Psychiatric Emergencies Associated with Drug Overdose
R. Thara, Lakshmi Vijayakumar in Emergencies in Psychiatry in Low- and Middle-Income Countries, 2017
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).
Treating Depression in Elderly People
José León-Carrión, Margaret J. Giannini in Behavioral Neurology in the Elderly, 2001
Potent antidepressants, the tricyclic and tetracyclic antidepressants, for many years were virtually the only pharmacological option, and therefore there has been a great deal of experience with their use. The side effects of the tricyclic drugs (Table 17.1) and numerous pharmacological interactions limit their use in elderly people. Currently, these drugs are reserved for treatment of major depressions with melancholy and for patients who do not respond to other antidepressants.
Chronic pain and depression
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in 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.
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.
Optimization of mirtazapine loaded into mesoporous silica nanostructures via Box-Behnken design: in-vitro characterization and in-vivo assessment
Published in Drug Delivery, 2022
Abeer A. Musallam, M. A. Mahdy, Hanan M. Elnahas, Reem A. Aldeeb
Depression is a prevalent and dangerous health condition that interrupts an individual's ability to feel, think and behave normally. People suffering from depression seem to have a lousy mindset with a deep feeling of melancholy, anxiety, suicidal tendencies, interrupted sleep, and perhaps a diminished interest in formerly pleasurable activities for most of the day. It can also result in a vast number of mental and physical issues, as well as an impaired performance at work and home (Ph.D. Nemeroff et al., 2022). Regrettably, nearly 280 million individuals suffer from depression on a global scale. Depression, at its worst, can result in suicide. Regarding the degree and sequence of depressive episodes in a time, medical care providers may recommend psychotherapy in addition to various drugs, such as selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and tetracyclic antidepressants (Rouini et al., 2014; WHO, 2021). Mirtazapine (MRT) is an unconventional antidepressant authorized to treat moderate to severe depression patients, usually accompanied by anxiety disorders. It is a tetracyclic antidepressant that works on noradrenergic and specific serotonergic receptors (NaSSA). It is the only tetracyclic antidepressant licensed for the treatment of depression by the food and drug administration (FDA) (Rouini et al., 2014). Mirtazapine shows poor water solubility, with a partition coefficient of 2.9 (K. M. Ezealisiji et al., 2017). Additionally, it has a low bioavailability of about 50%. It was estimated that increasing its water solubility might result in increased bioavailability and reduce the dose required to achieve the desired therapeutic effect (K. E. Ezealisiji et al., 2015).
Related Knowledge Centers
- Amine
- Antidepressant
- Chemical Structure
- Cyclic Compound
- Mirtazapine
- Tricyclic Antidepressant
- Tetracyclic
- Maprotiline
- Mianserin
- Setiptiline