Tricyclic Research Articles

Electrocardiographic changes in severe quetiapine poisoning

Introduction Quetiapine shares sodium channel-blocking properties with tricyclic antidepressants. We present the electrographic findings in two patients with severe quetiapine poisoning. Case summaries Two patients poisoned with quetiapine presented with impaired consciousness, requiring mechanical ventilation and vasopressor support, with one also experiencing status epilepticus. Their peak serum quetiapine concentrations were 4.52 mg/L and 25.6 mg/L. Images On admission, electrocardiograms for both patients revealed a tall R wave in lead aVR, deep S wave in lead I, and QRS complex duration of 120 ms. These findings gradually resolved in parallel with the improvement in their symptoms. Conclusion Severe quetiapine poisoning may cause electrographic changes. Further studies are needed to determine the utility of these electrocardiogram findings for predicting the severity of quetiapine poisoning.

Retraction Note: Disruption of lipid-raft localized Gαs/tubulin complexes by antidepressants: a unique feature of HDAC6 inhibitors, SSRI and tricyclic compounds.

Retraction Note: Disruption of lipid-raft localized Gαs/tubulin complexes by antidepressants: a unique feature of HDAC6 inhibitors, SSRI and tricyclic compounds.

Headaches and adolescents: why so many failures in their management

The management of headaches in children and adolescents is still a challenge, with patients experiencing pain for years and polypharmacy. We reviewed the medical history of 31 patients referred to our pain clinic for chronic headaches between April 2023 and April 2024. There were more female than male patients (73%). Patients have been reporting headaches for 52 ± 44 months on average. Twenty-nine patients (94%) were experiencing different types of pain besides headaches. The most common medication prescribed in this group of patients was topiramate (70%), followed by tricyclic antidepressants (35%) and triptans (21%). Patients had been prescribed and tried, on average, 4.5 ± 2 (range 1–10) different medications to manage headaches and concomitant psychiatric disorders. Twenty-two patients (71%) had been diagnosed with a psychiatric disorder, including depression, anxiety, and PTSD, and 16% had a history of attempted suicide/self-harm. Fourteen of them (45%) had been prescribed antidepressants or benzodiazepines. They had been prescribed, on average, 2 ± 1 (range 1–4) psychiatric stabilizer medications. We agreed with the referral diagnosis in 39% of the patients. We attributed the headaches to more complex chronic pain conditions, including fibromyalgia (15%) and AMPS (15%), autism with sensory integration problems (9%), and major depression (9%). Patients had seen an average of 3 ± 1 (range 1–5) different specialists; none consulted a pain specialist. Patients underwent between 0 (12%) and four tests (6%), including MRI (52%) and CT of the brain (8%). These neuroimaging studies did not demonstrate any brain pathology. We prescribed new medications and treatments, including nerve blocks, in 19 (61%) patients. In 47% of the cases, patients reported improved headaches, while 22% did not feel our recommendations were effective. Twenty-one percent of patients never came back to the clinic for a follow-up. Significant catastrophizing was present in 57% of the patients; 52% of patients had mild to severe anxiety, and 57% had symptoms of depressive disorder. Conclusions: Headaches are often the manifestation of more complex pain syndromes that require a more holistic approach, different from conventional pharmacological management.What is Known:• Headache is one of the most disabling diseases.• Prevalence of headaches in hildrens and adolescents can be as high as 58%.What is New:• Conventional pharmacological management often fails to help young patients.• A relationship between chronic headaches and psychopathology should be investigated in these young patients.

Neuroplasticity and Mechanisms of Action of Acute and Chronic Treatment with Antidepressants in Preclinical Studies

Pharmacotherapy for depression includes drugs such as monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), noradrenaline (NA) and serotonin (5-HT) reuptake inhibitors (NaSSAs), and atypical antidepressants; these drugs exert differentially beneficial effects on symptoms of depression after acute and chronic treatment in animal models. Said effects are established through neuroplastic mechanisms involving changes in neurogenesis and synaptogenesis as result of the activation of intracellular signaling pathways associated with neurochemical and behavioral changes. Antidepressants increase the synaptic availability of monoamines (monoaminergic hypothesis) such as 5-HT, NA, and gamma-aminobutyric acid (GABA) by inhibiting their reuptake or degradation and activating intracellular signaling pathways such as the responsive element binding protein (cAMP-CREB) cascade, which regulates the expression of genes related to neuroplasticity and neurogenesis, such as brain-derived neurotrophic factor (BDNF), in various brain structures implicated in depression. The aim of this review is to analyze the mechanisms of action of different antidepressants and to compare the effects of acute and chronic treatment on neuroplasticity in animal models of depression. A thorough search was conducted in PubMed, Scopus, and Web of Science, focusing on studies since 1996 with keywords like antidepressants, acute and chronic treatment, neuroplasticity, and experimental depression. Studies included had to investigate antidepressant effects experimentally, with full-text access, while excluding those that did not. Data extraction focused on study design, findings, and relevance to understanding treatment differences. Only high-quality, peer-reviewed studies were considered to ensure a comprehensive synthesis of current knowledge.

One-Pot Regio- and Diastereoselective Gold-Catalyzed Propargylation of in Situ Activated Chromones and Consecutive Cyclization.

Herein, we report a gold-catalyzed propargylation of chromone derivatives by propargylsilanes. Chromones are synergistically activated by the silylium cation resulting from the gold activation of the propargylsilane. The reaction exclusively occurs at the C2-position of the chromone, and a single diastereoisomer is formed. Computational studies performed on the reaction mechanism rationalize the formation of the preferred diastereoisomer. Finally, a dual consecutive cascade reaction based on different gold catalysts enables the formation of complex tricyclic compounds.

Evaluating pain management practices for cancer patients among health professionals in cancer and supportive/palliative care units: a Belgian survey.

Pain is reported in 66% of cancer patients with advanced disease. Adequate pain management is a cornerstone of comprehensive supportive cancer care. The purpose of this study was to assess pain management in Oncology Units in Belgium. A descriptive research design was applied. A structured questionnaire developed by a writing committee was sent to 37 healthcare professionals in 2021. Twenty-four replied. In most centers, pain management is organized through the pain clinic (91.7%), followed by a multidisciplinary team (83.3%) and the palliative care unit (75%). Eighty-seven percent use tools to assess the pain, mostly for in-patients. Pain guidelines are applied in 17 centers with the ESMO guidelines being the most often mentioned. Mild to moderate pain is managed with paracetamol, non-steroidal anti-inflammatory drugs, and tramadol. All centers handle severe pain with strong opioids, including buprenorphine and fentanyl. Only 62% are concerned about the side effects of strong opioids. In case of neuropathic pain, treatments with pregabalin, gabapentine, and tricyclic antidepressants are the most common, followed by opioids and interventional therapies for refractory neuropathic pain. Asking advice to the pain clinic, combination therapy and opioid rotation are used for patients with inadequate analgesia. Eighty to 90% of the centers have access to intraspinal and epidural techniques, respectively. An active teaching program on pain relief is offered in 66%, but only 33% of the centers do active research focused on pain management. This is the first survey on pain management in the Belgian centers. Surprisingly only one-third of the health professionals ask advice to the pain clinic in case of inadequate pain relief, meaning that we are far away from a multidisciplinary patient-centered approach. Therefore, the BSMO Supportive Care Task Force promotes the development of an interdisciplinary committee in every oncology unit.

A Review of Pharmacologic and Non-Pharmacologic Therapies in the Management of Irritable Bowel Syndrome: Current Recommendations and Evidence.

Irritable bowel syndrome (IBS) is a highly prevalent and debilitating disorder of gut-brain interaction (DGBI) affecting millions globally. It imposes a significant burden on healthcare systems and is a leading cause of workplace absenteeism. IBS is classified into several subtypes based on predominant presenting symptoms, including IBS with constipation (IBS-C) and IBS with diarrhea (IBS-D), with each requiring targeted approaches to treatment. Some treatments, such as psychotherapy, dietary intervention, and medications like tricyclic antidepressants, are nonspecific and recommended for managing IBS symptoms across all subtypes. In contrast, therapies like secretagogues for IBS-C and eluxadoline or rifaximin for IBS-D are subtype-specific. However, many IBS treatments carry conditional recommendations and are based on low-certainty evidence, emphasizing the need for further research to expand the available treatment options. This review compares the latest IBS management guidelines from the American Gastroenterological Association (AGA), American College of Gastroenterology (ACG), British Society of Gastroenterology (BSG), and European Society for Neurogastroenterology and Motility (ESNM). Pharmacologic and non-pharmacologic therapies, including established and emerging interventions, will be explored to provide a comprehensive guide to management.

Oral Manifestations in Patients in Treatment with Antidepressants: A Systematic Review.

Background/Objectives: The rising use of antidepressants is linked to oral health risks, including xerostomia, caries, and periodontal disease. Recognizing these risks is essential for improving patient care. To systematically review oral manifestations in patients undergoing antidepressant treatment. Methods: This review follows the PRISMA guidelines and includes observational studies published in the last 21 years. A PICO-based question was developed to select relevant studies, which were assessed for quality using a modified STROBE checklist. Results: A total of 11 studies were analyzed, revealing a consistent association between antidepressant use and the increased risk of xerostomia, caries, and periodontal disease. Additional findings included taste dysfunction and oral bleeding complications. Among the antidepressants, selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) were most commonly associated with xerostomia and caries. However, no significant impact was observed on the chemical composition of saliva or on hemostasis in invasive dental procedures. Conclusions: Antidepressant use may lead to significant oral health issues, notably xerostomia and caries. Further studies are recommended to clarify the influence of specific antidepressants and confounding factors, such as treatment duration, dosage, and hygiene habits, on oral health outcomes.

Integrating genome-wide information and wearable device data to explore the link of anxiety and antidepressants with pulse rate variability.

This study explores the genetic and epidemiologic correlates of long-term photoplethysmography-derived pulse rate variability (PRV) measurements with anxiety disorders. Individuals with whole-genome sequencing, Fitbit, and electronic health record data (N = 920; 61,333 data points) were selected from the All of Us Research Program. Anxiety polygenic risk scores (PRS) were derived with PRS-CS after meta-analyzing anxiety genome-wide association studies from three major cohorts- UK Biobank, FinnGen, and the Million Veterans Program (NTotal =364,550). PRV was estimated as the standard deviation of average five-minute pulse wave intervals over full 24-hour pulse rate measurements (SDANN). Antidepressant exposure was defined as an active antidepressant prescription at the time of the PRV measurement in the EHR. Anxiety PRS and antidepressant use were tested for association with daily SDANN. The potential causal effect of anxiety on PRV was assessed with one-sample Mendelian randomization (MR). Anxiety PRS was independently associated with reduced SDANN (beta = -0.08; p = 0.003). Of the eight antidepressant medications and four classes tested, venlafaxine (beta = -0.12, p = 0.002) and bupropion (beta = -0.071, p = 0.01), tricyclic antidepressants (beta = -0.177, p = 0.0008), selective serotonin reuptake inhibitors (beta = -0.069; p = 0.0008) and serotonin and norepinephrine reuptake inhibitors (beta = -0.16; p = 2×10-6) were associated with decreased SDANN. One-sample MR indicated an inverse effect of anxiety on SDANN (beta = -2.22, p = 0.03). Anxiety and antidepressants are independently associated with decreased PRV, and anxiety appears to exert a causal effect on reduced PRV. Those observational findings provide insights into the impact of anxiety on PRV.

Antidepressant drugs targeting on the histone deacetylase (HDAC) research progress

Abstract. Depression is a high incidence, low clinical cure rate, and high recurrence rates of mental disorders. Antidepressant drug development has been going on for several years, and is widely used in the market of monoamine oxidase inhibitors, for example, tricyclic antidepressants. There has been a lot of progress, but they still can't take effect immediately, and may cause adverse reactions or other defects in the patients nervous system and urinary system. At present, with the rapid development of global society, people are facing increasing mental stress, and the high incidence of depression is becoming increasingly severe. The development of antidepressant drugs is of urgency and importance. This article from the perspective of epigenetics, is based on the modification of histone acetylation, analysis of depression causes the histones to acetylate enzyme (HDAC), and targeted at HDAC drugs, mainly HDAC inhibitors (HDACi). This article reviews the therapeutic effects and therapeutic mechanisms of histone deacetylase (HDAC)-targeted drugs on depression, so as to provide a reference for exploring new treatment methods for depression.

Impact of using dosing criteria to refine pharmacogenomic clinical decision support for tricyclic antidepressants.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To evaluate the impact of dose-specific logic for tricyclic antidepressant (TCA) pharmacogenomic (PGx) clinical decision support (CDS). We aimed to provide guidance in an area with limited supporting literature, ensure optimal dosing through CDS, and limit alert fatigue. The primary outcome was the reduction in alerts prescribers encountered, while the secondary outcome included an analysis across specialties. A retrospective chart review was conducted to examine TCA PGx CDS before and after implementation of dosing criteria for alerts. Data were abstracted from the electronic medical record. A χ2 test was performed to analyze the frequency of alerts in behavioral health and other specialties. In the cohort lacking dose criteria, most TCA orders were for indications other than depression (76%) and guidelines would not apply to the majority of these orders. Using dosing criteria to refine CDS reduced the volume of TCA alerts by 74.8%. Alert volume decreased the most in specialties other than behavioral health due to prescriptions for indications other than anxiety or depression (P = 0.035). Dose-centric alerts may be used as a strategy to achieve optimal dosing. Alerting clinicians when dose modifications should occur contributes to getting the right dose to the right patient. Future efforts should focus on optimal dosing of medication through CDS enhancements.

An overview of the non-procedural treatment options for peripheral neuropathic pain.

Peripheral neuropathic pain is common in patients with peripheral nerve injury and can significantly impact both their function and quality of life. There is a wide variety of non-interventional treatment approaches, including pharmacologic therapy, physical/occupational therapy, modalities (therapeutic, mechanical, thermal, etc.), psychology, and lifestyle modification. First line pharmacologic therapy for peripheral neuropathic pain includes gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors. Other classes of medications, such as topical treatments, opioids, and cannabinoids, have more limited usefulness in treatment but remain part of a treatment regimen. Physical and occupational therapy, psychological interventions, and lifestyle medicine are important adjuncts in the treatment and prevention of future peripheral neuropathic pain. The strength of the evidence supporting each intervention varies, with that for pharmacologic intervention being the strongest. A combination of these options tailored to the individual needs of the patient likely will result in the best treatment outcome for peripheral neuropathic pain.

Impact of sedative and appetite-increasing properties on the apparent antidepressant efficacy of mirtazapine, selective serotonin reuptake inhibitors and amitriptyline: an item-based, patient-level meta-analysis

In an influential network meta-analysis, the tricyclic antidepressant (TCA) amitriptyline was found to be the most efficacious of 21 antidepressants, hence outranking selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs). The alpha2/5HT2A/2C/3/H1 antagonist mirtazapine was ranked as the second most effective and appeared at least as effective as the SSRIs and SNRIs that followed next. Since the most common effect parameter in depression trials-the sum score of the Hamilton Depression Rating Scale (HDRS-17-sum)-includes three items measuring sleep and two measuring appetite and weight, this outcome could be the result of amitriptyline and mirtazapine being more sedative and orexigenic. The main aim of this study was to compare mirtazapine with SSRIs or amitriptyline with respect to impact on core depression symptoms. Access to patient-level data from all company-sponsored, acute-phase, HDRS-based, and randomized trials of mirtazapine in adult major depression available to Merck was granted. Thirty-two studies compared mirtazapine to placebo and/or amitriptyline or an SSRI whereas five compared mirtazapine to another TCA or an SNRI, venlafaxine. Data were divided into subgroups for direct comparisons of mirtazapine vs placebo or different subgroups of antidepressants. Indirect comparisons of SSRIs vs amitriptyline were also undertaken. Mixed models for repeated measures were used to assess efficacy as reflected by i) HDRS-17-sum, ii) six core depression symptoms (HDRS-6-sum), and iii) all individual items. The dataset consisted of 5974 participants. Mirtazapine (n=1362) outperformed SSRIs (n=1369) on HDRS-17-sum, but this was due to differences regarding items reflecting sleep, appetite, and gastrointestinal dysfunction-with respect to reducing depressed mood, suicidality, and psychic anxiety, SSRIs and/or venlafaxine were more effective. Amitriptyline (n=622) was superior to mirtazapine (n=606) in reducing depressed mood, and the combined group of all TCAs (n=831) outperformed mirtazapine (n=824) also with respect to other core depression symptoms. Since there were no head-to-head comparisons of amitriptyline vs SSRIs, no firm conclusion may be drawn with respect to relative efficacy of the two, but indirect comparisons support the notion that amitriptyline and other tricyclics may be superior also to SSRIs. While the apparent superiority of mirtazapine over SSRIs is explained by its sedative and orexigenic properties, and by its absence of gastrointestinal side effects, amitriptyline appeared more effective in reducing core symptoms of depression than mirtazapine and possibly also than SSRIs; given the indirect nature of the latter comparison, this outcome should however be interpreted with caution. Lack of information regarding dosing was another important limitation. The study illustrates the value of item-based analyses when assessing the relative efficacy of antidepressants. The Swedish Research Council, the Swedish Brain Foundation. The Gothenburg Society of Medicine, the Swedish Society of Medicine, Åke Wiberg's Foundation, Märta Lundqvist's Foundation, Fredrik and Ingrid Thuring's Foundation, Söderström-Königska Foundation and Frimurare-Barnhusdirektionen in Gothenburg.

Retrospective study on the use of venlafaxine in 176 cats diagnosed with behavioral disorders

Behavioral disorders in cats can severely affect their well-being and the owner-pet relationship, sometimes resulting in relinquishment or euthanasia. While selective serotonin reuptake inhibitors (SSRIs) and tricyclic anti-depressants (TCAs) have been routinely used, venlafaxine, a serotonin norepinephrine reuptake inhibitor (SNRI) that has been effective in treating various human psychiatric conditions, offers potential for veterinary use in addressing feline behavioral disorders.This retrospective study evaluates the use of venlafaxine in 176 cats diagnosed with a variety of behavioral disorders to assess its efficacy, safety, and ease of administration within privately owned-cats. Cats were from multiple veterinary practices which collected data on dosage, administration, adverse effects, and overall treatment outcomes. Both quantitative and qualitative data were gathered through veterinary records and owner surveys, allowing for a comprehensive analysis of venlafaxine’s effect on cat behavior and wellbeing.Findings from this study highlight venlafaxine as an effective treatment for a broad spectrum of behavioral disorders in cats, with a noteworthy rate of owner compliance in administering the drug, facilitated by its convenient formulation. Adverse effects were reported in 35.4% of the cats (N=61), they were primarily minor and of short duration. Dosage adjustments based on individual responses and specific behavioral diagnoses improved treatment outcomes and minimized adverse effects. A significant portion of the treated population exhibited substantial behavioral improvement, with 20% (N=35) of cats successfully weaned off the medication without a relapse of clinical signs.Venlafaxine represents a promising pharmacological intervention for behavioral disorders in cats, meriting further investigation in prospective studies.

A New Perspective in Diagnosis of Neuroendocrine Tumors and Pseudo Pheochromocytomas, Understanding the Biology Behind a Mislabeled Medical Terminology

Recently the incidence of undiagnosed hypertension that does not fit into either category of essential hypertension or secondary hypertension is becoming largely increased. Most of these cases are attributed to anxiety or forms of panic attacks associated with high blood pressure. Some in fact are lethal yet clinicians have been challenged to know the real cause of the disease. The term pseudopheochromocytoma widely used for patients who have typical presentation of pheochromocytoma but yet no concrete evidence of disease manifested in their imaging or lab reports to suggest increased production of adrenaline or neurepinephrine, as seen in typical pheochromocytomas. These patients suffer from life threatening attacks of hypertension, yet the only medical revenue offered are anxiolytics, or tricyclic antidepressants. Here we review a case of suspected pheochromocytoma and we present a novel theory about the real player behind all cases of pseudopheochromocytomas. Since in contrast to all other tumors, performing a tissue biopsy is detrimental in the case of pheochromocytomas, and therefore no one logically considers a tissue biopsy for adrenal gland, liquid biopsy( NETest by WREN Laboratory) is a great substitute with high accuracy to replace the tissue biopsy. We conclude that performing liquid biopsy on all cases of pseudopheochromocytoma is essentially life saving and can lead the clinician to appropriate course of action, when the other labs and functional imaging are inconclusive or negative. This is the very perfect example of why the traditional thinking of required presence of metanephrines in urine or blood, and nuclear studies(Dotetate scan/ Octrascan/ MiBG scan, etc…) for diagnosis of pheochromocytoma and surgical interventions depending on such tests is outdated.

Assessment of small fiber neuropathy and distal sensory neuropathy in female patients with fibromyalgia.

We investigated sudomotor dysfunction, small fiber neuropathy (SFN), and their clinical significance in female fibromyalgia patients. Fibromyalgia patients and healthy controls (HCs) were recruited. Clinical and laboratory data were measured. Electrochemical skin conductance (ESC) values of hands and feet were assessed by SUDOSCAN. Additionally, several other methods were employed, including nerve conduction study (NCS), electromyography (EMG), and questionnaires. Spearman correlation coefficient was calculated to identify factors associated with ESC values of SUDOSCAN. Twenty-two female fibromyalgia patients and 22 female HCs were recruited. The fibromyalgia group had lower EQ5D and higher Toronto Clinical Neuropathy scores than the HC group. Most of the EMG/NCS findings of motor and proximal sensory nerves were comparable between the fibromyalgia and HC groups, whereas sensory nerve action potential amplitudes of distal sensory nerves were significantly lower in the fibromyalgia group. Mean ESC values of hands and feet were significantly lower in the fibromyalgia group than in the HC group (57.6 ± 16.2 vs. 68.8 ± 10.3 μS, p = 0.010 for hands, 64.9 ± 11.5 vs. 72.0 ± 8.2 μS, p = 0.025 for feet, respectively). Moderate to severe SFN was more common in the fibromyalgia group (68.2%) than in the HC group (68.2 vs. 50%, p = 0.019). Fibromyalgia disease duration was significantly correlated with the ESC values of hands/feet, and tricyclic antidepressant (TCA) responders had higher ESC values than non-responders. SFN was commonly detected in fibromyalgia patients who had normal EMG/NCS findings and was more severe in fibromyalgia patients with longer disease duration. SUDOSCAN may predict response to TCA therapy.

Prevalence of potentially inappropriate medication use in the older population living in Germany

Abstract Background Potentially inappropriate medications (PIM) are medicines for which the risks for adverse events (AEs) usually outweigh the clinical benefits in older adults. PIM is associated with an increased risk of AEs, hospitalizations, mortality and higher health care costs. This analysis presents the prevalence of PIM use and associated factors in people aged 66+ years living in Germany. Methods Data from the nationally representative Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2021-2023 by the Robert Koch Institute, was analyzed. All medicines used, prescribed and over-the-counter (OTC), in the 7 days before the interview were classified into anatomical therapeutic chemical codes. PIM use was identified based on the PRISCUS 2.0 list. Weighted prevalences and associated factors for PIM use are presented. Results 96% of the sample (N = 1,474) took at least 1 medication in the 7 days before the interview. The prevalence of PIM use was 29% (95% CI: 26%-32%), 23% took 1 PIM and 6% 2+. There were no sex differences but a significant increase with age: 23% in the age group 66-74, 33% in the age group 75-84, and 39% in the age group 85 + (29% 1 PIM and 10% 2+). People with a low educational level had a PIM prevalence of 32% compared to 21% in those with a high educational level. Among those reporting having chronic diseases, the PIM prevalence was 34% compared to 19% among those not reporting them. The prevalence of PIM increased with the number of medicines used: 13% in 1-4 medicines, 31% in 5-9 medicines, and 53% in 10+ medicines. The most frequently used PIM in this sample was ginkgo biloba leaf extract (plant-based antidementia drug) followed by diclofenac (non-steroidal anti-inflammatory drug), and then by tricyclic antidepressant drugs (opipramol and amitriptyline). Conclusions PIM use was higher than suggested by prescription data analysis. It was associated with higher age, chronic diseases, polypharmacy and a low educational level. Key messages • PIM use was common, affecting more people with chronic diseases, older age groups and people with a low educational level. • Strategies to promote and monitor appropriate medication use are needed.

Current Developments in the Treatment of Postpartum Depression: Zuranolone.

Pregnancy is a period in a woman's life during which she experiences physiological, psychological, and social changes. These changes can lead to various mental illnesses, including postpartum depression (PPD), which is common during the perinatal period. Postpartum depression is a significant cause of morbidity and mortality for both the mother and baby. A peripartum-onset major depressive episode is defined as PPD when it occurs during pregnancy or up to 4 weeks postpartum. The frequency of this condition is extremely high. Its etiology is influenced by biological, psychological, and sociocultural factors. Depressed mood, anhedonia, feelings of guilt, irritability, lack of concentration, psychomotor agitation or retardation, sleep disturbance, and changes in appetite and weight can all be symptoms of PPD. There are various treatment options available, many of which are adapted from those used for major depression. Selective serotonin reuptake inhibitors, serotonin-noradrenaline reuptake inhibitors, tricyclic antidepressants, estradiol, progesterone, psychotherapies, electroconvulsive therapy, and brexanolone can be used to treat PPD. In addition, the newest drug approved by the FDA (Food and Drug Administration) for this condition is oral zuranolone. This review aims to analyze recent developments on zuranolone, the latest drug approved by the FDA for PPD, based on current studies.

Specific anti-toxic immunotherapy: use in medical practice and perspectives

The results of use of approaches and means of antitoxic immunotherapy in medical practice are summarized: passive transfer of various variants of antibodies specific to toxic compounds, vaccination – specific active immunization with vaccines carrying determinants of the immunochemical specificity of target toxic compounds. The practical effectiveness of the known approaches of passive transfer and vaccination is associated with the ability of specific antibodies, by binding target bioactive compounds with pronounced toxicity, to change the availability of corresponding structures in the body-targets and, in the presence of a sufficient number of specific antibodies with high binding ability to the target compounds, neutralize their toxicity. In medical practice, polyspecific heterologous antisera or the gamma globulin fraction of antisera (extremely rare monoclonal antibodies of narrow specificity) are widely used for passive transfer as antidotes in the treatment of victims in order to prevent deaths and extensive necrosis of soft tissues at the site of the bite of poisonous snakes and insects. Active immunization – vaccination with appropriate antigenic drugs should create in immunized individuals a state of humoral immunity with the corresponding characteristics of antibody formation specific to the target compound. When a target toxic compound enters an immunized organism, it is also possible to neutralize its toxicity. The most successful experience in using the principles of active immunization as a technology for specific antitoxic therapy is associated with the practice of using toxoids for toxinemic infections. Specific practical techniques used to achieve the effectiveness of possible approaches to specific antitoxic immunotherapy in the form of passive transfer of specific antibodies or their fragments are considered: to combat lethal infections in the pathogenesis of which the toxic effects of bacterial exotoxins are significant; when treating victims of snake and insect bites, exposure to poisons of marine organisms, algae and plant toxins; in the treatment of severe intoxication with certain low molecular weight toxic substances: digoxin, colchicine, tricyclic antidepressants. The most successful experiences of using the principles of active immunization as a technology for specific antitoxic therapy, based on the use of toxoids with specificity for diphtheria, tetanus, botulism, cholera, typhoid fever, dysentery, gas gangrene and other toxinemic infections, are also considered. The fairly high immunogenicity of toxoids with the possibility of activating both constitutional and adaptive immunity has become the basis for their use as macromolecular carriers of hapten analogues of narcotic substances – a promising direction in drug addiction, in the implementation of which a number of experimental molecular and combined vaccines of opiates, methamphetamine, cocaine, and nicotine. This variant of practical efforts in medicine can be regarded as a new direction of specific antitoxic immunotherapy – an option to combat drug addiction by vaccinating drug addicts.

Study of prescribing pattern of drugs in the management of migraine with psychiatric comorbidities at integral institute of medical science and research

Background: Migraine headaches, a prevalent and serious brain condition, often coincide with mental health issues. This study aims to explore drug prescribing patterns for migraine patients with psychiatric comorbidities. Methods: Over six months, a prospective observational study was conducted at the psychiatric department of IIMS&R Hospital. 100 prescriptions were analyzed based on specific criteria. Results: Total 14 different drugs were prescribed. NSAIDs were most common (87%), followed by multivitamins (50%), benzodiazepines (30%), and tricyclic antidepressants (23%).Naxdom (NSAIDs) was frequently used (87%). Patients aged 31-45 years had higher prevalence. Comorbidities associated are depression (18%), anxiety disorder (10%), insomnia (5%). Conclusions: The study highlights various orally administered drugs, including anti-migraine meds, antidepressants, anticonvulsants, and more. Patients within the 31-45years age group were significantly affected. Migraine correlated with depression, anxiety, and insomnia. The most common medication was naxdom 250mg taken orally.