High blood pressure. Causes, symptoms, treatments

Advertisements impact the physiological efficacy of a branded drug.

2017-04-23

All 23 drugs were detected in the examined hair samples. The agreement between the self-reported drug and the drug found in hair was excellent for most analytes (P < 0.001, Cohen's kappa); a statistically significant relationship (P < 0.05, linear regression analysis) between dose and hair level was found for amitriptyline, citalopram, delorazepam, duloxetine, lorazepam, and venlafaxine.

Major depressive disorder is a serious and disabling illness in the world and is common chronic and recurrent disorder. It is the fourth most important cause of worldwide loss in disability.

The efficacy of trazodone and clorazepate to relieve anxiety and depressive symptoms in 21 HIV-positive subjects with adjustment disorders was determined in a 28-day single-centre, randomized, double-blind study. Subjects were evaluated using the Hospital Anxiety and Depression Scale, the Revised Symptom Checklist, the European Organization for Research and the Treatment of Cancer Quality of Life Questionnaire, and a binary criterion based on the Clinical Global Impression. The incidence of successful treatment was 80% for trazodone compared with 64% for clorazepate; the sample number was too small to establish a significant difference. Bayesian analysis revealed the probability of making a wrong decision in prescribing trazodone rather than clorazepate reduced from 35% to 18% in this small sample. Clinical evaluations using the different scales suggest some benefit from trazodone, although this was not significant. Safety of both treatments was similar. Trazodone is devoid of the risk of abuse and dependence, and may be a valuable alternative to benzodiazepines for the treatment of HIV-related adjustment disorders.

The trazodone Contramid formulation was more effective than placebo in major depressive disorder and was well tolerated.

The functional role of brain 5-HT and 5-HT receptor subtypes in periaqueductal gray (PAG) induced aversion has been investigated in rats. Antiaversive effects were found with the serotonin agonists TFMPP, mCPP and DOI but not with RU 24969 which was found to facilitate PAG aversion. The first three serotonin agonists share potent 5-HT1C activity while RU 24969 differs with a high 5-HT1A activity. Proaversive effects were found with the mixed 5-HT1C/5-HT2 antagonists cyproheptadine and ritanserin; this effect was already reported for the mixed 5-HT1C/5-HT2 antagonists metergoline and mianserin and is opposite to the effects of the selective 5-HT2 antagonists ketanserin, pirenperone, trazodone and spiperone. The antiaversive effects of mCPP (1 mg/kg) could be prevented by pretreatment of the animals with mianserin (1 and 10 mg/kg). These results suggest that 5-HT1C receptors play an important role in the serotonergic control of PAG aversion. 5-HT1C receptor activation seems to mediate antiaversive effects whereas acute 5-HT1C receptor blockade appears to facilitate PAG aversion. Functional interactions take place between several receptor types in the in vivo control of PAG aversion, where 5-HT1C receptors appear to play a predominant function.

We conducted a double-blind, randomized and controlled trial during periods of 7-9 days at baseline and 2 weeks of treatment.

Thirty-eight studies were selected. Eighteen were excluded. Eleven preventive drugs were compared with placebo in a total of 15 studies. Drug-drug comparisons were made in just six studies. For only four drugs (L-5-hydroxytryptophan [L-5HTP], flunarizine, clonidine, and propranolol) were two or more studies selected. For only six drugs (trazodone, L-5HTP, propranolol, flunarizine, papaverine, and nimodipine) were data reported for effect on frequency. For no individual drug were comparable data reported in more than one study, thus meta-analysis was not possible. Two placebo-controlled studies showed a beneficial effect on the primary outcome measure, headache frequency. They were for the drugs propranolol and flunarizine. The propranolol study reported a dichotomous outcome (proportion of children responding), and it was possible to calculate a number-needed-to-treat to produce a two-thirds reduction in headache frequency (NNT = 1.5, 95%CI 1.15 to 2.1). The flunarizine study produced a SMD of 1.51 (95% confidence interval, -2.21 to -0.82), which was statistically significant in favour of flunarizine (p < 0.001). Nimodipine, timolol, papaverine, pizotifen, trazodone, L-5HTP, clonidine, metoclopramide, and domperidone showed no efficacy in reduction of frequency of attacks. The available studies on cyproheptadine, phenobarbitone, phenytoin, amitriptyline, carbamazepine, metoprolol, and piracetam were excluded for various reasons.

In accordance with the Quorum statement, we searched PubMed, EMBASE, Psych Info and Medline databases using the terms alcohol, insomnia/sleep and treatment/management with no year/language restrictions.

In three patients with trazodone-resistant unipolar depression, carbamazepine 400 mg/day was co-administered for 4 weeks. They all showed favourable responses; two non-delusional patients completely or almost recovered, while one delusional patient showed considerable improvement in depressive symptoms other than delusions of guilt. Plasma concentrations of trazodone and its active metabolite m-chlorophenylpiperazine (m-CPP) were decreased, while the m-CPP/trazodone ratio was increased in all cases. The present report suggests that carbamazepine augments antidepressant effects of trazodone by an enhancement of serotonin function.