Sudden valproate-induced hyperammonemia managed with L-carnitine in a medically healthy bipolar patient: Essential review of the literature and case report

Valproic Acid is a commonly used psychiatric drug primarily used as a mood stabilizer. Mild hyperammonemia is a Valproic Acid common adverse effect. This report presents an example of treated hyperammonemia on Valproic acid therapy managed with L-carnitine administration in BD patients characterized by sudden vulnerability

Antidepressant discontinuation syndrome: A state-of-the-art clinical review

Antidepressant drugs are prescribed to patients with depressive, anxiety disorders, and other conditions. Evidence about antidepressant discontinuation syndrome (ADS) and related outcomes is sparse, although potentially burdensome in some patients. The present state-of-the-art review aims to appraise the most current evidence about ADS critically. ADS has been documented for most antidepressant drugs, although most literature focuses on selective serotonin reuptake inhibitors prescribed for depression. While down-titration cannot exclude the chance of ADS, it is nonetheless warranted in the clinical setting, especially for short half-life and sedative compounds such as paroxetine. Integrative management with concurrent pharmacotherapy and psychotherapy may minimize the eventual unpleasant effects arising within the discontinuation process. In addition, patient-tailored interventions and education should be part of the discontinuation strategy. Future research must rely on broadly accepted definitions for ADS and related phenomena such as antidepressant withdrawal and shed further light on the underpinning neurobiology. Discriminating between ADS-related phenomena and relapse of depression is likewise warranted, along with a neuroscience-based nomenclature instead of a class one

Adjunctive agomelatine therapy in the treatment of acute bipolar II depression: a preliminary open label study

The circadian rhythm hypothesis of bipolar disorder (BD) suggests a role for melatonin in regulating mood, thus extending the interest toward the melatonergic antidepressant agomelatine as well as type I (acute) or II cases of bipolar depression

Mood Disorders and Inflammatory Markers: Pathophysiology and Implications for Treatment

INTRODUCTION: Mood disorders are chronic disorders, responsible for disability worldwide. In recent years a growing body of literature has proposed a psycho-neuro-immunological hypothesis, according to which inflammation may play a role in the development and response to treatment of such diseases. Both Major Depressive Disorder and Bipolar Disorder have been associated with peculiar patterns of cytokine alterations and, on the other hand, some psychotropic drugs showed the ability to affect cytokines production, making an immunomodulatory action of these drugs plausible. METHODS: Our research also included a comparison of Neurokinin-1Receptor (NK-1R) expression and Substance P (SP) ability to induce NF-\u3baB activation in monocytes from BD patients and healthy donors (HD). A further study was conducted on human monocytes, which were used as such or differentiated into M1 and M2 macrophages. Cells were treated with vortioxetine before or after differentiation, and their responsiveness, in terms of included oxy-radical and TNF\u3b1 production, TNF\u3b1 and PPAR\u3b3 gene expression, and NF-\u3baB translocation was evaluated. RESULTS: An increase in pro-inflammatory cytokines such as IL-4, TNF-\u3b1, soluble interleukin-2receptor (sIL2-R), IL-1\u3b2, IL-6, soluble receptor of TNF-alpha type1 (STNFR1) and C-reactive protein (CRP) is reported in BD patients, during all phases of the disease. IL\u20101\u3b2, IL\u20106, and TNF\u2010\u3b1 serum levels are elevated and an increased microglial activation can be observed in some brain regions in MDD patients. NK-1R expression showed relevant alterations in BD patients and SP involvement appeared plausible. Vortioxetine showed anti-inflammatory effect. CONCLUSIONS: Neuro-immunomodulation must be taken into consideration when dealing with the pathophysiology of psychiatric disorders and in the choice of antidepressants; the effect of medications affecting the serotoninergic pathway on the innate immune system should be further investigated, also in a disease-specific context

“Gestione manifestazioni psicotiche associate a disturbi bipolari - focus su gli antipsicotici atipici”, Società Italiana di Neuropsicofarmacologia (SINPF), Torino 3-6 giugno 2014. Co-relatori: Marco Vaggi, Carlo Ignazio Cattaneo, Raffaella Ada Colombo.

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The shocking attitude towards ECT in Italy

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Immigrants\u2019 Pathways to Outpatient Mental Health: Are there Differences with the Native Population?

A poor use of mental health services has been described in immigrants. We compared the sociodemographic, clinical and treatment features of immigrants and natives attending a Community Mental Health Centre (CMHC). 191 immigrants and 191 randomly selected natives applying to the Borgomanero CMHC between 1 January 2003 and 31 August 2013 were compared. Our sample consisted mainly of the so-called “economic” immigrant. Adjustment disorders and reaction to stress were the most frequent diagnoses; in most cases symptoms onset occurred after migration. Although treatment features overlapped in the two groups (duration, number of contacts), immigrants showed a higher frequency of treatment dropout. While it is necessary to improve access to mental health services for immigrants, for the “economic” immigrant it may be more important to focus on establishing a therapeutic relationship that can be experienced as reliable and trustworthy. The finding of similar pathways to access the CMHC in natives and immigrants is encouraging

Efficacy and safety of selegiline across different psychiatric disorders: A systematic review and meta-analysis of oral and transdermal formulations

Selegiline is an irreversible, selective type-B monoamine oxidase inhibitor (MAOI) approved for Parkison's disease—oral and major depressive disorder—transdermal formulation) resulting in non-selective MAOI activity at oral doses≥20 mg/day. The present systematic review and meta-analysis appraises the evidence of different formulations/dosages of selegiline across different psychiatric conditions. We inquired PubMed/MEDLINE/Cochrane-Central/WHO-ICTRP/Clarivate-WebOfScience and the Chinese-Electronic-Journal Database from inception to 10/26/2022 for selegiline trials involving psychiatric patients. Random-effects meta-analyses assessed heterogeneity, publication/risk biases, and confidence in the evidence, followed by sensitivity, subgroup, and meta-regression analyses. Co-primary outcomes were: changes in symptom score (standardized mean difference=SMD) and author-defined response (risk ratios=RRs). RRs of adverse events and all-cause discontinuation were secondary and acceptability outcomes, respectively. Systematic-review included 42 studies; meta-analysis, 23. Selegiline outperformed placebo in depressive symptom reduction (SMD=-0.96, 95%C.I.=-1.78, -0.14, k = 10, n = 1,308), depression (RR=1.61, 95%C.I.=1.20, 2.15, k = 9, n = 1,238) and atypical-depression response (RR=2.23, 95%C.I.=1.35, 3.68, k = 3, n = 136). Selegiline failed to outperform the placebo in negative (k = 4) or positive symptoms of schizophrenia (k = 4), attention-deficit-hyperactivity disorder (ADHD) symptoms reduction (k = 2), and smoking abstinence rate (k = 4). Selegiline did not differ from methylphenidate and ADHD scores (k = 2). No significant difference emerged in acceptability, incident diarrhea, headache, dizziness, and nausea RRs, in contrast to xerostomia (RR=1.58, 95%C.I. =1.03, 2.43, k = 6, n = 1,134), insomnia (RR=1.61, 95%C.I.=1.19, 2.17, k = 10, n = 1,768), and application-site reaction for transdermal formulation (RR=1.81, 95%C.I.=1.40, 2.33, k = 6, n = 1,662). Confidence in findings was low/very-low for most outcomes; moderate for depressive symptoms reduction (transdermal). Selegiline proved effective, safe, and well-tolerated for depressive disorders, yet further evidence is warranted about specific psychiatric disorders