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Psychotropic Use during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Monoamine oxidase inhibitors (MAOIs) are another medication class to treat depression. No epidemiological studies are published that analyzed the safety of MAO agents during pregnancy. Only 21 pregnancies with first trimester exposure to the monoamine oxidase inhibitors are published, with an apparent increase in birth defects (Heinonen et al., 1977). It is impossible to make clinically useful recommendations because the sample size is too small.
Pharmacology of Opioids
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
It has been suggested that if patients are taking selective serotonin or serotonin-norepinephrine inhibitors, or tricyclic antidepressants, there is no restriction to the use of most opioids, although there is a need to be aware of the rare potential risk when prescribing fentanyl, oxycodone, methadone, and tapentadol: pethidine and tramadol may be contraindicated in some patients (Baldo & Rose, 2020). In patients taking monoamine oxidase inhibitors, the potential for significant interactions with all other medications should be checked prior to use. Mild cases of serotonin toxicity will usually resolve once the drug is ceased, but more severe cases can be life-threatening and require urgent treatment.
Dermal and Transdermal Drug Delivery Systems
Published in Tapash K. Ghosh, Dermal Drug Delivery, 2020
Kenneth A. Walters, Majella E. Lane
Bodkin and Amsterdam (2002) randomly assigned 177 adult outpatients with major depressive disorder to receive transdermal selegiline (20 mg patch applied once daily) or placebo for six weeks. Diet was restricted to reduce the level of intake of tyramine. Greater improvement was observed after six weeks in patients treated with transdermal selegiline than in those given placebo. There were no differences in adverse events for the patients given selegiline and those given placebo, although application site reactions were more common with the selegiline transdermal system. Importantly, the side effects commonly seen with traditional monoamine oxidase inhibitor antidepressants were not observed. This was followed by a double-blind study that included younger patients with no dietary restrictions (Amsterdam, 2003). In this study, 289 patients (18 to 65 years old) were randomly assigned to receive either a 20 mg patch daily or placebo for up to eight weeks. The results demonstrated that transdermal selegiline had a statistically significant but modest antidepressant effect compared with placebo in the absence of a tyramine-restricted diet. Once again side effects were similar for treatment and placebo groups, with the exception of application site reaction, which was observed in 31.5% of treatment patients and 15.1% of placebo-treated patients.
Anti-depressant effects of ethanol extract from Cannabis sativa (hemp) seed in chlorpromazine-induced Drosophila melanogaster depression model
Published in Pharmaceutical Biology, 2021
Yejin Ahn, Sung Hee Han, Min Guk Kim, Ki-Bae Hong, Woo Jung Kim, Hyung Joo Suh, Kyungae Jo
Anti-depressants typically work by blocking the reuptake of certain neurotransmitters (norepinephrine, serotonin, and dopamine) to the post-synaptic neuron. Anti-depressants that are mainly used are monoamine oxidase inhibitors which improve the function of monoamine transporters, and tricyclics that increase the levels of norepinephrine and serotonin (Thanacoody 2020). Recently, selective serotonin reuptake inhibitors, such as fluoxetine (Prozac), which selectively act on the serotonin system, are being used (Kumar and Sharma 2020). However, these medications have shown negative side effects, such as sexual dysfunction, vomiting, diarrhoea, constipation, gastrointestinal disorders, loss of appetite, dry mouth, anxiety, and insomnia (Ries et al. 2017). Therefore, many people are seeking naturally derived anti-depressants.
Integrating psychotherapy and psychopharmacology: psychedelic-assisted psychotherapy and other combined treatments
Published in Expert Review of Clinical Pharmacology, 2020
Kyle T. Greenway, Nicolas Garel, Lisa Jerome, Allison A. Feduccia
The first drug to be described as an antidepressant was isoniazid, a tuberculosis treatment that was serendipitously observed in the 1950s to improve various symptoms associated with depression [30]. Further clinical and pharmacological research led to the discoveries of a number of similar molecules, now classed as monoamine oxidase inhibitors [30], as well as the formulation of the ‘monoamine hypothesis’ which postulates that depression is a result of the depletion of serotonin, norepinephrine, and/or dopamine [31]. The discovery and study of psychedelics played a key role in this line of investigation [32,33], as discussed below, as well as the resultant overall shift toward a biomedical model of psychiatry. The monoamine hypothesis was fruitful, yielding a number of new classes of antidepressants that act primarily on monoamines, including the tricyclics, the selective serotonin reuptake inhibitors (SSRIs), the serotonin-norepinephrine reuptake inhibitors (SNRIs), and a variety of other molecules [30,34]. The SSRIs and SNRIs are currently the most commonly prescribed antidepressants by a significant margin, mostly because of their superior safety and tolerability [34,35].
Drug-induced arterial hypertension – a frequently ignored cause of secondary hypertension: a review
Published in Acta Cardiologica, 2018
Camelia Cristina Diaconu, Giorgiana Nicoleta Dediu, Mihaela Adela Iancu
Monoamine oxidase inhibitors may severely elevate the blood pressure in patients who eat foods containing tyramine [20]. Tricyclic antidepressants may also modestly increase the blood pressure, as well as venlafaxine or fluoxetine, through increasing levels of norepinephrine, but only in a minority of patients [21–24]. A study examined the effect of fluoxetine 20 mg daily for up to 12 weeks in 796 depressed patients [21]. 1.7% of the patients receiving fluoxetine had sustained arterial hypertension, much lower than the rates reported for venlafaxine (4.8%) [21,24]. Treatment with venlafaxine is associated with a small, but statistically significant, increase of blood pressure during acute treatment and also with persistent elevations of blood pressure during chronic therapy [24]. This effect is dose-dependent and should not lead to treatment discontinuation if the patient has an indication for it; in these patients, a simple dose reduction of venlafaxine may suffice to decrease the blood pressure values. If the reduced dose of venlafaxine is less effective on depression symptoms, usual dosage may be tried again, with addition of an antihypertensive drug, or a different drug could be used [24].