This review article aims to provide insight into the mechanisms of action, pharmacokinetics, clinical efficacy, safety and tolerability of four novel antidepressants including desvenlafaxine, vortioxetine, vilazodone, and levomilnacipran. Following keywords are used in PubMed and Scopus to search for relevant articles: (depression) AND (psychopharmacology OR desvenlafaxine OR levomilnacipran OR vortioxetine OR vilazodone). Patients with a lack of effectiveness or tolerability to certain antidepressants may get benefit from selecting a new antidepressant with different mechanism of action. These medications can be an option in the selection of newer antidepressants. Depression may not be caused by the simple deficiency of serotonin in the brain, but rather a complex interplay of various neurotransmitters including serotonin, norepinephrine, glutamate, and histamine at certain brain areas. The above-mentioned novel antidepressants exert their therapeutic benefits by acting on multiple neurotransmitters. The complexity of underlying the neurobiological mechanism should be considered while formulating a plan of care.
Pregabalin is used for the treatment of neuropathic pain, partial seizures, generalized anxiety disorder, social anxiety disorder, and insomnia. The discontinuation symptoms of pregabalin are mild to moderate which resolve in about one week after the discontinuation of pregabalin. This case report describes the withdrawal symptoms in a 62-year-old patient despite a slow titration over a period of several weeks. It highlights the importance of cautious monitoring of withdrawal symptoms during the period of taper.
Major depressive disorder (MDD) becomes difficult to treat when the patient has a comorbid personality disorder. For such patients, even a combination of psychotherapy and pharmacotherapy has been ineffective. Electroconvulsive therapy (ECT) has been the first line of therapy for the treatment-resistant depression. We used this mode of therapy for a patient who had MDD along with borderline personality disorder and had failed trials of multiple medications and psychotherapy. ECT was very successful in our patient.
Early recognition and treatment of posttraumatic stress disorder (PTSD) in youth are critical. This article provides a comprehensive overview of the up-to-date evidence for pharmacological options for children with PTSD. Eight electronic databases were searched and a manual search of the full text of included articles was performed. Two independent reviewers performed screening of the articles using the predetermined eligibility criteria. The data were extracted by two independent reviewers. The search generated 32 articles with a total patient population of 833. The pharmacological options were antidepressants, antipsychotics, mood stabilizers, alpha-adrenergic agents, beta-blockers, serotonin and histamine antagonists, and opioid agonists. The mood stabilizers and second-generation antipsychotics should be reserved for patients with significant safety concerns or aggressive behaviors because of their side-effect profile. Alpha-adrenergic agonists can be used in patients who are re-experiencing symptoms of PTSD and without safety concerns. [ Psychiatr Ann . 2020;50(5):209–228.]
Background: Carotid body paragangliomas are rare neuroendocrine neoplasms of chromaffin negative glomus cells. This case report explains an atypical case with unusual presentation and treatment. Case Report: A healthy smoker technician by profession was brought to the emergency room (ER) with coprolalia. The general physical exam did not reveal any information. His history revealed unilateral tinnitus and odynophagia leading to a consultation by the neurologist with head imaging. Acoustic neuroma was ruled out and the caregiver was asked to elaborate the events mentioned in the history and a psychiatric examination was done. The personality changes were evaluated by the psychiatrist that showed overlapping of delirium and depression. The patient was further examined by a vascular surgeon. After careful revisiting of the history, examination and indication of tender mass in the neck by the patient's vascular surgeon, the diagnosis of carotid body paraganglioma was made which was followed by surgical resection for treatment. Conclusion: Carotid Body Paragangliomas are very vascular structures and their manipulation in a surgery setting requires expertise. This case presented with personality changes and tinnitus, a very less likely event to occur in a carotid body tumor. The present care report, thus adds on to the literature of carotid body tumors and its presenting symptoms.
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