Depressive Symptoms Predict Increased Incidence of Neuropsychiatric Side Effects in Patients Treated with Efavirenz

Depression is a frequent comorbid disorder of many inflammatory diseases and it is suggested that brain inflammatory processes have a pathogenic role in mood dysregulation. Several immunocompromised patients have been treated with cytokines and long-term treatments have resulted in a variety of neuropsychiatric side-effects. The objective of the study was to present evidence for an association between the induction of neuropsychiatric side-effects during treatment with interferon-α (IFN-α) and changes in serotonergic and immunological parameters. Moreover, the use of IFN-α-induced depression as a paradigm for research into the pathophysiology of depressive disorders in general will be discussed. This literature review focused on the relationships between tryptophan, serotonin, cytokines and depression associated with interferon treatment. Immunotherapy with IFN-α influences several immunological and serotonergic parameters, and induces in most patients neurovegetative, somatic and depressive symptoms. Literature findings indicate that the development of depressive symptoms in patients undergoing cytokine therapy are secondary to cytokine induction and could be mediated by a reduced availability of tryptophan to the brain, resulting ultimately in decreased serotonergic activity. Changes in the metabolism of tryptophan and consequently of serotonin may play a role in the pathophysiology of interferon-induced depression. Studies on interferon-induced neuropsychiatric side-effects may be a promising research paradigm and shed light on the role of immunological and serotonergic factors in the pathogenesis of depressive disorders in general. However, first the appropriate symptomatology of the interferon-induced depressive states has to be documented.

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Management of Hematologic and Neuropsychiatric Side Effects in Treatment of Chronic HCV Infection

The Journal for Nurse Practitioners ◽

10.1016/j.nurpra.2005.11.012 ◽

2006 ◽

Vol 2 (1) ◽

pp. 38-45 ◽

Cited By ~ 2

Author(s):

Jason E. Farley ◽

David J. Dial ◽

Marguerite Littleton-Kearney

Keyword(s):

Side Effects ◽

Hcv Infection ◽

Chronic Hcv Infection ◽

Chronic Hcv ◽

Neuropsychiatric Side Effects

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Quality of life during the first 6 months of interferon-b treatment in patients with MS

Multiple Sclerosis Journal ◽

10.1177/135245850000600508 ◽

2000 ◽

Vol 6 (5) ◽

pp. 338-342

Author(s):

J HA Arnoldus ◽

J Killestein ◽

L EMA Pfennings ◽

B Jelles ◽

B MJ Uitdehaag ◽

...

Keyword(s):

Quality Of Life ◽

Depressive Symptoms ◽

Side Effects ◽

Physical Functioning ◽

Bodily Pain ◽

Significant Linear Trend ◽

Role Physical ◽

Sf 36 ◽

The Impact

Objectives: To determine the quality of life (QoL) of MS patients during the initial 6 months of treatment with interferon-b (IFN-b). Furthermore, to determine whether changes in QoL relate to disability, emotional state, therapeutic expectations or side effect profile. Background: IFN-b has been shown to have beneficial effects on the course of MS. Since the aim of IFN-b treatment is not to cure but to slow down the disease it is important to know how this treatment affects QoL. Surprisingly, the impact of treatment with IFN-b on QoL measures has not been extensively studied so far. Methods: Case report documentation, including EDSS, SF-36 and MADRAS scores, of 51 relapsing-remitting MS patients treated with IFN-b was obtained at baseline and at months 1, 3 and 6. Patients also filled in a form about their expectations of therapy and a questionnaire on side effects. Results: During treatment there was a significant linear trend indicating improvement in the role-physical functioning (RPF) scale of the SF-36 (F1,50=4.9, P=0.032). A transient decrease at month 1 was found in the scale for bodily pain, indicating more experienced pain (F1,50=19.8, P50.001). Subgroup analysis showed that patients with most depressive symptoms on the MADRAS at baseline contributed most to the increase in RPF scores over time (F1,24=5,6 P=0.026). Furthermore, we found associations between adverse event scores and several domains of QoL. Conclusions: Our findings suggest that IFN-b therapy has an impact on QoL of MS patients in that it improves role-physical functioning and transiently worsens experienced bodily pain. QoL during treatment with IFN-b is influenced by depressive symptoms at baseline as well as by treatment-associated side-effects.

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An Open Study of Two Dose Levels of ‘Vivalan’ (Viloxazine Hydrochloride ICI 58 834) in Depression in General Practice

Journal of International Medical Research ◽

10.1177/030006057400200401 ◽

1974 ◽

Vol 2 (4) ◽

pp. 253-259 ◽

Cited By ~ 4

Author(s):

P F C Bayliss ◽

J W Harcup ◽

M Mayer ◽

R Million ◽

J E Murphy ◽

...

Keyword(s):

General Practice ◽

Depressive Symptoms ◽

Side Effects ◽

Side Effect ◽

Open Study ◽

Anxiety Symptoms ◽

High Dose ◽

Dose Levels

Forty-eight mild to moderate depressives were treated by six genera practitioners with a chemically novel anti-depressant, ‘Vivalan’ (viloxazine hydrochloride, ICI 58 834). Twenty-five patients took 150 mg/day in three divided doses, and twenty-three took 200 mg/day in two divided doses, each for twenty-one days. The severity of both the depressive symptoms and the anxiety symptoms showed a statistically highly significant reduction over the duration of the study. There was no difference between the efficacy of the two dose levels. Viloxazine was generally well tolerated and there was no difference between the two dose levels as far as side-effects or withdrawals were concerned. The usual sedative and anti-cholinergic side-effects of the tricyclic anti-depressants were virtually absent. The only side-effect seen was a transient upper gastro-intestinal disturbance. It was commoner at the high dose but not significantly so. It is concluded that viloxazine hydrochloride appears to be an effective anti-depressant in this type of patient and produces little or no sedative or anti-cholinergic side-effects. Either 150 mg/day or 200 mg/day would seem a reasonable dose to use in general practice.

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Treatment for depression comorbid with dementia

Evidence-Based Mental Health ◽

10.1136/ebmental-2019-300113 ◽

2019 ◽

Vol 22 (4) ◽

pp. 167-171 ◽

Cited By ~ 3

Author(s):

Nina Baruch ◽

Jennifer Burgess ◽

Manjunadh Pillai ◽

Charlotte Louise Allan

Keyword(s):

Depressive Symptoms ◽

Side Effects ◽

Music Therapy ◽

Treatment Modality ◽

Small Data ◽

Data Sets ◽

Late Life Depression ◽

Therapeutic Benefits ◽

Life Threatening ◽

Randomised Controlled

Depression is a common comorbidity in dementia. Randomised controlled studies of antidepressants do not show a significant improvement in depressive symptoms in patients with comorbid dementia and are known to lead to an increase in side effects. However, there are relatively few studies of depression in dementia, and drawing firm conclusions about the use of antidepressants is limited by the amount of data available. Furthermore, it is unclear whether data can be extrapolated from similar populations (eg, those with late-life depression) to inform pharmacotherapy in this patient group. Given the lack of effectiveness and risk of side effects associated with pharmacological treatments, psychological interventions may offer important therapeutic benefits. There is evidence for the effectiveness of individual psychological therapy, and further research will establish which psychological approach is the most effective. Some studies have shown an improvement in depressive symptoms using structured sleep hygiene programmes, exercise, arts interventions and music therapy. These studies are hampered by small data sets, and the benefits to individuals may not be well captured by standard outcome measures. At present, the best evidence for arts-based approaches is in music therapy. Depression with comorbid dementia responds well to electroconvulsive therapy and this is a useful treatment modality for those with severe or life-threatening depressive symptoms. Alternative neurostimulation techniques such as transcranial magnetic stimulation are not widely used at present and further research is needed before they can be a more widely used treatment modality.

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Neuropsychiatric Side Effects of Drugs in the Elderly

The Journal of Nervous and Mental Disease ◽

10.1097/00005053-198207000-00015 ◽

1982 ◽

Vol 170 (7) ◽

pp. 433

Author(s):

Kenneth Solomon

Keyword(s):

Side Effects ◽

The Elderly ◽

Neuropsychiatric Side Effects

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Predictors of Discontinuation of Efavirenz as Treatment for HIV, Due to Neuropsychiatric Side Effects, in a Multi-Ethnic Sample in the United Kingdom

AIDS Research and Human Retroviruses ◽

10.1089/aid.2019.0193 ◽

2020 ◽

Vol 36 (6) ◽

pp. 459-466

Author(s):

Johnson Kai Chun Law ◽

Laurie T. Butler ◽

Matthew M. Hamill

Keyword(s):

United Kingdom ◽

Side Effects ◽

The United Kingdom ◽

Neuropsychiatric Side Effects

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Antimicrobial-induced cognitive side effects

Mental Health Clinician ◽

10.9740/mhc.2016.07.207 ◽

2016 ◽

Vol 6 (4) ◽

pp. 207-214 ◽

Cited By ~ 7

Author(s):

Amanda Warstler ◽

Jennifer Bean

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Side Effects ◽

Clinical Symptoms ◽

Case Reports ◽

Time Frame ◽

Drug Induced ◽

Pubmed Search ◽

Neuropsychiatric Side Effects ◽

Cognitive Side Effects

Abstract Introduction: Antimicrobial-induced cognitive side effects are often overlooked or underreported. Literature often reports symptoms of antimicrobial-induced cognitive impairment under more general blanket terms, such as neuropsychiatric side effects, neurotoxicity, or drug-induced delirium or encephalopathy. Methods: A PubMed search using terms including antibiotics, antifungals, antivirals, antimalarials, side effects, cognitive, neurotoxicity, encephalopathy, and delirium was conducted. Respectively, symptoms of cognitive impairment were teased out of the multiple neurologic complications presented for each case and reported based on antimicrobial class. Articles were excluded if they focused solely on neuropsychiatric side effects such as seizures, psychosis, hallucinations, or mood disturbances, were conducted in animals, or involved antiretroviral medication therapies. Results: Of over 50 case reviews, case reports, retrospective chart reviews, and prospective cohort studies analyzed, 25 were deemed appropriate for purposes of this review. Common antimicrobial-induced cognitive side effects for all antimicrobial classes included confusion, delirium, encephalopathy, and impaired concentration or attention. Recurring risk factors included, but were not limited to, older age and renal impairment. Mechanisms of cognitive impairment were relatively specific to each antimicrobial class. Discussion: Awareness of the potential for antimicrobial-induced cognitive side effects, including the general time frame of symptom onset and symptom presentation, is critical in challenging patient cases. This review article aims to summarize the risk factors, clinical symptoms, mechanisms, and management of antimicrobial-induced cognitive side effects. Pharmacists can play a key role in prevention through adjustment of medications for renal or hepatic dysfunction, avoidance of polypharmacy, and knowledge of critical drug interactions that may precipitate cognitive decline.

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