Use Of Venlafaxine Research Articles

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.

Simultaneous use of venlafaxine and calcium channel blockers on tolerance to morphine: The role of mitochondrial damage and oxidative stress in the brain

BackgroundOne of the reasons for tolerance to morphine is increased oxidative stress and dysfunction of cell mitochondria in the hippocampus. Venlafaxine and calcium channel blockers can protect mitochondrial function. The investigation of the role of mitochondrial damage and oxidative stress in the simultaneous use of venlafaxine and calcium channel blockers on the acute analgesic effects of morphine and the induction of tolerance to its effects in mice was assessed. MethodIn this experimental study, to induce tolerance to morphine, NMRI mice were treated with 50 mg/kg morphine for three consecutive days and 5 mg/kg morphine on the fourth day. Venlafaxine (20 mg/kg) alone or in combination with calcium channel blockers, nimodipine (10 mg/kg), and diltiazem (40 mg/kg) was administered 30 min before morphine, and the hot plate test was used. Then, hippocampal mitochondria were isolated by differential centrifugation method, and the levels of mitochondrial dehydrogenase activity, mitochondrial membrane potential, mitochondrial ROS production rate, as well as the content of glutathione and malondialdehyde in hippocampal mitochondria, were measured. ResultsThe administration of venlafaxine-nimodipine and venlafaxine-diltiazem increased morphine's acute analgesic effects (P < 0.05) and reduced the induction and expression of tolerance to the analgesic effects of morphine (P < 0.05). Morphine significantly decreased MTT and GSH and increased MDA, mitochondrial membrane damage, and ROS compared to the control group (P < 0.01). Injection of venlafaxine-nimodipine and also venlafaxine-diltiazem 30 min before morphine can improve these alterations (P < 0.05). Discussion and conclusionOur data showed that the simultaneous use of venlafaxine with calcium channel blockers could increase the acute analgesic effects of morphine and reduce the induction and expression of tolerance to it. Also, the preventive and protective roles of simultaneous administration of venlafaxine and calcium channel blockers on morphine-induced mitochondrial oxidative stress and damage during the tolerance test were achieved.

Periodontitis and Depressive Disorders: The Effects of Antidepressant Drugs on the Periodontium in Clinical and Preclinical Models: A Narrative Review.

Background/Objectives: Several psychological conditions, including stress and depression, can adversely affect oral health; in fact, antidepressants, commonly used to treat depressive disorders, may have conflicting effects on the periodontal status of individuals. The aim of this review was to determine the effects of antidepressants on the periodontium. Methods: A literature search was conducted using electronic databases, Pubmed/MEDLINE, Cochrane Library, focusing on the use of antidepressants and their effects on periodontal health in animals or humans. Results: Seventeen articles have been included with the use of amitriptyline (two studies), desipramine (one study), imipramine (two studies), desvenlafaxine (one study), fluoxetine (six studies), venlafaxine (three studies) and tianeptine (two studies). One study evaluated several categories of antidepressants, such as selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), tricyclic, atypical and monoamine oxidase inhibitors (MAO). Most trials showed improvements in periodontal health, especially with fluoxetine, but also with imipramine, desipramine, desvenlafaxine and tianeptine; on the contrary, worsening of clinical periodontal indices and increased loss of alveolar bone were reported with venlafaxine. Conclusions: This review suggests that in the presence of comorbidity between periodontitis and depression, pharmacological treatment with SNRIs, SSRIs and mixed antidepressants is associated with improvement in periodontal parameters, except for venlafaxine. Healthcare professionals (especially oral and mental health professionals) should investigate proper adherence to medication therapy in patients with a history of periodontitis and depression. Further clinical trials are needed to confirm these results.

Prescribed Drug Use and Aneurysmal Subarachnoid Hemorrhage Incidence: A Drug-Wide Association Study.

Current benefits of invasive intracranial aneurysm treatment to prevent aneurysmal subarachnoid hemorrhage (aSAH) rarely outweigh treatment risks. Most intracranial aneurysms thus remain untreated. Commonly prescribed drugs reducing aSAH incidence may provide leads for drug repurposing. We performed a drug-wide association study (DWAS) to systematically investigate the association between commonly prescribed drugs and aSAH incidence. We defined all aSAH cases between 2000 and 2020 using International Classification of Diseases codes from the Secure Anonymised Information Linkage databank. Each case was matched with 9 controls based on age, sex, and year of database entry. We investigated commonly prescribed drugs (>2% in study population) and defined 3 exposure windows relative to the most recent prescription before index date (i.e., occurrence of aSAH): current (within 3 months), recent (3-12 months), and past (>12 months). A logistic regression model was fitted to compare drug use across these exposure windows vs never use, controlling for age, sex, known aSAH risk factors, and health care utilization. The family-wise error rate was kept at p < 0.05 through Bonferroni correction. We investigated exposure to 205 commonly prescribed drugs between 4,879 aSAH cases (mean age 61.4, 61.2% women) and 43,911 matched controls. We found similar trends for lisinopril and amlodipine, with a decreased aSAH risk for current use (lisinopril odds ratio [OR] 0.63, 95% CI 0.44-0.90, amlodipine OR 0.82, 95% CI 0.65-1.04) and an increased aSAH risk for recent use (lisinopril OR 1.30, 95% CI 0.61-2.78, amlodipine OR 1.61, 95% CI 1.04-2.48). A decreased aSAH risk in current use was also found for simvastatin (OR 0.78, 95% CI 0.64-0.96), metformin (OR 0.58, 95% CI 0.43-0.78), and tamsulosin (OR 0.55, 95% CI 0.32-0.93). By contrast, an increased aSAH risk was found for current use of warfarin (OR 1.35, 95% CI 1.02-1.79), venlafaxine (OR 1.67, 95% CI 1.01-2.75), prochlorperazine (OR 2.15, 95% CI 1.45-3.18), and co-codamol (OR 1.31, 95% CI 1.10-1.56). We identified several drugs associated with aSAH, of which 5 drugs (lisinopril and possibly amlodipine, simvastatin, metformin, and tamsulosin) showed a decreased aSAH risk. Future research should build on these signals to further assess the effectiveness of these drugs in reducing aSAH incidence. This study provides Class III evidence that some commonly prescribed drugs are associated with subsequent development of aSAH.

Ten years of maintenance treatment of severe melancholic depression in an adult woman including discontinuation experiences.

There are only few publications on long-term treatments for major depressive disorder (MDD) lasting 5 years or longer. Most clinical controlled trials lasted no longer than 2 years and some recent studies suggested an advantage of cognitive behavioral therapy (CBT) over antidepressants in relapse prevention of MDD. Exclusively outpatient "real world" treatment of severe melancholia, prospectively documented over 10 years with different serial treatment strategies, discontinuation phenomena and complications. Compared to CBT, agomelatine, mirtazapine, bupropion and high-dose milnacipran, high-dose venlafaxine (extended-release form, XR) was effective, even sustainably. Asymptomatic premature ventricular contractions (PVCs) were found at the beginning of the treatment of the MDD, which initially led to the discontinuation of high-dose venlafaxine (300 mg daily). Even the various treatment strategies mentioned above were unable to compensate for or prevent the subsequent severe deterioration in MDD (2 rebounds, 1 recurrence). Only the renewed use of high-dose venlafaxine was successful. PVC no longer occurred and the treatment was also well tolerated over the years, with venlafaxine serum levels at times exceeding 5 times the recommended upper therapeutic reference level (known bupropion-venlafaxine interaction, otherwise 2.5 to 3-fold increase with high-dose venlafaxine alone). During dose reduction or after gradual discontinuation of high-dose venlafaxine, rather mild withdrawal symptoms occurred, but as described above, also two severe rebounds and one severe recurrence happened. This long-term observation supports critical reflections on the discontinuation of successful long-term treatment with antidepressants in severe MDD, even if it should be under "the protection" of CBT. The PVC seemed to be more related to the duration of the severe major depressive episode than to the venlafaxine treatment itself. A particular prospective observation of this longitudinal case study is that relapses (in the sense of rebounds) during or after previous venlafaxine tapering seemed to herald the recurrence after complete recovery. Remarkably, neither relapses nor recurrence could be prevented by CBT. In this case, high-dose venlafaxine has a particular relapse-preventive (and "recurrence-preventive") effect with good long-term tolerability.

Effect of severity of depression on augmentation of antidepressant medication in young adults with depression.

Antipsychotics (AP) have been used to augment antidepressant (AD) medication in treatment-resistant depression. In this study we examined factors (including severity of depression and initial antidepressant) affecting AP augmentation, as well as which APs were initiated as augmentation in young adults. Data were extracted from Finnish nationwide registers. Of persons aged 18-29 years diagnosed with a depression during 2004-2017 we focused on incident AD users (who initiated AD 6 months before and after the diagnosis) whose severity level of depression was recorded (N = 21,966). AP augmentation was studied during 1 year after diagnosis of depression. Persons diagnosed with severe depression with psychotic features (n = 1486) were excluded from main analyses and analyzed separately. Overall, 8.4% of new antidepressant users initiated AP augmentation. Risk of augmentation increased with severity of depression as 3.9%, 5.8%, and 14.0% of persons with mild, moderate, and severe depression, respectively, initiated augmentation. Male sex, comorbid anxiety and personality disorders, substance abuse and selfharm/suicide attempt were positively associated with augmentation. Compared to citalopram, use of tricyclic antidepressant, paroxetine and venlafaxine were associated with increased risk of augmentation, while use of bupropion was associated with a decreased risk. Quetiapine and risperidone were the most common APs used in augmentation. Among persons with severe depression with psychotic features, use of sertraline was associated with AP augmentation, whereas use of fluoxetine decreased risk of augmentation. Use of APs as augmentation of AD therapy was common in severe depression. Comorbidities had only a small effect to augmentation, but selection of initial AD was more closely associated to risk of augmentation. Interestingly, use of bupropion decreased risk of augmentation, which warrants further studies, as well as the decrease in risk of augmentation when fluoxetine in case of psychotic depression was used.

Effectiveness of venlafaxine in patients with ankylosing spondylitis with a neuropathic component of the pain syndrome

Annotation. In aim to study the effectiveness of the use of venlafaxine in the complex therapy of ankylosing spondylitis in the presence of neuropathic pain, the results of treatment of 131 patients with ankylosing spondylitis were studied: 88 patients without neuropathic pain, 22 patients with neuropathic pain who received standard treatment, and 21 patients with neuropathic pain who received venlafaxine in addition to standard therapy. Statistical analysis of differences in quantitative features was performed using the non-parametric Mann-Whitney test, categorized using Fisher's exact test (one-sided) at p&lt;0.05. Significantly better dynamics in the course of treatment were found in patients with neuropathic pain treated with venlafaxine compared to patients with neuropathic pain and without neuropathic pain treated with standard therapy. ASAS20 compliance was achieved in 31.8% of patients without neuropathic pain and in 13.6% of patients with neuropathic pain who received standard therapy and in 47.6% of patients with neuropathic pain who received venlafaxine in addition to standard therapy. The calculation of the odds ratio proved that the presence of neuropathic pain increases the risk of resistance to treatment (failure to achieve ASAS20 by almost three times (odds ratio 2.95; confidence interval 0.8-10.8). Prescribing venlafaxine to patients with ankylosing spondylitis and the presence of neuropathic pain increases the chances of achieving ASAS20 by 5.75 times with a confidence interval of 1.3-25.5 (p&lt;0.05). Patients who received venlafaxine in addition to standard therapy achieved significantly better scores on BASMI, ASAS, HAQ, depression and reactive anxiety after 12-week therapy. This gives reasons to recommend the introduction of venlafaxine to the treatment regimen of AS in the presence of neuropathic pain

A Review of Therapeutics for Treatment-Resistant Depression in the Older Adult.

One-third of older adults with depression meet criteria for treatment resistance, typically defined as a lack of response to two or more adequate trials of an antidepressant. Treatment resistance contributes to an unfavorable prognosis, compromised medical outcomes, heightened disability, accelerated cognitive decline, and an elevated risk of developing dementia. Despite this significant morbidity, evidence is sparse for how to proceed with treatment in this population. Non-pharmacologic therapy (e.g., diet, psychotherapy) can be utilized as adjunctive therapy, despite little published evidence of benefit, given that the risks are low. Pharmacotherapy trials in the treatment-resistant late-life depression population lack strong methods and external validity; however, the use of venlafaxine as monotherapy and add-on therapy, as well as lithium, bupropion, or aripiprazole as add-on therapy to standard antidepressant therapy, have enough evidence that a trial with appropriate monitoring is a prudent strategy. Electroconvulsive therapy remains a well-studied safe therapy, especially when used as maintenance treatment once an initial cycle is completed but is traditionally underutilized in the treatment-resistant late-life depression population. Ensuring non-pharmacologic and pharmacologic strategies are optimized and given a sufficient trial in those with treatment-resistant late-life depression is the best we can do for this vulnerable population.

Antidepressants and the Risk of Fall-Related Injury in Older Adults with Incident Depression in the United States: A Comparative Safety Analysis

Though it is well documented that antidepressants are associated with an increased risk of falls in older adults at the drug class level, the comparative risk between individual antidepressants for fall injury in older adults with depression is unknown. Currently, clinicians are making decisions at the drug class level without consideration of the potential that there could be safer choices within classes. We compared the risk of fall injury among initiators of bupropion, duloxetine, fluoxetine, paroxetine, and venlafaxine to those of (es)citalopram and, separately, sertraline. We performed a retrospective cohort study using the MarketScan® Medicare Supplemental claims from 2007 to 2019. Individuals had incident depression (washout in previous continually enrolled year) with a first antidepressant claim up to three months after depression diagnosis. Individuals were followed for the first three months of antidepressant use until the first occurrence of fall injury, change/discontinuation of antidepressant, discontinued insurance coverage, or end of study. Propensity score inverse probability of treatment-weighted Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals for each antidepressant comparison and fall injury. We identified 114,505 individuals (mean age 76.6 years, 68% female, 97% without prior fall). A higher risk of fall injury was associated with initiating bupropion (HR 1.20 to 1.61), duloxetine (HR 1.27 to 1.36), paroxetine (HR 1.14 to 1.22), and venlafaxine (HR 1.22 to 1.34) when compared to (es)citalopram or sertraline. New use of duloxetine, bupropion, paroxetine, and venlafaxine was associated with a higher risk of fall injury compared to (es)citalopram and sertraline.

A retrospective study on the clinical use and owner perception of venlafaxine efficacy as part of a multimodal treatment for canine fear, anxiety, and aggression

The serotonin-norepinephrine reuptake inhibitor venlafaxine is labeled for use in the treatment of several emotional disorders in people and has been steadily growing in popularity for the treatment of aggression, anxiety, and fear-related behavior problems in canine patients. Current publications describing the clinical use of venlafaxine in dogs are limited to a narcolepsy-cataplexy case report and its suggested use for pain and narcolepsy. In this retrospective open-label clinical trial, the records for dogs administered venlafaxine for a minimum of 21 days in combination with an individual management and behavior modification plan for the treatment of fear, anxiety, and aggressive behaviors were reviewed. The following factors were considered: owner-reported efficacy, dose range, diagnosis, number of diagnoses, and previously trialed and concurrent medications. Of the 110 dogs included, 71.8% (N = 79) percent of owners reported venlafaxine as helpful during at least one follow-up and 39.1% (N = 43) found it helpful at all three follow-up points. For those who found it helpful, the median dose used was 1.65 mg/kg by mouth every 12 hours (range 0.63-5.91 mg/kg every 12 hours). Venlafaxine was not more helpful in treating any specific diagnosis or number of diagnoses. Due to the efficacy and low frequency of adverse effects (N = 20, 18.2%), venlafaxine might be a useful medication option in dogs showing clinical signs of aggression, anxiety, and fear.

Clinical outcomes of recommended active pharmacotherapy agents from NICE guideline for post-traumatic stress disorder: Network meta-analysis

BackgroundPost-traumatic stress disorder (PTSD) is a mental disorder that can emerge after an individual experiences a traumatic event such as physical abuse, sexual/relationship violence, combat exposure, witnessing death, or serious injury. This study aimed to identify the most suitable drugs for the management of PTSD based on a network meta-analysis (NMA). MethodsSix databases (Ovid Medline, EMBase, CENTRAL, PsycINFO, Ovid Health and Psychosocial Instruments, and Web of Science) were searched from inception to September 6, 2022. ResultsThirty articles with a total of 5170 participants were included. Compared with placebo, active drugs including olanzapine (SMD = −0.66, 95% CI: −1.19 to −0.13), risperidone (SMD = −0.23, 95% CI: −0.42 to −0.03), quetiapine (SMD = −0.49, 95% CI: −0.93 to −0.04), venlafaxine (SMD = −0.29, 95% CI: −0.42 to −0.16), sertraline (SMD = −0.23, 95% CI: −0.34 to −0.11), paroxetine (SMD = −0.48, 95% CI: −0.60 to −0.36) and fluoxetine (SMD = −0.27, 95% CI: −0.42 to −0.12), significantly reduced the total clinician-administered PTSD scale score. ConclusionThe results of this study support the use of paroxetine, venlafaxine, and quetiapine as first-line treatment for PTSD. In addition, quetiapine is recommended for patients with PTSD affected by symptoms of hyperarousal and re-experience disorder. Clinicians should prescribe medications based on the severity of PTSD symptoms and other conditions to develop the best treatment strategy for this patient population.

Serotonin and norepinephrine reuptake inhibitors association with dry mouth in a hospital population.

Xerostomia, or dry mouth, is a condition that results from the reduction or absence of saliva flow secondary to the use of certain medications. The objective of the present study was to analyze the relationship between xerostomia patients and the consumption of serotonin norepinephrine reuptake inhibitors (SNRIs). The University of Florida (UF) Integrated Data (IDR) i2b2, for the period of June 2015 to September 2022, was used based on aggregates of the International Classification of Diseases 10th edition (ICD-10) diagnoses of dry mouth and use of SNRI. MedCalc Software was used to calculate odds ratios. The odds ratio for dry mouth in the SNRI group was 5.95 (95% CI 5.47 to 6.48, P < .0001). The odds ratio for dry mouth in females on SNRI was 5.48 (95% CI 4.97 to 6.02, P < .0001), for males 5.48 (95% CI 4.56 to 6.95), P < .0001), for children 2.87 (95% CI 1.19 to 6.96, P = .0192), and for adults 4.46 (95% CI 4.09 to 4.86, P < .0001). When the different SNRIs were analyzed separately, the odds ratio for dry mouth with the use of venlafaxine was 5.83 (95% CI 5.12 to 6.6, P < .0001), duloxetine 6.97 (95% CI 6.33 to 7.67, P <.0001), desvenlafaxine 5.24 (95% CI 3.65 to 7.52, P < .0001), and milnacipran 9.61 (95% CI 5.66 to 16.31, P < .0001). According to the present study, patients who are taking SNRIs are five-fold more likely to develop dry mouth compared to those not on medications. The results could be informative to medical professionals who prescribe SNRIs and who are not currently aware of the effect they have on salivary production and therefore quality of life, as well as the dental practitioners treating these patients with dry mouth sequalae.

The Risk of Fatal Arrhythmias in Post-Myocardial Infarction Depression in Association With Venlafaxine.

Venlafaxine is a second line anti-depressant and the most commonly used in the treatment of selective serotonin reuptake inhibitor nonresponders in major depression; due to its effects on the noradrenergic and serotonergic systems as a serotonin and norepinephrine reuptake inhibitor, there has been considerable apprehension regarding its use in patients with cardiovascular diseases, particularly post-myocardial infarction depression, some of the feared adverse effects include QT prolongation, arrhythmias including torsades de pointes and sudden cardiac death. We tried to resolve the facts regarding the risks associated with venlafaxine use in cardiac patients. We have reviewed all the relevant information up to May 2022 regarding the risks of venlafaxine use in cardiovascular disease, particularly with a focus on post-myocardial infarction depression, and gathered around 350 articles in our research and narrowed it down to 49 articles. The database used was PubMed and the keywords used were venlafaxine, arrhythmia, major depression, post-myocardial infarction, and ventricular tachycardia. We carefully screened all relevant articles and found articles supporting and refuting the effects of venlafaxine in increasing cardiovascular morbidity and mortality. We have concluded that there is a significant variability due to confounding factors affecting individual cases. Overall there is no increased arrhythmia risk in comparison with other anti-depressants except in high-risk cases such as with pre-existing cardiovascular disease, certain genotypes, and other co-morbidities. Any patient with a high risk of arrhythmias due to any etiology should receive a screening electrocardiogram before venlafaxine prescription for baseline QT interval and periodically while on therapy to check for changes. We encourage further research, including randomized clinical trials and post-marketing surveillance regarding the use of venlafaxine in high-risk cases such as patients with multiple co-morbidities, elderly patients, or patients with certain genotypes.

Pharmacological Management of Nightmares Associated with Posttraumatic Stress Disorder.

Posttraumatic stress disorder (PTSD) can be a chronic and disabling condition. Post-traumatic nightmares (PTNs) form a core component of PTSD and are highly prevalent in this patient population. Nightmares in PTSD have been associated with significant distress, functional impairment, poor health outcomes, and decreased quality of life. Nightmares in PTSD are also an independent risk factor for suicide. Nightmare cessation can lead to improved quality of life, fewer hospital admissions, lower healthcare costs, and reduced all-cause mortality. Effective treatment of nightmares is critical and often leads to improvement of other PTSD symptomatology. However, approved pharmacological agents for the treatment of PTSD have modest effects on sleep and nightmares, and may cause adverse effects. No pharmacological agent has been approved specifically for the treatment of PTNs, but multiple agents have been studied. This current narrative review aimed to critically appraise proven as well as novel pharmacological agents used in the treatment of PTNs. Evidence of varying quality exists for the use of prazosin, doxazosin, clonidine, tricyclic antidepressants, trazodone, mirtazapine, atypical antipsychotics (especially risperidone, olanzapine and quetiapine), gabapentin, topiramate, and cyproheptadine. Evidence does not support the use of venlafaxine, β-blockers, benzodiazepines, or sedative hypnotics. Novel agents such as ramelteon, cannabinoids, ketamine, psychedelic agents, and trihexyphenidyl have shown promising results. Large randomized controlled trials (RCTs) are needed to evaluate the use of these novel agents. Future research directions are identified to optimize the treatment of nightmares in patients with PTSD.

Painful ejaculation induced by venlafaxine: a case report

IntroductionSexual dysfunction is a quite common side effect of antidepressant treatment. Sexual side effects may affect the person’s adherence to treatment, quality of life, and relations. Premature ejaculation is rarely seen as an adverse effect of antidepressant drugs.ObjectivesWe aimed to present a clinical case of a 53-year-old man who developed painful ejaculation with the use of venlafaxine.MethodsWe made a narrative literature search in Pubmed and Google scholar with the terms of painful ejaculation induced by venlafaxine and antidepressant treatment.Results A 53-year-old man was admitted to the psychiatric outpatient unit with symptoms of anhedonia, decreased sleep, decreased self-esteem for the last month. The patient was diagnosed with depression and he started to take 37,5 mg venlafaxine per day. After one month, when venlafaxine dose was increased to 75mg and the patient started to complain of painful ejaculation. The pain continued from the beginning to the end of the ejaculation. The pain increased more when the venlafaxine dose increased to 150mg per day. The patient was consulted at the urology clinic. The urological examination, laboratory tests (direct microscopic examination of the urethral discharge and urethral culture), and serum prostate-specific antigen levels were normal. No pathology was found in uroflowmetry and ultrasonography of the urinary system. The dose of venlafaxine decreased and the patient started to take 20 mg of fluoxetine per day. His symptoms disappeared after venlafaxine was discontinued.ConclusionsTo literature, this is the second presentation of painful ejaculation observed during the use of venlafaxine.DisclosureNo significant relationships.

Impact of COVID- 19 pandemic on antidepressants consumptions by wastewater analysis in Turkey

The COVID-19 pandemic has been a major challenge worldwide, forcing countries to take restrictive measures beyond conventional methods in their fight against the spread of the disease. Followingly, many studies have been conducted on the effects of these measures on mental health. Wastewater-based epidemiology (WBE) was used in this study to monitor and estimate changes in antidepressant use under normal conditions (2019) and COVID-19 pandemic conditions (2020). Likewise, this study utilized wastewater-based epidemiology (WBE) to monitor and assess changing trends from the pre-pandemic period (2019) to COVID-19 pandemic conditions in antidepressant use (2020).Wastewater samples were collected from 11 cities in Turkey throughout six sampling periods covering the pre-pandemic and during-pandemic periods (June 2019–December 2020). Then, samples were analyzed via LC-MS/MS method. As a result, we observed that venlafaxine was the drug with the highest concentration (mean ± SD: 103.6 ± 112.1 mg/1000p/day). Moreover, city number 6 presented the highest venlafaxine use and the most dramatic increase during the pandemic period. Finally, this study revealed the potential of WBE to estimate the changing trends in mental health during the ongoing pandemic.

Effects of Zuojin Pill (Rhizoma Coptidis and Fructus Evodiae preparation) on the pharmacokinetics and side effects of venlafaxine in humans.

Venlafaxine (VEN), a first-line antidepressant, and Zuojin Pill (ZJP), a common herbal medicine consisting of Rhizoma Coptidis and Fructus Evodiae, are high likely co-administered in China. ZJP could significantly inhibit VEN pharmacokinetics in vitro and in rats through suppression of CYP2D6 activity. To date, however, no clinical study has demonstrated the clinical relevance. Here, the VEN pharmacokinetics at a single dose of VEN with or without co-administration of ZJP was compared. ZJP had a weak herb-drug interactions (HDI) on the pharmacokinetics of VEN. The geometric means of Cmax and AUC0-∞ of VEN increased by 36.7% and 34.6%, respectively, and the corresponding 90% confidence intervals (CIs) of geometric mean ratios (GMRs) exceed outside bioequivalent range of 0.80-1.25. However, the corresponding 90% CIs of GMRs of these parameters for ODV were within the range. Since ODV exposure (AUC), approximately 3.4-fold higher than that of VEN, hardly changed, the systemic exposure of VEN active moiety (VEN + ODV) with ZJP increased slightly (≤8.5%) compared with that of VEN alone. In addition, the incidence of VEN-related side effects, especially gastrointestinal relevance, was significantly reduced with ZJP. Therefore, rational concomitant use of VEN and ZJP might have low risk of HDI and be promising in clinical practice.

Venlafaxine Extended Release in the Treatment of Post Herpetic Neuralgia: A Quasi-Experimental Study

Background: Anti depressant drugs are sometimes used to treat neuropathic pain like Postherpetic Neuralgia (PHN) however, their analgesic efficacy is unclear. Venlafaxine is a reasonably well tolerated anti depressant and is a Serotonin Norepinephrine Reuptake Inhibitor (SNRI) and weak noradrenaline reuptake inhibitor. Although not licensed for the treatment of chronic or neuropathic pain in most countries, it is sometimes used for this indication. The present study evaluated the efficacy, tolerability and Quality of Life (QoL) of venlafaxine use for 12 weeks in patients with PHN.&#x0D; Materials and methods: This quasi-experimental (Pretest-posttest design) was conducted in the department of Neurology, Dhaka Medical College Hospital, from July 2012 to June 2013. Four hundred and fifty two patients were included in the study and Venlafaxine extended release tablet (75 to 150 mg) were administeredfor 12 weeks. Pain severity score, pain interference score and QoL score were assessed by a self-rated questionnaire before treatment and at 12 weeks follow-up.&#x0D; Results: Majority of the patients were male (63.7%) with a mean age of 48.1 years. After 12 weeks of Venlafaxine treatment, 330 (73%) patients reported at least 50% relief in pain, whereas three (0.7%) patients did not report any pain relief. Pain was relieved completely in 32 (7.0%) patients. There was a significant decrease in the mean pain severity score, (5.8±2.0 versus 3.6±2.2) and meanpain interference score (4.5±2.0 versus 3.1±1.9) from baseline to 12 weeks. The mean QoL scale score improved significantly from 5.9±1.6 at baseline to 8.0±1.7 at week 12. Only 2.8% (13/452) patients experienced at least one adverse effect during the study period.&#x0D; Conclusion: Venlafaxine was found to be effective, safe and well tolerated in the patients of PHN for relieving pain and improving QoL. Further double blinded randomize study is needed to validate these findings.&#x0D; JCMCTA 2021 ; 32 (1) : 31-34

Venlafaxine and L-Thyroxine Treatment Combination: Impact on Metabolic and Synaptic Plasticity Changes in an Animal Model of Coexisting Depression and Hypothyroidism.

The clinical effectiveness of supportive therapy with thyroid hormones in drug-resistant depression is well-known; however, the mechanisms of action of these hormones in the adult brain have not been fully elucidated to date. We determined the effects of venlafaxine and/or L-thyroxine on metabolic parameters and markers involved in the regulation of synaptic plasticity and cell damage in an animal model of coexisting depression and hypothyroidism, namely, Wistar Kyoto rats treated with propylthiouracil. In this model, in relation to the depression model itself, the glycolysis process in the brain was weakened, and a reduction in pyruvate dehydrogenase in the frontal cortex was normalized only by the combined treatment with L-thyroxine and venlafaxine, whereas changes in pyruvate and lactate levels were affected by all applied therapies. None of the drugs improved the decrease in the expression of mitochondrial respiratory chain enzymes. No intensification of glucocorticoid action was shown, while an unfavorable change caused by the lack of thyroid hormones was an increase in the caspase-1 level, which was not reversed by venlafaxine alone. The results indicated that the combined administration of drugs was more effective in normalizing glycolysis and the transition to the Krebs cycle than the use of venlafaxine or L-thyroxine alone.

Venlafaxine as an analgesic in the treatment of chronic pain in patients with depression – scientific evidence and clinical cases

Depression is sometimes referred to as the state of “mental pain” as its symptoms generate a state of generalised suffering. Mental distress is very often accompanied by physical pain. The prevalence of somatic symptoms in the population of patients with depression varies significantly depending on the study population and ranges from 30 to 95%. The incidence and severity of pain are correlated with the aging process and they tend to increase with age. The most common pain symptoms in depression include headache, back and lower back pain, pain of joints and limbs, migraine headaches and abdominal pain. The pain may sometimes mask depression by coming to the fore in the clinical picture and making it difficult to establish an accurate diagnosis. The fact that antidepressants are effective in chronic pain syndromes, while not all antidepressants show the same analgesic efficacy, is the direct evidence for the common pathogenetic mechanisms of chronic pain and depression. Tricyclic antidepressants were the first antidepressants to be used in the treatment of pain symptoms in various disease states. Numerous studies have confirmed the analgesic efficacy of serotonin and noradrenaline reuptake inhibitors, which are characterised by a much better tolerance and a more favourable safety profile compared to tricyclic antidepressants; however, their analgesic effect is clearly marked only at doses that, in addition to the effect on serotonergic transmission, also affect the noradrenergic transmission. The article summarises the scientific evidence for the purposefulness of the use of venlafaxine in the treatment of chronic pain, in particular pain syndromes associated with depression, and presents two clinical cases with a commentary.