Abstract:Late-life major depression is a high-incidence and difficult-to-treat affective disorder. Diagnosis of major depression in old age could also could be a challenge, due to aspects like (1) there is a higher vulnerability to the stigma of depression in this population, (2) hypochondriac ideation and somatic symptoms are the main symptoms, while depressive disposition or anhedonia are under-reported by such patients, (3) differential diagnosis includes various organic diseases, but also severa… Show more
“…The vast majority of the existing antipsychotics are associated with adverse metabolic effects, and switching from the currently administered agent to a metabolically more favourable one is not always possible or even recommended ( 19 ). In addition, monotherapy is rarely used in clinical practice in patients with severe mental disorders, and other pharmacological agents (mood stabilizers, antidepressants and sedatives) used as add-ons may further complicate the adverse events profile ( 20 ).…”
Section: Metabolic Dysfunctions In Patients Undergoing Antipsychotic ...mentioning
Metabolic dysfunctions have been reported in patients diagnosed with severe mental illnesses who are undergoing treatment with antipsychotics, especially second-generation agents. Sodium-glucose co-transporter 2 inhibitors (SGLT2Is) and glucagon-like peptide receptor agonists are new-generation antidiabetics whose favourable effects in the treatment of diabetes mellitus in the non-psychiatric population may raise interest in their use in patients presenting with severe mental illnesses and metabolic comorbidities possibly related to the use of antipsychotics. The objectives of this review were to investigate the evidence to support the use of SGLT2Is in this population and to find the most important aspects that need to be addressed by future research. A total of one preclinical trial, two guideline-format clinical recommendations, one systematic review and one case report were found, and their conclusions were analysed. The results support the following conclusions: i) SGLT2Is may be combined with metformin in selected cases of type 2 diabetes mellitus in the context of antipsychotic treatment, as they have been associated with favourable metabolic effects; and ii) data for the recommendation of SGLT2Is as second-line treatment in patients with diabetes mellitus who are also treated with olanzapine or clozapine are supported by very limited preclinical and clinical evidence. Further high-quality, large-scale research is needed in the field of the management of metabolic dysfunctions in patients with severe psychiatric illnesses who undergo treatment with second-generation antipsychotics.
Contents1. Metabolic dysfunctions in patients undergoing antipsychotic treatment: General considerations 2. Objectives and methods of the review 3. Results
Conclusions and clinical observations
“…The vast majority of the existing antipsychotics are associated with adverse metabolic effects, and switching from the currently administered agent to a metabolically more favourable one is not always possible or even recommended ( 19 ). In addition, monotherapy is rarely used in clinical practice in patients with severe mental disorders, and other pharmacological agents (mood stabilizers, antidepressants and sedatives) used as add-ons may further complicate the adverse events profile ( 20 ).…”
Section: Metabolic Dysfunctions In Patients Undergoing Antipsychotic ...mentioning
Metabolic dysfunctions have been reported in patients diagnosed with severe mental illnesses who are undergoing treatment with antipsychotics, especially second-generation agents. Sodium-glucose co-transporter 2 inhibitors (SGLT2Is) and glucagon-like peptide receptor agonists are new-generation antidiabetics whose favourable effects in the treatment of diabetes mellitus in the non-psychiatric population may raise interest in their use in patients presenting with severe mental illnesses and metabolic comorbidities possibly related to the use of antipsychotics. The objectives of this review were to investigate the evidence to support the use of SGLT2Is in this population and to find the most important aspects that need to be addressed by future research. A total of one preclinical trial, two guideline-format clinical recommendations, one systematic review and one case report were found, and their conclusions were analysed. The results support the following conclusions: i) SGLT2Is may be combined with metformin in selected cases of type 2 diabetes mellitus in the context of antipsychotic treatment, as they have been associated with favourable metabolic effects; and ii) data for the recommendation of SGLT2Is as second-line treatment in patients with diabetes mellitus who are also treated with olanzapine or clozapine are supported by very limited preclinical and clinical evidence. Further high-quality, large-scale research is needed in the field of the management of metabolic dysfunctions in patients with severe psychiatric illnesses who undergo treatment with second-generation antipsychotics.
Contents1. Metabolic dysfunctions in patients undergoing antipsychotic treatment: General considerations 2. Objectives and methods of the review 3. Results
Conclusions and clinical observations
“…Diana Vetter 1 , Nicolas Salvetat 1 , Francisco Checa Robles 1 , Christopher Cayzac 1 , Jacques Dainat 1 , Benjamin Dubuc 1 , Aurélie Delacretaz 2 , Vincent Masetti 2 , Franziska Gamma 2 , Jean-Philippe Lang 3 , Dinah Weissman 1,* 1 ALCEDIAG, 2 Les Toises, 3 Les Toises, ALCEDIAG Introduction: In clinical practice, differentiating bipolar disorder (BD) from unipolar depression is challenging due to the depressive symptoms, which are the core presentations of both disorders.…”
Section: Mdd From Bipolar Depression In Patientsmentioning
confidence: 99%
“…Yuichi Esaki 1,* , Kenji Obayashi 2 , Keigo Saeki 2 , Kiyoshi Fujita 1 , Nakao Iwata 3 , Tsuyoshi Kitajima 3 1 Okehazama Hospital, 2 Nara Medical University School of Medicine, 3 Fujita Health University School of Medicine Introduction: A previous cross-sectional study reported that nighttime light is associated with increased occurrence of manic symptoms in bipolar disorder; however, the longitudinal association between nighttime light and subsequent mood episode relapses remains unclear. We determined whether bedroom nighttime light was associated with mood episode relapses in patients with bipolar disorder.…”
Section: P59 | Effect Of Nighttime Bedroom Light Exposure On Mood Epi...mentioning
“…Combining multiple antidepressants or adding different agents to the ongoing antidepressant in order to improve its efficacy or to speed its onset is not without risks, and adverse events might appear more often in these patients, especially in vulnerable populations (i.e., patients with late-life depression, multiple somatic or psychiatric comorbidities, etc.) [ 3 , 4 , 5 , 6 , 7 ]. The risk of negative pharmacokinetic and pharmacodynamic interactions also needs to be considered when multiple medications are concomitantly administered in patients with MDD, potentially triggering more frequent treatment tolerability and tolerance problems than in the case of monotherapy [ 5 , 8 , 9 , 10 ].…”
The estimated rate of treatment-resistant major depressive disorder (TRD) remains higher than 30%, even after the discovery of multiple classes of antidepressants in the last 7 decades. Toludesvenlafaxine (ansofaxine, LY03005, or LPM570065) is a first-in-class triple monoaminergic reuptake inhibitor (TRI) that has reached clinical use. The objective of this narrative review was to summarize clinical and preclinical evidence about the efficacy, tolerability, and safety of toludesvenlafaxine. Based on the results of 17 reports retrieved in the literature, the safety and tolerability profiles of toludesvenlafaxine were good in all clinical trials, and the pharmacokinetic parameters were well described in the phase 1 trials. The efficacy of toludesvenlafaxine was demonstrated in one phase 2 and one phase 3 trial, both on primary and secondary outcomes. In conclusion, this review highlights the favorable clinical results of toludesvenlafaxine in only two short-term trials that enrolled patients with major depressive disorder (MDD) (efficacy and tolerability were good for up to eight weeks), indicating the need for more good quality, larger-sample, and longer-term trials. Exploring new antidepressants, such as TRI, can be considered a priority for clinical research due to the high rates of TRD, but also due to the significant percentages of relapse in patients with MDD.
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