Evidence Needed for Efficacy of Antidepressant Medications Among Patients With Rheumatoid Arthritis

Patients with rheumatoid arthritis (RA) experience pain from inflammation, joint destruction, and neuropathy. Antidepressants may play a role among patients with RA and depression, fibromyalgia, or neuropathy to achieve desired outcomes. This commentary evaluated evidence for medications individually and identified important variables for future research. While we await the results of well-designed studies, a trial of duloxetine or milnacipran may be considered for patients with remnant pain and RA remission. Research is needed to evaluate the efficacy and safety of serotonin–norepinephrine reuptake inhibitors and tricyclic antidepressants in patients with RA and associated comorbid conditions.

Decreased mobility, lack of social support, haemosiderosis and use of antidepressant medications may predict recurrent venous leg ulcers within 12 months of healing: A prospective longitudinal study

Aim To identify clinical, medical and psychosocial predictors of venous leg ulcer recurrence within 12 months of healing. Methods A multi-site study was conducted in Australia in community and hospital outpatient settings. Adults with venous leg ulcers were recruited within 4 weeks of healing and data were collected on preventative treatments and health, medical, clinical and psychosocial factors. Follow-up data on recurrences were collected every 3 months until ulcer recurrence, or until 12 months after healing pending which occurred first. Factors associated with time to recurrence were analysed using a Cox proportional hazards regression model. Design Secondary data analysis of a multi-site, prospective longitudinal study to validate a risk assessment tool for recurrence. Results A sample of 143 participants was recruited (51% male, M age = 73 years, SD 13.6). Almost half (49.6%) had an ulcer recurrence within 12 months, with a mean time to ulcer recurrence of 37 weeks ( SE 1.63, 95% CI 33.7–40.1). Factors measured at the time of healing that were significant independent predictors of recurrence were: prescribed antidepressant medications ( p = .035), presence of haemosiderosis ( p = .006), decreased mobility (longer sitting times) ( p = .007) and lower social support scale scores ( p = .002). Participants who wore compression systems providing 20 mmHg or higher for at least 5 days/week were less likely to recur, although not reaching statistical significance ( p = .06). Conclusion Results provide evidence that antidepressant medications, haemosiderosis, decreased mobility and lack of social support are risk factors associated with ulcer recurrence; therefore, these variables are modifiable and could guide early intervention.

Metabolic and Anti-Inflammatory Effects of Antidepressants in Patients Diagnosed with Major Depressive Disorder: A Prospective Cohort Study

Introduction: There is growing evidence showing a correlation between major depression disorder (MDD), metabolic syndrome and inflammation. To examine the influence of antidepressant medications on the metabolic, inflammatory profiles, oxidative stress and endothelial derangement of patients suffering from MDD. Results Depressive patients displayed significantly higher serum triglycerides than control group, which increased significantly during eight weeks of antidepressive treatment. In the patients' group, serum levels of ALT and AST increased significantly during treatment. Serum peroxide level was significantly higher in patients before and during treatment vs. controls and decreased significantly in the patients' group during treatment. Macrophage chemoattractant protein-1 and hs-CRP serum levels were higher in patients before treatment as compared with controls. The percentage of gated IgM CD19+ and CD14+ cells in depressive patients before treatment was significantly higher than in the control group. The percentage of T regulatory cells increased significantly during antidepressive treatment. Discussion MDD patients had increased oxidative stress, inflammatory responses, metabolic derangements and endothelial injury. Antidepressant medications increased the percentage of T regulatory cells. Methods Twenty-nine patients aged 22-58 who were diagnosed with MDD but not medicated, were selected for the study. During the 8-week duration of the research, patients received anti-depressant medication.

Frequency and Predictors of Potential Drug Interactions among Psychiatry Outpatients on Treatment with Antidepressant Medications

Antidepressant medications are prescribed to treat depression and related psychiatric illnesses. In patients with depression, many categories of drugs are prescribed to treat clinical conditions and comorbidities. Hence, it is essential to screen such patients for potential drug interactions. The study aimed to assess the frequency of potential drug interactions (pDDIs) associated with antidepressant medications administered to the outpatients of the psychiatry department. This cross-sectional investigation was conducted in a psychiatry outpatient setting. Patients satisfying inclusion criteria were screened for pDDIs by reviewing the patients’ electronic case records. All the identified pDDIs were further evaluated using Micromedex database 2.0.A total of 131 eligible patients’ case records were reviewed. The frequency of pDDIs between antidepressants and other psychotropic medications, antidepressants and non-psychotropic medications, antidepressants,tobacco, antidepressants, and ethanol was 48.1%,9.2%, 7.6%, and 3.8%, respectively. Use of more than three medications [RR: 1.5; CI: 1.1-2.1], presence of total [RR: 7.9; CI: 1.1-52.5] as well as psychiatric polypharmacy [RR: 4.8; CI: 1.3-17.9] were identified as predisposing factors of pDDIs.The results of the multiple regression indicated that the model was a significant predictor of pDDIs (F[3, 127]= 6.368, p<0.01, R2 = 0.13). In comparison,psychiatric polypharmacy was the only variable contributing significantly to the model (B = -0.423, p<.05). Nearly fifty percent of patients taking antidepressant medications were found to have the potential for developing drug interactions. Review of treatment charts for psychotropic, non-psychotropic, and non-prescription medications, along with different medical conditions that patients suffer from and the social habits of patients,is essential to identify and resolve potential drug interactions in at-risk patients.

Improvement of Depression in a Patient with Hypothyroidism and Deiodinase Polymorphism with LT3 Therapy

We report a 54-year-old man with treatment-resistant depression (TRD) and hypothyroidism who responded to LT3/LT4 combination, rather than LT4 alone. He was able to discontinue all antidepressant medications eventually. Interestingly, the patient has a DIO2 polymorphism.