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Psychiatry
Published in Seema Khan, Get Through, 2020
Donepezil is a reversible acetylcholinesterase inhibitor that acts on the CNS. Its main use is in Alzheimer’s disease. Dothiepin (also known as dosulepin) is a TCA; this class of antidepressant has the highest risk of seizures. SSRIs (first-line treatment for depression) and venlafaxine (second-line treatment) are the agents of choice in epilepsy. MAOIs, although safe, are limited by their side-effect profile.
D
Published in Caroline Ashley, Aileen Dunleavy, John Cunningham, The Renal Drug Handbook, 2018
Caroline Ashley, Aileen Dunleavy, John Cunningham
Dosulepin is excreted in the urine, mainly in the form of its metabolites; small amounts are also excreted in the faeces. Elimination half-lives of about 14–24 and 23–46 hours have been reported for dosulepin and its metabolites, respectively.
Fatigue
Published in Wesley C. Finegan, Angela McGurk, Wilma O’Donnell, Jan Pederson, Elizabeth Rogerson, Care of the Cancer Patient, 2018
Wesley C. Finegan, Angela McGurk, Wilma O’Donnell, Jan Pederson, Elizabeth Rogerson
Is the patient depressed? This could either be causing, or could be caused by, the fatigue. Depression may present as chronic fatigue in the absence of any history of sleeplessness. Treat any underlying depression with an antidepressant such as amitriptyline, dosulepin or lofepramine. Depression may present with anxiety that prevents the patient from getting to sleep, or as early-morning wakening. Sleep improvement should be seen after a few days, but an antidepressant effect may take 2 to 6 weeks.
Is neurotrophin-3 (NT-3): a potential therapeutic target for depression and anxiety?
Published in Expert Opinion on Therapeutic Targets, 2020
A. S. de Miranda, J. L. V. M. de Barros, Antonio Lucio Teixeira
Antidepressants influence CNS and peripheral expression of NT-3. Intraperitoneal administration of the antidepressant desipramine (5 mg/kg), a selective blocker of neuronal noradrenaline reuptake, for 8 weeks, significantly decreased mRNA expression of NT-3 in the LC of rats. Conversely, the administration of fluoxetine and trazodone did not influence the expression of NT-3 in this specific region. None of the antidepressants altered the expression of TrkC in the LC or hippocampus [107]. Similar findings were reported in a clinical study that investigated NT-3 levels in the cerebrospinal fluid (CSF) of patients with major depression. Lower levels of NT-3 were found in the CSF of patients treated with antidepressants that affect central noradrenergic neurotransmission, such as tricyclics and monoamine oxidase inhibitors (MAOIs), compared with those treated with SSRIs or not taking antidepressants [108]. In contrast, a recent prospective study with young adults with mild and moderate major depression showed that a 6-week treatment with the SSRI sertraline increased the serum levels of NT-3. No significant changes in the serum levels of NT-3 were found in patients presenting mild to moderate depression treated with the tricyclic dosulepin or in patients with severe depression treated with the SNRI venlafaxine [90]. Altogether, these studies revealed that NT-3 specific effects in response to antidepressants might be dependent on several factors, including the type of antidepressant, age, and severity of the underlying condition.
Deaths by poisoning in New Zealand, 2008–2013
Published in Clinical Toxicology, 2019
John S. Fountain, David M. Reith, Andrew M. Tomlin, Alesha J. Smith, Murray W. Tilyard
The most common substances primarily contributing to death identified in this study differ from those identified from 2001 New Zealand coronial data [12]. While carbon monoxide, ethanol, morphine, and methadone were the most implicated agents in both studies, dosulepin, diazepam, paracetamol, and dextropropoxyphene were no longer significant based on this current study’s findings and had been replaced by codeine, butane, clozapine, and helium. Zopiclone was found in both studies. These changes may reflect successful interventions that include the removal of the opioid drug dextropropoxyphene from the New Zealand market, in August 2010, due to toxicity and lack of efficacy [10,23] and raised awareness of excess deaths related to the antidepressant dosulepin [11].