Selective Serotonin Reuptake Inhibitor Medication Research Articles

Persistent postural perceptual dizziness (PPPD) in pediatric patients after COVID-19 infection

BackgroundPatients with long-COVID suffer from symptoms that continue or develop after a COVID-19 or SARS-CoV-2 infection and are present for four or more weeks after the initial infection. This case series describes a group of previously healthy adolescent patients with long-COVID who were seen in a pediatric vestibular clinic for evaluation of severe dizziness and were diagnosed with persistent postural-perceptual dizziness (PPPD). By presenting their symptoms, management and treatment effects, this study aims to provide a diagnostic and therapeutic framework for providers who encounter these patients. MethodsPatient records were reviewed for past medical history, symptoms, physical exam findings, results of audiometric and vestibular testing, dizziness handicap inventory for patient caregiver (DHI-pc) scores, and treatment recommendations. Parents of patients were contacted for a follow up survey to assess treatment adherence and outcomes including changes in symptoms and return to activity. ResultsA series of 9 adolescent patients were referred from a multidisciplinary long-COVID clinic and diagnosed with PPPD. Recommended treatment included vestibular physical therapy, selective serotonin reuptake inhibitor medication, and cognitive behavioral therapy. The majority of patients experienced an improvement in their symptoms, and all patients had improved activity levels and DHI-pc scores after treatment. ConclusionTo the best of our knowledge, no previous reports exist discussing PPPD in long-COVID patients. This case series provides insight into symptom evolution and treatment efficacy in this patient population.

Expert Opinion on the Prescription Practice of Selective Serotonin Reuptake Inhibitors for Major Depressive Disorder in Indian Settings

Objective: To gather expert opinions and insights on the prevalence of anxiety and depression, along with prescription trends for different therapeutic options based on escitalopram, in Indian outpatient settings. Methodology: The questionnaire-based survey, comprising 28 questions, collected perspectives of experts across India regarding the prescription practice of selective serotonin reuptake inhibitors (SSRIs) with a special focus on escitalopram for treating major depressive disorder. Additionally, information on the symptoms of major depressive disorder and the age range of those affected by the disorder was also collected. Results: About 53% of the 331 participants reported that behavioral symptoms were the most frequent among depressed patients. Among the various classes of antidepressants, about 86% of the participants indicated SSRIs as their preferred choice for treating depression. In comparison to vilazodone, paroxetine, and sertraline medications, approximately 87% of the respondents favored escitalopram as the ideal option for treating depression. According to 64% of the respondents, the use of escitalopram has led to improvements in 50-75% of patients. Around 74% of the respondents reported a significant correlation between early responders to antidepressant therapies and achieving full remission. About 49% stated that it may take 8 weeks for depressive patients undergoing escitalopram therapy to experience remission. Adverse effects and poor response were highlighted as the reasons for depressive patients transitioning from other SSRI medications to escitalopram by approximately 43% of the respondents. Conclusion: The survey emphasizes the significance of the 8-week regimen of escitalopram in achieving full remission in patients with depression. The majority of respondents underscored the superiority of escitalopram among SSRIs when compared to other options like vilazodone, paroxetine, and sertraline, reaffirming its role as a preferred choice for effective depression treatment.

Fluoxetine removal by anodic oxidation using different anode materials and graphite cathode

ABSTRACT Fluoxetine (FLX) is a selective serotonin reuptake inhibitor (SSRI) medication commonly used to treat mental health disorders, but it can be harmful to the environment if not properly disposed of due to incomplete metabolism. In this study, electrochemical anodic oxidation with mixed metal oxide anodes was studied as a method to remove FLX from water and wastewater. Iridium dioxide-coated titanium (Ti/IrO2) and ruthenium dioxide-coated Ti (Ti/RuO2) electrodes were found to be more effective than platinum-coated Ti (Ti/Pt) electrodes, with removal efficiencies of 91.5% and 93.9%, respectively. Optimal conditions for FLX removal were determined to be an applied current of 150 mA, initial pH of 5, and oxidation time of 120 min. The rate of FLX degradation (kFLX) for the Ti/Pt, Ti/IrO2, and Ti/RuO2 electrodes were determined to be 0.0081 min−1 (R2:0,8161), 0.0163 min−1 (R2:0,9823), and 0.0168 (R2:0,9901) min−1 for 25 mg/L initial FLX concentration, respectively. The kFLX values varied based on the initial FLX concentration and decreased as the initial FLX concentration increased. The specific energy consumption (SEC) after 120 min of operation was 51.0 kWh/m3 for the Ti/Pt electrode, 39.6 kWh/m3 for the Ti/IrO2 electrode, and 48.6 kWh/m3 for the Ti/RuO2 electrode under optimised conditions. Overall, electrochemical anodic oxidation is an effective method for removing FLX from water and wastewater, with Ti/IrO2 and Ti/RuO2 electrodes providing superior performance compared to Ti/Pt electrodes.

Neuroanatomical dimensions in medication-free individuals with major depressive disorder and treatment response to SSRI antidepressant medications or placebo

Major depressive disorder (MDD) is a heterogeneous clinical syndrome with widespread subtle neuroanatomical correlates. Our objective was to identify the neuroanatomical dimensions that characterize MDD and predict treatment response to selective serotonin reuptake inhibitor (SSRI) antidepressants or placebo. In the COORDINATE-MDD consortium, raw MRI data were shared from international samples (N = 1,384) of medication-free individuals with first-episode and recurrent MDD (N = 685) in a current depressive episode of at least moderate severity, but not treatment-resistant depression, as well as healthy controls (N = 699). Prospective longitudinal data on treatment response were available for a subset of MDD individuals (N = 359). Treatments were either SSRI antidepressant medication (escitalopram, citalopram, sertraline) or placebo. Multi-center MRI data were harmonized, and HYDRA, a semi-supervised machine-learning clustering algorithm, was utilized to identify patterns in regional brain volumes that are associated with disease. MDD was optimally characterized by two neuroanatomical dimensions that exhibited distinct treatment responses to placebo and SSRI antidepressant medications. Dimension 1 was characterized by preserved gray and white matter (N = 290 MDD), whereas Dimension 2 was characterized by widespread subtle reductions in gray and white matter (N = 395 MDD) relative to healthy controls. Although there were no significant differences in age of onset, years of illness, number of episodes, or duration of current episode between dimensions, there was a significant interaction effect between dimensions and treatment response. Dimension 1 showed a significant improvement in depressive symptoms following treatment with SSRI medication (51.1%) but limited changes following placebo (28.6%). By contrast, Dimension 2 showed comparable improvements to either SSRI (46.9%) or placebo (42.2%) (β = –18.3, 95% CI (–34.3 to –2.3), P = 0.03). Findings from this case-control study indicate that neuroimaging-based markers can help identify the disease-based dimensions that constitute MDD and predict treatment response.

Characteristics of breastfeeding newborns in the first month of life with in utero selective serotonin reuptake inhibitor medication exposure: a scoping review protocol.

The objective of this scoping review is to understand the extent and type of evidence in relation to the characteristics of breastfeeding newborns in the first month of life who have been exposed in utero to selective serotonin reuptake inhibitor (SSRI) medications. SSRIs are the most commonly prescribed antidepressant medication in pregnancy. Up to 30% of newborns who are prenatally exposed to SSRIs demonstrate withdrawal signs. Poor neonatal adaptation syndrome represents a constellation of signs observed in these newborns. Little information has been studied regarding breastfeeding, as it relates to the impact of in utero SSRI exposure on the newborn. Parents have many questions regarding the safety of taking medications during pregnancy and breastfeeding. It is important for health care providers to collate evidence-based information and facilitate shared decision-making. We aim to identify the approaches researchers have used to investigate in utero SSRI exposure among breastfed newborns to determine knowledge gaps. Primary peer-reviewed studies will be considered for inclusion according to the following criteria: newborns, 31 days of age or less, with in utero SSRI exposure in any trimester of pregnancy, who were breastfed or received breast-milk feedings. MEDLINE, CINAHL, Embase, LactMed, the Maternity and Infant Care Database, and ClinicalTrials.gov databases will be searched. JBI methodology will be used. Abstracts will be assessed for eligibility and full texts will be retrieved if they meet the inclusion criteria. Two reviewers will independently extract the data from identified studies using a data extraction form and the results will be summarized descriptively and in tabular format. Open Science Framework osf.io/2bt39.

Comparative analysis of the use of selective serotonin reuptake inhibitors during pregnancy and the postpartum period. Safety of sertraline

Depressive disorders and anxiety are the most common mental disorders in the perinatal period, occurring in 14–23% of women. Antidepressants from the selective serotonin reuptake inhibitor (SSRI) group are considered the drugs of choice for the treatment of these disorders. Although SSRIs are the best-studied antidepressants used in pregnant women, there are still conflicting opinions about their effect on pregnancy course and outcomes of pregnancy. At the same time, the risks associated with their use in pregnant women are often exaggerated, while the risks of untreated mental disorders are underestimated. SSRI use during pregnancy has been associated with a modestly increased risk of adverse events, including postpartum haemorrhage, miscarriage, preterm birth, cesarean delivery, fetuses small for their gestational age and low birth weight, low Apgar scores, and increased rates of neonatal hospitalization to intensive care units. However, depressive and anxiety disorders in the mothers themselves also contribute to similar outcomes, so it is not always possible to distinguish the contribution of medication and illness. Comparative data on the effects of different SSRI medications on outcome for the mother and fetus during pregnancy are limited, but paroxetine and fluoxetine are reported to pose the greatest risk to the fetus/neonate. Information on the safety of citalopram and escitalopram during pregnancy and lactation is limited. Citalopram has the highest concentrations in amniotic fluid of all SSRIs. According to current data, sertraline has the most favourable safety profile during pregnancy and lactation, which is explained by its low penetration through the placenta. Sertraline concentrations in the fetus are approximately 1/3 of those in maternal plasma. Sertraline has the lowest concentrations in breast milk of all SSRIs and is associated with a low risk of adverse effects in a baby, making it the drug of choice for nursing mothers. In conclusion, sertraline is one of the best studied SSRIs and has a favourable safety profile for both the mother and the fetus/neonate.

Patterns and factors associated with SSRI medication adherence: a retrospective study using pharmacy claims data

Abstract Objectives To assess the patterns and risk factors associated with selective serotonin reuptake inhibitor (SSRI) medication adherence among enrollees of a multiple employer welfare beneficiary association operating in Florida. Methods This study used a pharmacy claims database for beneficiaries of the Independent Colleges and Universities Benefits Association. The sample of 2541 patients were enrollees who filled two or more consecutive SSRI prescriptions during the analysis period 2015–20. Adherence was measured as the proportion of days covered by a medication. Multiple logistic regression analysis was used to explore the relationship between sociodemographic, healthcare access, and clinical and medication-related factors and adherence. Key findings Adherence was associated with higher odds of being female [odds ratio (OR): 1.2, 95% confidence interval (CI): 0.995–1.464, P < .10] and higher pill burden (OR: 1.3, CI: 1.021–1.642, P< 0.05). Patients using only retail pharmacies (OR: 0.356, CI: 0.196–0.645, P < .01), having any out-of-pocket costs (OR: 0.552, CI: 0.348–0.875, P < .50), changing the prescriber over the duration of the treatment (OR: 0.708, CI: 0.589–0.851, P < .01), taking antihypertensive (OR: 0.708, CI: 0.5077–0.988, P < 0.50), and asthma (OR: 0.609, CI: 0.450–0.826, P < .01) medications were less likely to be adherent. Prescriber specialty was not found to be associated with adherence. Conclusion These findings can inform policymakers and healthcare insurance companies on barriers to medication access and recommend strategies to eliminate these barriers and design interventions to improve the adherence of groups at risk for nonadherence. Healthcare providers can identify patients who are less likely to be adherent and customize counseling interventions for these patients.

Developing an Electroencephalography-Based Model for Predicting Response to Antidepressant Medication

Untreated depression is a growing public health concern, with patients often facing a prolonged trial-and-error process in search of effective treatment. Developing a predictive model for treatment response in clinical practice remains challenging. To establish a model based on electroencephalography (EEG) to predict response to 2 distinct selective serotonin reuptake inhibitor (SSRI) medications. This prognostic study developed a predictive model using EEG data collected between 2011 and 2017 from 2 independent cohorts of participants with depression: 1 from the first Canadian Biomarker Integration Network in Depression (CAN-BIND) group and the other from the Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care (EMBARC) consortium. Eligible participants included those aged 18 to 65 years who had a diagnosis of major depressive disorder. Data were analyzed from January to December 2022. In an open-label trial, CAN-BIND participants received an 8-week treatment regimen of escitalopram treatment (10-20 mg), and EMBARC participants were randomized in a double-blind trial to receive an 8-week sertraline (50-200 mg) treatment or placebo treatment. The model's performance was estimated using balanced accuracy, specificity, and sensitivity metrics. The model used data from the CAN-BIND cohort for internal validation, and data from the treatment group of the EMBARC cohort for external validation. At week 8, response to treatment was defined as a 50% or greater reduction in the primary, clinician-rated scale of depression severity. The CAN-BIND cohort included 125 participants (mean [SD] age, 36.4 [13.0] years; 78 [62.4%] women), and the EMBARC sertraline treatment group included 105 participants (mean [SD] age, 38.4 [13.8] years; 72 [68.6%] women). The model achieved a balanced accuracy of 64.2% (95% CI, 55.8%-72.6%), sensitivity of 66.1% (95% CI, 53.7%-78.5%), and specificity of 62.3% (95% CI, 50.1%-73.8%) during internal validation with CAN-BIND. During external validation with EMBARC, the model achieved a balanced accuracy of 63.7% (95% CI, 54.5%-72.8%), sensitivity of 58.8% (95% CI, 45.3%-72.3%), and specificity of 68.5% (95% CI, 56.1%-80.9%). Additionally, the balanced accuracy for the EMBARC placebo group (118 participants) was 48.7% (95% CI, 39.3%-58.0%), the sensitivity was 50.0% (95% CI, 35.2%-64.8%), and the specificity was 47.3% (95% CI, 35.9%-58.7%), suggesting the model's specificity in predicting SSRIs treatment response. In this prognostic study, an EEG-based model was developed and validated in 2 independent cohorts. The model showed promising accuracy in predicting treatment response to 2 distinct SSRIs, suggesting potential applications for personalized depression treatment.

Reasons for Discontinuation or Change of Selective Serotonin Reuptake Inhibitors in Online Drug Reviews

Selective serotonin reuptake inhibitors (SSRIs) are a commonly prescribed medication class to treat a variety of mental disorders. However, adherence to SSRIs is low, and uncovering the reasons for discontinuation among SSRI users is an important first step to improving medication persistence. To identify the reasons SSRIs are discontinued or changed, as reported by patients and caregivers in online drug reviews. This qualitative study used natural language processing and machine learning to extract mentions of changes in SSRI intake from 667 drug reviews posted on the online health forum WebMD from September 1, 2007, to August 31, 2021. The type of medication change, including discontinuation, switch to another medication, or dose change and the reason for the change were manually annotated. In each instance in which an adverse event was reported, the event was categorized using Medical Dictionary for Regulatory Activities primary system organ class (SOC) codes, and its relative frequency was compared with that in spontaneous reporting systems maintained by the US Food and Drug Administration and the UK Medicines and Healthcare Products Regulatory Agency. Reasons for SSRI medication change as assessed using SOC codes. In total, 667 reviews posted by 659 patients or caregivers (516 [78%] of patients were female; 410 [62%] 25-54 years of age) were identified that indicated a medication change: 335 posts indicated SSRI discontinuation, 188 posts indicated dose change, and 179 posts indicated switched medications. Most authors 625 (95%) were patients. The most common reason for medication discontinuation or switching was adverse events experienced, and the most common reason for dose change was titration. Both uptitration and downtitration were initiated by either a health care professional or patient. The most common adverse events were classified by SOC codes as psychiatric disorders, including insomnia, loss of libido, and anxiety. Compared with those in regulatory data, psychiatric adverse events, adverse events recorded by investigations (mostly weight gain) and adverse events associated with the reproductive system (mostly erectile dysfunction) were reported disproportionately more often. This qualitative study of online drug reviews found that useful information was provided directly by patients or their caregivers regarding their medication behavior, specifically, information regarding SSRI treatment changes that may inform interventions to improve adherence. These findings suggest that these reported adverse events may be associated with SSRI persistence and that people may feel more inclined to report such events on social media than to clinicians or regulatory agencies.

(097) SSRI-Associated Sexual Side Effects: How Are Women Impacted?

Abstract Introduction Approaches to the treatment of sexual difficulties, especially female sexual difficulties, have garnered greater attention in recent years. Some feminist sexuality scholars have cautioned that trends in biomedicine to bolster pharmaceutical interventions for sexual problems may have resulted in unnecessary medicalization of sexual difficulties. Furthermore, medicalization of other health problems can lead to iatrogenic sexual difficulties. Objective In the current study, we explore issues of antidepressant medication use and associated sexual side effects, focusing on the ways that women are impacted differently than men. We also address the lack of consensus in biomedicine around selective serotonin reuptake inhibitor (SSRI) mechanisms of action and implications for sexual and romantic side effects. Based on the role of serotonin in sexual desire and romantic interest, and existing findings indicating impacts of antidepressant use on sexual and relationship function, we investigate the impacts of SSRI treatment on various sexual and romantic ‘side effects’ for women as compared to men. Methods We conducted a secondary analysis using three waves of data from an annual online survey. All three waves included data from over 5,000 single (unmarried and unpartnered) U.S. adults ages 18 and older, and one of the three waves included additional data from over 1,000 married U.S adults. Participants answered questions about their romantic and sexual behavior, SSRI use, and background information. Results Compared to men, women were more than twice as likely to be taking SSRI medication. Across the sample, 43% reported experiencing a sexual/romantic side effect from their SSRI, including 38% of women and 51% of men. However, our data showed a significant difference between single and married participants, with 53% of married women reporting sexual/romantic side effects compared to 36% of single women. Married women were also more likely to report these side effects compared to single men. Additionally, among single women, there were different patterns of side effects and impacts than among single men. For example, we found SSRI use to be significantly associated with more interest in sexual exploration for men but not women. Conclusions Although sexual difficulties can sometimes be influenced by depression itself, existing research shows that SSRIs affect sexual functioning in ways that are unrelated to depressive symptomology. Women, who have greater levels of antidepressant use than men, experience SSRI-associated sexual side effects differently than men. Our results reflect this pattern in a large national sample of U.S. adults. Our findings raise questions about how women taking SSRIs may experience their relationships, especially considering that married women were more likely to report sexual/romantic side effects than single women. There are additional questions raised about potential challenges women may face in relationships with partners who are experiencing SSRI-associated side effects. For example, women may experience greater sexual pressure if they have a male partner with an increased desire for sexual exploration resulting from SSRI treatment. Overall, our findings highlight the need for further attention to sexual and romantic side effects associated with SSRI use and a more nuanced approach to these issues in research and in clinical settings. Disclosure Yes, this is sponsored by industry/sponsor: Match Group Clarification: Industry funding only - investigator initiated and executed study Any of the authors act as a consultant, employee or shareholder of an industry for: Match Group

Effect of self-reported clinician experience level on perceptions of the relative rankings of risk factors for biological complications with dental implant therapy

Statement of problemThe effect of clinician experience on the perception of risks for biological complications associated with dental implant therapy is unknown. PurposeThe purpose of this study was to determine whether clinician experience levels, as assessed by the number of implants placed and/or restored, as well as by type of clinical experience (restorative/prosthodontic and/or surgical), influence the perception of risk for biological complications with dental implant therapy. Material and methodsA 10-item survey instrument was developed that asked participants from a convenience sample to rank different risk factors for peri-implant complications in the areas of patient history, clinical findings, and clinician choices and postimplant placement findings. Information about participant experience (number of implants placed and restored and type of experience) was also captured. The Kruskal-Wallis and Mann-Whitney U test statistical analyses were performed to determine the degree, if any, to which the level of clinician experience influenced risk factor rankings (α=.05). ResultsClinicians with more experience viewed the use of selective serotonin reuptake inhibitor (SSRI) medications and clinician inexperience as more important risk factors than did less experienced clinicians. Clinicians with less experience viewed treated moderate or severe chronic periodontitis and thin tissue biotype as more important risk factors than did more experienced clinicians. Clinicians with predominantly surgical experience viewed a heavy plaque index as a more important risk factor than clinicians with predominantly restorative experience. ConclusionsThe data indicate that the level of clinical experience influences how risk factors associated with biological complications of dental implant therapy are viewed by clinicians.

FMRI neurofeedback leads to long-term symptomatic reduction in treatment-resistant patients with obsessive-compulsive disorder

Introduction Obsessive‐compulsive disorder (OCD) is a severe condition with a profound impact on the health, social and professional functioning of the patients. More than one third of the patients do not achieve remission of the symptoms after first‐line treatment with cognitive‐behavioral therapy and selective serotonin reuptake inhibitor medication. Neurofeedback is a promising technique that allows the non‐invasive self‐regulation of neural activity associated with symptomatic manifestation. Previous literature reported preliminary evidence of positive effects of functional magnetic resonance imaging (fMRI) neurofeedback on OCD symptoms. However, these studies have small samples and/or were not controlled. Additionally, these studies did not involve treatment‐resistant patients. Objectives We aim at developing a fMRI neurofeedback task to treatment-resistant OCD patients and to explore the underlying brain changes. Methods We implemented a sham‐controlled double‐blinded fMRI neurofeedback protocol to target hyperactivity in orbitofrontal regions in treatment‐resistant OCD patients with contamination/cleaning symptoms. The protocol had two sessions of neurofeedback (72 min of total training). The patients included were under treatment‐as‐usual. Results Our preliminary results with the experimental group (n = 10 patients) demonstrated decreased OCD and stress symptoms three months after the neurofeedback sessions. Moreover, immediately after the neurofeedback sessions, we observed reduced functional connectivity between orbitofrontal and temporoparietal regions, and increased brain activity in dorsolateral prefrontal and premotor areas during symptomatic provocation. The brain functional changes might be associated with a better control over obsessions. Conclusions fMRI neurofeedback led to long-term symptomatic reduction in treatment-resistant patients with OCD. Our results need further validation with the sham‐control group but highlight the efficacy of fMRI neurofeedback for refractory OCD and the necessity of prolonged neurofeedback protocols. Disclosure of Interest None Declared

Prevalence of pediatric acute-onset neuropsychiatric syndrome (PANS) in children and adolescents with eating disorders

BackgroundPediatric obsessive–compulsive disorder (OCD) and eating disorder symptoms frequently overlap, clouding diagnostic certainty and hypothesized etiologic factors. Pediatric acute-onset neuropsychiatric syndrome (PANS) is defined by abrupt emergence of core obsessive–compulsive behaviours and/or food restriction with concurrent, ancillary cognitive and behavioral symptoms. Inflammatory and immune processes have putative roles in both PANS and a related described condition with cardinal obsessive–compulsive or tic symptoms, known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). While prevalence of PANS and PANDAS has been examined in tic, movement disorder and OCD populations, this has not yet been systematically examined in a pediatric eating disorder sample.ObjectivesTo identify the lifetime prevalence of those meeting PANS and/or PANDAS criteria within a pediatric eating disorder cohort.MethodsConvenience sampling method was utilized to select consecutive youth (ages 8–18-years) presenting to an interdisciplinary pediatric eating disorder subspecialty program with a confirmed eating disorder and completed parent-report PANS/PANDAS questionnaire (n = 100). A parent-reported measure was used to establish lifetime prevalence rates for PANS and PANDAS. Descriptive and exploratory comparative analyses were conducted between PANS and non-PANS groups. Continuous measures were analyzed using two-tailed independent sample t-tests and categorical measures were analyzed using two-tailed Fisher’s exact tests.ResultsAmong participants, 52% (n = 52) met PANS criteria and 0% (n = 0) met PANDAS diagnostic criteria. Core, abrupt-onset PANS symptoms included both food restriction and obsessive–compulsive symptoms in 63.5% (n = 33), food restriction only in 25% (n = 13), and obsessive–compulsive symptoms only in 11.5% (n = 6) of participants. In comparison to those who did not meet PANS criteria, those in the PANS subgroup were less likely to be male and more commonly prescribed a selective serotonin reuptake inhibitor medication. Significant group differences did not emerge for onset age, body mass index, eating disorder type or comorbid psychiatric/medical/autoimmune illness.ConclusionLifetime prevalence of symptoms in keeping with PANS diagnostic criteria within a pediatric eating disorder cohort was notably higher than that previously reported in OCD or tic disorder cohorts. The overlap between starvation effects and ancillary PANS symptoms may challenge the practical utility of this putative syndrome within the eating disorder population.

Pharmacological Treatment for Pediatric Anxiety Disorders.

Pediatric anxiety disorders (PADs) occur in up to 20% of youth and can cause impairment across the lifespan. Coronavirus disease 2019 (COVID-19) added unique pressures on those with PADs, as children and adolescents endured the longest pandemic restrictions, stymieing their ability to develop socially, emotionally, and cognitively. Although first-line treatment for PADs is psychotherapy, those with severe anxiety symptoms will require pharmacological interventions. Selective serotonin reuptake inhibitor and serotonin norepinephrine reuptake inhibitor (SNRI) medications are effective in treating PADs, yet only duloxetine (a SNRI) is approved by the U.S. Food and Drug Administration for children aged >7 years with generalized anxiety disorder. Treatment of children and adolescents with benzodiazepines for PADs presents unique challenges with potential paradoxical reactions. Caution must be observed as well due to risk for misuse related to long-term use of benzodiazepines with PADs. [Journal of Psychosocial Nursing and Mental Health Services, 60(9), 6-9.].

Psychosocial Characteristics and Reporting Patterns of Women's Experiences With SSRI-Linked Sexual and Non-Sexual Side Effects

ABSTRACT Introduction A majority of women who use Selective Serotonin Reuptake Inhibitors (SSRIs) experience iatrogenic sexual dysfunction – primarily decreased arousal and desire (Lorenz et al., 2016). Experiencing SSRI-linked sexual side effects predicts decreased medication satisfaction and adherence, but few psychosocial factors have been identified that may increase risk of experiencing SSRI-linked side effects. Objective To describe characteristics of young women who report experiencing sexual versus non-sexual side effects linked with SSRI use. Methods 818 emerging adult women (mean age = 19.7, SD = 2.5) in the Southeastern and Midwestern United States reported their lifetime history of medication use (including SSRIs), mental health, unwanted sexual activity, and age of sexual debut. Those who reported ever using an SSRI medication indicated if they had ever experienced any of 20 possible SSRI-related effects, including sexual effects (e.g., desire changes, problems becoming aroused, problems having an orgasm, and increased pain during sex) and 16 non-sexual effects (e.g., weight gain, insomnia, emotional dulling). Linear logistic regression examined psychosocial predictors of reporting sexual versus non-sexual SSRI-linked side effects. Results 187 women (22.9% of sample) reported ever using an SSRI to manage mental health. Among the women who reported lifetime SSRI use, 89 (47.6%) reported experiencing at least one non-sexual side effect, while 45 (24.1%) reported experiencing at least one sexual side effect. Of those who reported that they experienced non-sexual side effects, 45 (50.6%) also reported one or more sexual effect. Every respondent who reported experiencing sexual effects also reported nonsexual effects – that is, nobody reported sexual side effects in the absence of nonsexual side effects. Respondents were 3.8x more likely to report sexual side effects if they ever experienced unwanted sex, p = .005; while mental health disorder history did not significantly predict sexual side effect reporting, p = .226. On the other hand, unwanted sexual experiences did not contribute to models predicting non-sexual effect reporting, p = .236; whereas mental health disorder history was a significant factor, linked with 1.76x increased odds for each positive screening of three possible psychiatric diagnoses, p = .016. Respondents’ age of sexual debut did not significantly contribute to predictions of sexual or non-sexual effects, ps = .813 and .709. Conclusions Among this sample of young women who used SSRIs, sexual and nonsexual side effect reporting was not unilaterally distributed; while non-sexual effects sometimes occurred independently from sexual effects, sexual effects always occurred in the presence of non-sexual effects. This finding raises important questions about whether sexual side effects might be mediated by other secondary effects, like fatigue or emotional dulling. Further, women's unwanted sexual experiences uniquely predicted increased likelihood of reporting sexual effects, whereas their mental health disorder history uniquely predicted increased odds of reporting non-sexual effects. Future directions include testing how patient-provider communication influences patient perception of side effects and how various unwanted sexual experiences (forced and coerced) may differentially impact women's risk of experiencing SSRI-linked side effects. Disclosure No

Association between CYP metabolizer phenotypes and selective serotonin reuptake inhibitors induced weight gain: a retrospective cohort study

BackgroundPrescription medications such as selective serotonin reuptake inhibitors (SSRIs), commonly used to treat depression, are associated with weight gain. The role of pharmacogenomics in predicting SSRI-induced weight gain is unclear.MethodsIn this retrospective cohort study from participants in the Mayo Clinic RIGHT study who were prescribed citalopram, paroxetine, sertraline, or fluoxetine, our aim was to evaluate the association of metabolizer phenotype and total body weight after 6 months of SSRIs initiation. We evaluated the metabolizer phenotypes (poor/intermediate, normal, and rapid/ultra-rapid) of the cytochromes P450 enzymes genes: CYP2C9, CYP2C19, and CYP2D6 known to influence the metabolism of SSRI medications: CYP2C19 for citalopram, CYP2D6 for paroxetine, CYP2D6 and CYP2C19 for sertraline, and CYP2D6 and CYP2C9 fluoxetine. In addition, we assessed the association of metabolizer phenotype and total body weight change at six months following SSRI prescription using parametric analysis of covariance adjusted for baseline body weight and multivariate regression models.ResultsCYP2C19 poor/intermediate metabolizers prescribed citalopram gained significantly more weight than normal or rapid/ultra-rapid metabolizers at 6 months (TBWG %: 2.6 [95% CI 1.3—4.1] vs. 0.4 [95% CI -0.5 – 1.3] vs. -0.1 [-95% CI -1.5—1.1]; p = 0.001). No significant differences in weight outcomes at six months of treatment with paroxetine, sertraline, or fluoxetine were observed by metabolizer status.ConclusionsWeight gain observed with citalopram may be mediated by CYP2C19 metabolizer status.

P701. Association of SSRI Medications and Menstrual Cycle Phase With Neuroactive Steroid Levels in a Transdiagnostic Outpatient Sample With Suicidality

Neuroactive steroids (NAS) have been associated with depressive symptoms, and selective serotonin reuptake inhibitors (SSRIs) alter plasma and brain NAS concentrations. Many NAS are metabolites of the cyclical ovarian hormone progesterone. However, few studies incorporate the menstrual cycle into research on SSRIs and NAS levels. We compared NAS levels between patients with and without SSRI use at three menstrual cycle phases to identify associations between 1) menstrual cycle and NAS levels; 2) SSRIs and NAS levels; and 3) cycle phase moderation of SSRI effects.

Bioresonance, an alternative therapy for mild and moderate depression.

Depression is a negative emotional state that may persist for short or long periods of time with varying severity. The aim of the present study was to evaluate the method by which bioresonance therapy can improve the severity of recurrent depressive disorder with moderate and mild episodes experienced by patients. Bioresonance therapy is a method of energy treatment that processes the electromagnetic information of the human body using a sensitive Mora Nova device using electrodes. In addition, this improvement was compared with the one obtained by applying monotherapy with selective serotonin reuptake inhibitors. The study included two groups of patients suffering from depression. The first group received bioresonance treatment for five weeks. The second group received either newly introduced or on-going pharmacological treatment with selective serotonin reuptake inhibitor antidepressants, as monotherapy, for five weeks. An outcome measurement of severity was performed. Results revealed that, the score improvement on the Hamilton Scale, used for assessing depression and comprising 17 items, showed a mean of 3.1 [standard deviation (SD), 1.28] for the bioresonance group one and a mean of 2.2 (SD, 0.61) for the second group. The difference between the two data series was statistically significant (P<0.0001, Student's t-test). As the bioresonance therapy outcome was higher than the selective serotonin reuptake inhibitor medication outcome, it can be concluded that bioresonance can reduce the severity of the patients facing recurrent depressive disorder with moderate and mild episodes. Furthermore, the reduction in severity for the bioresonance group compared with the antidepressant medication group was statistically significant.

Are SSRI antidepressants effective in preventing death from COVID-19?

A new study conducted by Oskotsky and colleagues in JAMA Network Open’s November 2021 issue found an association suggesting that patients with COVID-19 who take selective serotonin reuptake inhibitor (SSRI) antidepressants—specifically fluoxetine hydrochloride and fluvoxamine maleate—are less likely to experience severe forms of COVID-19 requiring hospitalizations resulting in death. SSRIs have long been used to treat psychological disorders like depression and anxiety. Since COVID-19 currently has no cure, researchers are investigating trends and repurposing drugs to prevent, treat, and manage symptomes of COVID-19. Epidemiologists had previously noticed associations between patients with major depression and a reduction in mortality from COVID-19, suggesting protective effects from antidepressant use in this population. Previous studies with small samples sizes have found an association between SSRI use and reduction in COVID-19–related mortality. Oskotsky and colleagues set out to perform a large retrospective cohort study leveraging a combined clinical dataset from the Cerner Real World Data COVID-19 deidentified electronic health record database of 490,373 patients with COVID-19 across 87 health care centers. After standardizing the dataset based on time of SSRI exposure, comorbidities, and demographic characteristics to reduce confounding variables, 83,584 patients who were 18 years or older were included in the analysis, with 3,401 of those patients receiving an SSRI medication order at least once within 10 days before and 7 days after their first recorded COVID-19 diagnosis. Data from patients taking an SSRI from January to September 2020 were compared to patients with COVID-19 who did not have SSRI orders. Patients taking fluoxetine were 28% less likely to experience COVID-19–related mortality and others taking fluoxetine or fluvoxamine were 26% less likely to experience COVID-19–related mortality compared to matched control groups not taking SSRIs.

Maternal Medication Transmission through Human Milk

Maternal Medication Transmission through Human Milk