Various Classes Of Antidepressants Research Articles

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.

Research on the current status and future prospects in the development of antidepressant drugs

Depression is a significant global health burden, affecting millions of people worldwide. The development of antidepressant drugs has been crucial in providing relief for individuals suffering from depression. This paper reviews the current status of antidepressant drug development, focusing on various classes of antidepressants, their mechanisms of action, and the challenges faced during their development. Additionally, the paper discusses potential future directions in antidepressant drug research, including novel targets, personalized medicine approaches, and emerging technologies. Understanding the current state and future prospects of antidepressant drug development is vital to advancing treatment options for individuals with depression and improving their quality of life. The paper finds the main drawbacks of traditional antidepressant drugs and focuses on the outlook of the new generation of drugs, the research process, and potential benefits.

Peripheral edema associated with antidepressant use: Systematic review of case reports.

Oedema associated with psychotropics can impose a considerable burden, leading to increased morbidity and cost. Peripheral oedema is sometimes related to the use of antidepressants, which are among the most prescribed psychotropic medications. We reviewed the reported cases of antidepressant-associated oedema to understand the risk factors, aetiology and outcome. We searched the Medline, Web of Science and Embase databases to identify reported cases of peripheral oedema associated with antidepressant use. We included studies published in English and those with full-text availability. A systematic review of the reports was done to identify the antidepressants associated with oedema, explore possible risk factors, investigate potential mechanisms, and assess the outcome. We identified a total of 45 cases (27 case reports and five case series) that reported oedema associated with antidepressant use. Almost all major classes of antidepressants were found to be associated with oedema. Among these drugs, trazodone, mirtazapine, and escitalopram were the most implicated. Older age and female gender were more commonly associated with oedema. Etiologically, antagonism of α1 adrenergic receptors and 5HT2A receptors, leading to vasodilation and oedema, emerged as the most prevalent mechanisms. In most cases, the oedema subsided following the discontinuation of the antidepressants. Peripheral oedema associated with antidepressant use can represent a significant adverse drug reaction involving various classes of antidepressants. To ensure timely identification and proper management of oedema, regular monitoring is crucial.

Effects of Antidepressants on COVID-19 Outcomes: Retrospective Study on Large-Scale Electronic Health Record Data.

Antidepressants exert an anticholinergic effect in varying degrees, and various classes of antidepressants can produce a different effect on immune function. While the early use of antidepressants has a notional effect on COVID-19 outcomes, the relationship between the risk of COVID-19 severity and the use of antidepressants has not been properly investigated previously owing to the high costs involved with clinical trials. Large-scale observational data and recent advancements in statistical analysis provide ample opportunity to virtualize a clinical trial to discover the detrimental effects of the early use of antidepressants. We primarily aimed to investigate electronic health records for causal effect estimation and use the data for discovering the causal effects of early antidepressant use on COVID-19 outcomes. As a secondary aim, we developed methods for validating our causal effect estimation pipeline. We used the National COVID Cohort Collaborative (N3C), a database aggregating health history for over 12 million people in the United States, including over 5 million with a positive COVID-19 test. We selected 241,952 COVID-19-positive patients (age >13 years) with at least 1 year of medical history. The study included a 18,584-dimensional covariate vector for each person and 16 different antidepressants. We used propensity score weighting based on the logistic regression method to estimate causal effects on the entire data. Then, we used the Node2Vec embedding method to encode SNOMED-CT (Systematized Nomenclature of Medicine-Clinical Terms) medical codes and applied random forest regression to estimate causal effects. We used both methods to estimate causal effects of antidepressants on COVID-19 outcomes. We also selected few negatively effective conditions for COVID-19 outcomes and estimated their effects using our proposed methods to validate their efficacy. The average treatment effect (ATE) of using any one of the antidepressants was -0.076 (95% CI -0.082 to -0.069; P<.001) with the propensity score weighting method. For the method using SNOMED-CT medical embedding, the ATE of using any one of the antidepressants was -0.423 (95% CI -0.382 to -0.463; P<.001). We applied multiple causal inference methods with novel application of health embeddings to investigate the effects of antidepressants on COVID-19 outcomes. Additionally, we proposed a novel drug effect analysis-based evaluation technique to justify the efficacy of the proposed method. This study offers causal inference methods on large-scale electronic health record data to discover the effects of common antidepressants on COVID-19 hospitalization or a worse outcome. We found that common antidepressants may increase the risk of COVID-19 complications and uncovered a pattern where certain antidepressants were associated with a lower risk of hospitalization. While discovering the detrimental effects of these drugs on outcomes could guide preventive care, identification of beneficial effects would allow us to propose drug repurposing for COVID-19 treatment.

Impact of Antidepressant Treatment on Heart Rate Variability in Patients with Depression - A Cross Sectional Study

Heart rate variability (HRV) is a non-invasive index of cardiac autonomic regulation. HRV is reduced in depression, which indicates decreased Autonomic Nervous System flexibility. It is associated with an increase in the frequency of cardiac co-morbidities. Depression medications usually take six months for complete remission, but no data on patients on antidepressants for more than six months. Therefore, it becomes necessary to determine if anti-depressants have a better impact on HRV. The current study focused on analyzing the correction of HRV parameters after six months of antidepressant therapy. A cross-sectional study was conducted from February to September 2021 at the AFT lab inpatients. They were recruited from the Psychiatry department, Victoria Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India. The sample size was calculated to be 40 (20 Patients and 20 Healthy controls). AFT was done on all participants using Power Lab equipment and analyzed using Lab Chart 8 software. Heart rate variability parameters (AFT results) were analyzed using statistical software. The results with a p-value of &gt;0.05% were considered statistically significant and taken up for the study. 55% of the patients with depression in our study were in the age group of 18-25 years, and the mean Ham-D (Hamilton Depression Rating Scale) score was found to be 9.8. There is a reduction in autonomic function flexibility among patients who are on antidepressants when compared to healthy controls, even after six months of treatment. No conclusion could arrive on the class of antidepressant which was more beneficial owing to its effect on autonomic functions. Hence, randomized controlled studies comparing various classes of antidepressants to assess efficacy in reducing autonomic complications of depression should be taken up

Antidepressants for the treatment of depression in people with cancer.

Antidepressants for the treatment of depression in people with cancer.

Antidepressants Usage and Risk of Pneumonia Among Elderly Patients With the Parkinson's Disease: A Population-Based Case-Control Study.

The patients with Parkinson's disease (PD) are associated with a higher risk of pneumonia. Antidepressants exert an anticholinergic effect in varying degrees and various classes of antidepressants also can produce a different effect on immune function. The relationship between the risk of pneumonia and the use of antidepressants among elderly patients with PD is unknown. The study investigated the risk of pneumonia associated with the use of antidepressants in elderly patients with PD. This case-control study was based on data from the longitudinal health insurance database in Taiwan. We analyzed the data of 551,975 elderly patients with PD between 2002 and 2018. To reduce the potential confounding caused by unbalanced covariates in non-experimental settings, we used propensity score matching to include older patients without pneumonia to serve as the comparison. The antidepressants in the study included tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin, and norepinephrine reuptake inhibitors (SNRIs). The conditional logistic regression was used to investigate the association between antidepressants and pneumonia. Control variables in the study included sex, age, income level, urbanization, Charlson comorbidity index score, and comorbidities related to pneumonia. In terms of TCAs users, compared with patients not receiving TCAs, current users had a lower risk of incident pneumonia (adjusted odds ratio [aOR] = 0.86, 95% CI = 0.82–0.90) and recent users (aOR = 0.83, 95% CI = 0.80–0.87). In terms of MAOIs users, current users had a lower risk of incident pneumonia (aOR = 0.88, 95% CI = 0.83–0.93), recent users (aOR = 0.89, 95% CI = 0.85–0.93). In terms of SSRIs users, current users had a higher risk of incident pneumonia (a OR = 1.13, 95% CI = 1.01–1.17), recent users (aOR = 1.01, 95% CI = 1.06–1.13), and past users (aOR = 1.19, 95% CI = 1.17–1.21). In terms of SNRIs users, past users had a higher risk of incident pneumonia (aOR = 1.07, 95% CI = 1.03–1.10). The incident pneumonia is associated with the use of individuals of different classes of antidepressants. The use of TCAs (such as, amitriptyline and imipramine) had a lower odds of incident pneumonia. The use of MAOIs (such as, selegiline and rasagiline) had a lower odds of pneumonia during recent use. The use of SSRIs (such as, fluoxetine, sertraline, escitalopram, paroxetine, and citalopram) and SNRIs (such as, milnacipran, and venlafaxine) had a higher odds of incident pneumonia.

The Effect of Natural Therapies in Combination with Usual Care for Depression: A Narrative Review

Introduction: Major depressive disorder (MDD) is the most common and debilitating form of depression with a 12-month prevalence of 4.7% and a lifetime prevalence of 11.2% in Canada. Various classes of antidepressants are commonly used treatments for MDD; however, high failure rates occur due to adverse events and discontinuation of use. Non-drug and alternative interventions are commonly sought by people when drug treatment fails. The purpose of this investigation was to analyze the evidence on the effect of natural therapies in combination with pharmaceutical standard of care for the management of MDD Methods: The following inclusion criteria were defined before conducting the literature search: 1) population of adults with major depressive disorder, 2) intervention of lavender, folic acid or acupuncture, combined with standard treatment, 3) comparison group of a placebo, standard treatment or natural therapy used alone, 4) changes to Hamilton Depression Rating Scale (HAM-D) as the primary outcome. PubMed, APA PsycARTICLES and Google scholar were used for the research. The articles were limited to randomized clinical trials (RCTs), and systematic reviews with meta-analyses. The different therapies were used as key words in the literature search. Results: The literature search for ‘lavender’ yielded 214 studies, of which 3 RCTs met the criteria. ‘Folic acid’ yielded 680 studies of which 2 RCTs and 1 systematic review with meta-analysis met the criteria. ‘Acupuncture’ yielded 2240 studies of which 2 RCTs and 2 systematic reviews with meta-analyses met the criteria. Only the RCTs not summarized in the systematic reviews and meta-analyses were summarized in this review. Discussion: All ten studies using natural interventions showed a statistically significant decrease in the mean score change versus comparison groups, however, the magnitude of the effect varied between the studies. Sample sizes were small and there was significant heterogeneity between studies. Conclusion: Evidence suggests that natural therapies can be used adjunctively to the pharmaceutical care of MDD, however, the overall research quality is low and substantial heterogeneity exists between studies. Further, additional research using more rigorous methodologies and standardized interventions is needed.

Antidepressant Use and Risk of Suicidal Behavior in Older Persons With Depression: A Cohort Study in Hong Kong

Background: Depression is highly prevalent in older adults and requires treatment. However, debate persists on whether antidepressant use is associated with an elevated risk of suicidal behavior. This study aims to examine the short- and long-term risk of suicidal behavior by various classes of antidepressants in older persons with depression. Methods: Persons aged 40 years and above and received a clinical diagnosis of depression between January 1, 2001, and December 31, 2016 were identified from the Clinical Data Analysis and Reporting System in Hong Kong. The risk of suicidal behavior in persons who were prescribed antidepressants was compared with persons who were not prescribed any antidepressant drugs. Antidepressants were classified as tricyclic and related antidepressant drugs (TCAs), selective serotonin reuptake inhibitors (SSRIs), noradrenergic and specific serotonergic antidepressants (NaSSAs), serotonin–norepinephrine reuptake inhibitors (SNRIs) and others. Incidence and adjusted hazard ratio (aHR) of subsequent self-harm and suicide within one-year and the whole study period were estimated by age groups. Results: A total of 34,927 persons aged 40-64 years, and 19,300 persons aged 65+ years were included. In the younger age group, the highest short-term and long-term risks were found in others (aHR, 2.33; 1.02-5.34) and NaSSAs (2.88; 2.15-3.86), respectively. In the older age group, no significant association was observed between antidepressant use and suicidal behavior across all antidepressant classes. Conclusion: The self-harm and suicide associated risks vary across antidepressant classes and age groups. Cautions are always needed for antidepressant prescriptions.

Peculiarities of treatment with antidepressants in patients with schizoaffective disorder in the interictal period

To investigate the effect of therapy with various classes of antidepressants on the quality of remission and adherence to therapy in patients with schizoaffective disorder (SAD) in remission. We examined 87 outpatients, including 29 men (33.33%), 58 women (66.67%) diagnosed with SAD according to ICD-10 criteria (item F25), in whom 341 cases of remission were studied. The average age of the patients was 41.40±12.56 years. Cases of remission in patients receiving therapy with nonselective monoamine reuptake inhibitors (NSMRIs) were included in group 1 (n=228), cases of remission formed on therapy with selective neuronal reuptake inhibitors (SNRI) were included in group 2 (n=113). Clinical follow-up and statistical methods were used. In both groups, mood disorders in remission were represented by subdepression. Delusional disorders at the stage of remission were almost 7 times more common in group 1 (12.28%), compared with group 2 (1.77%). The duration of the interictal period in patients treated with NSMRIs was higher (504.0±60.67 days) compared with patients receiving SNRI (176.46±17.88 days). In group 2, residual affective-delusional symptoms in remission were significantly less common. Cases of refusal from therapy in group 2 were 12 times less frequent, which indicates a greater adherence to therapy in patients receiving SNRI. It is possible to recommend treatment with NSMRIs for patients with depressive affect in the structure of SAD to increase the duration of the interictal period. At the same time, for patients with SAD in the presence of delusional and affective-delusional symptoms, it is preferable to prescribe SNRI.

Chronic, but not acute, buprenorphine leads to antidepressant‐like effects in both male and female mice

Current antidepressant medications lack efficacy in a large fraction of patients and typically take weeks to reduce symptoms in individuals who do respond to treatment. However, the factors that govern treatment responses to various classes of antidepressants remain largely unknown. The incidence and presentation of mood and anxiety disorders are both characterized by sex differences, and sex differences in response to antidepressants have been reported for both selective serotonin reuptake inhibitors (SSRIs) and tricyclics (TCAs). As new antidepressants are developed, it will be critical to determine their efficacy in both male and female subjects to enable appropriate treatment selection. Previous research has investigated the antidepressant effects of buprenorphine, which has high affinity for mu opioid receptor (MOR), kappa opioid receptor (KOR), and some affinity for delta opioid receptor (DOR). Though previous studies have shown support for buprenorphine as an antidepressant, the effects have only been demonstrated in males. This study examined potential sex differences in the behavioral and molecular responses to acute and chronic buprenorphine administration in mice. The effects of buprenorphine were measured with the forced swim test, open field test, and light dark emergence test. In contrast to published research, acute buprenorphine showed no significant main effect of treatment in any of these behavioral tests in either sex. However, chronic treatment with buprenorphine showed a main effect of treatment in both the open field and forced swim tests, suggesting that both males and females are responsive to this drug. While gene expression analysis did show that female mice expressed higher levels of pro‐opiomelanocortin (POMC) in the striatum compared to males, no sex by drug interactions were observed. These studies show that chronic, but not acute, buprenorphine treatment has antidepressant effects, and that females do not appear to have reduced sensitivity to these effects.

The Comparison of a New Ultrasound-Induced Depression Model to the Chronic Mild Stress Paradigm.

Willner’s “chronic mild stress” (CMS) model is a globally recognized and most commonly used depression model. A depression model induced by ultrasonic exposure of variable frequencies has been created in our laboratory. This article compares two models of the depressive-like state according to three validity criteria. Face validity has been demonstrated in sucrose preference test, Porsolt test, social interest, open field and the Morris water maze. Rats after ultrasound impact have more pronounced anhedonia and social isolation. The construct validity has been proven due to increased levels of corticosterone, epinephrine and norepinephrine and reduced levels of dopamine and some of its metabolites in rat plasma after ultrasound exposure. Predictive validity has been described previously, where the therapeutic effects of various classes of antidepressants have been shown. Our study has demonstrated that the ultrasound-induced depression model is suitable, such as the generally accepted CMS protocol, and meets all required validity criteria. The model presented in this article might help to study pathogenetic mechanisms of depressive disorders, as well as to test promising methods of depression treatment.

Effects of antidepressant treatments on health service utilization and medical costs among patients with depression: a nationwide population-based retrospective cohort study in Taiwan.

This study aimed to assess the associations between the use of different types of antidepressants and health service utilization and costs among depressed patients. Data used in this study were retrieved from the Taiwan National Health Insurance Research Database. We identified 447 411 new antidepressant users during the study period (2011-2015) and they were individually followed for a 1-year period. Two-part generalized estimating equation models were conducted. Results demonstrated that there was a substantial decrease in outpatient service utilized by patients undertaking serotonin antagonists and reuptake inhibitors (β = -0.2074), serotonin-norepinephrine reuptake inhibitors (β = -0.0452), tricyclic antidepressants (β = -0.1308), or other antidepressants (β = -0.0637), compared with their counterparts in the selective serotonin reuptake inhibitors group (all P < 0.05). Compared with patients who were treated with selective serotonin reuptake inhibitors, those who were prescribed serotonin antagonists and reuptake inhibitors (β = -0.4934, P < 0.05) or tricyclic antidepressants (β = -0.4194, P < 0.05) had incurred lower costs pertaining to outpatient service, while considerably higher costs were borne by those patients embarked on the treatment of serotonin-norepinephrine reuptake inhibitors (β = 0.3228, P < 0.05) or other antidepressants (β = 0.1118, P < 0.05). We concluded that the initiation of various classes of antidepressants led to significant variations in health service utilization and costs among depressed patients.

Comparisons of the risk of medication noncompliance and suicidal behavior among patients with depressive disorders using different monotherapy antidepressants in Taiwan: A nationwide population-based retrospective cohort study

BackgroundThe aim of this study was to assess the association between various classes of antidepressants and the risk of medication noncompliance as well as suicidal behavior among depressed patients. MethodsA retrospective cohort study was conducted utilizing two nationwide population-based datasets in Taiwan from 2010 to 2016. The outcome measures included the risk of medication noncompliance, attempted suicide, and completed suicide. Cox proportional hazards models with stratification of the propensity score deciles were performed. ResultsA total of 447,411 new antidepressant users were identified. Compared to SSRIs, patients who received SARIs [adjusted hazard ratio (aHR) = 1.124, 95% confidence interval (CI) = 1.108–1.142], SNRIs (aHR = 1.049, 95% CI = 1.033–1.065), and other classes of antidepressants (aHR = 1.037, 95% CI = 1.024–1.051) were more likely to exhibit poor medication noncompliance. Patients who received SNRIs had a higher risk of attempted suicide (aHR = 1.294, 95% CI = 1.114–1.513), compared to SSRIs. However, patents in the TCAs group revealed the opposite result (aHR = 0.543, 95% CI = 0.387–0.762). Concerning the risk of completed suicide, this analysis detected no statistical significance across different types of antidepressants. LimitationsAlthough the universal coverage of Taiwan's national health insurance program tends to minimize the risk of selection and recall bias, it is difficult to rule out medical surveillance bias by using claim data. ConclusionsThis study demonstrated that classes of antidepressants exert different degrees of impact on the risk of medication noncompliance and attempted suicide, but not completed suicide, among depressed patients.

Peptic ulcer risk with antidepressants and NSAIDs

Although the selective serotonin reuptake inhibitors (SSRIs) have a very good safety profile, they have been associated with spontaneous bleeding in some patients. The risk could be further increased if patients are taking concurrent nonsteroidal anti‐inflammatory drugs (NSAIDs). Investigators recently conducted a retrospective analysis to evaluate the risk of peptic ulcer disease associated with concomitant use of both classes of drugs, as compared with use of antidepressants alone, as well as to examine the differential risk among the various classes of antidepressants and individual antidepressants.

Prefrontal theta cordance in the prediction of antidepressant response to various classes of antidepressants in patients with depressive disorder

Introduction and objectivesPrevious studies demonstrated efficacy of reduction of QEEG prefrontal theta cordance (RC) after the first week of treatment in the prediction of antidepressant response.AimsThe study aimed to compare the ability of RC in the prediction of response to various antidepressant classes.MethodsAll patients (n = 142) were treated with antidepressants (SSRI-58, SNRI-47, NDRI-22, NaSSA-15) for ≥ 4 weeks. Response was defined as MADRS reduction ≥ 50%. EEG were performed at baseline and week 1 of treatment and cordance was calculated for 3 prefrontal electrodes (Fp1, Fp2, Fz).ResultsLogistic regression identified RC as a predictor of response to SSRI, SNRI and NDRI but not for NaSSA. Predictive parameters of RC for response to mentioned antidepressant classes are displayed in the Table 1.Areas under curves of ROC analysis (AUC) of RC for response prediction were not significantly different among antidepressant classes.ConclusionThe predictive efficacy of RC for response to SSRI, SNRI and NDRI was comparable.This study was supported by the grants of MH CZ nr.15-29900A, MH CZ – DRO (NIMH-CZ, 00023752) and by the project Nr. LO1611 from the MEYS under the NPU I program.

Identification of Lysophosphatidic Acid Receptor 1 in Astroglial Cells as a Target for Glial Cell Line-derived Neurotrophic Factor Expression Induced by Antidepressants

Preclinical and clinical evidence suggests that glial cell line-derived neurotrophic factor (GDNF) is important in the therapeutic effect of antidepressants. A previous study demonstrated that the tricyclic antidepressant amitriptyline induces Gαi/o activation, which leads to GDNF expression in astrocytes. However, the specific target expressed in astrocytes that mediates antidepressant-evoked Gαi/o activation has yet to be identified. Thus, the current study explored the possibility that antidepressant-induced Gαi/o activation depends on lysophosphatidic acid receptor 1 (LPAR1), a Gαi/o-coupled receptor. GDNF mRNA expression was examined using real-time PCR and Gαi/o activation was examined using the cell-based receptor assay system CellKeyTM in rat C6 astroglial cells and rat primary cultured astrocytes. LPAR1 antagonists blocked GDNF mRNA expression and Gαi/o activation evoked by various classes of antidepressants (amitriptyline, nortriptyline, mianserin, and fluoxetine). In addition, deletion of LPAR1 by RNAi suppressed amitriptyline-evoked GDNF mRNA expression. Treatment of astroglial cells with the endogenous LPAR agonist LPA increased GDNF mRNA expression through LPAR1, whereas treatment of primary cultured neurons with LPA failed to affect GDNF mRNA expression. Astrocytic GDNF expression evoked by either amitriptyline or LPA utilized, in part, transactivation of fibroblast growth factor receptor and a subsequent ERK cascade. The current results suggest that LPAR1 is a novel, specific target of antidepressants that leads to GDNF expression in astrocytes.

Review of antidepressants in the treatment of neuropathic pain

Abstract Introduction Neuropathy is a pathological pain disorder characterized by burning, stabbing, and cramping sensations. There are multiple etiologies for this pain such as diabetes, vascular disorders, and chemotherapy treatment. Neurotransmitters, such as norepinephrine and serotonin, are thought to play a part in the modulation of this pain. The objective of this review is to summarize the current literature to support the efficacy and impact of adverse events of the various classes of antidepressants utilized in the treatment of neuropathic pain. Methods A Medline/Pubmed search was conducted to identify randomized clinical trials within the last 12 years examining the efficacy and safety of antidepressants for the treatment of neuropathy. Systematic reviews and meta-analyses were also included. Results Antidepressants are commonly used in the treatment of neuropathy, with meta-analyses supporting the use of tricyclic antidepressants and selective norepinephrine serotonin reuptake inhibitors. Trials indicate that venlafaxine, duloxetine, and tricyclic antidepressants (TCAs) have comparable efficacy, but TCAs have a higher incidence of adverse effects. Other antidepressants, such as citalopram, paroxetine, and bupropion have limited evidence supporting their use in neuropathy. Discussion Based on the evidence reviewed, venlafaxine and duloxetine should be used as first-line agents. TCAs should be used as second-line agents, due to higher incidence of adverse effects. Other treatment options include citalopram, paroxetine, and bupropion, but data supporting their efficacy is limited.

Stereo-specific LC and LC-MS bioassays of antidepressants and psychotics.

Stereochemistry in drug action is gaining importance because the enantiomers often differ in their biological activity and pharmacokinetic profiles. The use of racemic drugs may contribute to adverse effects owing to the presence of either inactive or toxic enantiomers. Most of the drugs currently used to treat psychiatric disorders, including depression, contain one or more chiral centers and are mostly sold as racemates. Single-enantiomer drugs provide greater selectivity for their biological targets, improved therapeutic indices and better pharmacokinetics compared with racemates. Therefore it is of great importance to monitor body fluid/tissue levels of drugs used to treat depression and psychiatric disorders. The present manuscript gives an overview of liquid chromatographic and mass spectrometric techniques reported during 2000-2013 for enantiomeric separation of various classes of antidepressants, viz. selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, noradrenergic and specific serotonergic antidepressants, norepinephrine reuptake inhibitors, norepinephrine-dopamine reuptake inhibitors, nonamphetamine central nervous system stimulants, serotonin and dopamine inhibitors and γ-aminobutyric acid receptor agonists in biological matrices. Techniques used for extraction, separation and quantification are discussed.

Utilization Pattern of Anti-Depressants at a Tertiary Hospital in Oman: A Retrospective Analysis

Introduction: Antidepressants play a major role in managing depression and other conditions. The use of various classes of antidepressants varies from a country to another but information about the use of these agents in the developing countries is scarce. Results: A total number of 1416 prescriptions were analyzed. Of these 880 (62.1%) were for females and 536 (37.9%) were for males. Tricyclic antidepressant (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin/ norepinephrine reuptake inhibitors (SNRIs) and mirtazapine accounted for 34.6%, 32.1%, 13.3% and 19.9% of prescriptions, respectively. Monotherapy accounted for 89.3% of prescriptions. The most used single antidepressant drug was amitriptyline (28.5%) followed by mirtazapine (19.9%) and paroxetine (17.9%). SSRIs, SNRIs and mirtazapine were mainly used for psychiatric conditions in 82.2%, 73.0% and 68.8% of the cases, respectively, while TCAs were mainly indicated (63.7%) for non-psychiatric conditions. Conclusion: Monotherapy antidepressant is the preferred mode of therapy with SSRIs and mirtazapine as first line therapy for depression which is consistent with therapeutic guidelines recommendations.