Pharmacotherapy of fibromyalgia – current knowledge

Ból ◽  
2021 ◽  
Vol 22 (1) ◽  
pp. 36-45
Author(s):  
Anna Julia Krupa ◽  
Krzysztof Wojtasik Bakalarz ◽  
Jarosław Woroń ◽  
Marcin Siwek ◽  
Jerzy Wordliczek
Keyword(s):  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Current Knowledge ◽  
Pain Syndrome ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Beneficial Effects ◽  
Knowledge Based ◽  
Inflammatory Drugs ◽  
Underlying Pathophysiology

Fibromyalgia is a chronic pain syndrome, which affects 2–4% of the general population. Despite its substantial prevalence in the community, the underlying pathophysiology of fibromyalgia remains largely unknown, and the diagnosis is made using symptom-based criteria. As a result, patients may be classified as suffering from fibromyalgia in spite of differing in the pathogenesis of their complaints. Therefore it is no surprise, that the efficacy of pharmacotherapy of fibromyalgia remains limited. This work aims to provide a summary of current knowledge based on trials which assessed the efficacy of fibromyalgia pharmacotherapy. The drugs with the highest amount of research proving their efficacy in reducing fibromyalgia symptoms are duloxetine, milnacipran, pregabalin and amitriptyline. Studies documenting the efficacy of venlafaxine, gabapentin and antidepressants other than serotonin and noradrenalin reuptake inhibitors are smaller in number. Data obtained in trials verifying the effects of selective serotonin reuptake inhibitors, tramadol or cannabinoids are too sparse to draw any clear conclusions. There are reports indicating that opioids (other than tramadol) are contradicted in fibromyalgia, the use of selective serotonin reuptake inhibitors seems disputable too, due to the risk of inducing a change in the pain phenotype. There is a lack of data suggesting the efficacy of nonsteroid anti-inflammatory drugs in fibromyalgia. Furthermore, there are individual studies showing beneficial effects of other drugs and dietary supplements or combinations thereof in patients with fibromyalgia. In summary, the obtained data show that the amount of medicines whose efficacy in fibromyalgia has been verified in numerous studies is limited. More studies exploring the pathophysiology of fibromyalgia and trials verifying the effects of pharmacotherapy are needed to achieve the optimal efficacy of fibromyalgia pharmacotherapy.

scholarly journals Great boast, small roast on effects of selective serotonin reuptake inhibitors: response to a critique of our systematic review

2018 ◽  
Vol 30 (5) ◽  
pp. 251-265 ◽  
Author(s):  
Kiran Kumar Katakam ◽  
Naqash Javaid Sethi ◽  
Janus Christian Jakobsen ◽  
Christian Gluud
Keyword(s):  
Systematic Review ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Rating Scale ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Serious Adverse Events ◽  
Hamilton Depression Rating Scale ◽  
Beneficial Effects ◽  
Post Hoc

Our systematic review inBMC Psychiatryconcluded that selective serotonin reuptake inhibitors (SSRIs) compared with placebo significantly increase the risk of serious adverse events (SAEs) in patients with major depression and the potential beneficial effects of SSRIs seem to be outweighed by the harms. Hieronymus et al. accused us of methodological inaccuracies and blatant errors. In theirpost-hocanalysis of our data, they reported that SSRIs only increase the risk of SAEs in elderly and seems safe for non-elderly patients. They also found our review misleading because our efficacy analyses were based on the 17-item Hamilton Depression Rating Scale; we included suboptimal SSRI doses; and we missed some ‘pivotal trials’. We do not agree with Hieronymus et al. regarding several of the ‘errors’ they claim that we have made. However, we acknowledge that they have identified minor errors and that we missed some trials. After rectifying the errors and inclusion of the missed trials by us and Hieronymus et al., we re-analysed the data. The updated analyses are even more robust and confirm our earlier conclusions. SSRIs significantly increase the risk of an SAE both in non-elderly (p=0.045) and elderly (p=0.01) patients [overall odds ratio 1.39; 95% confidence interval (CI) 1.13 to 1.73;p=0.002; I2=0%]. Moreover, SSRIs did not change noticeably the 17-item Hamilton Depression Rating Scale, the internationally accepted scale (mean difference −2.02 points; 95% CI −2.38 to −1.66;p<0.00001). We found no differential effect of dose (p=0.20).

Hyponatremia associated with selective serotonin-reuptake inhibitors

2017 ◽  
Vol 41 (S1) ◽  
pp. S758-S758
Author(s):  
S. Petrykiv ◽  
L. De Jonge ◽  
M. Arts
Keyword(s):  
Risk Factors ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Current Knowledge ◽  
Case Reports ◽  
Serotonin Reuptake Inhibitors ◽  
Older Age ◽  
Selective Serotonin ◽  
Cochrane Library ◽  
Baseline Serum

IntroductionPsychotropic agents have been implicated in the cause of hyponatremia, including the majority of selective serotonin reuptake inhibitors (SSRIs). The reported incidence of hyponatremia caused by SSRIs varies widely up to 40%. Important risk factors are older age and concomitant use of diuretics. Though there are numerous retrospective studies available, an update of current knowledge SSRI induced hyponatremia is warranted.Objectives and aimsTo review the incidence, risk factors, mechanism, times of onset and resolution, and treatment of hyponatremia associated with selective serotonin-reuptake inhibitors (SSRIs).MethodsAn English language literature search was conducted using Pubmed, EMBASE and Cochrane library (December 1980–December 2015) using the search terms selective serotonin-reuptake inhibitor, hyponatremia, syndrome of inappropriate secretion of antidiuretic hormone, citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline.ResultsNumerous case reports, observational studies, and case-controlled studies, as well as one prospective clinical trial, have reported hyponatremia associated with SSRI use, with an incidence of 15%. Risk factors for the development of hyponatremia with SSRIs include older age, female gender, and concomitant use of diuretics, low body weight, and lower baseline serum sodium concentration. Predisposing factors, such as volume status, diuretic use, or concomitant use of other agents known to cause SIADH, may predispose to the development of hyponatremia. In published reports, hyponatremia developed within the first few weeks of treatment and resolved within 2 weeks after therapy was discontinued.ConclusionPractitioners should be on the alert for this potentially life-threatening adverse event, especially in older adults.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals To Evaluate Synergetic Potential of Piperine with Citalopram on Chronic Unpredictable Mild Stress- Induced Depression in Wistar Rats

2019 ◽  
Vol 4 (04) ◽  
pp. 58-62
Author(s):  
Katta Sunand ◽  
Lankadasari Divya Shree ◽  
Matla Harika ◽  
Meesala Basanti ◽  
Merugu Manisha ◽  
...  
Keyword(s):  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Forced Swim Test ◽  
Synergetic Effect ◽  
Tail Suspension Test ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Mild Stress ◽  
Beneficial Effects ◽  
State Of Mind

Depression is a neurological and mood disorder identified by a discouraged state of mind and low confidence, influencing the cognitive and social wellness of an individual. An imbalance in the monoamine neurotransmit¬ters leads to depression. Selective serotonin reuptake inhibitors drugs are the generally recommended anti-depressants as they enhance the levels of serotonin in the brain. The efficiency of selective serotonin reuptake inhibitors (SSRIs) in mild or moderate cases of depression has been disputed. In this study, co-administration of piperine, along with citalopram, was evaluated. Citalopram, in combination with piperine, possesses effective potency to improve the behavioral imperfections through forced swim test (FST), tail suspension test (TST), and acto-photometer behavioral tests. Thus, the results revealed that a combination of piperine with citalopram has excellent beneficial effects than an individual in the treatment of depression. This synergetic effect of piperine with citalopram may attribute to their inhibitory activity of the CYP450 enzymes.

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