventions or antidepressant medication, or both. The aim of this review is to evaluate the effectiveness of different antidepressants and to compare their effectiveness with placebo, treatment as usual or other forms of treatment. Thisis an update of a review last published in 2014. To assess the effectiveness and safety of antidepressant drugs in comparison with any other treatment (psychological, psychosocial, or pharmacological), placebo, or treatment as usual for postnatal depression. We searched Cochrane Common Mental Disorders's Specialized Register, CENTRAL, MEDLINE, Embase and PsycINFO in May 2020. We also searched international trials registries and contacted experts in the field. We included randomised controlled trials (RCTs) of women with depression during the first 12 months postpartum that compared antidepressant treatment (alone or in combination with another treatment) with any other treatment, placebo or treatment as usual. Two review authors independently extracted data from the study reports. We requested missing information from study authors wherever possible. We sought data to allow an intention-to-treat analysis. Where we identified sufficient comparable studies we pooled data and conducted random-effects meta-analyses. We identified 11 RCTs (1016 women), the majority of which were from English-speaking, high-income countries; two were from middle-income countries. Women were recruited from a mix of community-based, primary care, maternity and outpatient settings. Most studies used selective serotonin reuptake inhibitors (SSRIs), with treatment duration ranging from 4 to 12 weeks. Meta-analysis showed that there may be a benefit of SSRIs over placebo in response (55% versus 43%; pooled risk ratio (RR) 1.27, 95% confidence interval (CI) 0.97 to 1.66); remission (42% versus 27%; RR 1.54, 95% CI 0.99 to 2.41); and reduced depressive symptoms (standardised mean difference (SMD) -0.30, 95% CI -0.55 to -0.05; 4 studies, 251 women), at 5 to 12 weeks' follow-up. We were unable to conduct meta-analysis for adverse events due to variation in the reporting of thisbetween studies. There was no evidence of a difference between acceptability of SSRI and placebo (27% versus 27%; RR 1.10, 95% CI 0.74 to 1.64; 4 studies; 233 women). The certainty of all the evidence for SSRIs was low or very low due to the small number of included studies and a number of potential sources of bias, includinghigh rates of attrition. There was insufficient evidence to assess the efficacy of SSRIs compared with other classes of antidepressants and of antidepressants compared with other pharmacological interventions, complementary medicines, psychological and psychosocial interventions or treatment as usual. A substantial proportion of women experienced adverse effects but there was no evidence of differences in the number of adverse effects between treatment groups in any of the studies. Data on effects on children, including breastfed infants, parenting, and the wider family were limited, although no adverse effects were noted. There remains limited evidence regarding the effectiveness and safety of antidepressants in the management of postnatal depression, particularly for those with more severe depression. We found low-certainty evidence that SSRI antidepressants may be more effective in treating postnatal depression than placebo as measured by response and remission rates. However, the low certainty of the evidence suggests that further research is very likely to have an important impact on our effect estimate. There is a continued imperative to better understandwhether, and for whom, antidepressants or other treatments are more effective for postnatal depression, and whether some antidepressants are more effective or better tolerated than others. In clinical practice, the findings of this review need to be contextualised by the extensive broader literature on antidepressants in the general population and perinatal clinical guidance, to inform an individualised risk-benefit clinical decision. Future RCTs shouldfocus on larger samples, longer follow-up, comparisons with alternative treatment modalities and inclusion of child and parenting outcomes.

Antidepressants for functional abdominal pain disorders in children and adolescents.

Functional Abdominal Pain Disorders (FAPDs) present a considerable burden to paediatric patients, impacting quality of life, school attendance and causing higher rates of anxiety and depression disorders. There are no international guidelines for the management of this condition. A previous Cochrane Review in 2011 found no evidence to support the use of antidepressants in this context. To evaluate the current evidence for the efficacy and safety of antidepressants for FAPDs in children and adolescents. In this updated review, we searched the Cochrane Library, PubMed, MEDLINE, Embase, PsycINFO and two clinical trial registers from inception until 03 February 2020. We also updated our search of databases of ongoing research, reference lists and 'grey literature' from inception to 03 February 2020. We included randomised controlled trials (RCTs) comparing antidepressants to placebo, to no treatment or to any other intervention, in children aged 4 to 18 years with a FAPD diagnosis as per the Rome or any other defined criteria (as defined by the authors). The primary outcomes of interest included treatment success (as defined by the authors), pain severity, pain frequency and withdrawal due to adverse events. Two review authors checked all citations independently, resolving disagreement with a third-party arbiter. We reviewed all potential studies in full text, and once again made independent decisions, with disagreements resolved by consensus. We conducted data extraction and 'Risk of bias' assessments independently, following Cochrane methods. Where homogeneous data were available, we performed meta-analysis using a random-effects model. We conducted GRADE analysis. We found one new study in this updated search, making a total of three trials (223 participants) eligible for inclusion: two using amitriptyline (AMI) and one using citalopram. For the primary outcome of treatment success, two studies used reports of success on a symptom-based Likert scale, with either a two-point reduction or the two lowest levels defined as success. The third study defined success as a 15% improvement in quality of life (QOL) ratings scales. Therefore, meta-analysis did not include this final study due to the heterogeneity of the outcome measure. There is low-certainty evidence that there may be no difference when antidepressants are compared with placebo (risk ratio (RR) 1.17, 95% confidence interval (CI) 0.87 to 1.56; 2 studies, 205 participants; I2 = 0%). We downgraded the evidence for significant imprecision due to extremely sparse data (see Summary of findings table 1). The third study reported that participants receiving antidepressants were significantly more likely than those receiving placebo to experience at least a 15% improvement in overall QOL score at 10 and 13 weeks (P = 0.007 and P = 0.002, respectively (absolute figures were not given)). The analysis found no difference in withdrawals due to adverse events between antidepressants and placebo: RR 3.17(95% CI 0.65to 15.33), with very low certainty due to high risk of bias in studies and imprecision due to low event and participant numbers. Sensitivity analysis using a fixed-effect model and analysing just for AMI found no change in this result. Due to heterogeneous and limited reporting, no further meta-analysis was possible. There may be no difference between antidepressants and placebo for treatment success of FAPDs in childhood. There may be no difference in withdrawals due to adverse events, but this is also of low certainty. There is currently no evidence to support clinical decision making regarding the use of these medications. Further studies must consider sample size, homogenous and relevant outcome measures and longer follow up.

Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis

ObjectiveTo investigate the efficacy and safety of antidepressants for back and osteoarthritis pain compared with placebo.DesignSystematic review and meta-analysis.Data sourcesMedline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, International Pharmaceutical...

Interactions between Antidepressants and Warfarin: A Review

Background:Since warfarin has a very narrow therapeutic index, the interaction between warfarin and antidepressants is very critical and has potentially severe consequences. It is unclear whether clinicians have sufficient knowledge about the risk of bleeding when warfarin and antidepressants are used concomitantly.Objective:In this systematic review, we discuss the main considerations when using warfarin with antidepressants.Methods:The information about warfarin-antidepressant interactions was obtained from Google Scholar®, PubMed/MEDLINE® and a hand search of the published literature. The following research terms which were systematically combined with each other to find articles: warfarin, anticoagulant, interactions, antidepressant (and each antidepressant name individually), SSRI, SNRI, TCA, MAOI.Results:Several possible mechanisms that can cause bleeding when antidepressants and warfarin are used concomitantly, have been discussed. According to the available data, sertraline and citalopram/ escitalopram are safer antidepressants to use with warfarin, whereas fluoxetine and fluvoxamine have a higher interaction potential with warfarin. The remaining antidepressants appear to lie somewhere in between and have little empirical data to guide the clinicians.Conclusion:It is recommended that when an antidepressant is prescribed to a patient using warfarin, patient’s international normalized ratio (INR) level should be checked regularly. In this review, the interaction between warfarin and antidepressants, including new ones, were evaluated inclusively and in detail.

Antidepressants largely ineffective for back pain and osteoarthritis

Antidepressants have limited benefit for back and osteoarthritis pain and could cause harm, a study in the BMJ has concluded (20 January 2021)​[1]​. Researchers carried out a systematic review and meta-analysis of 33 randomised controlled trials comparing the efficacy and/or safety of antidepressants for lower back or neck pain, sciatica, or hip and knee osteoarthritis. They found moderate certainty evidence that serotonin-norepinephrine reuptake inhibitors (SNRIs) […]

Postpartum depression Part 2. Biological treatment: practical aspects &amp; safety issues. Review of the literature

Introduction: Mother with postnatal depression is not able to adequately respond to the needs of her child. Maternal depression poses a serious health &amp; safety risk for mother and child. They both need treatment with rapid onset of action and minimal influence on the infant.&#x0D; Aim: Discussion of professional boards’ recommendations together with RCT results and clinical observations reffering to nursing depressed women with emphasis on practical aspects and future directions.&#x0D; Methods: Discussion on postnatal depression treatment national guidelines and results from meta-analyses and systematic reviews found in Pubmed and Cochrane databases with "postanatal" or "postpartum" or "puerperium" and "depression" keywords. Selection of articles based on practical aspects of management.&#x0D; Results: Despite its widespread use, the safety and efficacy of SSRIs in postpartum mood disorders have not yet been clearly confirmed. Long-term observation of behaviour and development of children after early exposure to SSRIs up to adulthood is necessary to fully assess the risk of antidepressant treatment in nursing mothers.&#x0D; Conclusions: Pharmacotherapy remains the most accessible method of treating depression in the puerperal period, however, knowledge about the safety of antidepressants during lactation is still insufficient. Individualization of treatment depending on the patient's condition, specific needs, availabity of procedures and mental or physical comorbidity is necessary.