Tricyclic Research Articles

Uncovering antidepressant prescription patterns: a three-year analysis of outpatient trends

BackgroundAntidepressants (ADs) are prescribed for various conditions, including neurological and rheumatoid diseases. This study aims to analyze ADs prescribing trends in Iranian outpatients over three years, with a focus on age, sex, and ADs class.MethodsA retrospective cohort study was conducted using prescription data from the Iranian Health Insurance Organization (IHIO) between March 2021 and March 2024. The dataset included 8,924,431 prescriptions from 3,524,273 patients who received at least one ADs. ADs were classified into four groups: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and atypical ADs. The data were processed via the cross-industry standard process for data mining and analyzed using a multivariate logistic regression model.ResultsSSRIs were the most commonly prescribed class, accounting for 63.71% of prescriptions, with sertraline being the most common drug (24.65%). Females accounted for 66.11% of the patient population. ADs prescriptions increased with age, and females were more likely to receive TCAs and SNRIs than males, who had higher rates of atypical ADs use.ConclusionsThis study revealed a notable increase in ADs prescriptions in Iran, particularly among women and older individuals. Continued monitoring of ADs prescription is crucial for optimizing outcomes, especially for vulnerable groups such as elderly individuals.

Electrochemical biosensors for depression: Diagnosis and therapeutic monitoring.

Electrochemical biosensors have revolutionized the detection of biomarkers related to depression and the quantification of antidepressant drugs. These biosensors leverage nanomaterials and advanced assay designs to achieve high sensitivity and selectivity for clinically relevant analytes. Key neurotransmitters implicated in depression, such as serotonin, dopamine, and glutamate, can be accurately measured via biosensors, providing insights into the effects of antidepressant treatments on neurotransmission. Biosensors can also detect biomarkers of inflammation, oxidative stress, and neuronal health that are altered in depression. Real-time biosensing techniques such as fast-scan cyclic voltammetry enable monitoring of dynamic neurotransmitter changes during depressive episodes and pharmacological interventions. Advancements incorporating graphene, gold nanoparticles, and other nanomaterials have enhanced biosensor performance, enabling the detection of low biomarker concentrations. Closed-loop biosensing systems hold promise for precision medicine by automating antidepressant dosage adjustments on the basis of neurotransmitter levels. A wide range of depression biomarkers, including apolipoprotein A4, heat shock protein 70, brain-derived neurotrophic factor, microRNAs, proteins, and combinatorial biomarker panels, have been detected via sophisticated biosensor platforms. Emerging biosensors show selectivity for antidepressant drugs such as serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and selective serotonin reuptake inhibitors in biological samples. This review emphasizes the transformative potential of electrochemical biosensors in combating depression. By facilitating earlier and more accurate diagnoses, these biosensors can revolutionize patient care and enhance treatment outcomes.

The Anti-inflammatory Potential of Tricyclic Antidepressants (TCAs): A Novel Therapeutic Approach to Atherosclerosis Pathophysiology

Atherosclerosis, a chronic inflammatory disease, is driven by complex molecular mechanisms involving inflammatory cytokines and immune pathways. According to recent research, tricyclic antidepressants (TCAs), which are typically prescribed to treat depressive disorders, have strong anti-inflammatory effects. TCAs, including imipramine and amitriptyline, alter inflammatory signaling cascades, which include lowering the levels pro-inflammatory cytokines like TNF-α, IL-1β, and IL-6 and inhibiting NF-κB activation. By inhibiting the NLRP3 inflammasome and suppressing pathways including JAK/STAT, MAPK, and PI3K, these effects are produced, improving endothelial function and reducing oxidative stress. The intricacy of TCAs’ anti-inflammatory actions has demonstrated by the existence of contradictory findings about how they alter IL-6 levels. The dependence of the heterogeneity of the reaction on the use of particular TCAs and experimental settings is shown by the fact that some studies show reduced IL-6 production, while others indicate increases or no changes. This review explores the multifaceted mechanisms through which TCAs modulate inflammatory pathways. TCAs inhibit NF-κB activation, reduce oxidative stress, and suppress the production of key inflammatory mediators, including IL-6 and TNF-α. They also regulate Toll-like receptor (TLR) signaling and NOD-, LRR-, and NLR family pyrin domain-containing protein 3 (NLRP3) inflammasome activation, reducing the release of IL-1β and IL-18, critical drivers of endothelial dysfunction and plaque instability. Given their capacity to target critical inflammatory molecules and pathways, TCAs provide great potential in the therapy of atherosclerosis, particularly for individuals with associated depression and cardiovascular risk factors. Nevertheless, further research is essential to clarify the precise molecular mechanisms, resolve inconsistencies in current findings, and establish the clinical applicability of TCAs as anti-inflammatory agents in atherosclerosis management.

Trends in tricyclic antidepressant prescribing and poisoning in England and Wales 2016-2020.

Tricyclic antidepressants (TCAs) are commonly prescribed despite no longer being a NICE-recommended first-line treatment for depression and their recognized toxicity in overdose. This study examined prescribing, mortality, hospital admissions and clinical TCA data to quantify the use and impact of TCAs in England and Wales. Primary care prescription data for the eight TCAs currently licensed in England and Wales were analysed alongside hospital admission and mortality data relating to TCAs over the study period (January 2016-December 2020 inclusive). Monthly Toxbase™ accesses regarding TCAs during the study period for each TCA were quantified. National Poisons Information Service (NPIS) enquiry data involving TCA exposure were obtained and patient demographics, circumstance, dose ingested and poisoning severity were analysed. English and Welsh mean monthly TCA prescriptions per 100 000 people significantly increased during the study period, both driven by amitriptyline 10mg tablets (95% confidence interval [CI] 3.49-4.59 and 6.36-7.92, respectively). Deaths from poisoning where a TCA was mentioned on the death certificate fell. Toxbase™ accesses increased for amitriptyline and nortriptyline but decreased for all other TCAs. NPIS telephone enquiries relating to TCAs decreased. Hospital admission data did not demonstrate an increase in admissions related to TCAs. Reduced TCA poisoning mortality in England and Wales was seen despite increased dispensing of TCAs in both nations. The prescribing of low-dose amitriptyline formulations was associated with increased consultation with Toxbase™ but not increased hospital admissions or NPIS enquiries, suggesting a fall in TCA poisoning severity resulting from their changing pattern of usage.

Unveiling New Reactivities in Complex Mixtures: Synthesis of Tricyclic Pyridinium Derivatives.

The discovery of new transformations drives the development of synthetic organic chemistry. While the main goal of synthetic chemists is to obtain the maximum yield of a desired product with minimal side product formation, meticulous characterization of the latter offers an opportunity for discovering new reaction pathways, alternative mechanisms, and new products. Herein, we present a case study on the discovery and development of a new chemical transformation using online mass spectrometry. This highly sensitive method enabled the discovery of a new reaction pathway in a catalyst-free cross-dehydrogenative coupling of 1,2,3,4-tetrahydroisoquinoline with acetone via peroxide intermediate, ultimately yielding a tricyclic pyridinium compound. Mass spectrometry was instrumental in detecting and identifying the structure of the pyridinium compound, initially formed as a trace byproduct, which allowed us to develop a general methodology for its exclusive formation.

An Exploration of the Interplay Between Caffeine and Antidepressants Through the Lens of Pharmacokinetics and Pharmacodynamics.

Caffeine consumption is regarded as a widespread phenomenon, and its usage has continued to increase. In addition, the growing usage of antidepressants worldwide and increase in mental health disorders were shown in recent statistical analyses conducted by the World Health Organisation. The coadministration of caffeine and antidepressants remains a concern due to potential interactions that can alter a patient's response to therapy. This review investigates the pharmacokinetic and pharmacodynamic interactions between caffeine and the five main classes of antidepressants: selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and other antidepressants not categorised by class, which we have categorised as 'miscellaneous'. The interaction between fluvoxamine and caffeine resulted in increased concentrations of caffeine in the body and lowered the renal clearance of fluvoxamine. Other SSRIs such as fluoxetine and escitalopram had augmented antidepressant effects by decreasing their renal clearance and prolonging their effects in the body when coadministered with caffeine. Caffeine may also increase the concentration of paroxetine, potentially affecting its pharmacodynamic effects. TCAs such as clomipramine, imipramine, desipramine, and sertraline, were found to reduce the metabolism of caffeine. However, studies suggest caffeine had no significant effect on the concentration of these medications in blood or brain tissue. The inhibition of caffeine at high doses when used with MAOIs such as tranylcypromine and phenelzine was found to lead to a higher likelihood of experiencing hypertension. Coadministration of caffeine with venlafaxine (SNRIs) suggests minimal interactions between the two substances and the pharmacodynamic effects of venlafaxine were unlikely to be impacted by caffeine consumption. Miscellaneous antidepressants (reboxetine, mianserin, agomelatine, maprotiline, and mirtazapine) displayed varying pharmacodynamic interactions with caffeine, resulting in increased antidepressant effects where vortioxetine, maprotiline, and mirtazapine failed to demonstrate any interactions. In conclusion, caffeine demonstrated varying effects on the pharmacokinetic and pharmacodynamic properties of each class of antidepressants, with several classes of antidepressants demonstrating a similar effect on caffeine.

Patterns of self-harm presentations at a Tertiary Urban Hospital in Kenya: A retrospective 5-year study (2018-2022).

Self-harm represents a complex and multifaceted public health issue of global significance, exerting profound effects on individuals and communities alike. It involves intentional self-poisoning or self-injury with or without the motivation to die. Although self-harm is highly prevalent, limited research has focused on the patterns and trends of self-harm among hospital populations in low- and middle-income countries, particularly within Africa. This study aims to explore the socio-demographic and clinical profile of patients presenting with self-harm and determine the common self-harm patterns at a tertiary facility in Kenya. We carried out a descriptive retrospective study and included patients from inpatient units and outpatient settings within the Secion of Psychiatry at the Aga Khan University Hospital, Nairobi from January 1st 2018 to December 31st 2022. A data abstraction tool was used to collect data from eligible files sourced from the medical records department for all patients who met the study criteria. Summary statistics were reported as frequencies and percentages for categorical data and as means and standard deviations for continuous data. A total of 507 files were reviewed in the given timeframe and 497 patients were included in the analysis. Of these patients, 28.1% (n = 144) presented with self-harm. The mean age of the self-harm patients was 26.5 years (SD = 10.5) and a majority (74.3%) were female. The first point-of-contact was at the emergency department in 72.9% of the cases. A majority of them, i.e. 89.6%, reported a past psychiatric diagnosis. Based on the psychiatric diagnosis evaluation of the patients- depression was the most common diagnosis at 88.2%, followed by anxiety disorder at 27.8% and bipolar mood disorder at 17.4%. The majority of reported self-harm cases involved overdose incidents (68.8%), with self-injury accounting for 56.3% of cases. Analgesics were the most frequently reported type of overdose, followed by tricyclic antidepressants. In context of self-injury, cutting emerged as the predominant form of self-harm. Family conflict was reported to be the most common reason for self-harm at 39.6%. This study shows a high rate of self-harm among patients with mental illness in this facility, necessitating the development of self-harm prevention and management protocols. A national registry of self-harm behavior would also help further elucidate the occurrence and mechanisms of self-harm in the population, improving the possibility for early interventions and prevention.

Predictors of response to low-dose amitriptyline for irritable bowel syndrome and efficacy and tolerability according to subtype: post hoc analyses from the ATLANTIS trial

BackgroundLow-dose amitriptyline, a tricyclic antidepressant (TCA), was superior to placebo for irritable bowel syndrome (IBS) in the AmitripTyline at Low-dose ANd Titrated for Irritable bowel syndrome as Second-line treatment (ATLANTIS)...

Antidepressants and risk of postural hypotension: a self-controlled case series study.

Background Antidepressants are associated with postural hypotension (PH), but it is not typically recognised as a common adverse effect. PH is linked with serious complications in older adults (e.g. falls, stroke, cognitive decline). Randomised Controlled Trials (RCTs) examining antidepressants often exclude older people and do not focus on adverse effects. Aim To examine risk of PH associated with antidepressants in adults aged ≥60 in UK primary care. Design & setting Self-controlled case series using routinely collected primary care data from the IQVIA Medical Research Database (IMRD). Method We obtained data from >41,000 adults aged ≥60 in IMRD between 1 Jan 2000 to 31 Dec 2018. Antidepressant prescriptions were determined using code lists based on British National Formulary classification. Risk of PH was examined during four risk-periods (90-days pre-prescription; day 1-28, 29-56, 57+) compared with periods outside these risk windows. Results Amongst 41,005 people with incident PH in the study period, 8,313 were prescribed a selective-serotonin reuptake inhibitor (SSRI); 8,899 were prescribed a tricyclic antidepressant (TCA); and 4,656 were prescribed an "Other antidepressant". We observed a consistent increased risk of PH in day 1-28 in all antidepressants, that reduced thereafter. Risk of PH was highest with SSRIs (IRR 4.22, 95% CI: 3.76-4.74), followed by "Other antidepressants" (IRR 2.17 (95% CI: 1.76- 2.68), TCAs (IRR 2.12, 95% CI: 1.79-2.50). Conclusion A striking increased risk of PH was observed with all antidepressants in the first month, particularly SSRIs. Prescribers should be aware of this risk and may consider PH monitoring when initiating antidepressants.

Reactivity of Olanzapine and Tricyclic Antidepressants on the Protective Effects of Trolox on Lipid Peroxidation Evaluated Using Fluorescence Anisotropy, Electron Paramagnetic Resonance Spectrometry, and Thermal Analysis.

Multiacting receptor-targeting antipsychotics and tricyclic antidepressants stimulate various neurotransmitter receptors despite the different targets of postsynaptic receptors and presynaptic reuptake transporters. Their auxiliary and adverse effects may be caused by multiple targets or the modification of the neuronal membrane. To evaluate the membrane responses to olanzapine, imipramine, desipramine, amitriptyline, lidocaine, and dibucaine, we examined the inhibition of lipid peroxidation in egg yolk phosphatidylcholine liposomes. By contrast, their effects on membrane fluidity were measured as the suppressive contributions of the inhibitory activity of Trolox on lipid oxidation. These drugs inhibit lipid peroxidation and exclude harmful reactive oxygen species and the protective effect of Trolox. The fluorescence anisotropy of 1,6-diphenyl-1,3,5-hexatriene in saturated phospholipid liposome-containing drugs suggested that olanzapine, imipramine, and dibucaine enhanced membrane fluidity. The radical scavenging activity of 2,2-diphenylpicrylhidrazyl and galvinoxyl radicals was determined using electron paramagnetic resonance experiments, and their molecular flexibility was determined using thermograms for differential scanning calorimetry. Multiple regression analyses of the linear free energy relationship approach and comparative investigations revealed that the membranous fluidity of the liposomes, independent of the radical scavenging activity of the drugs, induced the inhibitory activity on lipid peroxidation. We discussed how these drugs act on nervous membranes and aimed to identify the relationship between uncertified functions and membranous fluidity.

Baylis-Hillman adducts as a valuable source for synthesis of functionalized [4,4,4]-propellone bislactone derivatives.

A simple and facile synthesis of functionalized [4,4,4]-propellone bislactone derivatives from Baylis-Hillman adducts via bis-alkylation of cyclic 1,3-diketones and subsequently bis-lactonization has been described. This methodology is appealing with reliability and scalability with gram scale products can be synthesized. These tricyclic compounds can be exploited for their biological activity.

Physicians’ and patients’ perceived risks of chronic pain medication and co-medications in Quebec, Canada: a cross-sectional study

BackgroundThe risks associated with medications and co-medications for chronic pain (CP) can influence a physician’s choice of drugs and dosages, as well as a patient’s adherence to the medication. High-quality care requires patients to participate in medication decisions. This study aimed to compare perceived risks of medications and co-medications between physicians and persons living with CP.MethodsThis cross-sectional survey conducted in Quebec, Canada, included 83 physicians (snowball sampling) and 141 persons living with CP (convenience sampling). Perceived risks of adverse drug reaction of pain medications and co-medications were assessed using 0–10 numerical scales (0 = no risk, 10 = very high risk). An arbitrary cutoff point of 2-points was used to ease the interpretation of our data. Physicians scored the 36 medication subclasses of the Medication Quantification Scale 4.0 (MQS 4.0) through an online survey, while CP patients scored the medication subclasses they had taken in the last three months through telephone interviews.ResultsPersons living with CP consistently perceived lower risks of adverse drug reaction compared to physicians. For eight subclasses, the difference in the mean perceived risk score was > 2 points and statistically significant (p < 0.05): non-specific oral NSAIDs, acetaminophen in combination with an opioid, short-acting opioids, long-acting opioids, tricyclic antidepressants, antipsychotics, benzodiazepines, and medical cannabis.ConclusionsDivergent risk perceptions between physicians and patients underscore the necessity of facilitating a more extensive discussion on medications and co-medications risks to empower patients to make informed decisions and participate in shared decision-making regarding their treatments.

Design, Synthesis, and Pharmacological Evaluation of Nonsteroidal Tricyclic Ligands as Modulators of GABAA Receptors.

GABAA receptors (GABAARs) are the major elements of inhibitory neurotransmission in the central nervous system (CNS). They are established targets for regulation by endogenous brain neuroactive steroids (NASs) such as pregnanolone. However, the complexity of de novo synthesis of NAS derivatives has hindered attempts to circumvent the principal limitations of using endogenous NASs, including selectivity and limited oral bioavailability. In this study, we designed a series of tricyclic compounds, inspired by the structures of pregnanolone and pregnenolone sulfate, to explore novel nonsteroidal alternatives. Using patch clamp electrophysiology, we demonstrate that these compounds exhibit either positive or negative allosteric modulation of GABAARs. Specifically, we discover a positive allosteric modulator (PAM) and a series of tricyclic sulfate-based negative allosteric modulators (NAMs) all active at the micromolar level. This research has significantly broadened the chemical diversity of ligands targeting GABAARs offering potential for efficacious allosteric modulators while avoiding the complexity of NAS synthesis.

Managing depression in the elderly: real-world clinical considerations and perspectives.

This study aims to elucidate current trends in clinical practice for managing depression in elderly patients, focusing on the utilization of pharmacotherapeutics and integrated care models to improve patient outcomes. A comprehensive survey was conducted among physicians from various European countries to gather insights into prescribing habits, treatment patterns, and the impact of comorbidities on therapeutic choices, with a focus on trazodone. The participants included psychiatrists, general practitioners, and neurologists actively involved in elderly depression care. The findings reveal a preference among physicians for using antidepressants like trazodone, due to efficacy and tolerability. Selective serotonin reuptake inhibitors and serotonin-noradrenaline reuptake inhibitors were also commonly prescribed, while tricyclic antidepressants and monoamine oxidase inhibitors were less favored. Psychiatric conditions and sleep disturbances significantly influenced treatment decisions. The survey underscored the importance of multidisciplinary management and the crucial role of caregivers in the treatment process. Effective management of depression in the elderly demands a precision approach that incorporates a thorough understanding of pharmacology, comorbidities, and a collaborative approach to maximize the effects of treatment while trying to minimize polypharmacy and the co-occurring side effects. The study highlights the need for tailored treatment strategies that address the complex needs of the elderly to enhance their quality of life and treatment outcomes.

Association of antidepressants with cataracts and glaucoma: a disproportionality analysis using the reports to the United States Food and Drug Administration Adverse Event Reporting System (FAERS) pharmacovigilance database.

Antidepressants are commonly prescribed for mood disorders. Epidemiological studies suggest antidepressant use may be associated with cataracts and glaucoma. We aim to investigate the association between antidepressants and cataracts and glaucoma. Data was collected from the United States Food and Drug Administration Adverse Event Reporting System. Reporting odds ratio (ROR) and Bayesian information components (IC025) were calculated for antidepressants (ie, selective serotonin reuptake inhibitors [SSRIs], selective norepinephrine reuptake inhibitors [SNRIs], serotonin-norepinephrine-dopamine reuptake inhibitors, serotonin modulators and stimulators, serotonin antagonists and reuptake inhibitors [SARIs], norepinephrine reuptake inhibitors, norepinephrine-dopamine reuptake inhibitors, tricyclic antidepressants [TCAs], tetracyclic antidepressants [TeCAs], and monoamine oxidase inhibitors [MAOIs]). The reference agent was acetaminophen. TeCAs and MAOIs were significantly associated with a decreased risk of cataracts (ROR = 0.11-0.65 and 0.16-0.69, respectively). TCAs, brexanolone, esketamine, and opipramol reported an increased cataract risk (ROR = 1.31-12.81). For glaucoma, SSRIs, SNRIs, SARIs, TCAs, MAOIs, and other investigated antidepressants reported significant RORs ranging from 1.034 to 21.17. There was a nonsignificant association of angle closure glaucoma (ACG) and open angle glaucoma (OAG) with the investigated antidepressants. For adverse event cases, multiple suspected product names are listed, and as cases are not routinely verified, there may be a possibility of duplicate reports and causality cannot be established. Most of the investigated antidepressants were associated with a lower risk of cataract reporting. TCAs, brexanolone, esketamine, and opipramol were associated with greater odds of cataract. For most antidepressants, there was an insignificant increase in reports of ACG and OAG.

Updated document on the management of functional dyspepsia by the Asociación Española de Neurogastroenterologia y Motilidad (ASENEM) and Sociedad Española de Medicina Familiar y Comunitaria (semFYC).

Functional dyspepsia (FD) is a gut-brain axis disorder characterized by postprandial fullness, early satiety, bloating and/or epigastric pain, which are presumed to originate in the gastroduodenal tract. While the international recommendations in the Rome IV consensus require endoscopy to rule out an organic condition before establishing a diagnosis of FD, international guidelines recommend that, in the absence of risk factors, patient management be initiated at the primary care level by establishing Helicobacter pylori infection status, with eradication when positive, followed by empiric therapy with proton pump inhibitors and/or prokinetics, and that endoscopy be reserved for patients refractory to said measures. Second-line therapy includes neuromodulating agents, among which tricyclic antidepressants and atypical antipsychotics such as levosulpiride stand out. The latter has a predominant prokinetic effect, hence it is also used as first-line therapy for patients where early satiety and postprandial fullness predominate. Other therapy alternatives include phytotherapy using STW5 or peppermint/caraway oil, which have shown their superiority over placebo in controlled studies. Concurrently, dietary and lifestyle counseling, as well as psychological interventions such as cognitive-behavioral therapy, when available, may represent a therapeutic alternative worth considering for some patients.

Psychotropic Drugs in Dermatology Part 1: Anti-depressants and Mood Stabilisers.

Psycho-dermatology is an evolving speciality of psychosomatic medicine where psychological factors play a role in initiating and/or exacerbating the dermatological conditions. Dermatologists should be well versed with the basic pharmacotherapy of psycho-cutaneous disorders and work in close liaison with the psychiatrists when it comes to the holistic management of the same. The review has been divided into two parts, with part 1 consisting of anti-depressants and mood stabilisers and part 2 consisting of anti-psychotics, anxiolytics, and sedative-hypnotic agents used in psycho-dermatology. This comprehensive review focusses on the various psychotropic drugs which are of paramount significance to the dermatologists. The knowledge of these drugs will lead to the pertinent treatment of the psychiatric dermatoses, which has been a less explored territory in the arena of dermatology. Within the realm of psycho-dermatology, a diverse array of anti-depressants is utilised to address psychiatric dermatoses. These include selective serotonin reuptake inhibitors like citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline, alongside selective serotonin norepinephrine reuptake inhibitors such as venlafaxine, desvenlafaxine, and duloxetine. Additionally, norepinephrine dopamine reuptake inhibitors like bupropion; tricyclic antidepressants including doxepin, amitriptyline, imipramine, and clomipramine; and tetracyclic antidepressants like mirtazapine are commonly employed. Supplementary medications like anti-convulsants (e.g., gabapentin and pregabalin) further enrich the therapeutic landscape in psycho-dermatology. The approach to treatment in psycho-dermatology is meticulous, starting with a precise psychiatric diagnosis and followed by tailored drug interventions. Factors such as individual response, side-effect profiles, potential drug interactions, and concurrent medical conditions guide the selection and titration of medications. Typically, treatment initiates at conservative doses, with adjustments made based on patient progress and tolerability. This comprehensive review not only illuminates the psycho-cutaneous indications of these medications including in patients with co-morbidties but also underscores the imperative of vigilant monitoring for adverse effects and its management. This systematic review aimed to evaluate the use of psychotropic medications, including antidepressants and mood stabilizers, in dermatology. A comprehensive search of PubMed Central was conducted for studies published between 1986 and 2023, focusing on meta-analyses, reviews, and systematic reviews. After screening 2287 records, 26 studies met the inclusion criteria. The findings underscore the potential role of psychotropic drugs in managing dermatological conditions, highlighting the need for further research to strengthen the evidence base in psycho-dermatology.

Treatment of Anxiety and Depressive Disorders in Combatants in Modern Conditions: Focus on Efficacy and Safety

Military service in Ukraine today is associated with emotional overload, which leads to significant changes in mental health. On the background of a large number of stress factors, cognitive disorders develop rapidly, especially those related to attention and working memory, which significantly affects the effectiveness of service. For the treatment of stress and anxiety, selective serotonin reuptake inhibitors are used as first-line drugs: citalopram hydrobromide, escitalopram, paroxetine hydrochloride, sertraline, as well as serotonin and noradrenaline reuptake inhibitors: venlafaxine hydrochloride, duloxetine hydrochloride. Tricyclic antidepressants belong to the second line. Due to the wide range of side effects of these drugs, such pharmacotherapy is often poorly tolerated and is associated with unsatisfactory adherence. The issue of the safety of the use of any drugs in combatants is extremely important given the specifics of the tasks they perform. The search for effective and safe treatment of anxiety and depression is a pressing issue today. The objective: to assess the impact of herbal medicine which contains lavender oil (WS® 1265) on the mental health of combatants in real combat conditions. Materials and methods. 76 servicemen (mean age – 34 ± 2.2 years) were examined. They were treated at the clinical base of Military Medical Hospital 59. The average duration of stay in the combat zone before hospitalization was 5 ± 1.2 months. Somatic pathology was diagnosed in 31 (40.8%) combatants – arterial hypertension (AH) of stage I–II with 1–2 degrees of increased blood pressure (BP). The average value of “office” systolic blood pressure was 156.5 ± 7.4 mm Hg, diastolic blood pressure – 92.6 ± 4.4 mm Hg. Results. Anxiety disorders were determined in 49 combatants, and anxiety-depressive disorders – in 27 persons. For 10 days patients received herbal remedy with lavender oil (WS® 1265) 30 minutes before bedtime. Before the start of treatment, 89.5% of the examined experienced clinical anxiety, on the 5th day – only 9.2% (p &lt; 0.001), and on the 10th day no signs of clinical anxiety were recorded. The level of anxiety in the dynamics of treatment significantly decreased from 18.0 to 7.5 (p &lt; 0.001). Manifestations of depression before the start of treatment were detected in a significantly smaller number of combatants – 47.4% with a predominance of signs of subclinical depression – 32.9%. In the dynamics of the use of the drug on the 10th day of observation the signs of clinical depression were not determined in any combatant. Against the background of therapy with a medicinal product based on lavender oil (WS® 1265), blood pressure indicators significantly decreased (r = 0.51; p &lt; 0.001). Conclusions. It was found that the use of herbal preparation with lavender oil (WS® 1265) has a positive effect on the mental health of combatants, reducing the average level of both anxiety and depression, as well as reducing blood pressure indicators. The tolerance of the herbal preparation based on lavender oil (WS® 1265) was found as excellent in 90.8%.

Possibilities of a supramolecular system based on hexamolybdenum cluster complexes in the determination of amitriptyline by amperometric immunosensors in human urine

A method for the determination of amitriptyline as a representative of tricyclic antidepressants by immunosensors using supramolecular systems based on hexamolybdenum cluster complexes in human urine was developed. These complexes are electrochemically active and give a stable analytical signal, which was utilized in the development of amperometric immunosensors. Luminescence and dynamic light scattering methods were applied to prove the formation of a supramolecular system of self-organized hexamolybdenum nanoparticles and chitosan molecules. A composite material based on hexamolybdenum cluster complexes combined with reduced graphene oxide was developed. The working range of amitriptyline concentrations when determined by amperometric immunosensor was 1 × 10-9 -1 × 10-4 M, the lower limit of detectable contents lies at the level of 5 × 10-10 M, the content of amitriptyline in urine samples – at the level of (n – 7) × 10-8 M. Comparison of the results of the analysis by amperometric immunosensor and polarization fluorescence immunoassay showed the absence of significant systematic errors. The ability to determine amitriptyline in biological fluids makes it possible to select the optimal therapeutic dose of the drug, i.e., to develop approaches to the creation of personalized medicine.

Chronic abdominal pain. A multidisciplinary approach in gastroenterology and psychiatry

Background. Chronic abdominal pain syndrome is one of the manifestations of gut-brain interaction disorders, which occupy a significant place among gastrointestinal pathologies, but remain insufficiently recognized in clinical practice. Centrally mediated abdominal pain syndrome (CAPS) is singled out as a specific manifestation of this disorder in modern literature. This disease encompasses a range of gastrointestinal and extra-gastrointestinal symptoms and is closely associated with psychological distress, neurological and psychiatric disorders. Given an increase in stress factors in the modern world and the constant distress of wartime in Ukraine, the diagnosis of CAPS requires from clinicians an understanding of the relationship between the central nervous system and gastrointestinal diseases at each link of the health care system. Purpose: to review publications on the pathogenesis, general principles of diagnosis and treatment of CAPS as an independent nosology in the category of the gut-brain axis disorders (GBAD), as well as to draw attention to the need for a comprehensive psychosomatic approach to the management of patients with this disease. Materials and methods. A search was made for articles covering functional gastrointestinal disorders and chronic abdominal pain in domestic and foreign publications. Twenty-five works were used for the period from 1982 to 2024. Among them, 8 % were published in Ukraine, and 92 % — abroad. The publications considered the following topics: chronic abdominal pain as such — 13 articles, diagnosis of functional disorders in the context of surgery — 3 articles, psychosomatic influence on gastrointestinal pathologies — 3 articles, neuromodulation pharmacotherapy — 2 articles, communication and psychotherapeutic strategies in the management of patients with GBAD — 4 articles. Discussion. The development of CAPS is caused by central sensitization. Due to the need to exclude organic pathology and in a long-term observation of the patient, as well as due to the association of the diagnosis with mental pathologies, a critical factor is a thorough history collection, focusing on the description of pain. Antidepressants are the basis of pharmacological therapy for CAPS, with tricyclic antidepressants play a leading role due to their pronounced analgesic effect in low doses, but selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are also important as the drugs of choice in patients with chronic pain and depressive states. The effectiveness of drug treatment is enhanced in comprehensive therapy and combination with psychotherapeutic intervention methods, which should be offered to patients as early as possible. Conclusions. CAPS as a representative of the GBAD group is a gastrointestinal pain disorder with a central determinant. Due to the growing clinical prevalence and complexity of this group of diseases, there is an urgent need for a comprehensive approach to their management based on the modern biopsychosocial model. The choice of therapy should include all the features of the occurrence and course of the disease, and psychopharmacological agents and psychotherapeutic interventions chosen should be justified and effective.