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Fulcrum: the Glaxo Wellcome newsletter for investigators conducting research with lamotrigine in bipolar disorder
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Suicide and antidepressants
No full textThe causes of suicide are complex, and our understanding
of the processes and pathways leading to suicide is
complicated by the limitations of the available data.
Suicide is strongly associated with mental illness,
especially in patients with significant depressive features,
and those with a history of suicidal behaviour. Prevention
of suicide both in the general population and in severely
mentally ill patients is a feature of health policy initiatives
in many countries. However, whilst there is significant
evidence for the efficacy of treatment for depressive
disorders, a meta-analysis of treatment for the secondary
prevention of suicidal behaviour found that few treatments
were effective or feasible in practice. Randomised controlled
trials, analyses of pooled data, pharmacoepidemiological
studies, case series and psychological autopsy
studies provide different strands of evidence when examining
the question of whether antidepressant drugs might
provoke or prevent attempted and completed suicide.
Ecological studies consistently show an association between
increased antidepressant prescribing and reduction
of suicide. Recent pharmacoepidemiological reports found
no evidence for an increase in suicide associated with
different classes of antidepressant classes, although weak
evidence for an increase in suicidal behaviour in young
adults prescribed some antidepressants.
The challenge for the clinician continues to be the
effective management of patients with depressive symptoms
and suicidal behaviour, weighing the relative risks
and benefits from the evidence available
It's never too late to publish an abandoned trial
No full textIt is estimated that half of all trials have never been published which can lead to patients being denied the most effective treatment and being exposed to unnecessary side effects. Furthermore the trial participants have been misinformed since the trial results have not contributed to the care of future patients. However the non-publication of trials is often not due to a deliberate decision to cover up results. Commonly in academia it is due to more understandable reasons such as researchers having busy clinical posts, moving onto other more demanding projects, changing research areas or starting a family. This is called the “file drawer” problem. The examples in this editorial demonstrate that it is possible to go back, even decades later, and make the results available to inform future evidence based medicine. We call on others to look into their “file drawer” for unpublished trials
Importance of sleep disturbance in mood and anxiety disorders
No full textDisturbed sleep is so common a symptom in mood disorders, that is used to help support the diagnosis for major depressive episodes (in unipolar and bipolar disorder) and dysthymia: disturbed sleep is also listed within the diagnostic criteria for generalized anxiety disorder (GAD) and post-traumatic stress disorder. Furthermore, longitudinal studies indicate that complaints of disturbed sleep (in the absence of depression) at baseline are associated with an increased risk of depression at follow-up. Insomnia is often considered one of the most distressing symptoms by people experiencing depression, and is known to be associated with reduced quality of life, and increased risk of recurrence and suicide. Insomnia can be a troublesome and persistent residual symptom following treatment with antidepressants or cognitive behaviour therapy, and is often difficult to treat
Estimating the alcohol content of commonly consumed beverages: knowing the “standard drink"
No full textCo-morbid substance misuse in psychiatric patients. Prevalence and association with length of inpatient stay
No full textThe tolerability of venlafaxine
No full textThe need to reduce unwanted effects and improve the safety profile of a drug, particularly in overdose, must be an important consideration when assessing the overall value of a new treatment. Although accurately assessing the relative burden of the adverse effects of different drugs can be difficult, the current evidence suggests that the pharmacological properties of venlafaxine may underpin its favourable safety and tolerability profile. When compared to many of the first and second generation antidepressants, it appears to be relatively well tolerated, and preliminary data indicate that it is safe in overdose. Comparison with the SSRI fluoxetine revealed no significant differences in the safety profiles of the two drugs. With its extensive frist pass metabolism to the active metabolite O-desmethylvenlafaxine, the main focus for potential drug-drug interactions with venlafaxine is the effect it may have on the cytochrome P450 system. In vitro studies suggested that, when compared to SSRIs, venlafaxine had only a modest inhibitory effect on the metabolic capacity of the P450 system, and clinical studies have shown that it has minimal drug-drug interactions. Venlafaxine is consequently well tolerated in the elderly and in those requiring concomitant medication for physical illness. New data suggest that, whilst contraindicated during pregnancy, accidental exposure to venlafaxine does not appear to be associated with an increased risk of foetal abnormalities
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