Postpartum depression Part 2. Biological treatment: practical aspects & safety issues. Review of the literature

Introduction: Mother with postnatal depression is not able to adequately respond to the needs of her child. Maternal depression poses a serious health & safety risk for mother and child. They both need treatment with rapid onset of action and minimal influence on the infant. Aim: Discussion of professional boards’ recommendations together with RCT results and clinical observations reffering to nursing depressed women with emphasis on practical aspects and future directions. Methods: Discussion on postnatal depression treatment national guidelines and results from meta-analyses and systematic reviews found in Pubmed and Cochrane databases with "postanatal" or "postpartum" or "puerperium" and "depression" keywords. Selection of articles based on practical aspects of management. Results: Despite its widespread use, the safety and efficacy of SSRIs in postpartum mood disorders have not yet been clearly confirmed. Long-term observation of behaviour and development of children after early exposure to SSRIs up to adulthood is necessary to fully assess the risk of antidepressant treatment in nursing mothers. Conclusions: Pharmacotherapy remains the most accessible method of treating depression in the puerperal period, however, knowledge about the safety of antidepressants during lactation is still insufficient. Individualization of treatment depending on the patient's condition, specific needs, availabity of procedures and mental or physical comorbidity is necessary.

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Onset of action under antidepressant treatment

European Psychiatry ◽

10.1016/s0924-9338(97)89099-2 ◽

1997 ◽

Vol 12 (4) ◽

pp. 163-165 ◽

Cited By ~ 8

Author(s):

H.H. Stassen ◽

J Angst ◽

A Delini-Stula

Keyword(s):

Washout Period ◽

Antidepressant Treatment ◽

Practical Relevance ◽

Onset Of Action ◽

Cross Sectional ◽

Delayed Onset ◽

Starting Point ◽

Patients At Risk ◽

Cross Sectional Design ◽

Meta Analyses

SummaryThe issues of timing in antidepressant treatment are of great theoretical and practical relevance, even more so since recent meta-analyses yielded no evidence for a specific mode of action of antidepressants, which, according to the theory of delayed onset of action, is expected to emerge after 2 weeks of therapy. To address the issues of timing on a methodologically sound basis, future trials should adapt a ‘longitudinal’ rather than ‘cross-sectional’ design, standardized with respect to a washout period, baseline and first 2 week assessments. With this in mind, special attention should be paid to parameters which potentially enable the identification of placebo responders, true drug responders and patients at risk of non-improvement. Results and methods of the Zurich meta-analyses may serve as a starting point for further steps in this direction.

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Pharmacokinetic peculiarities of drugs used in the form of rapidly dispersible tablets (oral delivery system)

10.33920/med-13-2001-01 ◽

2020 ◽

pp. 7-24

Author(s):

Zhanna Kozlova ◽

Ivan Krasnyuk ◽

Yuliya Lebedeva ◽

Ekaterina Odintsova

Keyword(s):

Oral Mucosa ◽

Oral Delivery ◽

Chemical Properties ◽

Rapid Onset ◽

Systemic Circulation ◽

Systemic Delivery ◽

Onset Of Action ◽

Mucosal Drug Delivery ◽

Physical And Chemical ◽

Pass Metabolism

Oral mucosal drug delivery is an alternative method of systemic delivery with several advantages over both injectable and enteral methods. Drugs that are absorbed through the oral mucosa directly enter the systemic circulation, passing through the gastrointestinal tract and first-pass metabolism in the liver due to oral mucosa being highly vascularised. This results in rapid onset of action for some drugs because of a more comfortable and convenient way of delivery than the intravenous one. But not all drugs can be administered through the oral mucosa due to characteristics of the oral mucosa and physical and chemical properties of the drug.

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Faculty Opinions recommendation of Serotonin(4) (5-HT(4)) receptor agonists are putative antidepressants with a rapid onset of action.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1094841.549766 ◽

2007 ◽

Author(s):

Eric Nestler

Keyword(s):

Rapid Onset ◽

Onset Of Action ◽

Receptor Agonists

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A Review on Enteric Coated Pellets Composed of Core Pellets Prepared by Extrusion-Spheronization

Recent Patents on Drug Delivery & Formulation ◽

10.2174/1872211313666190212115139 ◽

2019 ◽

Vol 13 (2) ◽

pp. 83-90 ◽

Cited By ~ 1

Author(s):

Hetal Patel ◽

Mukesh Gohel

Keyword(s):

Dosage Form ◽

Extended Release ◽

Rapid Onset ◽

Enteric Coating ◽

Onset Of Action ◽

The Core ◽

Current State ◽

Enteric Coated ◽

Extrusion Spheronization ◽

Acid Labile

Enteric coated dosage form bypasses the stomach and releases the drug into the small intestine. Advantages of enteric coated pellets in comparison with enteric coated tablets are a) Pellets provide rapid onset of action and faster drug release due to the smaller size than tablets and b) Pellets exhibit less residence time of acid-labile drugs in the stomach compared to tablets. Dosage form coat can be damaged by longer resistance time in the stomach. The present review summarizes the current state of enteric coated pellets where core pellets are prepared by extrusion-spheronization technique and the enteric coating is applied in a fluidized bed processor. Two approaches are involved in the preparation of core pellets. In the first approach, a mixture of drug and excipient(s)/co-processed excipient is passed through extruders to prepare core pellets. In the second approach, excipient core pellets are prepared by extrusion technique and the drug is layered onto it before the enteric coating. The excipients present in the core pellets decide immediate or extended release of drug in the intestine. The coprocessed excipient pellets provide less batch variability and provide a platform for layering of many drugs before enteric coating. Some patents included enteric coating pellets [CN105456223 (A), CN105596310 (A), CN105616371 (A), CN105663095 (A), CN101611766B, CN106511862 (A), CN106668018 (A), CN106727381 (A), CN106924222 (A), TW200624127 (A), US 2017/0165248A1, US 2017/0224720A1] are discussed.

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Symptom Cluster-Matching Antidepressant Treatment: A Case Series Pilot Study

Pharmaceuticals ◽

10.3390/ph14060526 ◽

2021 ◽

Vol 14 (6) ◽

pp. 526

Author(s):

Sławomir Murawiec ◽

Marek Krzystanek

Keyword(s):

Depressive Symptoms ◽

Pilot Study ◽

Antidepressant Treatment ◽

Case Series ◽

Symptom Cluster ◽

Study Results ◽

Cluster Matching ◽

The Individual ◽

Meta Analyses ◽

Effectiveness Studies

Despite treating depression with antidepressants, their effectiveness is often insufficient. Comparative effectiveness studies and meta-analyses show the effectiveness of antidepressants; however, they do not provide clear indications as to the choice of a specific antidepressant. The rational choice of antidepressants may be based on matching their mechanisms of action to the symptomatic profiles of depression, reflecting the heterogeneity of symptoms in different patients. The authors presented a series of cases of patients diagnosed with depression in whom at least one previous antidepressant treatment was shown to be ineffective before drug targeted symptom cluster-matching treatment (SCMT). The presented pilot study shows for the first time the effectiveness of SCMT in the different clusters of depressive symptoms. All the described patients obtained recovery from depressive symptoms after introducing drug-targeted SCMT. Once validated in clinical trials, SCMT might become an effective and rational method of selecting an antidepressant according to the individual profile of depressive symptoms, the mechanism of their formation, and the mechanism of drug action. Although the study results are preliminary, SCMT can be a way to personalize treatment, increasing the likelihood of improvement even in patients who meet criteria for treatment-resistant depression.

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Nasal Delivery of Acute Medications for Migraine: The Upper Versus Lower Nasal Space

Journal of Clinical Medicine ◽

10.3390/jcm10112468 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2468

Author(s):

Vincent Martin ◽

John Hoekman ◽

Sheena K. Aurora ◽

Stephen B. Shrewsbury

Keyword(s):

Acute Treatment ◽

Drug Efficacy ◽

Hepatic Metabolism ◽

Rapid Onset ◽

Systemic Circulation ◽

Nasal Delivery ◽

Attractive Alternative ◽

Gi Tract ◽

Onset Of Action ◽

First Pass

The acute treatment of migraine requires effective drugs that are well tolerated and provide rapid and consistent pain relief. Oral tablets are the most commonly used acute treatment for migraine; however, their effectiveness is limited by the rate of gastrointestinal (GI) tract absorption and first-pass hepatic metabolism, and they may not be ideal for patients experiencing GI motility issues. Nasal delivery is an attractive alternative route as it may circumvent GI tract absorption, avoid first-pass metabolism in the liver, and potentially reduce the frequency of GI adverse events. The large surface area and high vascularity within the nose may permit rapid absorption of therapeutics into the systemic circulation, allowing for rapid onset of action. However, the site of drug deposition (upper versus lower nasal cavity) may influence drug pharmacokinetics. Most approved nasal migraine therapies target the lower nasal space where the epithelium is less permeable, and they may be quickly cleared away due to increased ciliary function or dripping from the nose or swallowing, resulting in variable absorption and limited bioavailability. Together with its abundant vascularization, relative mucosal thickness stability, and low clearance rates, the upper nasal space harnesses the benefits of nasal delivery to potentially maximize drug efficacy.

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Erratum: Rapid onset of action with alfuzosin 10 mg once daily in men with benign prostatic hyperplasia: a randomized, placebo-controlled trial

Prostate Cancer and Prostatic Diseases ◽

10.1038/sj.pcan.4500981 ◽

2008 ◽

Vol 11 (2) ◽

pp. 209-209

Author(s):

M I Resnick ◽

C G Roehrborn

Keyword(s):

Benign Prostatic Hyperplasia ◽

Controlled Trial ◽

Rapid Onset ◽

Prostatic Hyperplasia ◽

Onset Of Action ◽

Once Daily

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Einsatz von Secukinumab bei Patienten mit Psoriasis und Psoriasis-Arthritis – Ergebnisse einer nichtinterventionellen Studie unter Praxisbedingungen (SERENA-Studie)

Karger Kompass Autoimmun ◽

10.1159/000518345 ◽

2021 ◽

pp. 1-3

Author(s):

Michael Sticherling

Keyword(s):

Observational Study ◽

Real World ◽

Human Monoclonal Antibody ◽

Rapid Onset ◽

Onset Of Action ◽

The Real ◽

Interleukin 17A ◽

Favourable Safety ◽

Favourable Safety Profile

Introduction: Secukinumab, a fully human monoclonal antibody that directly inhibits interleukin-17A, has demonstrated robust efficacy in the treatment of moderate to severe psoriasis (PsO), psoriatic arthritis (PsA) and ankylosing spondylitis (AS), with a rapid onset of action, sustained long-term clinical responses and a consistently favourable safety profile across phase 3 trials. Here, we report the clinical data at enrolment from SERENA, designed to investigate the real-world use of secukinumab across all three indications. Methods: SERENA is an ongoing, longitudinal, observational study conducted at 438 sites across Europe in patients with moderate to severe plaque PsO, active PsA or active AS. Patients should have received at least 16 weeks of secukinumab treatment before enrolment in the study. Results: Overall 2800 patients were included in the safety set; patients with PsA (N = 541) were older than patients with PsO (N = 1799) and patients with AS (N = 460); patients with PsO had a higher mean body weight than patients with PsA and patients with AS; and patients with PsO and patients with AS were predominantly male. Time since diagnosis was longer in patients with PsO compared with patients with PsA and patients with AS, and about 40% of patients were either current or former smokers. The proportion of obese patients (body mass index ≥ 30 kg/m2) was similar across indications. Patients were treated with secukinumab for a mean duration of 1 year prior to enrolment (range 0.89–1.04). The percentages of patients with prior biologics exposure were 31.5% PsO, 59.7% PsA and 55% AS. The percentages of patients prescribed secukinumab monotherapy were 75% (n = 1349) in PsO, 48.2% (n = 261) in PsA and 48.9% (n = 225) in AS groups. Conclusion: Baseline demographics of the study population are consistent with existing literature. This large observational study across all secukinumab indications will provide valuable information on the long-term effectiveness and safety of secukinumab in the real-world setting.

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