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Psychopharmacological Interventions for Functional Bowel Disease
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Psychoactive drugs have been utilized in a variety of pain syndromes, and often result in significant improvement in symptoms (60). Psychopharmacological approaches to pain in functional GI disorders may be indicated in a variety of situations (61). By extrapolation, for patients who have significant pain—a frequent concomitant of functional GI disorders—treatment for this component may be indicated. Most of the available literature on chronic pain includes reports of the effects of tricyclic antidepressants. These agents have known beneficial effects, but also have a significant side-effects burden, including significant anticholinergic effects. Trazodone, a second-generation antidepressant, has beneficial effects in pain syndromes and no significant anticholinergic effects. Newer agents that are selective and potent inhibitors of serotonin may also be beneficial in treatment of pain syndromes. One study (46) reported beneficial effects of fluoxetine in a patient with chronic abdominal pain. Agents that modify visceral afferent transmission include the tricyclic antidepressants (TCAs) (imipramine, amitriptyline, and others), selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, paroxetine, fluvoxamine, and clomipramine (the last is both a tricyclic and serotonin-selective). Nefazodone, an atypical antidepressant with serotonin and norepinephrine reuptake inhibition and post-synaptic serotonin receptor (type 2) blockade, also may have clinical utility in pain syndromes.
Examples from Actual Clinical Trials in Choosing and Specifying Estimands
Published in Craig Mallinckrodt, Geert Molenberghs, Ilya Lipkovich, Bohdana Ratitch, Estimands, Estimators and Sensitivity Analysis in Clinical Trials, 2019
Craig Mallinckrodt, Geert Molenberghs, Ilya Lipkovich, Bohdana Ratitch
MDD is a common psychiatric condition with a lifetime incidence of approximately 15% (Kessler et al., 2005). The disorder ranges from mild to severe and is associated with significant potential morbidity and mortality, contributing to suicide and adverse impact on concomitant medical illnesses, interpersonal relationships, and work. The objectives of treatment are to reduce or resolve signs and symptoms of the disease, restore psychosocial and occupational function, and reduce the likelihood of relapse or recurrence (Primary Care Clinical Practice Guideline, 2010). Guidelines support pharmacological therapy for the treatment of depression in addition to psychotherapy. Antidepressant medications include selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, serotonin-dopamine activity modulators (SDAMs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) (Practice Guideline for The Treatment of Patients With Major Depressive Disorder, 2010).
Medications
Published in R. Andrew Chambers, The 2 × 4 Model, 2017
The ‘atypical antidepressants’ include mirtazapine, trazodone, buspirone, and bupropion. Mirtazepine and trazedone, while not as popular as SSRIs for straight-up anxiety and depression (and maybe not as effective), are very good for treating insomnia and supporting proper sleep architecture, while avoiding the dependence and cognitive risks of benzoids. Buspirone is well known as the non-benzoid anxiolytic, but has the reputation of being a high-priced placebo, although some patients do show and claim major benefits with it.
Treatment characteristics among patients with binge-eating disorder: an electronic health records analysis
Published in Postgraduate Medicine, 2023
William M. Spalding, Monica L. Bertoia, Cynthia M. Bulik, John D. Seeger
In the BED cohort, 70.6% of patients (271/384) were prescribed any pharmacotherapy (probable BED, 66.9% [440/658]; all BED, 68.2% [711/1042]) during the baseline period (Figure 3A). Among the pharmacotherapies (Figure 3A), 54.4% (209/384) of the BED cohort were prescribed antidepressants (probable BED, 52.4% [345/658]; all BED, 53.2% [554/1042]) and 25.3% (97/384) were prescribed stimulants (probable BED, 20.1% [132/658]; all BED, 22.0% [229/1042]). The most frequently prescribed antidepressants in the BED cohort were selective serotonin reuptake inhibitors (SSRIs) followed by atypical antidepressants (Table 4). Among stimulants, amphetamine-like stimulants were prescribed more frequently than nonamphetamine-like stimulants (Table 4).
Using a machine learning approach to investigate factors associated with treatment-resistant depression among adults with chronic non-cancer pain conditions and major depressive disorder
Published in Current Medical Research and Opinion, 2021
Drishti Shah, Wanhong Zheng, Lindsay Allen, Wenhui Wei, Traci LeMasters, Suresh Madhavan, Usha Sambamoorthi
Notwithstanding the limitations, our study provides important insights on factors associated with TRD among patients with CNPC using a large population-based real-world study. We identified biological and health-related factors among patients with CNPC and MDD such as number of CNPC, age, comorbid anxiety, polypharmacy, and factors related to MDD treatment and severity such as mental health specialist visits, use of psychotherapy, and class of index antidepressant as leading factors associated with TRD. These factors can serve as targets for replication of predictive models based on claims data and may be used by future studies to further understand and identify TRD at an early stage, when targeted interventions may have a higher potential to improve treatment outcomes in patients with CNPC and MDD. The study highlights an unmet need among patients with TRD and CNPC. In addition to exploring the role of atypical antidepressants with different mechanisms of action, novel treatments recently approved by the FDA that have evidence for efficacy not only in TRD but also in alleviating pain such as rTMS and intranasal esketamine may be promising [80–82]. However, more research is needed in understanding their real-world effectiveness. Moreover, a recent editorial in JAMA emphasized on individualizing maintenance interventions [83]. Identification of risk factors can help such interventions to target personalized maintenance therapy based on patient-level predisposing factors of TRD.
Pharmacokinetic and pharmacodynamic of bupropion: integrative overview of relevant clinical and forensic aspects
Published in Drug Metabolism Reviews, 2019
Rafaela Costa, Nuno G. Oliveira, Ricardo Jorge Dinis-Oliveira
According to the World Health Organization, depressive disorders are the single largest contributors to global disability, as shown by 7.5% of all Years Lived with Disability (World Health Organization 2017). Depression is also the major contributor to suicide. Antidepressants and/or psychotherapy are clinical approaches for the treatment of major depressive disorders. There are several classes of antidepressants: monoamine oxidase inhibitors (MAOIs; e.g. phenelzine), tricyclic antidepressants (e.g. desipramine), selective serotonin reuptake inhibitors (SSRIs; e.g. fluoxetine), serotonin and norepinephrine reuptake inhibitors (SNRIs; e.g. venlafaxine), and the atypical antidepressants (i.e. drugs that act by a mechanism of action other than the previously mentioned; e.g. bupropion). Even though the adverse effects, safety and tolerability profile of antidepressants vary widely between classes, the efficacy of different classes of antidepressants is similar.