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At least one Cp was drawn in 1057 unique patients with a TCA purchase. Of these, 18.4% (194/1057) patients (cases) had an elevated TCA Cp and were matched to 716 non-elevated Cp patients. Additionally, 27.3% (53/194) of the cases (matched to 196 controls) experienced a toxic TCA Cp. The best fitting model of an elevated TCA Cp included TCA dose category (daily doses >or=150 mg, OR = 4.08; doses of 50 to <100 mg, OR = 0.36; and doses <50 mg, OR = 0.18, p < 0.05 for all comparisons), female gender (OR = 1.78, p < 0.05) and concurrent use of fluoxetine or paroxetine (OR = 1.75, p < 0.05). The best fitting predictive model of a toxic TCA Cp included the same factors as for the predictive model of an elevated TCA Cp.
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In this systematic review we present information relating to the effectiveness and safety of the following interventions: cognitive therapy; continuity of care; dialectical behavioural therapy; emergency card; flupentixol depot injection; general practice-based guidelines; hospital admission; intensive outpatient follow-up plus outreach; mianserin; nurse-led case management; oral antipsychotics; paroxetine; problem-solving therapy; psychodynamic interpersonal therapy; and telephone contact.
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Treatment guidelines for major depressive disorder (MDD) recommend a continuous use of antidepressants for several weeks, while recent meta-analyses indicate that antidepressant efficacy starts to appear within 2 weeks and early treatment nonresponse is a predictor of subsequent nonresponse.
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After the advent of SSRI, antidepressants in low doses and in combination with neuroleptic treatment entered into use in clinical practice. The indication is the depression that may overlap with schizophrenic disorder.
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To analyze all studies reporting primary data on the rate of fetal malformations after early in utero exposure to paroxetine, investigated either specifically or jointly with other antidepressant medications.
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Thirty percent of lifelong PE patients seeking medical treatment for complaints of early ejaculation freely decided not to start any paroxetine treatment, and roughly 30% of patients who started therapy eventually discontinued it.
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We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of initial treatments for obsessive compulsive disorder in adults? What are the best forms of maintenance treatment for obsessive compulsive disorder in adults? What are the effects of treatments for obsessive compulsive disorder in adults who have not responded to initial treatment with serotonin reuptake inhibitors? We searched: Medline, Embase, The Cochrane Library and other important databases up to July 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
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The alpha(2)-adrenoreceptor antagonist mirtazapine, which is also a 5-HT(2), 5-HT(3) and H(1) receptors antagonist and the selective serotonin (5-HT) reuptake inhibitor paroxetine are effective antidepressant drugs which enhance 5-HT neurotransmission via different mechanisms. The present studies were undertaken to determine whether the mirtazapine-paroxetine combination could induce an earlier and/or a greater effect on the 5-HT system than either drug alone. Using in vivo electrophysiological paradigms, the firing activity of dorsal raphe 5-HT neurons was decreased by 70% in rats treated with paroxetine (10 mg/kg/day, s.c.) for 2 days and was back to normal after 21 days. In contrast, a 2-day treatment with mirtazapine (5 mg/kg/day, s.c.) did not alter the firing of 5-HT neurons whereas it was increased by 60% after 21 days of treatment. A low dose of mirtazapine (5 mg/kg/day, s.c.x2 days) failed to offset the decremental effect of paroxetine on the 5-HT neuron firing activity, but a higher dose (10 mg/kg/day, s.c.x2 days) did attenuate the decremental effect of paroxetine. In the dorsal hippocampus, neither mirtazapine (5 mg/kg/day, s.c.) nor a paroxetine (10 mg/kg/day, s.c.) treatment altered the responsiveness of 5-HT(1A) receptors to microiontophoretically-applied 5-HT. Both in controls and in rats treated for 2 days with paroxetine alone, the administration of the 5-HT(1A) antagonist WAY 100635 (25-100 microg/kg, i.v.) did not change the firing activity of dorsal hippocampus CA(3) pyramidal neurons. However, WAY 100635 increased significantly the firing activity of these neurons in rats treated with mirtazapine alone but to a greater extent with both mirtazapine and paroxetine for 2 days. After 21 days of treatment, WAY 100635 increased to a greater degree the firing rate of CA(3) pyramidal neurons in rats which received the combination over rats given either drug alone. It is concluded that the mirtazapine-paroxetine combination shortened the delay in enhancing the tonic activation of postsynaptic 5-HT(1A) receptors and produced a greater activation of the postsynaptic 5-HT(1A) receptors than either drug given alone. The present results suggested that mirtazapine may have a faster onset of action than a SSRI, and that the co-administration of mirtazapine and paroxetine may accelerate the antidepressant response and as well as being more effective than either drug alone.
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Significant differences (p < or = .05) were found between paroxetine and placebo on the HAM-D and CGI by Week 2 and on all efficacy outcome variables by Week 4. Improvement on the HAM-D sleep factor occurred 2 weeks prior to that seen on the retardation factor. Similar results were obtained when an adequate treatment group (therapy for > or = 28 days) was considered. A full clinical response (CGI-severity of illness score 1 or 2) was seen in over 40% of subjects. Adverse events were more common for paroxetine compared with placebo (p < or = .01). Somnolence was twice more common than nervousness. Dropout due to adverse events was similar between therapies. Paroxetine had no clinically significant effect on laboratory safety data or vital signs.
For the majority of assessments, HAM-D6 effect sizes were numerically larger than those estimated from the HAM-D17. Findings support that duloxetine 60 mg daily is the best effective dose.
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The impact of mild hypobaric hypoxia on the development of anxiety-like state in rats in experimentally simulated human post-traumatic stress disorder was studied. Three-trial exposure to mild hypobaric hypoxia (360 mm Hg for 2 hours daily, for 3 days) in preconditioning or post-conditioning mode performed, respectively, before or after exposure to severe traumatic stress in the "stress-restress" model produced a significant anxiolytic effect on the rat open-field and plus-maze behavior. Anxiolytic effect of modem antidepressant Paxil (20 mg/kg daily, for 3 days) was weaker. This drug produced side-effects on particular behavioral characteristics in the open field. The conclusion was made on the efficacy of mild hypobaric hypoxia and the possibility of its implementation as a medication-free tool for prophylaxis and correction of post-traumatic stress disorder.
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A randomized, placebo controlled fixed-dose trial was undertaken to determine the efficacy and tolerability of escitalopram in obsessive-compulsive disorder (OCD), using paroxetine as the active reference.
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Depression is a chronic and disabling illness that frequently requires long-term maintenance treatment. The probability of recurrence after recovery is extremely high, especially amongst patients who have experienced previous episodes of depression. Indeed, once a patient has suffered from three episodes of depression, the likelihood that they will have another episode within the next 2 years is more than 95%. Despite this, depression remains an under-recognized and under-treated disease. Mirtazapine has shown sustained efficacy in the long-term treatment of depression, being more effective than amitriptyline and at least as effective as the selective serotonin reuptake inhibitors paroxetine and citalopram. It is also well tolerated over prolonged periods. It should therefore prove suitable for use as maintenance treatment in depressed patients.
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The compound 6o (at 0.5, 1 and 2 mg/kg, ip) with optimum log P and pA2 value, was subjected to forced swim test (FST) and tail suspension test (TST). The compound 6o significantly reduced the duration of immobility in mice without affecting the base line locomotion in actophotometer. Moreover, 6o (2 mg/kg, ip), potentiated the 5-hydroxytryptophan (5-HTP)-induced head twitch responses in mice and at 1 and 2 mg/kg, ip antagonized the reserpine-induced hypothermia (RIH) in rats. In interaction studies with various standard drugs/ligands using FST, 6o (1 and 2 mg/kg, ip) potentiated the anti-depressant effect fluoxetine (5 mg/kg, ip) and reversed the depressant effect of parthenolide (1 mg/kg, ip) by reducing the duration of immobility. Furthermore, 6o (1 and 2 mg/kg, ip) potentiated the effect of bupropion (10 mg/kg, ip) in TST. The behavioural anomalies of the olfactory bulbectomised (OBX) rats were augmented by chronic 6o (1 and 2 mg/kg) treatment as observed from the modified open field test (parameters: ambulation, rearing, fecal pellet). The results suggest that compound 6o exhibited anti-depressant like effect in rodent models of depression.
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Monotherapy of all the SSRI/SNRI drugs showed significant weight increase, consistent with that of previous studies. The co-medication of bupropion and escitalopram showed a significantly higher increase in BMI than monotherapy (P = 0.0102). The increase in BMI in the other five co-medication groups was not significantly different from their respective monotherapy groups.
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Agomelatine, an agonist of melatonergic MT1 and MT2 receptors and antagonist of 5-HT2 receptors, is associated with similar rates of sexual dysfunction compared with placebo and lower rates compared with other antidepressants. Twice as many sexually active depressed patients (n = 193) reported a deterioration of sexual function during 12 weeks of treatment with venlafaxine compared with agomelatine (15.2% vs. 8.2%, p < 0.0001); however, no differences were found with respect to arousal. Using the Arizona Sexual Experience Scale in depressed patients (n = 399), the incidence of treatment-emergent sexual dysfunction (TESD) with agomelatine (3%) was significantly lower than placebo (8.6%) and selective serotonin reuptake inhibitors (10.1%). Among healthy male volunteers (n = 92), TESD was not increased compared with placebo in either agomelatine (25 and 50 mg/day) group over 8 weeks, and both were significantly lower than TESD with paroxetine (p < 0.0001). Moderate or severe TESD occurred in less than 5% of subjects receiving agomelatine versus 62% who received paroxetine (p < 0.001).
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This paper presents the development, optimization, and validation of an innovative method to analyze trace concentrations of seven selected psychoactive pharmaceuticals in environmental waters. Hereby, the solid-phase extraction (SPE) potential of molecularly imprinted polymers (MIPs) in terms of extraction recovery, breakthrough, precision, and selectivity is studied for the first time. Instrumental analysis by ultra-performance liquid chromatography coupled to triple quadrupole mass spectrometry allowed a rapid (run time = 7.5 min) and sensitive (instrumental detection limit < or = 7 pg injected) quantification of the target analytes. A systematic optimization study revealed that, among the seven compounds of interest, mainly the selective serotonin reuptake inhibitors paroxetine, fluoxetine, and citalopram are selectively retained on the MIPs. Experiments performed in spiked river water, sewage treatment plant (STP) effluent and influent showed for these compounds extraction recoveries higher than 70%, breakthrough volumes up to 200 mL, method detection limits (MDL) as low as 0.5 ng/L, and good precision (exemplified by relative standard deviations better than 15%, n > or = 3). Compared to the widely used hydrophilic-lipophilic balanced (HLB) polymers, the newly developed MIPs indicated to be more resistant toward matrix effects induced ion signal suppression particularly when dealing with relative dirty samples like STP influents. As a result of the better selectivity, the MDL obtained with the MIP-based SPE method was up to a factor of 7 lower compared to those obtained with a recently reported multi-residue HLB method. However, optimizing a HLB method in terms of selectivity, e.g., by introducing a stronger washing protocol, can significantly reduce its MDL up to values approximating those obtained with MIPs.
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The aim of this study was first to investigate the function of GABA(A)/BZD receptor and passive avoidance acquisition in the FPT "test-retest". The second aim of this study was to evaluate the capacity of the FPT to discriminate BZDs from other non-BZD anxiolytics in experienced mice.
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The scope of this study was to investigate the antidepressant-like effect of aripiprazole, when combined with conventional antidepressants drugs.
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To determine if voluntary prescription change forms for antidepressant drugs could induce dosing changes and reduce the cost of antidepressant therapy in a Medicaid population.
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The anxiety-reducing effect of long-term administration of serotonin reuptake inhibitors is usually seen only in subjects with anxiety disorders, and such patients are also abnormally inclined to experience a paradoxical anxiety-enhancing effect of acute serotonin reuptake inhibition. These unique responses to serotonin reuptake inhibitors in anxiety-prone subjects suggest, as do genetic association studies, that inter-individual differences in anxiety may be associated with differences in serotonergic transmission.
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It has been proposed that serotonin and norepinephrine reuptake inhibitors (SNRIs) may result in higher remission rates of major depressive disorder than therapy with selective serotonin reuptake inhibitors (SSRIs). To test this hypothesis, a meta-analysis of individual patient data (N = 1833) was performed for the complete set of 6 phase II/III studies that compared duloxetine (fixed doses; range, 40-120 mg/d) with 2 SSRIs (paroxetine or fluoxetine; 20 mg/d) in outpatients with major depressive disorder. Remission was defined as an end point score of less than or equal to 7 on the 17-item Hamilton Rating Scale for Depression (HAMD17); alternate outcome criteria were also examined, as were remission rates among the 1044 patients with moderate-to-severe depression (HAMD17 total score greater than or equal to 19). The HAMD17 remission rates were 40.3% (351/871), 38.3% (162/423), and 28.4% (144/507) for duloxetine, the 2 SSRIs, and placebo, respectively. Both active treatments were superior to placebo; the difference between duloxetine and SSRIs was not statistically significant. Similar findings were observed for alternate outcomes. Duloxetine therapy was significantly more effective than therapy with the 2 SSRIs for patients with more severe depression, with remission rates of 35.9% (183/510) versus 28.6% (70/245) (P = 0.046). A secondary analysis of dose-response relationships indicated that this advantage was not attributable to the studies using higher doses of duloxetine. Thus, whereas duloxetine and the 2 SSRIs were comparably efficacious overall, therapy with the serotonin and norepinephrine reuptake inhibitor resulted in a significantly higher remission rate among patients with moderate-to-severe depression.
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The intent-to-treat population consisted of 186 patients randomly assigned to paroxetine CR and 184 patients randomly assigned to placebo. Statistically significant differences in favor of paroxetine CR compared with placebo were observed in the change from baseline to week 12 last-observation-carried-forward (LOCF) dataset in LSAS total score (difference = -13.33, 95% confidence interval [CI] = -18.25 to -8.41, p <.001). In the CGI-Global Improvement responder analysis, 57.0% of patients treated with paroxetine CR achieved response (very much improved or much improved), compared with 30.4% of patients treated with placebo at week 12 LOCF (odds ratio = 3.12, 95% CI = 2.01 to 4.83, p <.001). Dropout rates due to adverse events were low and comparable in both treatment groups.