What Is New about New Antidepressants?

Dubovsky, Steven

doi:10.1159/000488945

Cited by 35 publications

(26 citation statements)

References 82 publications

(99 reference statements)

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“…The conceptual flaws and the spurious results of the literature have yielded two detrimental clinical consequences. One is the development of drugs geared to treatment resistance, such as ketamine/esketamine [25], which would not survive the test of a classic RCT in depression. The second consequence has been the assumption that treatment with whatever antidepressant is right in the first place, and failure to respond is entirely shifted (and implicitly blamed) upon patients' characteristics.…”

Section: The Wreck Of Depression Managementmentioning

confidence: 99%

The Deceptive Manifestations of Treatment Resistance in Depression: A New Look at the Problem

Fava

Cosci

Guidi

et al. 2020

Psychother Psychosom

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Section: The Wreck Of Depression Managementmentioning

confidence: 99%

The Deceptive Manifestations of Treatment Resistance in Depression: A New Look at the Problem

Fava

Cosci

Guidi

et al. 2020

Psychother Psychosom

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“…Although the available antidepressants are effective and most of them target the monoamine and serotonin pathways, > 30% of patients fail to recover [3]. Consequently, there is a great demand to introduce novel adjunctive approaches for MDD treatment [4].…”

Section: Introductionmentioning

confidence: 99%

The Phosphodiesterase Inhibitor Pentoxifylline as a Novel Adjunct to Antidepressants in Major Depressive Disorder Patients: A Proof-of-Concept, Randomized, Double-Blind, Placebo-Controlled Trial

El-Haggar

Eissa

Mostafa

et al. 2018

Psychother Psychosom

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Background: There is evidence for an association between major depressive disorder (MDD) and both inflammatory and phosphodiesterase (PDE) pathways. This study aimed to evaluate the adjunct role of the PDE inhibitor pentoxifylline (PTX), a compound with anti-inflammatory properties, in the treatment of adult patients with MDD. Methods: This was a prospective, 12-week, double-blind study of parallel groups. Eighty adult outpatients who met the DSM-IV criteria for MDD participated in the trial. Patients were required to have a baseline Hamilton Rating Scale for Depression (HAM-D) score of at least 18. Patients were allocated randomly: 40 received escitalopram 20 mg/day plus placebo while the other 40 received escitalopram 20 mg/day plus PTX (400 mg b.i.d.). Patients were assessed by a psychiatrist at baseline, and 4, 8, and 12 weeks after the medication had been started. The serum levels of TNF-α, IL-6, IL-10, BDNF, 8-OHdG, and serotonin were measured at baseline and after therapy. Results: After 8 and 12 weeks, the PTX group showed a statistically significantly greater improvement in HAM-D score compared to the control group (least squares mean difference [LSMD] –3.29, p = 0.000 and LSMD –3.49, p = 0.000, respectively). Moreover, the PTX group showed a statistically significantly greater reduction in the serum levels of TNF-α, IL-6, IL-10, and 8-OHdG along with a statistically significant increase in the levels of BDNF and serotonin in comparison with the control group after the treatment. Conclusion: The findings of this study suggest that PTX could be a promising adjunct to antidepressants in the treatment of MDD patients.

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“…However, neither the pathophysiology of obsessive-compulsive disorders nor the neurobiological mechanisms related to discontinuation of antidepressants/antidepressant withdrawal are currently sufficiently understood; neuronal processes etiologically involved in obsessive-compulsive disorders may not be relevant in drug-related obsessive-compulsive symptoms, particularly antidepressant withdrawal. Moreover, the serotonergic hypothesis regarding the mechanism of action of antidepressants was questioned (23). Therefore, a further discussion of potential pathophysiologic mechanisms related to the reported drug-related phenomenon is too speculative, and further research is necessary in this field.…”

Section: Discussionmentioning

confidence: 99%

Development of Obsessive-Compulsive Symptoms Following Abrupt Discontinuation of Venlafaxine

2020

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Withdrawal symptoms after discontinuation of antidepressants are common and have long been known. Typical symptoms after dose reduction or discontinuation of antidepressants are dizziness, drowsiness, headache, flu-like symptoms, hyperarousal, imbalance, insomnia, irritability, and nausea. Rebound, relapse, or recurrence associated with the underlying mental disorder may also occur. The occurrence of obsessivecompulsive symptoms (OCS) following abrupt discontinuation of antidepressants have not yet been reported. Here we report the development of OCS (obsessional suicidal thoughts) in a patient with major depressive disorder and absence of a previous obsessive-compulsive disorder following abrupt discontinuation of venlafaxine. Treatment with escitalopram facilitated remission of OCS. We discuss a possible causal link between abrupt discontinuation of venlafaxine and development of OCS under consideration of pathophysiologic aspects regarding obsessive compulsive disorders, the chronological sequence of symptoms in the present case, and pharmacodynamic and-kinetic aspects. Our case report suggests the possibility of the occurrence of obsessivecompulsive symptoms following abrupt discontinuation of venlafaxine.

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What Is New about New Antidepressants?

Cited by 35 publications

References 82 publications

The Deceptive Manifestations of Treatment Resistance in Depression: A New Look at the Problem

The Deceptive Manifestations of Treatment Resistance in Depression: A New Look at the Problem

The Phosphodiesterase Inhibitor Pentoxifylline as a Novel Adjunct to Antidepressants in Major Depressive Disorder Patients: A Proof-of-Concept, Randomized, Double-Blind, Placebo-Controlled Trial

Development of Obsessive-Compulsive Symptoms Following Abrupt Discontinuation of Venlafaxine

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