Selective serotonin re-uptake inhibitors beyond psychiatry: Are they useful in the treatment of severe, chronic, obstructive pulmonary disease?

Perna, Giampaolo; R, Cogo; Bellodi, Laura

doi:10.1002/da.20041

Cited by 18 publications

(17 citation statements)

References 6 publications

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“…These observations are supported by work by Smoller et al 27 who reported a decrease in breathlessness and a subjective improvement in exercise tolerance in a case series of seven people treated with sertraline 25–100 mg daily, three of whom met Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria for mood or anxiety disorders on structured clinical interview. Similar effects were found by Perna et al 26 in a small study looking at the use of citalopram for relief of breathlessness in six people, none of whom had a history of mood or anxiety disorders by DSM-IV criteria, reporting decreased breathing discomfort. Additionally, some studies which have investigated the use of SSRIs to manage anxiety and depression in the COPD population report that breathlessness scores are improved by the concomitant administration of these medications 28…”

Section: Introductionsupporting

confidence: 83%

“…Sertraline is a selective serotonin reuptake inhibitor (SSRI) used widely as an antidepressant and in generalised anxiety disorders. A previously published literature review20 identified two non-randomised pilot studies25 26 and a case series27 that report symptomatic benefit from SSRIs when used to manage chronic breathlessness in patients with chronic obstructive pulmonary disease (COPD). Papp et al 25 report a subjective improvement in well-being in six people with COPD, three of whom had a diagnosis of either phobia or panic disorder by standard psychiatric interview.…”

Section: Introductionmentioning

confidence: 99%

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Study protocol: a phase III randomised, double-blind, parallel arm, stratified, block randomised, placebo-controlled trial investigating the clinical effect and cost-effectiveness of sertraline for the palliative relief of breathlessness in people with chronic breathlessness

et al. 2016

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IntroductionBreathlessness remains a highly prevalent and distressing symptom for many patients with progressive life-limiting illnesses. Evidence-based interventions for chronic breathlessness are limited, and there is an ongoing need for high-quality research into developing management strategies for optimal palliation of this complex symptom. Previous studies have suggested that selective serotonin reuptake inhibitors such as sertraline may have a role in reducing breathlessness. This paper presents the protocol for a large, adequately powered randomised study evaluating the use of sertraline for chronic breathlessness in people with progressive life-limiting illnesses.Methods and analysisA total of 240 participants with modified Medical Research Council Dyspnoea Scale breathlessness of level 2 or higher will be randomised to receive either sertraline or placebo for 28 days in this multisite, double-blind study. The dose will be titrated up every 3 days to a maximum of 100 mg daily. The primary outcome will be to compare the efficacy of sertraline with placebo in relieving the intensity of worst breathlessness as assessed by a 0–100 mm Visual Analogue Scale. A number of other outcome measures and descriptors of breathlessness as well as caregiver assessments will also be recorded to ensure adequate analysis of participant breathlessness and to allow an economic analysis to be performed. Participants will also be given the option of continuing blinded treatment until either study data collection is complete or net benefit ceases. Appropriate statistical analysis of primary and secondary outcomes will be used to describe the wealth of data obtained.Ethics and disseminationEthics approval was obtained at all participating sites. Results of the study will be submitted for publication in peer-reviewed journals and the key findings presented at national and international conferences.Trial registration numberACTRN12610000464066.

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Section: Introductionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Study protocol: a phase III randomised, double-blind, parallel arm, stratified, block randomised, placebo-controlled trial investigating the clinical effect and cost-effectiveness of sertraline for the palliative relief of breathlessness in people with chronic breathlessness

et al. 2016

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“…Paroxetine decreases respiratory irregularity in patients with PD 95 . Respiratory function (forced expiratory volume in 1 second [FEV1], oxygen partial pressure [PaO 2 ], and PaCO 2 ) and dyspnea improve in patients with chronic obstructive pulmonary disease treated with citalopram 96 or sertraline 97 as well as in patients with PD treated with antipanic medications 98 . Paroxetine may be useful in the treatment of obstructive sleep apnea 99 .…”

Section: Are Successful Treatments Of Panic Disorder Specifically Actmentioning

confidence: 99%

Is panic disorder a disorder of physical fitness? A heuristic proposal

Perna

Caldirola²

2018

F1000Res

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Currently, panic disorder (PD) is considered a mental disorder based on the assumptions that panic attacks (PAs) are “false alarms” that arise from abnormally sensitive defense systems in the central nervous system and that PD is treated with therapies specifically acting on anxiety or fear mechanisms. This article aims to propose an alternative perspective based on the results of some experimental studies. Our heuristic proposal suggests not only that PD may be a mental disorder but also that patients with PD have real abnormal body functioning, mainly involving cardiorespiratory and balance systems, leading to a decline in global physical fitness. PAs, as well as physical symptoms or discomfort in some environmental situations, may be “real alarms” signaling that the adaptability resources of an organism are insufficient to respond appropriately to some internal or external changes, thus representing the transient conscious awareness of an imbalance in body functioning. The antipanic properties of several modern treatments for PD may include their beneficial effects on body functions. Although anxiety or fear mechanisms are evidently involved in PD, we hypothesize that a reduction of physical fitness is the “primum movens” of PD, while anxiety or fear is induced and sustained by repeated signals of impaired body functioning. We propose considering panic in a broader perspective that offers a central role to the body and to contemplate the possible role of somatic treatments in PD.

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“…Participants completed the CRQ -Dyspnea Subscale (CRQ) [22], participant and carer quality of life questionnaires (EORTC-QLQ-C15-Pal [23] and CQOLC [24]), HADS [20] and descriptors of breathlessness [25]. Participants completed a diary twice daily (days 0, 7,14,21,26,27,28) to record current breathlessness intensity, unpleasantness, and worst breathlessness on a 0-100 mm VAS and a 4-point Likert scale, and the modified Medical Research Council (mMRC) (Appendix 1) breathlessness scale [17]. Optionally, participants could remain on blinded treatment for an additional five months (six months treatment in total).…”

Section: Controlmentioning

confidence: 99%

“…Sertraline, an SSRI, shows potential benefit for chronic breathlessness, is well tolerated [11] and used first-line as an anti-depressant. Two non-randomised pilot studies and a case series have reported benefits of sertraline 12•5mg-100 mg in people with chronic breathlessness due to optimally treated chronic obstructive pulmonary disease (COPD) [12][13][14]. Another study enrolled people with COPD and depression for up to 19 weeks of treatment with paroxetine (another SSRI) in a small double blind study.…”

Section: Introductionmentioning

confidence: 99%

Sertraline in symptomatic chronic breathlessness: a double blind, randomised trial

Currow¹,

Louw²,

Hill³

et al. 2018

Rehabilitation and Chronic Care

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Selective serotonin re-uptake inhibitors beyond psychiatry: Are they useful in the treatment of severe, chronic, obstructive pulmonary disease?

Cited by 18 publications

References 6 publications

Study protocol: a phase III randomised, double-blind, parallel arm, stratified, block randomised, placebo-controlled trial investigating the clinical effect and cost-effectiveness of sertraline for the palliative relief of breathlessness in people with chronic breathlessness

Study protocol: a phase III randomised, double-blind, parallel arm, stratified, block randomised, placebo-controlled trial investigating the clinical effect and cost-effectiveness of sertraline for the palliative relief of breathlessness in people with chronic breathlessness

Is panic disorder a disorder of physical fitness? A heuristic proposal

Sertraline in symptomatic chronic breathlessness: a double blind, randomised trial

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