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Psychotropic Use during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Congenital anomalies were not increased in 134 infants exposed to clomipramine during the first trimester (McElhatton et al., 1996). In a large Swedish registry analysis of 1,425 infants exposed to clomipramine during the first trimester, infants (n = 28) had an increased frequency of heart defects. In newborns exposed to clomipramine during late pregnancy, seizures and abnormalities of perinatal adaptation were observed (Cowe et al., 1982; Ostergaard and Pedersen, 1982). Symptoms observed in one infant whose mother took clomipramine in late pregnancy were similar to withdrawal symptoms (increased irritability, alternating hypertonia and hypotonia, hyperreflexia, cyanosis, and hypothermia) (Boringa et al., 1992). An increased frequency of central nervous system and other anomalies was found among the offspring of pregnant mice exposed to clomipramine in doses 36 times those used in humans (Jurand, 1980). Persistent behavior changes were observed in offspring of pregnant rats treated with clomipramine at doses several fold the usual human dose (de Ceballos et al., 1985; Drago et al., 1985; File and Tucker, 1983).
Common/useful drugs
Published in Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson, Pocket Prescriber Psychiatry, 2019
Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson
Interactions:↓P450 (CYP2A6); ☠ ↑risk of severe toxic reaction with serotonergics, dopaminergics and noradrenergics: SSRIs, SNRIs, NARIs, TCAs (and related drugs), other MAOIs (inc for Parkinson's), carbamazepine, linezolid, triptans, pethidine, tramadol. ☠Do not start tranylcypromine until these drugs have been stopped and they have cleared: 5 wk for fluoxetine, 3 wk for clomipramine/imipramine, at least 7–14 days for other drugs.Wait 2 wk after stopping tranylcypromine before starting any of these medicines. ↑risk of hypertensive crisis with sympathomimetics, dopamine agonists, CNS stimulants, buspirone. ↑fx of CNS depressants, antimuscarinics, antidiabetics, antihypertensives.
Cerebral
Published in A. Sahib El-Radhi, Paediatric Symptom and Sign Sorter, 2019
Narcolepsy is a lifelong problem. Although the tricyclic antidepressant clomipramine remains the main treatment, remember that it may cause numerous and unpleasant side effects: constipation, urinary retention and dry mouth.
Can regular physical exercise be a treatment for panic disorder? A systematic review
Published in Expert Review of Neurotherapeutics, 2022
Sergio Machado, George Telles, Franklin Magalhaes, Diogo Teixeira, Sandra Amatriain-Fernández, Henning Budde, Claudio Imperatori, Eric Murillo-Rodriguez, Diogo Monteiro, Diogo Telles Correia, Alberto Souza Sá Filho
It is premature to speculate that exercise intervention alone will improve the severity of panic symptoms, as well as anxiety and depression symptoms in PD patients. Corroborating our hypothesis, PD patients who were treated with clomipramine had greater reductions in anxiety and disease severity compared to those who underwent exercise intervention [17]. CBT was also more effective in reducing anxiety and severity of illness than those who underwent exercise intervention [12]. However, exercise intervention associated with CBT has been an excellent option as adjunctive therapy to improve anxiety symptoms. Gaudlitz et al. examined the combination of aerobic exercise plus CBT compared to stretching exercises plus control CBT, with favorable results for aerobic exercise plus CBT with a reduction in anxiety levels and severity of disease [11]. Merom et al. investigated the effects of walking plus CBT compared to educational sessions and control plus CBT. They found it favorable to walking plus CBT to reduce anxiety and depressive symptoms [13]. Both studies with similar training prescriptions.
Contemporary management of unipolar depression in the perinatal period
Published in Expert Review of Neurotherapeutics, 2021
Bhuvaneshwari Sethuraman, Susan Thomas, Krishnamachari Srinivasan
Most protocols recommend the use of sertraline and citalopram as the first line of treatment for antenatal depression [3,10,84]. Paroxetine is to be avoided during pregnancy as its use during pregnancy is associated with an increased risk of cardiac malformations in the newborn [112]. Similarly, it is better to avoid clomipramine during pregnancy as in some studies it has been associated with an increased risk of congenital malformations such as cleft palate, open eyelids, ear defects and neck defects [114]. UK Teratology body recommends the use of amitriptyline and imipramine as the first line options for treatment of depression during pregnancy [10]. Benzodiazepines as a class of drugs should be avoided as some studies have noted its use to be associated with an increased risk for floppy infant syndrome, withdrawal signs in the newborn, congenital malformations such as esophageal atresia, microphthalmia and pulmonary valve stenosis [115] and impaired cognitive development in children [116]. There is limited evidence for safe and efficacious use of other antidepressant medications during pregnancy.
Are current pharmacotherapeutic strategies effective in treating OCD?
Published in Expert Opinion on Pharmacotherapy, 2020
Y. C. Janardhan Reddy, Shyam Sundar Arumugham
Clomipramine, an SSRI, was the first drug shown to be effective in treating OCD and remains the gold standard. Subsequently, SSRIs (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram, and escitalopram) were examined for their efficacy in treating OCD. Meta-analyses of randomized, double-blind, and placebo-controlled studies have demonstrated that SSRIs and clomipramine are effective in treating OCD with a mean difference in the Yale–Brown Obsessive Compulsive Severity Scale (YBOCS) scores ranging from 3.49 (1.81–5.12) to 4.72 (2.60–5.85), respectively, as compared to drug placebo [3]. Although earlier meta-analyses claimed superiority of clomipramine over the SSRIs [4,5], a recent network meta-analysis has demonstrated similar effect sizes for SSRIs and clomipramine after adjusting for publication year and other characteristics of the population [3]. Given the similar efficacy and higher adverse effect burden, clomipramine is generally not recommended as a first-line treatment [6]. There is also no evidence to support the superiority of one SSRI over the other [3], although it must be mentioned that head-to-head comparisons are few. The SSRIs and clomipramine are usually administered in higher doses and for a much longer period (about 10–12 weeks) than in depression to achieve an optimum response.