Pharmacokinetic interactions study between carvedilol and some antidepressants in rat liver microsoms – a comparative study

Background and aims. Cardiovascular diseases and depressive disorders are some of the most frequent diseases. The probability of concomitant prescription of antihypertensive and antidepressive medication is increasing. The aim of this study was to investigate the enzyme inhibition by bupropion, sertraline and fluvoxamine on the metabolism of carvedilol using rat pooled liver microsomes and to assess the importance of these interactions from the pharmacokinetic mechanism point of view. Methods. Two substrate concentrations (0.5 and 1 μM) and four inhibitor concentrations (0, 0.1, 0.75 and 1.5 μM) were used for each tested inhibitor. Results. The results of the in vitro experiments showed a significant decrease of the metabolic rate of carvedilol to 4'-hydroxyphenyl carvedilol, for all tested inhibitors, when the inhibitor was added to the incubation mixture containing the substrate. Moreover, an increase of the area under the concentration-time curve for carvedilol was observed after incubation with each tested inhibitor compared with the control state (no inhibitor). The most potent inhibitor was sertraline, followed by fluvoxamine and bupropion. Conclusion. The co-administration of tested antidepressants led to a significant alteration of carvedilol’s metabolism in vitro. CYP2D6 inhibition is the main pharmacokinetic mechanism that can explain these drug-drug interactions, with possible clinical implications.

Can adoption at an early age protect children at risk from depression in adulthood? A Swedish national cohort study

ObjectiveOur aim was to investigate whether the risk of depression in adulthood in children raised by substitute parents from an early age differ by care arrangements.MethodsRegister study in Swedish national cohorts born 1972–1981, with three study groups of children raised in adoptive or foster homes with care starting before the age of 2 years and a comparison majority population group. Cox regression estimated HRs of prescribed antidepressive medication and specialised psychiatric care with a diagnosis of depression in adulthood during 2006–2012.ResultsCompared with the general population, long-term foster care carried the highest age-adjusted and sex-adjusted HR for both antidepressive medication, 2.07 (95% CI 1.87 to 2.28), and psychiatric care for depression, 2.85 (95% CI 2.42 to 3.35), in adulthood. Adults raised by adoptive parents were far more similar to the general population with HR of 1.19 (95% CI 1.00 to 1.43) for domestic and 1.13 (95% CI 1.08 to 1.18) for international adoption for antidepressive medication. Adjusting the analysis for school marks and income attenuated these risks more in the long-term foster care group.ConclusionThe study demonstrates the benefits of early adoption when substitute parents are provided for young children, and underlines the importance of improved educational support for children in foster care.

A pharmacopsychometric overview of major depressive episodes in positive psychiatry

ABSTRACTBackground:The use of the pharmacopsychometric triangle to enhance patient-reported well-being as the ultimate goal of treatment has most intensively been studied in patients with a major depressive episode.Methods:The review is structured on the pharmacopsychometric triangle in which the desired clinical effect of an antidepressive medication is balanced against the undesired side effects induced by this medication in terms of restored well-being. As a biological treatment, the antidepressive medication is compared clinically with both electroconvulsive therapy and psychological treatment.Results:In the process of this review, evidence from a dose–response study in patients suffering from a major depressive episode with an adequate duration and symptom severity has demonstrated that the dose–response relationship emerged when using the patient-reported well-being outcome rather than the symptomatic reduction as outcome.Conclusion:The pharmacopsychometric triangle is in patients with major depressive episodes providing important information within positive psychiatry.

Effects of Antidepressive Medication on Lung Forced Expiratory Flow Rate in Patients with Major Depressive Disorder

Background: Major Depressive Disorder (MDD) is associated with depressed lung function.Objectives: To observe FEF25%-75% in newly diagnosed Major Depressive Disorder patients and after three months of antidepressive medication.Methods: This prospective study was carried out in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from January to December, 2014 to assess the lung function status in MDD patients. For this, 30 newly diagnosed MDD patients (Group B1), age 20 to 50 years were enrolled from the Department of Psychiatry of BSMMU. FEF25%-75% of all subjects were assessed by a portable digital spirometer (PONY FX, Cosmed, Italy) before and after (Group B2) three months of giving antidepressive medication. For statistical analysis, paired sample't' test was done and p value 0.05 is considered as level of significance.Results: There was no significant change found in patients taking antidepressive medication when compared between before and after three months of medication.Conclusion: From this study it may be concluded that there is no role in antidepressive medication in improvement of depressed lung function in major depressive disorderKYAMC Journal Vol. 8, No.-1, Jul 2017, Page 53-55

Drug eruption due to bupropion, a case report

IntroductionWe present a clinical case of eruption caused by the use of bupropion. Bupropion is known to cause hypersensitivity reactions.Case reportWe report the case of a 48-year-old female who was diagnosed of depressive disorder. She went to emergency because a few days after prescribing bupropion (150 mg/24 h) scaly skin eruptions were found distributed along the skin. In the present case, after its introduction, bupropion was found to be a probable etiological agent. The patient was successfully treated with corticosteroids. Because of that, bupropion dosage was stopped and replaced with fluoxetine. No remissions and exacerbations were noticed in a month's follow up.DiscussionIn this case report, we present a patient with an eruption related to bupropion. The aetiological spectrum of eruption include drugs, infectious agents and food additives. Drugs attributing eruption include nonsteroidal anti-inflammatory drugs, antibiotics, and anti-epileptic drugs, antidepressive medication amongst others.ConclusionsNo specific diagnostic criterion exists for eruption and the diagnosis is purely based on clinical presentation. Diagnostic features, which suggest eruption, are the acute onset (or recurrent nature) and skin lesions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Delirium associated with sertraline, a case report

IntroductionDelirium is a clinical entity consisting of acute loss of consciousness, with attention deficit and fluctuating evolution. Antidepressive medication can cause these symptoms or worsen them.Case reportWe report the case of a 84-year-old blind female who was diagnosed of delirium in relation to intoxication with sertraline. The patient was admitted into a short-stay psychiatric unit for three days. She presented behavioural disturbances consisting in auto and heteroaggressive behaviour, altered consciousness and visual hallucinations (rocks, turtles). When dosage of sertraline was doubled from 50 mg/day to 100 mg/day visual hallucinations started. There were not other medical causes found, so sertraline was suspended, achieving clinical improvement.DiscussionThis case report shows how a patient with antidepressive treatment can display delirium. The three main causes of delirium that are infections, side effects and methabolic syndrome.ConclusionsIn the case of treating a patient with delirium, the presence of previous illness has to be investigated. It is indispensable to describe the presence of previous illness, medication and recent changes of the dosages in the medical history in a patient with Sertraline.Disclosure of interestThe authors have not supplied their declaration of competing interest.