Trazodone - efficacy and safety in clinical practice

Trazodon należy do grupy antagonistów receptora 5-HT2 i inhibitorów wychwytu zwrotnego serotoniny (SARI). Jest lekiem przeciwdepresyjnym, który stosuje się w szerokim spektrum zaburzeń, począwszy od zaburzeń afektywnych i zaburzeń snu, kończąc na farmakoterapii uzależnień. Lek ten jest obecnie jedynym przedstawicielem tej grupy zarejestrowanym w Polsce. Ze względu na charakterystyczny profil działania trazodon stosuje się zarówno w monoterapii, jak i w połączeniu z innymi preparatami. Celem pracy jest przegląd właściwości farmakologicznych trazodonu ze szczególnym odniesieniem do praktyki klinicznej. Omówiono również działania niepożądane związane ze stosowaniem trazodonu.Trazodone is a SARI (serotonin(2A) antagonists/reuptake inhibitor) antydepressive drug which is commonly used in a wide variety of mental disorders from mood and sleep disorders to the pharmacotherapy of the drugs abuse. At present, trazodone is the only SARI representative registered in Poland. The characteristic profile of trazodone action makes it a suitable pharmaceutical agent in both monotherapy and in combined therapy with other drugs. The aim of this paper is to review the pharmacological properties of trazodone in scope of the contemporary clinical practice with its therapeutical applications, drug tolerance, safety and side-effects

CORTISOL AS AN INDICATOR OF HYPOTHALMIC-PITITUARY-ADRENAL AXIS DYSREGULATION IN PATIENTS WITH PANIC DISORDER: A LITERATURE REVIEW

Dysregulation of hypothalamic–pituitary-adrenal axis (HPA) is seen in numerous mental disorders. Data of HPA axis disturbance in panic disorder are inconsistent. In panic disorder HPA axis hyperactivity has been observed with elevated cortisol levels. However, hypocortisolism has also been noted. Salivary cortisol as a biomarker of HPA-axis activity has received special attention. The aim of this paper is to review the findings on cortisol levels in panic disorder

No relationship between baseline salivary alpha-amylase and State-Trait Anxiety Inventory Score in drug-naïve patients with short-illness-duration first episode major depressive disorder : an exploratory study

Salivary ?-amylase (sAA) activity alternations are observed in major depressive disorder (MDD) being associated with depression severity and its specific psychopathological dimensions with anxiety being attributed to distress. No data is available on sAA in MDD according to Hamilton Rating Scale for Depression (HAMD-17) and State-Trait Anxiety Inventory (STAI). The exploratory study examines whether and to what extent baseline sAA level is interrelated to the psychopathological features including severity of symptoms and specific psychopathological dimensions. The basal, non-stimulated sAA activity was studied in 20 non-late-life adult, treatment-naïve MDD patients with short-illness-duration and in 20 age- and sex-matched healthy controls along with psychometric assessments with Hamilton Rating Scale for Depression (HAMD-17) and Spielberger State-Trait Anxiety Inventory (STAI). Significantly lower (p=0.011) sAA activity was observed in MDD as compared to controls. No significant correlations were observed between sAA activity and the total HAMD-17 score as well as with regard to the specific core depression, insomnia, anxiety and somatic HAM-D psychopathological dimensions. No significant correlations were also found between sAA and STAIX-1 and STAIX-2 scores. Low baseline sAA levels in MDD with no correlations between sAA and psychopathological features including severity of symptoms and specific psychopathological dimensions was found

IMPULSIVITY IN ANXIETY DISORDERS. A CRITICAL REVIEW

Background: Anxiety symptoms and disorders are common. High comorbidity between anxiety and other psychiatric disorders has been observed in community. Still, the relationship between impulsivity and anxiety disorders is controversial and not well explored. Material and methods: The aim of this paper is to review measures of trait impulsivity in anxiety disorders. A literature review of the theoretical bases of the relationship between anxiety disorders and impulsivity is presented. Results: Impulsivity is a key feature of numerous psychiatric disorders. Traditional conceptualizations suggest that impulsivity might display a negative relationship with anxiety. However, an association of impulsivity in patients with anxiety disorders is present. Some studies support proposition that anxiety may influence impulsivity in individuals with predisposition toward behavioural disinhibition. Conclusion: There is a link between anxiety and impulsivity in psychiatric patients characterized by problems with impulse control (e.g. pathological gambling, self-harming behaviour, eating disorders), mood disorders and anxiety disorders. Behavioural and pharmacological interventions for decreasing impulsivity may effectively be used in the treatment

Morning and afternoon serum cortisol level in patients with post-myocardial infarction depression

Background: Post-myocardial depression is a highly prevalent condition which worsens the course and prognosis of coronary artery disease. One possible pathogenetic factor is dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in cortisol profile disturbances. Methods: Thirty seven patients hospitalized due to a first myocardial infarction (MI) were enrolled in this study. The Beck Depression Inventory (BDI) was used to rate the severity of their depressive symptoms. Morning and afternoon serum cortisol samples were taken on the fifth day of the MI. Results: Depression, defined as BDI ≥ 10, was present in 34.4% of the patients. A statistically significant difference was observed between the mean morning and the evening plasma concentrations in patients with depression compared to the no-depression group: F (1.29) = 5.0405, p = 0.0328. Conclusions: Patients with depressive symptoms directly after MI have a flattened diurnal serum cortisol profile. This is particularly expressed in patients with longer lasting symptoms

IMPULSIVITY AND PANIC DISORDER: AN EXPLORATORY STUDY OF PSYCHOMETRIC CORRELATES

Background: Impulsivity is associated with a wide variety of psychiatric disorders. However, the relationship between anxiety and impulsivity is not well explored. The objective of this study was to examine whether anxiety symptoms correlate with impulsivity in patients with panic disorder. Subjects and methods: We examined 21 psychotropic drug-naïve patients with panic disorder recruited from the outpatient setting. The severity of Panic Disorder was assessed with Panic and Agoraphobia Scale (PAS)-clinical rating version. Impulsivity was evaluated with Barratt Impulsiveness Scale, 11th version (BIS-11). Results: Our findings indicate the correlation between specific dimensions of impulsivity and selected subscales of Panic and Agoraphobia Scale. The positive correlation between attentional and non-planning dimensions of impulsivity, ‘disability’ and ‘worries about health’ in drug-naïve patients with PD was observed. Conclusions: The findings corroborate with the prior reports of higher impulsivity trait among patients with anxiety disorders

Depression with atypical symptoms

Depresja atypowa jako osobna kategoria diagnostyczna nie znajduje obecnie powszechnej akceptacji. W klasyfikacji ICD-10 pojęcie takie nie istnieje. Klasyfikacja DSM-IV używa określenia depresji z cechami atypowymi, które definiuje dużą depresję czy dystymię pod względem obrazu klinicznego. Nawiązuje ono bezpośrednio do definicji depresji atypowej, stworzonej przez grupę z Uniwersytetu Columbia. Pod względem obrazu klinicznego, a także cech biologicznych różni się ona od melancholii. Rozpowszechnienie depresji z cechami atypowymi ocenia się na około 4%, wśród osób z dużą depresją na 16–25%. Depresja z cechami atypowymi często występuje w sezonowej chorobie afektywnej, dwubiegunowym zaburzeniu afektywnym, zwłaszcza typu 2. Obecność cech atypowych stanowi wskazanie do stosowania leków o działaniu serotoninergicznym: selektywnych inhibitorów zwrotnego wychwytu serotoniny (SSRI) czy inhibitorów monoaminooksydazy (IMAO).Atypical depression as a separate diagnostic category is not commonly accepted. It does not exist in ICD-10 classification. DSM-IV uses the atypical features specifier to describe particular clinical picture of major depression or dysthymia. Its definition is based on early conception of so-called atypical depression made by the Columbia University group. Depression with atypical features differs from melancholia as regards clinical picture as well as biological characteristic. Prevalence of depression with atypical features is estimated at 4%, among major depression at 16-25%. Atypical features occur frequently in seasonal and bipolar II depression. Presence of atypical features specifier is an indicator for treatment with serotoninergic antidepressants: monoamine oxidase inhibitors (MAOI) or selective serotonin reuptake inhibitors (SSRI)

RAPID-ONSET AGRANULOCYTOSIS IN A PATIENT TREATED WITH CLOZAPINE AND LAMOTRIGINE

Background: Clozapine is the treatment of choice in drug-resistant schizophrenia. Lamotrigine is a mood stabiliser recommended as combined treatment strategy in clozapine-resistant patients. There are cases of late-onset agranulocytosis reported in literature. Some are associated with clozapine or lamotrigine, others with the combination of both. Case report: The article presents a case of rapid-onset agranulocytosis in a 60-year old clozapine-resistant patient, in whom lamotrigine was introduced as potentiation strategy. Discontinuation of both substances and GCSF treatment resulted in normalization of the absolute neutrophil count. Conclusions: The case suggests a possibility of developing rapid-onset agranulocytosis in clozapine-resistant patients who require lamotrigine as augmentation strategy. This emphasises the significance of monitoring a patient\u27s blood count and early management of any dyscrasias noticed

Trazodone in common clinical practice

Trazodon należy do grupy antagonistów receptora 5-HT2 i inhibitorów wychwytu zwrotnego serotoniny. Jest lekiem przeciwdepresyjnym, który stosuje się w szerokim spektrum zaburzeń, począwszy od zaburzeń afektywnych i zaburzeń snu, kończąc na farmakoterapii uzależnień. Celem pracy był przegląd zastosowań terapeutycznych trazodonu, ze szczególnym odniesieniem do praktyki klinicznej farmakoterapii depresji, gdzie w związku z charakterystycznym profilem farmakodynamicznym lek ten stosuje się zarówno w monoterapii, jak i w połączeniu z innymi preparatami. Omówiono również zastosowanie leku w zaburzeniach lękowych oraz w zaburzeniach snu, które należą do klasycznych zastosowań terapeutycznych trazodonu, a także wskazano na możliwe zastosowanie leku w wybranych postaciach zaburzeń zachowania w przebiegu otępienia oraz w leczeniu używania szkodliwego/uzależnienia od substancji psychoaktywnych. Psychiatria 2011; 8, 1: 1–6Trazodone is a SARI (serotonin[2A] antagonists/reuptake inhibitor) antidepressant which is commonly used in a wide variety of mental disorders from mood and sleep disorders up to the pharmacotherapy of the drug abuse/ /dependence. The aim of this paper is to review the scope of clinical applications of trazodone with specific focus on depression where both, monotherapy and combined treatment with other drugs are well founded in the general clinical practice. Trazodone use in pharmacotherapy of anxiety and sleep disorders is also addressed along with its use in behavioural symptoms of dementia and substance use/abuse. Psychiatry 2011; 8, 1: 1–