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Mood Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Madeleine A. Becker, Tal E. Weinberger, Leigh J. Ocker
Exposure to selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors during (more frequently late >20 weeks) pregnancy has been associated with an increased risk for PPHN compared to women with no exposure [65, 100], According to the studies demonstrating increased risk, this risk remains low but significant [101] at approximately 2.9 cases per 1000 live births compared with 1.8/1000 in unexposed mothers. One possible mechanism is high serotonin levels in the fetal lungs leading to vasoconstriction and increased pulmonary vascular resistance [102]. Sertraline may have a lower risk for PPHN compared to other selective serotonin reuptake inhibitors [103].
Pharmacology
Published in Bhaskar Punukollu, Michael Phelan, Anish Unadkat, MRCPsych Part 1 In a Box, 2019
Bhaskar Punukollu, Michael Phelan, Anish Unadkat
Noradrenaline Reuptake Inhibitor (NRI) – reboxetine selectively inhibits norepinephrine reuptake, with little inhibition of dopamine or serotonin reuptake. It has a low affinity for muscarinic or cholinergic receptors. It has no interaction with alpha or beta adrenergic or histaminic receptors.
Pain and Its Management in Older Adults
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Annie Philip, Diya Goorah, Rajbala Thakur
Antidepressants. This class of medications is considered for treatment of neuropathic pain as well as myofascial pain. Older adults rarely tolerate doses greater than 75–100 mg per day. Tertiary tricyclic antidepressant (amitriptyline, imipramine, and doxepin) should be avoided in older adults owing to anticholinergic and cognitive side effects. On the other hand, secondary tricyclic antidepressants (nortriptyline and desipramine) can be considered in older adults owing to their less anticholinergic and cognitive side effects. Selective serotonin and norepinephrine reuptake inhibitors can also be used. For example, duloxetine has also been approved for musculoskeletal back pain46 and painful osteoarthritis of knee47 in addition to diabetic neuropathic pain and fibromyalgia. The usual starting dose is 20 mg. Venlafaxine at 37.5 mg daily can also be used for the same indications. Analgesic effect is mediated by the blockade of reuptake of serotonin and norepinephrine that results in augmenting the descending inhibition of pain. Adverse effects include cognitive side effects, urinary retention, increased risk of falls, and worsening of anxiety. Venlafaxine is associated with dose-related increase in blood pressure.
The current state-of-the-art in pharmacotherapy for pediatric generalized anxiety disorder
Published in Expert Opinion on Pharmacotherapy, 2023
Peter J. Castagna, Elita Farahdel, Marc N. Potenza, Michael J. Crowley
In our review of the current state-of-the-art in pharmacotherapy for pediatric GAD, we examined evidence obtained from ten RCTs and six open-label trials between the years of 1991 and 2015, inclusive. We found that the most frequently studied pharmacotherapies included selective serotonin reuptake inhibitors (SSRIs). Specifically, most studies investigated fluoxetine (n = 6), fluvoxamine (n = 4) or sertraline (n = 3). The findings suggest efficacy of these agents, as well as for selective norepinephrine reuptake inhibitors (SNRIs) like atomoxetine, venlafaxine, and duloxetine. Limitations include heterogeneous samples, often with mixed anxiety disorders, complicating comparisons across studies. Nonetheless, based on results of these studies, expert opinions may be generated.
Exploring the Credibility of Psilocybin-assisted Therapy and Cognitive-behavioral Therapy for Depression
Published in Journal of Psychoactive Drugs, 2022
Brianna R. Altman, Mitch Earleywine, Joseph De Leo
Current options for combating depression include pharmacological and psychological treatments, as well as their combination (Cuijpers 2017). Typical antidepressants (e.g. selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors) might alleviate symptoms for some (with small effect sizes of ~.30), but research highlights concerns about differentiating real pharmacological relief from placebo effects (Khan and Brown 2015; Kirsch and Sapirstein 1999; Pigott et al. 2010). Further, these medications often induce negative side effects including weight gain, sexual dysfunction, fatigue, and withdrawal symptoms (Bet et al. 2013; Read and Williams 2018). Psychotherapy options, including cognitive-behavioral therapy (CBT), behavioral activation, and acceptance and commitment therapy also offer relief to some affected individuals. Nevertheless, therapy can be expensive, inaccessible, and slow to produce significant symptom change (Cuijpers 2017; Cuijpers et al. 2008). A combination of medication and therapy might exceed the effectiveness of either monotherapy, yet not all patients show improvements (Cuijpers et al. 2014; Cuijpers 2017; Furukawa et al. 2018; Karyotaki et al. 2016). Alternative treatment options are worthy of consideration, especially if they could provide relief to those who have not responded to conventional approaches (Earleywine and De Leo 2020).
Common systemic medications that every optometrist should know
Published in Clinical and Experimental Optometry, 2022
The anticholinergic properties of psychiatric medications commonly cause mydriasis and cycloplegia, resulting in accommodative changes. Tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and norepinephrine reuptake inhibitors (NRIs) have all been shown to cause these side effects. TCAs have been shown to cause blurred vision in up to one third of patients.53 Paresis of the ciliary muscle results in blurred vision at near and may necessitate prescription glasses for near. Optometrists can test for accommodative deficits in patients taking these classes of medications with clinical tests, such as NRA (negative relative accommodation) and PRA (positive relative accommodation), or amplitude of accommodation ‘push-up’ test. Patients who begin topiramate may complain of blurred vision as well. Topiramate has been shown to cause choroidal effusion, inducing acute myopia.54 Optometrists should monitor for refractive changes and avoid making prescription changes until it stabilises.