Depressive Illness and the Possibilities of Somatic Antidepressant Treatment

1996 ◽  
Vol 12 (4) ◽  
pp. 554-572
Author(s):  
Björn Mårtensson
Keyword(s):  
Antidepressant Treatment ◽  
Depressive Illness ◽  
Social Impairment ◽  
Treatment Modalities ◽  
Term Therapy ◽  
Efficient Treatment ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
The Individual ◽  
Long Term Therapy

AbstractDepression constitutes a considerable mental health problem. Depression is too often unrecognized or unproperly treated, which causes distress, social impairment, and increased risk of mortality for the individual, and large costs for society. However, several efficient treatment modalities and strategies exist. Different somatic antidepressant treatments for short- and long-term therapy and their respective quality-of-life and economic aspects will be presented and discussed.

Guidelines for treating depressive illness with antidepressants: A statement from the British Association for Psychopharmacology

1993 ◽  
Vol 7 (1_suppl) ◽  
pp. 19-23 ◽  
Author(s):  
Stuart A. Montgomery ◽  
P. Bebbington ◽  
P. Cowen ◽  
W. Deakin ◽  
P. Freeling ◽  
...  
Keyword(s):  
Side Effects ◽  
Depressed Mood ◽  
Antidepressant Treatment ◽  
Depressive Illness ◽  
Social Impairment ◽  
Self Blame ◽  
The Core ◽  
The Right ◽  
Therapeutic Doses ◽  
Core Symptoms

Depression is a common illness which affects some 3% of the population per year. At least 25% of those with marked depression do not consult their general practitioner and in half of those who do the illness is not detected. Depression is easy to recognize when four or five of the core symptoms have been present for 2 weeks which often coincides with some occupational and social impairment. The core symptoms are depressed mood, loss of interest or pleasure, loss of energy or fatigue, concentration difficulties, appetite disturbance, sleep disturbance, agitation or retardation, worthlessness or self blame and suicidal thoughts. A diagnosis of depression is made when five of these core symptoms, one of which should be depressed mood or loss of interest or pleasure, have been present for 2 weeks. Four core symptoms are probably sufficient. Response to antidepressants is good in those with more than mild symptoms. When there are only few or very mild depressive symptoms evidence of response to antidepressants is more uncertain. Antidepressants are effective, they are not addictive and do not lose efficacy with prolonged use. The newer antidepressants have fewer side effects than the older tricyclics, they are better tolerated and lead to less withdrawals from treatment. They are less cardiotoxic and are safer in overdose. Antidepressants should be used at full therapeutic doses. Treatment failure is often due to too low a dose being used in general practice. It may be difficult to reach the right dose with the older tricyclics because of side effects. To consolidate response, treatment should be continued for at least 4 months after the patient is apparently well. Stopping the treatment before this is ill-advised as the partially treated depression frequently returns. Most depression is recurrent. Long-term antidepressant treatment is effective in reducing the risk of new episodes of depression and should be continued to keep the patient well.

Treatment and risk of mortality for 58,953 cases of stage 1, ER+/PR+/HER2- breast cancer in four mutually exclusive race/ethnicities.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12101-e12101
Author(s):  
Vincent Caggiano ◽  
Carol Parise
Keyword(s):  
Breast Cancer ◽  
Hormone Therapy ◽  
White Women ◽  
Cox Regression ◽  
Treatment Modalities ◽  
Her2 Breast Cancer ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Race Ethnicity ◽  
Stage 1

e12101 Background: The estrogen receptor positive (ER+), progesterone receptor positive (PR+), human epidermal growth factor 2 negative (HER2-) subtype is the most common. Cases of stage 1, ER+/PR+/HER2- are most often treated with hormone therapy alone, although this is not universal. The purpose of this study was to determine if there were differences in mortality for patients with stage 1, ER+/PR+/HER2- breast cancer given no treatment, chemotherapy alone, or both chemotherapy and hormone therapy when compared with hormone therapy alone for four mutually exclusive race/ethnicities. Methods: We identified 58,953cases of Stage 1, ER+/PR+/HER2- first primary female invasive breast cancer from the California Cancer Registry 2000-2014. Cases were stratified into white (n = 41,716), black (n = 2,310), Hispanic (n = 8,186) and Asian/Pacific Islander (API) (n = 6,741). Treatment was categorized as none, hormone therapy alone, chemotherapy alone, or both chemotherapy and hormone therapy. Kaplan Meier survival analysis and Cox Regression were used to assess the risk of mortality associated with treatment using hormone therapy alone as the reference category. Treatment was considered a risk for mortality and hazard ratios (HR) and 95% confidence intervals reported if the Wald χ2 was statistically significant (p < 0.05). Models were adjusted for age, grade, socioeconomic status, and tumor size. Separate analyses were conducted for each race/ethnicity. Results: White women, having no treatment (HR = 1.33; 1.14-1.54), or chemotherapy alone (HR = 1.49; 1.10-2.00) was associated with an increased risk of mortality. For API women, having the combination of chemotherapy and hormone therapy was associated with increased risk of mortality (HR = 2.47; 1.34-4.56). For black and Hispanic women, there was no difference in risk of morality for any combination of treatment when compared with hormone therapy. Conclusions: The effectiveness of treatment modalities for the Stage 1, ER+/ER+/HER2- subtype varies considerably by race/ethnicity.

Temporal Changes in Fibrinolysis following Injury

2020 ◽  
Vol 46 (02) ◽  
pp. 189-198 ◽  
Author(s):  
Hunter B. Moore ◽  
Ernest E. Moore
Keyword(s):  
Fibrinolytic Activity ◽  
Tissue Injury ◽  
Plasminogen Activator Inhibitor ◽  
Trauma Patients ◽  
Plasminogen Activator Inhibitor 1 ◽  
Therapeutic Implications ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
The Individual ◽  
Global Transition

AbstractTrauma patients present to the emergency department with a spectrum of fibrinolytic activity. This wide variance in fibrinolysis activity is a complex multifactorial process impacted by the degree of hemorrhagic shock and the amount of tissue injury the individual sustains. The fibrinolytic activity of the trauma patient at presentation to the hospital has prognostic and therapeutic implications. Those patients with high fibrinolytic activity (hyperfibrinolysis) are at risk of mortality from hemorrhage, whereas those patients with low fibrinolytic activity (shutdown or hypofibrinolysis) are at an increased risk of delayed mortality from traumatic brain injury or organ failure. These phenotypes of fibrinolysis acutely following injury change with resuscitation, and the majority of trauma patients will transition to a fibrinolytic resistant state several hours after injury. The mechanism for this near-global transition to this acquired fibrinolysis appears to be related to the generation of plasminogen activator inhibitor-1 in the liver. Those patients who do not recover from this fibrinolytic state 24 hours after injury have a poor prognosis. The purpose of this article is to review the different states of fibrinolytic activity following injury and how they change over time following resuscitation and in the intensive care unit.

Practical Aspects of Long-Term Treatment with Lithium

1992 ◽  
Vol 6 (2_suppl) ◽  
pp. 330-333 ◽  
Author(s):  
Iain Glen
Keyword(s):  
Lithium Treatment ◽  
Depressive Illness ◽  
Term Treatment ◽  
Term Therapy ◽  
Manic Depressive Illness ◽  
Short Term Treatment ◽  
Manic Depressive ◽  
Long Term Treatment ◽  
Long Term Therapy

There is no increase in the overall mortality of patients undergoing long-term lithium treatment compared with those receiving short-term treatment. Lithium causes a reduction in the incidence of suicide in patients suffering from manic depressive illness. Long-term treatment with lithium is more effective than treatment with imipramine or amitriptyline. Drug interactions may cause problems during long-term therapy with lithium. A reduction in plasma levels of lithium should be considered in stable patients on long-term prophylaxis. Discontinuation of therapy often results in a relapse. The toxicity of lithium is related to its effects on calcium transport.

Social inequalities in antidepressant treatment

2013 ◽  
Vol 28 (S2) ◽  
pp. 75-75
Author(s):  
A. Bocquier ◽  
S. Cortaredona ◽  
H. Verdoux ◽  
P. Verger
Keyword(s):  
Low Income ◽  
Social Inequalities ◽  
Antidepressant Treatment ◽  
Logistic Models ◽  
Insurance Fund ◽  
List Type ◽  
Antidepressant Treatments ◽  
Long Duration ◽  
Increased Risk ◽  
The Individual

PurposeWe studied the relation between individual and neighborhood socioeconomic characteristics and the probability of:– new long-duration antidepressant treatment;– early antidepressant discontinuation.MethodsWe followed two cohorts of inhabitants of Marseille (aged 18–64 years) covered by the National Health Insurance Fund (NHIF) for 2.5 years. In the first cohort (316,412 individuals in 2008), we studied new long-duration antidepressant treatments (≥ 4 antidepressants prescription claims within 6 months after the index claim, and none in the 6 months before). The second cohort was restricted to the 14,518 individuals with a new episode of antidepressant treatment prescribed by a private GP in 2008–2009 to study early treatment discontinuation: < 4 antidepressant prescription claims in the 6 months following the index claim. We developed a deprivation index at the neighborhood level (census block) and used multivariate multilevel logistic models adjusted for consultations with GPs and psychiatrists. In the second cohort, analyses were further adjusted on GPs characteristics. resultsFirst cohort: the probability of new long-duration antidepressant treatments was negatively associated with both individual low income and neighborhood deprivation. Second cohort: low income, and prescribers’ clientele composition (high proportion of disadvantaged patients) were independently associated with an increased risk of early discontinuation. A significant interaction was found between low income and gender. ConclusionsOur results add further evidence supporting the existence of inequalities in antidepressant treatment at both the individual, GP and neighborhood levels, and that these inequalities occur principally during the processes of care. Inequalities in antidepressant continuation are more pronounced among women. Further research is warranted to improve our understanding of their mechanisms.

Association of HMG-CoA Reductase Inhibitors with Neuropathy

2003 ◽  
Vol 37 (2) ◽  
pp. 274-278 ◽  
Author(s):  
James M Backes ◽  
Patricia A Howard
Keyword(s):  
Peripheral Neuropathy ◽  
Case Reports ◽  
Epidemiologic Studies ◽  
Term Therapy ◽  
Hmg Coa Reductase ◽  
Reductase Inhibitors ◽  
Increased Risk ◽  
Hmg Coa Reductase Inhibitors ◽  
Coa Reductase ◽  
Long Term Therapy

OBJECTIVE: To review the possible association between statins and peripheral neuropathy. DATA SOURCES: Literature was obtained from MEDLINE (1984–September 2002) and International Pharmaceutical Abstracts (1970–June 2002). Key search terms included statin, neuropathy, and HMG-CoA reductase inhibitor. DATA SYNTHESIS: Epidemiologic studies and case reports suggest an increased risk of peripheral neuropathy with statin drugs. Most patients were receiving long-term therapy, although the onset was highly variable. The majority of cases were at least partially reversible with drug cessation. Specific risk factors or mechanisms have not been identified. CONCLUSIONS: Observational data suggest a link between chronic statin use and increased risk of peripheral neuropathy. However, the risk appears to be small relative to the significant cardioprotective benefits.

Hungry bone syndrome: biochemical and clinical risk factors

2019 ◽  
Vol 55 (1) ◽  
pp. 43-48
Author(s):  
Ewa Kozłowska ◽  
Olga Ciepiela
Keyword(s):  
Risk Factors ◽  
Term Therapy ◽  
Large Tumor ◽  
Efficient Treatment ◽  
Tumor Mass ◽  
Hungry Bone Syndrome ◽  
Efficient Control ◽  
Long Term Therapy ◽  
Hungry Bone

Primary hyperparathyroidismremains the first cause of hypercalcaemia. Parathyroid surgery is the most efficient treatment of primary hyperparathyroidism, however surgery entails risk of development of a Hungry Bone Syndrome (HBS) – rapid, profound, and prolonged hypocalcaemia. The risk factors of HBS are significantly elevated calcium and PTH concentration in plasma, large tumor mass, previously diagnosed osteoporosis and age over 61 years old before surgery. Pre-surgery supplementation of vitamin D3 and long-term therapy with bisphosphonate allows for more efficient control of hypocalcemia and bone metabolism after surgery.

1507: Acute Urinary Retention is Associated with an Increased Risk of Mortality

2007 ◽  
Vol 177 (4S) ◽  
pp. 497-497
Author(s):  
James Armitage ◽  
Nokuthaba Sibanda ◽  
Paul Cathcart ◽  
Mark Emberton ◽  
Jan Van Der Meulen
Keyword(s):  
Urinary Retention ◽  
Acute Urinary Retention ◽  
Risk Of Mortality ◽  
Increased Risk

Efficacy of Crisis Intervention

Crisis ◽  
1999 ◽  
Vol 20 (2) ◽  
pp. 78-85 ◽  
Author(s):  
Thomas Reisch ◽  
Petra Schlatter ◽  
Wolfgang Tschacher
Keyword(s):  
Crisis Intervention ◽  
Intervention Program ◽  
Suicide Ideation ◽  
Indirect Evidence ◽  
Well Being ◽  
Term Therapy ◽  
Contributing Factors ◽  
Step Therapy ◽  
Long Term Therapy ◽  
The Impact

This study assesses the efficacy of the treatment approach implemented in the Bern Crisis Intervention Program, where particular emphasis is placed on the remediation of suicide ideation and suicidal behavior, and depression, fear, and phobia are generally considered to be contributing factors. Four questionnaires addressing psychopathology, emotional well-being, social anxiety, and personality were administered prior to and after the treatment of 51 patients over a period of 2 to 3 weeks. The reduction of symptoms contributing to suicidal ideation and behavior was interpreted as indirect evidence of an antisuicidal effect of the program. Significant improvements were found in the psychopathology ratings, with depression and anxiety showing the largest reductions. The impact on personality and social phobia, however, was only moderate, and on average patients still exhibited symptoms after attending the program. This residual symptomatology points to the necessity of introducing a two-step therapy approach of intensive intervention targeted at the precipitating causes of the crisis, augmented by long-term therapy to treat underlying problems.

Antithrombotic Therapy for DVT/PE

1997 ◽  
Vol 17 (03) ◽  
pp. 161-162
Author(s):  
Thomas Hyers
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Cost Effective ◽  
Therapeutic Agents ◽  
Great Promise ◽  
Term Therapy ◽  
Low Molecular Weight ◽  
Long Term Therapy

SummaryProblems with unfractionated heparin as an antithrombotic have led to the development of new therapeutic agents. Of these, low molecular weight heparin shows great promise and has led to out-patient therapy of DVT/PE in selected patients. Oral anticoagulants remain the choice for long-term therapy. More cost-effective ways to give oral anticoagulants are needed.

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