scholarly journals Serotonergic Antidepressants and Risk for Traumatic Intracranial Bleeding

2021 ◽  
Vol 12 ◽  
Author(s):  
Harri Isokuortti ◽  
Grant L. Iverson ◽  
Jussi P. Posti ◽  
Jori O. Ruuskanen ◽  
Antti Brander ◽  
...  
Keyword(s):  
Emergency Department ◽  
Head Trauma ◽  
Intracranial Hemorrhage ◽  
Antidepressant Medication ◽  
Intracranial Bleeding ◽  
Increased Risk ◽  
Tertiary Center ◽  
Traumatic Intracranial Hemorrhage ◽  
Antidepressant Use ◽  
Antithrombotic Medication

Background: Serotonergic antidepressants may predispose to bleeding but the effect on traumatic intracranial bleeding is unknown.Methods: The rate of intracranial bleeding in patients with antidepressant medication was compared to patients not antidepressants in a cohort of patients with acute head injury. This association was examined by using a consecutive cohort of head trauma patients from a Finnish tertiary center emergency department (Tampere University Hospital, Tampere, Finland). All consecutive (2010–2012) adult patients (n = 2,890; median age = 58; male = 56%, CT-positive = 22%, antithrombotic medication users = 25%, antidepressant users = 10%) who underwent head CT due to head trauma in the emergency department were included.Results: Male gender, GCS <15, older age, and anticoagulation were associated with an increased risk for traumatic intracranial bleeding. There were 17.8% of patients not taking antidepressants and 18.3% of patients on an antidepressant who had traumatic intracranial bleeding (p = 0.830). Among patients who were taking antithrombotic medication, 16.6% of the patients not taking antidepressant medication, and 22.5% of the patients taking antidepressant medication, had bleeding (p = 0.239). In a regression analysis, traumatic intracranial hemorrhage was not associated with antidepressant use.Conclusions: Serotonergic antidepressant use was not associated with an increased risk of traumatic intracranial hemorrhage.

Psychological interventions as an alternative and add-on to antidepressant medication to prevent depressive relapse: systematic review and meta-analysis

2020 ◽  
pp. 1-8
Author(s):  
Josefien Johanna Froukje Breedvelt ◽  
Maria Elisabeth Brouwer ◽  
Mathias Harrer ◽  
Maria Semkovska ◽  
David Daniel Ebert ◽  
...  
Keyword(s):  
Psychological Intervention ◽  
Meta Analysis ◽  
Antidepressant Medication ◽  
Cochrane Library ◽  
Psychological Interventions ◽  
Relapse Risk ◽  
Increased Risk ◽  
Antidepressant Use ◽  
Randomised Controlled ◽  
Risk Of Relapse

Background After remission, antidepressants are often taken long term to prevent depressive relapse or recurrence. Whether psychological interventions can be a viable alternative or addition to antidepressants remains unclear. Aims To compare the effectiveness of psychological interventions as an alternative (including delivered when tapering antidepressants) or addition to antidepressants alone for preventing depressive relapse. Method Embase, PubMed, the Cochrane Library and PsycINFO were searched from inception until 13 October 2019. Randomised controlled trials (RCTs) with previously depressed patients in (partial) remission where preventive psychological interventions with or without antidepressants (including tapering) were compared with antidepressant control were included. Data were extracted independently from published trials. A random-effects meta-analysis on time to relapse (hazard ratio, HR) and risk of relapse (risk ratio, RR) at the last point of follow-up was conducted. PROSPERO ID: CRD42017055301. Results Among 11 included trials (n = 1559), we did not observe an increased risk of relapse for participants receiving a psychological intervention while tapering antidepressants versus antidepressants alone (RR = 1.02, 95% CI 0.84–1.25; P = 0.85). Psychological interventions added to antidepressants significantly reduced the risk of relapse (RR = 0.85, 95% CI 0.74–0.97; P = 0.01) compared with antidepressants alone. Conclusions This study found no evidence to suggest that adding a psychological intervention to tapering increases the risk of relapse when compared with antidepressants alone. Adding a psychological intervention to antidepressant use reduces relapse risk significantly versus antidepressants alone. As neither strategy is routinely implemented these findings are relevant for patients, clinicians and guideline developers.

scholarly journals Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists

Medicina ◽  
2020 ◽  
Vol 56 (6) ◽  
pp. 308 ◽  
Author(s):  
Gabriele Savioli ◽  
Iride Francesca Ceresa ◽  
Sabino Luzzi ◽  
Cristian Gragnaniello ◽  
Alice Giotta Lucifero ◽  
...  
Keyword(s):  
Emergency Department ◽  
Head Trauma ◽  
Intracranial Hemorrhage ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Mortality Rates ◽  
Control Group ◽  
Number Of Patients ◽  
Blunt Head Trauma ◽  
Significant Difference

Background and objectives: Anticoagulants are thought to increase the risks of traumatic intracranial injury and poor clinical outcomes after blunt head trauma. The safety of using direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) after intracranial hemorrhage (ICH) is unclear. This study aims to compare the incidence of post-traumatic ICH following mild head injury (MHI) and to assess the need for surgery, mortality rates, emergency department (ED) revisit rates, and the volume of ICH. Materials and Methods: This is a retrospective, single-center observational study on all patients admitted to our emergency department for mild head trauma from 1 January 2016, to 31 December 2018. We enrolled 234 anticoagulated patients, of which 156 were on VKAs and 78 on DOACs. Patients underwent computed tomography (CT) scans on arrival (T0) and after 24 h (T24). The control group consisted of patients not taking anticoagulants, had no clotting disorders, and who reported an MHI in the same period. About 54% in the control group had CTs performed. Results: The anticoagulated groups were comparable in baseline parameters. Patients on VKA developed ICH more frequently than patients on DOACs and the control group at 17%, 5.13%, and 7.5%, respectively. No significant difference between the two groups was noted in terms of surgery, intrahospital mortality rates, ED revisit rates, and the volume of ICH. Conclusions: Patients with mild head trauma on DOAC therapy had a similar prevalence of ICH to that of the control group. Meanwhile, patients on VKA therapy had about twice the ICH prevalence than that on the control group or patients on DOAC, which remained after correcting for age. No significant difference in the need for surgery was determined; however, this result must take into account the very small number of patients needing surgery.

scholarly journals Immediate and Delayed Traumatic Intracranial Hemorrhage in Patients With Head Trauma and Preinjury Warfarin or Clopidogrel Use

2012 ◽  
Vol 59 (6) ◽  
pp. 460-468.e7 ◽  
Author(s):  
Daniel K. Nishijima ◽  
Steven R. Offerman ◽  
Dustin W. Ballard ◽  
David R. Vinson ◽  
Uli K. Chettipally ◽  
...  
Keyword(s):  
Head Trauma ◽  
Intracranial Hemorrhage ◽  
Traumatic Intracranial Hemorrhage

scholarly journals Antidepressant medication use, depression, and the risk of preeclampsia

CNS Spectrums ◽  
2015 ◽  
Vol 20 (1) ◽  
pp. 39-47 ◽  
Author(s):  
Lyndsay Ammon Avalos ◽  
Hong Chen ◽  
De-Kun Li
Keyword(s):  
Medication Use ◽  
Antidepressant Medication ◽  
Population Based ◽  
Adjusted Relative Risk ◽  
Second Trimester ◽  
Kaiser Permanente ◽  
Antidepressant Medications ◽  
Increased Risk ◽  
Antidepressant Use ◽  
Risk Of Preeclampsia

ObjectiveTo assess the effects of depression and antidepressant medication use during pregnancy on the risk of preeclampsia.MethodsWe conducted a retrospective, population-based cohort study that linked automated clinical and pharmacy databases including comprehensive electronic medical records of 21,589 pregnant Kaiser Permanente Northern California members between 2010 and 2012.ResultsThe overall risk of preeclampsia was 4.5%. The timing of antidepressant medication exposure was an important factor. A significant increase in the risk of preeclampsia emerged for women with a depression diagnosis who took antidepressant medications during the second trimester compared to women with untreated depression (adjusted relative risk [aRR]: 1.6, 95% CI: 1.06, 2.39) and to women without depression (aRR: 1.70, 95% CI: 1.30, 2.23). Similar associations existed for women who took antidepressant medications, but without depression. In contrast, depressed women with psychotherapy showed no increased risk of preeclampsia compared to women with untreated depression or no depression. There was also a statistically significant relationship between the duration of antidepressant medication use and preeclampsia. The observed association appeared stronger for selective serotonin reuptake inhibitor (SSRI) use, although a nonsignificant trend was also noted for use of norepinephrine-dopamine reuptake inhibitors (NDRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).ConclusionStudy findings suggest that antidepressant use during pregnancy may increase the risk of preeclampsia, especially use during the second trimester.

Prevalence and Characteristics of Traumatic Intracranial Hemorrhage in Elderly Fallers Presenting to the Emergency Department without Focal Findings

2009 ◽  
Vol 57 (8) ◽  
pp. 1470-1474 ◽  
Author(s):  
Anupama S. Gangavati ◽  
Dan K. Kiely ◽  
Lara K. Kulchycki ◽  
Richard E. Wolfe ◽  
J. Lawrence Mottley ◽  
...  
Keyword(s):  
Emergency Department ◽  
Intracranial Hemorrhage ◽  
Traumatic Intracranial Hemorrhage

Intracranial Hemorrhage and Early Mortality in Patients Receiving Extracorporeal Membrane Oxygenation for Severe Respiratory Failure

2018 ◽  
Vol 44 (03) ◽  
pp. 276-286 ◽  
Author(s):  
Deepa Arachchillage ◽  
Maurizio Passariello ◽  
Michael Laffan ◽  
TC Aw ◽  
Leah Owen ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Intracranial Hemorrhage ◽  
Underlying Disease ◽  
Early Mortality ◽  
Severe Respiratory Failure ◽  
Membrane Oxygenation ◽  
Increased Risk ◽  
Tertiary Center ◽  
Vv Ecmo

AbstractIntracranial hemorrhage (ICH) is a serious complication in patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO) and is associated with high mortality. It is unknown whether ICH may be a consequence of the ECMO or of an underlying disease. The authors first aimed to assess the incidence of ICH at initiation and during the course of VV-ECMO and its associated mortality. The second aim was to identify clinical and laboratory measures that could predict the development of ICH in severe respiratory failure. Data were collected from a total number of 165 patients receiving VV-ECMO from January, 2012 to December, 2016 in a single tertiary center and treated according to a single protocol. Only patients who had a brain computed tomography within 24 hours of initiation of ECMO (n = 149) were included for analysis. The prevalence and incidence of ICH at initiation and during the course of VV-ECMO (at median 9 days) were 10.7% (16/149) and 5.2% (7/133), respectively. Thrombocytopenia and reduced creatinine clearance (CrCL) were independently associated with increased risk of ICH on admission; odds ratio (95% confidence interval): 22.6 (2.6–99.5), and 10.8 (5.6–16.2). Only 30-day (not 180-day) mortality was significantly higher in patients with ICH on admission versus those without (37.5% [6/16] vs 16.4% [22/133]; p = 0.03 and 43.7% [7/16] vs 26.3% [35/133]; p = 0.15, respectively). Reduced CrCL and thrombocytopenia were associated with ICH at initiation of VV-ECMO. The higher incidence of ICH at initiation suggests it is more closely related to the severity of the underlying lung injury than to the VV-ECMO itself. ICH at VV-ECMO initiation was associated with early mortality.

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