Sertraline Effects on Dyspnea in Patients With Obstructive Airways Disease

Smoller, Jordan W.; Pollack, Mark H.; Systrom, David; Kradin, Richard L.

doi:10.1016/s0033-3182(98)71377-5

Cited by 113 publications

(66 citation statements)

References 24 publications

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“…(33) In a previous study, (7) our group described the clinical features pulmonary membranes and are important in the maintenance of upper airway patency in obstructive sleep apnea. (23,24) Sertraline, a selective serotonin reuptake inhibitor, reduces dyspnea in patients with COPD, (25) and paroxetine relieves respiratory symptoms in patients with obstructive sleep apnea. (26) The endogenous opioid system has been recognized as an important regulator of the central respiratory drive.…”

Section: Hyperventilationmentioning

confidence: 99%

Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications

et al. 2009

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Multiple respiratory abnormalities can be found in anxiety disorders, especially in panic disorder (PD). Individuals with PD experience unexpected panic attacks, characterized by anxiety and fear, resulting in a number of autonomic and respiratory symptoms. Respiratory stimulation is a common event during panic attacks. The respiratory abnormality most often reported in PD patients is increased CO 2 sensitivity, which has given rise to the hypothesis of fundamental abnormalities in the physiological mechanisms that control breathing in PD. There is evidence that PD patients with dominant respiratory symptoms are more sensitive to respiratory tests than are those who do not manifest such symptoms, and that the former group constitutes a distinct subtype. Patients with PD tend to hyperventilate and to panic in response to respiratory stimulants such as CO 2 , triggering the activation of a hypersensitive fear network. Although respiratory physiology seems to remain normal in these subjects, recent evidence supports the idea that they present subclinical abnormalities in respiration and in other functions related to body homeostasis. The fear network, composed of the hippocampus, the medial prefrontal cortex, the amygdala and its brain stem projections, might be oversensitive in PD patients. This theory might explain why medication and cognitive-behavioral therapy are both clearly effective. Our aim was to review the relationship between respiration and PD, addressing the respiratory subtype of PD and the hyperventilation syndrome, with a focus on respiratory challenge tests, as well as on the current mechanistic concepts and the pharmacological implications of this relationship.Keywords: Panic disorder; Anxiety; Respiration; Hyperventilation; Carbon dioxide. ResumoMúltiplas anormalidades respiratórias podem ser encontradas em pacientes com transtornos de ansiedade, particularmente no transtorno de pânico (TP). Indivíduos com TP experimentam ataques de pânico inesperados, caracterizados por ansiedade, medo e diversos sintomas autonômicos e respiratórios. A estimulação respiratória é um fenômeno comum durante os ataques de pânico. A anormalidade respiratória mais citada em pacientes com TP é a sensibilidade aumentada para o CO 2 , que originou a hipótese de uma disfunção fundamental nos mecanismos fisiológicos de controle da respiração no TP. Há evidências de que pacientes com TP com sintomas respiratórios predominantes são mais sensíveis a testes respiratórios do que aqueles sem a manifestação de tais sintomas, representando um subtipo distinto. Pacientes com TP tendem a hiperventilar e a reagir com pânico como resposta a estimulantes respiratórios como o CO 2 , gerando uma ativação de um circuito de medo hipersensível. Apesar de a fisiologia respiratória desses pacientes permanecer normal, algumas evidências recentes apontam a presença de disfunções subclínicas na respiração e em outras funções relacionadas à homeostase corporal. O circuito do medo, composto pelo hipocampo, córtex pré-frontal medial, amígd...

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Section: Hyperventilationmentioning

confidence: 99%

Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications

et al. 2009

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“…Alguns estudos preliminares observaram que a sertralina (ISRS) foi útil no manejo da dispneia na doença pulmonar obstrutiva crônica e nos transtornos de ansiedade e do humor comórbidos 27,28 . Tem sido relatado que os níveis plasmáticos de serotonina livre estão aumentados em pacientes com asma sintomáticos 29,30 .…”

Section: Discussionunclassified

Medicação antipânico e função pulmonar em pacientes com transtorno de pânico

Nascimento¹,

de-Melo-Neto²,

Valença³

et al. 2009

Rev. psiquiatr. clín.

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ResumoContexto: Estudos sugerem uma associação entre transtorno de pânico (TP) e prejuízos na função pulmonar. Objetivos: Avaliar a função pulmonar em 11 pacientes com TP assintomáticos e investigar efeitos da medicação antipânico na função respiratória. Método: A função pulmonar foi avaliada em duas ocasiões diferentes (com medicação antipânico e após "washout"). Consistiu de uma avaliação espirométrica e do teste de broncodilatação (inalação de salbutamol). Subjective Units of Disturbance Scale (SUDS) foi aplicada antes e após cada teste espirométrico. Resultados: Um paciente apresentou obstrução leve de vias aéreas. Antes do teste de broncodilatação, o volume expiratório forçado no primeiro segundo (VEF 1 ) e o fluxo expiratório forçado entre 25% e 75% da capacidade vital forçada ) foram significativamente maiores em pacientes com medicação antipânico do que no período de "washout". Após a inalação de salbutamol, apenas o VEF 1 foi significativamente maior em pacientes com medicação antipânico em comparação ao outro grupo, embora tenha sido detectado aumento significativo em VEF 1 e FEF F em pacientes sem medicação antipânico depois da inalação de salbutamol. O nível de ansiedade subjetiva não foi diferente entre os pacientes em ambos os dias de testes. Conclusão: Os resultados sugerem uma possível ação benéfica da medicação antipânico na função pulmonar em pacientes com TP. Nascimento I, et al. / Rev Psiq Clín. 2009;36(4):123-9Palavras-chave: Função pulmonar, espirometria, respiração, salbutamol, transtorno de ansiedade. AbstractBackground: Studies suggest an association between panic disorder (PD) and impairment of lung function. Objectives: To evaluate lung function in 11 asymptomatic PD patients and to investigate antipanic drug effects on respiratory function. Method: Lung function was evaluated on two different occasions (with antipanic drugs and after drug washout). It was comprised of a spirometric evaluation and a bronchodilation test (salbutamol inhalation). Subjective Units of Disturbance Scale (SUDS) was applied before and after each spirometric assessment. Results: One patient showed mild obstructive airway impairment. Before bronchodilation test forced expiratory volume in 1 sec (FEV 1 ) and forced expiratory flow between 25% and 75% of the forced vital capacity (FEF 25-75 ) were significantly higher in patients on antipanic drugs than in those in the washout period. After salbutamol inhalation, only FEV 1 was significantly higher in patients with antipanic drugs in comparison to the other group, whereas a significant increase in

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“…Another reason may be side effects of antidepressant medications, although some work has suggested that certain antidepressants may actually help with dyspnea. 19 Physician concerns with use of antidepressants in depressed patients with COPD due to medication interactions or other such concerns may play a role, even though the evidence for use of antidepressants in chronic medical illnesses including COPD is favorable. 33 Comorbidity with anxiety and posttraumatic stress disorder was common in our study population, and this may also have played a role.…”

Section: Discussionmentioning

confidence: 99%

“…17 Antidepressants have also been shown to be effective for treating depression in patients with COPD. 18,19 Antidepressant prescribing is increasing in primary care, 20 and some antidepressant agents may even have effects beyond their primary indication, such as reducing symptoms of dyspnea in patients with COPD. 19 However, patients with COPD with depression may be more likely to have poor adherence to antidepressants, and this may be observed early in the course of treatment.…”

mentioning

confidence: 99%

“…18,19 Antidepressant prescribing is increasing in primary care, 20 and some antidepressant agents may even have effects beyond their primary indication, such as reducing symptoms of dyspnea in patients with COPD. 19 However, patients with COPD with depression may be more likely to have poor adherence to antidepressants, and this may be observed early in the course of treatment. A pharmacologic trial for depression in elderly patients with COPD found that 25% of these patients accepted treatment, and only 12% completed the trial.…”

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