Doxepin and Amitriptyline in Atypical Depression and Their Cardiac Side Effects

Although there is no doubt about its efficiency, pharmacotherapy of depression still faces several problems that have to be focused upon and hopefully solved. Besides the problem of drug-resistance and delayed response, the need to achieve remission has become increasingly important.As for the near future, there is great hope that new mechanisms of action can overcome the limitations of the traditional and current antidepressant medications. Unfortunately, some of the recent developments that raised the most interest either turned out to be less effective than hoped, such as the substance P antagonists, or did not yet lead to a drug likely to be marketed in the near future, such as CRF antagonists, for example. On the other hand the first melatonergic antidepressant, agomelatine, is seen as a successful new development.Drug development can currently be based on improved brain imaging techniques, better animal models, and an increased knowledge of genetic markers. Hopefully this will result in a change in the pharmacotherapy of depression and psychiatric diseases in general. From a clinical point of view, new antidepressants should target the following unmet needs: early onset of action; increased proportion of remission; broad spectrum of efficacy including physical symptoms, pain, sleep disorders, circadian rhythm disorders, etc; good efficacy in subtypes of depression, such as atypical depression; efficacy in bipolar depression without inducing switches to mania; lack of side effects of TCAs and modern antidepressants, especially lack of cardiac side effects, anticholinergic side effects, sedation, weight gain, sexual side effects, etc.

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Cardiooncology—dealing with modern drug treatment, long-term complications, and cancer survivorship

Clinical & Experimental Metastasis ◽

10.1007/s10585-021-10106-x ◽

2021 ◽

Author(s):

Claudia de Wall ◽

Johann Bauersachs ◽

Dominik Berliner

Keyword(s):

Side Effects ◽

Checkpoint Inhibitors ◽

Heart Diseases ◽

Tumor Therapy ◽

Treatment Strategies ◽

Tumor Treatment ◽

Cardiac Side Effects ◽

Cardiovascular Side Effects ◽

Modern Drug

AbstractModern treatment strategies have improved prognosis and survival of patients with malignant diseases. The key components of tumor treatment are conventional chemotherapy, radiotherapy, targeted therapies, and immunotherapy. Cardiovascular side-effects may occur in the early phase of tumor therapy or even decades later. Therefore, knowledge and awareness of acute and long-lasting cardiac side effects of anti-cancer therapies are essential. Cardiotoxicity impairs quality of life and overall survival. The new cardiologic subspecialty ‘cardio-oncology’ deals with the different cardiovascular problems arising from tumor treatment and the relationship between cancer and heart diseases. Early detection and treatment of cardiotoxicity is of crucial importance. A detailed cardiac assessment of patients prior to administration of cardiotoxic agents, during and after treatment should be performed in all patients. The current review focusses on acute and long-term cardiotoxic side effects of classical cytotoxic and selected modern drug treatments such as immune checkpoint inhibitors and discusses strategies for the diagnosis of treatment-related adverse cardiovascular effects in cancer patients.

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What the Cardiologist Needs to Consider in the Management of Oncologic Patients with STEMI-Like Syndrome; A Case Report and Literature Review

Pharmaceuticals ◽

10.3390/ph14060563 ◽

2021 ◽

Vol 14 (6) ◽

pp. 563

Author(s):

Aneta Aleksova ◽

Giulia Gagno ◽

Alessandro Pierri ◽

Carla Todaro ◽

Alessandra Lucia Fluca ◽

...

Keyword(s):

Myocardial Infarction ◽

Case Report ◽

Side Effects ◽

Single Agent ◽

St Segment Elevation ◽

Cardiac Catheterization Laboratory ◽

Cardiac Side Effects ◽

Coronary Syndrome ◽

St Segment ◽

Oncologic Patients

In pre-hospital care, an accurate and quick diagnosis of ST-segment elevation myocardial infarction (STEMI) is imperative to promptly kick-off the STEMI network with a direct transfer to the cardiac catheterization laboratory (cath lab) in order to reduce myocardial infarction size and mortality. Aa atherosclerotic plaque rupture is the main mechanism responsible for STEMI. However, in a small percentage of patients, emergency coronarography does not reveal any significant coronary stenosis. The fluoropyrimidine agents such as 5-Fluorouracil (5-FU) and capecitabine, widely used to treat gastrointestinal, breast, head and neck cancers, either as a single agent or in combination with other chemotherapies, can cause potentially lethal cardiac side effects. Here, we present the case of a patient with 5-FU cardiotoxicity resulting in an acute coronary syndrome (ACS) with recurrent episodes of chest pain and ST-segment elevation.. Our case report highlights the importance of widening the knowledge among cardiologists of the side effects of chemotherapeutic drugs, especially considering the rising number of cancer patients around the world and that fluoropyrimidines are the main treatment for many types of cancer, both in adjuvant and advanced settings.

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Omentin-1 attenuates glucocorticoid-induced cardiac injury by phosphorylating GSK3β

Journal of Molecular Endocrinology ◽

10.1530/jme-20-0236 ◽

2021 ◽

Vol 66 (4) ◽

pp. 273-283

Author(s):

Zhousheng Jin ◽

Fangfang Xia ◽

Jiaojiao Dong ◽

Tingting Lin ◽

Yaoyao Cai ◽

...

Keyword(s):

Side Effects ◽

Cardiac Hypertrophy ◽

Cardiac Injury ◽

Experimental Studies ◽

Chronic Administration ◽

Cardiovascular Complications ◽

Rat Serum ◽

Cardiac Side Effects ◽

Beneficial Effects

Glucocorticoid excess often causes a variety of cardiovascular complications, including hypertension, atherosclerosis, and cardiac hypertrophy. To abrogate its cardiac side effects, it is necessary to fully disclose the pathophysiological role of glucocorticoid in cardiac remodelling. Previous clinical and experimental studies have found that omentin-1, one of the adipokines, has beneficial effects in cardiovascular diseases, and is closely associated with metabolic disorders. However, there is no evidence to address the potential role of omentin-1 in glucocorticoid excess-induced cardiac injuries. To uncover the links, the present study utilized rat model with glucocorticoid-induced cardiac injuries and clinical patients with abnormal cardiac function. Chronic administration of glucocorticoid excess reduced rat serum omentin-1 concentration, which closely correlated with cardiac functional parameters. Intravenous administration of adeno-associated virus encoding omentin-1 upregulated the circulating omentin-1 level and attenuated glucocorticoid excess-induced cardiac hypertrophy and functional disorders. Overexpression of omentin-1 also improved cardiac mitochondrial function, including the reduction of lipid deposits, induction of mitochondrial biogenesis, and enhanced mitochondrial activities. Mechanistically, omentin-1 phosphorylated and activated the GSK3β pathway in the heart. From a study of 28 patients with Cushing’s syndrome and 23 healthy subjects, the plasma level of glucocorticoid was negatively correlated with omentin-1, and was positively associated with cardiac ejection fraction and fractional shortening. Collectively, the present study provided a novel role of omentin-1 in glucocorticoid excess-induced cardiac injuries and found that the omentin-1/GSK3β pathway was a potential therapeutic target in combating the side effects of glucocorticoid.

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Antipsychotics and Cardiac Side Effects

Brain and Heart Dynamics ◽

10.1007/978-3-030-28008-6_47 ◽

2020 ◽

pp. 721-729

Author(s):

Annamaria Mascolo ◽

Cristina Scavone ◽

Concetta Rafaniello ◽

A. Capuano

Keyword(s):

Side Effects ◽

Cardiac Side Effects

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A closed audit reviewing the electrocardiograms of patients presenting to the memory assessment team

BJPsych Open ◽

10.1192/bjo.2021.133 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S30-S30

Author(s):

Joseph Heath ◽

Maroulla Anderson ◽

Jonathan Miles-Stokes

Keyword(s):

Side Effects ◽

Acetylcholinesterase Inhibitors ◽

Left Ventricular ◽

Cardiac Conduction ◽

North West ◽

Cardiac Side Effects ◽

Memory Assessment ◽

The North ◽

Conduction Disorders ◽

Clinically Significant

AimsTo review the ECGs of all patients referred to MAT services over the preceding 5 year period.BackgroundNeurodegenerative conditions such as Alzheimer's Disease can be treated with Acetylcholinesterase Inhibitors (AChEI) to slow down cognitive decline. Side effects of AChEIs include bradycardia, syncope and cardiac conduction disorders. An electrocardiograms (ECG) is completed prior to memory assessment team (MAT) medical assessments to screen for those who may be at risk of the cardiac side effects of AChEIs. ECGs may be included in the initial referral to the service or completed by the MAT. Given the predominantly elderly population referred to the MATs service, other incidental abnormalities are to be expected. Not all MAT referrals that are screened by memory nurses reach the threshold to be reviewed by the medical team and therefore not all ECGs are routinely reviewed, potentially missing clinically significant abnormalities.ResultA total of 1795 patients were identified as being referred to a single mental health unit in the North West on England over a five-year period. 781 (44%) of the patients had an ECG completed by the MAT, of which 452 (58%) showed an abnormality. Significant abnormalities that were previously unknown to the patients’ primary care provider include eight cases of Atrial Fibrillation (AF), four cases of Trifasciular Block, and 19 cases of Left Ventricular Hypertrophy (LVH). 64 (8%) of patients who had an ECG by the MAT had a bradycardia.ConclusionIn addition to identifying abnormalities that could interfere with memory medication, this audit showed that over half of the ECGs completed by the MAT had an atypical trace. Cardiology was consulted to identify which abnormalities were considered clinically significant and if not already known, the general practitioner (GP) was informed. A change in the local service means that all ECGs completed by the MAT are now screened at point of filling into the notes, so any future abnormalities are identified and followed up immediately.

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