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PURPOSE: There are few studies that document antidepressant prescribing in young patients. Although tricyclic antidepressants (TCAs) are considered equal in efficacy to selective serotonin reuptake inhibitors (SSRIs), the latter have an improved side effect profile. The aim of this study was to investigate the prescribing patterns of TCAs and SSRIs among adolescents and young adults, with reference to prescribing frequency, cost and dose. METHOD: A retrospective drug utilization study was conducted over a 14-month period, from January 2000 to February 2001. RESULTS: There were 166 antidepressants prescribed to 98 adolescents and young adults. TCAs were prescribed more frequently than SSRIs, with amitryptiline and fluoxetine being the two most frequently prescribed antidepressants. Fluoxetine accounted for a higher ratio of cost to prescribing frequency than amitryptiline. Amitryptiline was issued in small quantities of tablets, resulting in a low average calculated prescribed daily dose (PDD). Duration of treatment was not considered optimal for SSRIs or TCAs. CONCLUSION: This study elicits prescribing patterns that contribute to the relative scarcity of data on antidepressant drugs for young patients.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12899111&dopt=Abstract
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Hokkaido Igaku Zasshi. 1999 Jan;74(1):41-52.
[Effects of methamphetamine on responsiveness to conditioned fear stress]
[Article in Japanese]
Tsuchiya K.
Department of Psychiatry, Hokkaido University School of Medicine, Sapporo, Japan.
The present study examined the effect of repeated methamphetamine (MA) pretreatment on conditioned fear stress in male Wistar-King rats. Rats received MA or the vehicle according to the repeated escalating dose schedule (1.25, 2.5, 3.75, 5 mg/kg s.c x2/every other day for a week). After a 5 day drug abstinent period, the rats were exposed to conditioned fear stress (CFS; exposure to an environment paired previously with footshock). Repeated but not single MA pretreatment significantly increased conditioned freezing behavior, suggesting that rats previously exposed to chronic MA are hypersensitive to subsequent stress than control rats. Repeated MA treatment did not decrease basal dopamine concentrations in the brain. Furthermore, repeated co-administration of MK-801 (non-competitive NMDA antagonist), amfonelic acid (dopamine reuptake inhibitor) or fluoxetine (serotonin reuptake inhibitor) with MA did not alter the enhanced freezing behavior. Taken together, it seems that MA-induced hypersensitivity to stress is not due to the neurotoxic effect of MA. While co-administration of SCH23390 (D1/5 antagonist) or raclopride (D2/3 antagonist) had no effect on the MA-induced increase in freezing, co-administration of nemonapride (D2/3/4 antagonist) prevented this increase. These results suggest that MA-induced enhancement of anxiety might be mediated by D4 receptors. The homovanilic acid (HVA) levels in the striatum were elevated by footshock in MA-treated rats but not in saline-treated rats. Furthermore, MA-treated rats showed increased metabolism of dopamine (DA) in the medial prefrontal cortex (mPFC), even when placed in the shock chamber without shocks. The HVA levels in the striatum in MA-treated rats were more elevated by CFS than these in saline-treated rats. These results suggest that the striatum DA system, as well as the mPFC DA system suggested previously, may be associated with emotional hypersensitivity to stress following repeated MA treatment.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10331059&dopt=Abstract
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Yonsei Med J. 1999 Apr;40(2):144-51.
Fluoxetine inhibits L-type Ca2+ and transient outward K+ currents in rat ventricular myocytes.
Park KS, Kong ID, Park KC, Lee JW.
Department of Physiology, Yonsei University Wonju College of Medicine, Korea.
The most common cardiovascular side effects of antidepressants are cardiac arrhythmias and orthostatic hypotension. Little is known, however, about the mechanisms by which these adverse reactions may occur, especially with regard to newer drugs such as fluoxetine. We hypothesized that these side effects may have an electrophysiological basis at the level of the cardiac myocyte. Thus, we investigated the effects of fluoxetine and other antidepressants on action potentials and ionic currents of rat ventricular myocytes using the amphotericin B perforated patch clamp technique. Fluoxetine (10 microM) prolonged the action potential duration (APD50) to 146.7 +/- 12.9% of control value without altering resting membrane potential. Fluoxetine and sertraline potently inhibited the L-type Ca2+ current (IC50 = 2.82 and 2.31 microM, respectively), but did not significantly modify the steady-state inactivation. Amitriptyline and imipramine had similar, but slightly weaker, effects (IC50 = 3.75 and 4.05 microM, respectively). Fluoxetine attenuated the peak transient outward K+ current and also altered current kinetics, as shown by accelerated decay. Fluoxetine did not change the voltage-dependence of the steady-state inactivation. Sertraline, amitriptyline and imipramine inhibited the transient outward K+ current with potencies very similar to fluoxetine. In contrast to the other antidepressants tested, trazodone weakly inhibited the Ca2+ and K+ currents and moclobemide had no detectable effect. Our comparative pharmacology data suggest that selective serotonin reuptake inhibitors, such as fluoxetine, are as potent as tricyclic antidepressants in inhibiting L-type Ca2+ and transient outward K+ currents. These inhibitory effects may contribute to cardiovascular complications such as arrhythmias and orthostatic hypotension.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10333718&dopt=Abstract
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