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Immunosuppressants, rheumatic and gastrointestinal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Antidepressant drugs are less effective than stimulant medication. Atomoxetine, a selective norepinephrine reuptake inhibitor, is, on the other hand, a promising drug that is currently under study in Europe and is already licensed in the United States [32].
Exploring the types and manifestation of disorders
Published in Jane Hanley, Mark Williams, Fathers and Perinatal Mental Health, 2019
Management of the condition is to improve the core symptoms of inattention, hyperactivity and impulsive behaviour. A combination of therapies combined with medication is known to affective. The most commonly used medications are stimulants, including selective norepinephrine reuptake inhibitors. These increase the activity of norepinephrine and dopamine in the prefrontal cortex, increase the activity of the extracellular concentrations of norepinephrine and dopamine at the neuronal synapse, increase the release of catecholamines from the presynaptic neurons, block reuptake of catecholamines into the presynaptic neuron, and inhibit monoamine oxidase. They have been shown to enhance behavioural and social functioning in the short term. This leads to positive self-esteem and improved parent child relationships. The available catecholamines, acting as neurotransmitters, stimulate the reticular activating system, limbic system and other areas of the brain that control attention, arousal, and the inhibitory process (Devilbiss & Berridge 2008, Wilens 2008, Sudre et al. 2017).
Attention Deficit-Hyperactivity Disorder
Published in Merlin G. Butler, F. John Meaney, Genetics of Developmental Disabilities, 2019
Mark L. Wolraich, Melissa A. Doffing
Initial medication titration can be accomplished in weekly intervals by phone or office visit. Screening for side effects, and attainment of target goals gives the best measurement of medication effectiveness. Once the best dose is determined (the dose where the child is having maximum success in achieving target goals and having the fewest side effects), monitoring can be stretched to monthly and ultimately quarterly office visits. However, with each monthly refill request, it is helpful to check on adherence, impairment, and side effects. Second-line medications include selective norepinephrine reuptake inhibitors (atomoxetine), antidepressants (imipramine and desipramine), alpha adrenergics (clonidine and guanfacine), and buproprion. Adequate studies to evaluate the use of such medications for ADHD are considerably more limited than the information available on stimulant medications and the potential side effects can be more serious. Atomoxetine is a selective norepinephrine reuptake inhibitor. Phase 3 trials demonstrated promising effects. The side effects include appetite suppression, drowsiness, and nausea. The tricyclic antidepressants (imipramine and desipramine) have strong evidence of efficacy but have more significant side effects with dry mouth and possible cardiac arrhythmias and have a fairly narrow margin of safety. The antihypertensive medications, while appearing to work clinically, have very limited rigorous evidence of efficacy and the evidence is also limited for buproprion.
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).
Cognitive Behavioral Therapy, Ketamine, and Combination Treatment for Depression: Impressions of Credibility in Participants with Self-Reported Depressive Symptoms
Published in Journal of Psychoactive Drugs, 2022
Mitch Earleywine, Brianna R. Altman, Joseph De Leo
Publications on psychological and pharmacological treatments now include at least 500 randomized clinical trials and 70 meta-analyses (Cuijpers 2017). Success rates for both types of treatment leave considerable room for improvement (Earleywine and De Leo 2020). A review of 21 relevant medications reported that the best antidepressant drug was 2.37 times better than placebo (Cipriani et al. 2018). Standard antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors, tricyclic antidepressants and monoamine oxidase inhibitors, frequently take several weeks before onset. These standard antidepressants also create side effects that range from sexual dysfunction (Read and Williams 2018) to increased mortality (Konttinen et al. 2016). Up to 30% of depression cases are “treatment resistant,” requiring more than two medications (Rush et al. 2006). These medications also generate months of severe withdrawal in nearly half of patients (Davies and Read 2019).