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Psychotropic Use during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Maprotiline is a tetracyclic antidepressant. The frequency of congenital anomalies was not increased among 107 pregnancies exposed to maprotiline during the first trimester (McElhatton et al., 1996; see Table 10.3). The frequency of birth defects was not increased among experimental animals (Esaki et al., 1976; Hirooka et al., 1978).
Psychiatric Emergencies Associated with Drug Overdose
Published in R. Thara, Lakshmi Vijayakumar, Emergencies in Psychiatry in Low- and Middle-Income Countries, 2017
S. Haque Nizamie, Sai Krishna Tikka, Nishant Goyal
Apart from anabolic steroids, an overdose of steroids used in clinical medical settings is also known to cause psychiatric manifestations. The reported incidence of steroid psychosis is 3%–57% (Ling, Perry and Tsuang 1981; Lewis and Smith 1983). The risk factors for steroid psychosis are female sex, doses of above 40 mg/day in the case of prednisolone, and long-term administration (Ling, Perry and Tsuang 1981; Hall et al. 1979). Steroid psychosis occurs within the first two weeks of corticosteroid therapy and is dose-related (Brown, Khan and Nejtek 1999). The psychiatric manifestations are often both affective, in the form of over-talkativeness, distractibility, or low mood, and non-affective, in the form of hallucinations or core delusions. It is, however, depression that is the most prevalent among these patients, its incidence being as high as about 40% (Ling, Perry and Tsuang 1981; Hall et al. 1979). The treatment involves a reduction in the dose or discontinuation of steroids. The use of psychotropic agents becomes essential in such a setting because a reduction in the dose or discontinuation of the steroid results in worsening of the underlying disease requiring steroid therapy. Antipsychotics are the mainstay of treatment, while lithium has been used to treat mood symptoms, both manic as well as depressive (Siegal 1978). Tricyclic and tetracyclic antidepressants should be used cautiously as they have been reported to induce the exacerbation of agitation (Hall, Popkin and Kirkpatrick 1978).
Chronic pain and depression
Published in Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen, Clinical Pain Management, 2008
Tricyclic antidepressants have a central three-ring structure with a single side chain. Tertiary amine tricyclics, including amitriptyline and imipramine, have two methyl groups at the end of the side chain while secondary amines, such as desipramine and nortriptyline, have one methyl group. Tetracyclic antidepressants, such as maprotiline and mianserin, are a related group of drugs that are not as widely used as the tricyclic compounds.
Anxiety disorders and CRP in a population cohort study with 54,326 participants: The LifeLines study
Published in The World Journal of Biological Psychiatry, 2018
Petrus J. W. Naudé, Annelieke M. Roest, Dan J. Stein, Peter de Jonge, Bennard Doornbos
For the assessment of current medication use participants were asked to bring the medication containers to interview. During the interview the research assistant noted the name and dose of the prescribed medication in a database where it was classified according to the World Health Organization Anatomical Therapeutic Chemical classification (ATC). For the analysis in this study, anti-inflammatory medication included amino salicylic acid and similar agents (A07EC), anti-allergic agents (A07EB), systemically applied corticosteroids (H02A), anti-inflammatory and anti-rheumatic products (M01), other analgesics and antipyretics (N02B) and statins (C10AA, C10B) as covariates. As different classes of antidepressants are found to influence immune function, medication included selective serotonin reuptake inhibitors (SSRIs) (N06AB), serotonin-norepinephrine reuptake inhibitors (SNRI) (N06AX16, N06AX21), tricyclic antidepressants (TCAs) (N06AA) and tetracyclic antidepressants (TeCA) (N06AX03, N06AX05, and N06AX11). Other anti-depressant medications were also included (N06AX12, N06AX18 and N06AX22).
Therapy for pruritus in the elderly: a review of treatment developments
Published in Expert Opinion on Pharmacotherapy, 2018
Manuel P. Pereira, Sonja Ständer
Antidepressants should be used with caution in elderly patients due to reported severe side effects, mainly those of a cardiac nature. Serotonin reuptake inhibitors (e.g. paroxetine, fluvoxamine) are the most widely used antidepressants for the treatment of CP. Possible indications include somatoform, paraneoplastic, and aquagenic pruritus arising from hematoproliferative conditions [29–31]. For the treatment of cholestatic pruritus, sertraline has proven to be both effective and well tolerated, as reported in a randomized controlled trial. It is thus recommended for this indication [32]. Tetracyclic antidepressants, namely mirtazapine, in a lower dose (15–30 mg/d) showed a beneficial effect on patients with impaired sleep quality due to the CP [33]. Tricyclic agents (amitriptilyline, doxepin) have also shown an antipruritic effect on CP of various origins in case reports and in a randomized controlled trial enrolling dialysis patients [34,35]. The treatment with these agents should be thoroughly considered in elderly patients due to the frequent occurrence of side effects [36].
Changes in healthcare resource use and costs associated with early versus delayed initiation of atypical antipsychotic adjunctive treatment in major depressive disorder
Published in Journal of Medical Economics, 2018
Arpamas Seetasith, Mallik Greene, Ann Hartry, Chakkarin Burudpakdee
Antidepressants are the mainstay of treatment for MDD. The American Psychiatric Association recommends the use of antidepressant medication as an initial treatment of choice for patients with all level of MDD severity (mild, moderate, and severe)6. Different classes of antidepressants are available, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic or tetracyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and atypical antidepressants. Despite promising results of new-generation antidepressants7, findings from a large clinical trial, STAR*D, show that only one-third of patients experience remission with initial monotherapy antidepressant treatment8–10.