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3 results

  • Are all antidepressants the same? The consumer has a point

  • Sebastian Camino, Sergio A. Strejilevich, Antonella Godoy, Jose Smith, Alejandro Szmulewicz
  • Journal:
    Psychological Medicine / Volume 53 / Issue 9 / July 2023
    Published online by Cambridge University Press:
    29 March 2022, pp. 4004-4011
    • Article
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  • Background

    Although a large variety of antidepressants agents (AD) with different mechanisms of action are available, no significant differences in efficacy and safety have been shown. However, there have been few attempts to incorporate data on subjective experiences under different AD.

    Method

    We conducted a qualitative and quantitative analysis of the posts from the website www.askapatient.com from different AD. We reviewed a random sample of 1000 posts.

    Result

    After applying the inclusion and exclusion criteria, we included a final sample of 450 posts, 50 on each of the most used AD: sertraline, citalopram, paroxetine, escitalopram, fluoxetine, venlafaxine, duloxetine, mirtazapine, and bupropion. Bupropion, citalopram, and venlafaxine had the higher overall satisfaction ratings. Sertraline, paroxetine, and fluoxetine had high reports of emotional blunting, while bupropion very few. Overall satisfaction with AD treatment was inversely associated with the presence of the following side-effects: suicidality, irritability, emotional blunting, cognitive disturbances, and withdrawal symptoms. After adjusting for confounders, only emotional blunting was shown to be more frequently reported by users of serotonergic agents, as compared to non-serotoninergic agents.

    Conclusion

    This research points out that the subjective experience of patients under treatment should be taken into consideration when selecting an AD as differences between agents were evident. In contrast to the more frequent treatment decisions, users might prefer receiving a non-serotoninergic agent over a serotonergic one due to their lower propensity to produce emotional blunting.

  • Case 32 - Violent tongue biting recurring during sleep

  • from Part VII - Sleep-related movement disorders
  • Edited by Antonio Culebras
  • Book:
    Case Studies in Sleep Neurology
    Published online:
    10 November 2010
    Print publication:
    23 September 2010, pp 227-233

  • Summary

    This chapter discusses the case of a 43-year-old male having problems with his nocturnal sleep at the age of 23 when he started to present recurrent nocturnal awakenings from sleep associated with involuntary eating. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. Actigraphic recordings for 2 weeks disclosed persistent muscular activity during the nocturnal period and two to five episodes per night of further enhanced muscular activity that corresponded to the eating episodes noted by the patient in his diary. The sleep medicine specialist established a diagnosis of sleep-related eating disorder (SRED) based on the clinical history and on the results of the video-polysomnography (PSG) recording. Low-dosage dopaminergic agents such as levodopa/carbidopa at bedtime, sometimes combined with codeine and/or clonazepam, bromocriptine and pramipexole, have been shown to reduce the eating episodes.

  • 7 - Restless legs syndrome and periodic limb movement disorder

  • from SECTION 2 - SLEEP DISORDERS
  • Edited by Harold R. Smith, University of California, Irvine, Cynthia L. Comella, Birgit Högl
  • Book:
    Sleep Medicine
    Published online:
    08 August 2009
    Print publication:
    10 April 2008, pp 113-128

  • Summary

    The most characteristic features of the restless legs syndrome (RLS) are uncomfortable sensations in one or more usually lower limbs, associated with an urge to move the affected limbs. Those sensations vary widely in severity from merely annoying to significantly unpleasant. Periodic limb movements disorder (PLMD) can only be diagnosed when a polysomnographic recording has been performed. In the past few decades neuroimaging, neurophysiological, and pharmacological studies have contributed to the development of a variety of hypotheses on the pathogenesis of the disorder. The usually immediate and striking efficacy of treatment with dopaminergic agents, and the observation that dopamine receptor antagonism can clinically worsen RLS symptoms, indicates a central role of the dopaminergic system in RLS pathophysiology. Peripheral polyneuropathy, which, similar to RLS, often causes paresthesias and pain in the limbs and tends to worsen at night, is probably the most common differential diagnosis.