Modafinil As An Alternative to Methylphenidate As Augmentation for Depression Treatment (original) (raw)

Cardiac Surgery in a Patient Taking Monoamine Oxidase Inhibitors

Anesthesia & Analgesia, 1994

M onoamine oxidase inhibitors (MAOIs), are used to treat endogenous psychotic depression. The MAOIs do not inhibit catecholamine synthesis; rather they block the oxidative deamination of endogenous catecholamines into inactive vanillylmandilic acid. This block of MA0 produces an accumulation of endogenous catecholamines in adrenergically active tissues, such as the brain, which is thought to be responsible for alleviation of depression. Major concerns with the clinical use of MAOIs are related to 1) the risk of dietary intake of tyramine, an indirect sympathomimetic, which can trigger a release of accumulated catecholamines, 2) drug interactions, specifically with opioids, which have been reputed to cause a syndrome of hyperpyrexia, hypertension, tachycardia, and coma (1 1, and 3) hepatotoxicity, which does not seem to be related to dose or duration of treatment. When patients on MAOIs require urgent surgery or the relief of severe pain, there is concern about these potentially fatal drug interactions. Despite such potential interactions and risks, adverse outcomes are rarely reported in clinical practice. However, there are 12 case reports in the world literature implicating the combination of meperidine and MAOIs as potentially fatal, this being related to an inhibition of 5-hydroxytryptamine (5-HT) uptake by both the opioid and MA01 in the brain leading to increased levels of 5-HT at the synaptic cleft and consequent adverse reactions including hyperpyrexia, hypertension, hypotension, tachycardia, or convulsions (2-12). There has been only one case described of an adverse morphine/MAOI interaction (13). This involved a patient who became hypotensive and unconscious after receiving morphine (6 mg intravenously [IV]), but the etiology was uncertain. Five cases have been reported of fentanyl being administered to patients on chronic MA01 therapy (14-16); four of these cases did not have an adverse outcome

Combined use of sedatives and antidepressant mandates rational approach

2023

Abstract The incidence and prevalence of anxiety and depression is increasing with time and more number of patients are reporting for consultation for the same. Still a large group of patients due to inhibition and social stigma associated with anxiety and depressive illness, either do not report or get delayed consultation when severity of symptoms has increased, then they seek consultation from the specialist. One more important aspect is that many patients of anxiety and depression report with functional complaints pertaining to various systems of body like headache, pain abdomen, Irritable bowel syndrome, anorexia, breathlessness and chest pain etc. but when you in depth analyze and on regularly following these patients, it is concluded that these are not organic complaints but functional. In many specialties and superspecialties, even this group reaches to 30% of total patients seen being thought to be having problem related to that speciality or super-speciality. Many of above patients of Anxiety and Depression has prominent problem of insomnia for which sedatives are added but in view of their interaction with antidepressant and antiaxiety drugs, there can occur serious side effects, which can even be life threatening. Hence, a rationale use and awareness of all these interactions is must for treating physicians

Acute fluoxetine overdose: A report of 234 cases

The American Journal of Emergency Medicine, 1992

Limited toxicity information is available in the medical literature on the antidepressant fluoxetine (Proxac, Dista Products Co, Indianapolis, IN). The goal of this prospective multicenter study was to develop a toxicity profile of initial signs and symptoms observed in an acute fluoxetine overdose. A prospecfive study was made of patients reported to one of four American Association of Poison Control Centers' regional poison control centers after ingesting an acute overdose of fluoxetine. A standard data collection form was used on all patients ingesting fluoxetine. Information obtained included age, current medications, dose, coingested drugs, presenting symptoms, vital signs, electrocardiogram abnormalities, outcome, and fluoxeline levels. The authors collected 272 cases; 234 cases met the criteria of the study. Fluoxetine was ingested alone in 87 cases and with ethanol or other drugs in the remaining 147 cases. Of the 87 cases where fluoxetine was ingested alone, 67 patients were adults and 20 were children. Symptoms that were seen in the adult group included: tachycardia (15/67), drowsiness (14/67), tremor (five/67), vomiting (four/67), or nausea (fouV67). Thirty patients did not develop symptoms. Twelve of the adult overdose patients had total fluoxetine levels ranging fmm 232 lo 1390 ng/mL. The authors conclude that symptoms that develop after an acute overdose of fluoxethre appear minor and of short duration. Aggressive supportive care is the only intenrention necessary. (Am J Emerg Med lgg2;10:115-120. Copyright 0 1992 by W.B. Saunders Company)

Drug treatment of depression in medically ill patients

Journal of Psychosomatic Research - J PSYCHOSOM RES, 1992

Depressive symptoms are common in medically ill patients although depressive disorders arc considerably underdiagnosed and undertreated. Drug treatments for depression are reviewed in terms of a risk/beneht analysis. The main benefit is approximately to double the chance of recovery (from about 30 to 65%), with possible associated improvements in physical condition. The risks of treatment are considerable and include overdose. unwanted effects at therapeutic dose and interaction with other drugs. Among the risks associated with specific medical conditions are orthostatic hypotension, cardiotoxicity, deterioration of seizure control in epileptic patients and increased side effects in patients with renal and hepatic impairment. The available data suggest that there is relatively little to choose between antidepressants in terms of efficacy (although the quantity and quality of these data vary). It is therefore primarily the risks which should determine the choice of antidepressant, and these must be separately evaluated for each patient.

Psychopharmacologic treatment of depression in the medically ill

Psychosomatics, 1998

Appropriate selection of an antidepressant agent in medically ill patients requires a careful risk-benefit assessment matching the pharmacokinetic and pharmacodynamic properties of the drug being considered against the patient's physiological vulnerabilities, potential for drug interactions, and primary symptoms of the patient's depression. While in the past antidepressant drug selection was limited by the almost sole availability of the tricyclic antidepressants, newer drugs such as selective serotonin reuptake inhibitors, bupropion, and venlafaxine have vastly simplified treating depression in the medically ill. In refractory cases of depression in patients with medical illness, electroconvulsive therapy can be used with appropriate anesthetic management.