High blood pressure. Causes, symptoms, treatments

Dihydrotestosterone and the concept of 5alpha-reductase inhibition in human benign prostatic hyperplasia.

2017-04-30

We investigated whether urine drug screens (UDS) at admission and platelet paroxetine binding, a measure of serotonin transporter sites, were related to outcome measures for cocaine patients in treatment. Tritiated paroxetine binding sites on platelets were assayed and UDS were obtained for 105 African American cocaine-dependent outpatients. Outcome measures included number of negative urines, days in treatment, dropouts, and number of treatment sessions attended. A significant association was found between cocaine-positive UDS at admission and negative urines, treatment retention, dropouts, and treatment sessions; while Bmax values of paroxetine binding (density of serotonin transporter sites) were significantly associated with treatment retention and negative urines. Moreover, UDS and paroxetine binding combined to enhance prediction of retention and abstinence. Although both admission UDS and paroxetine binding seem to contribute individually in predicting outcome of cocaine patients, a combination of the two variables seems to have a stronger effect in terms of predicting treatment-outcome.

This article reviews the pharmacology of antidepressants, particularly focusing on those that act acutely by blocking the reuptake of norepinephrine (NE) and/or serotonin (5-HT). Such drugs have a very wide range of potencies, measured in vitro, to inhibit the reuptake of these biogenic amines. As a group, the selective serotonin reuptake inhibitors (SSRIs) are the most potent at inhibiting the reuptake of 5-HT. Some tricyclic antidepressants (TCAs), such as desipramine and nortriptyline, are much more potent at blocking NE reuptake than 5-HT reuptake, as is the new non-TCA drug reboxetine. Among SSRIs, paroxetine is most potent at blocking the reuptake of NE. When considering whether such potencies measured in vitro translate into pharmacologic effects clinically, it is necessary to know how much drug gets to its site of therapeutic action, presumably the brain. Most, but not all, antidepressants are extensively bound to plasma proteins, and this binding limits considerably the penetration of these drugs across the blood-brain barrier. The amount of drug present in the extracellular fluid (ECF) of brain approximates the non-protein-bound drug concentration in plasma. Comparison of the concentration of antidepressants in ECF with their potencies to inhibit the reuptake of 5-HT and/or NE reveals why some drugs block the reuptake of these biogenic amines in either a selective or nonselective manner. This analysis reveals that venlafaxine may be unique among antidepressants in having a dose-dependent nonselectivity; at low doses it acts primarily as an SSRI, but at higher doses it inhibits the reuptake of NE as well.

A prospective study, using routinely collected hospital and pharmacy data, was conducted among 43 patients between 18 and 70 years old and on >4 weeks of paroxetine therapy. The genotype for the serotonin transporter (5-HTTLPR), trough paroxetine levels, platelet function analyser (PFA)-closure time (collagen/epinephrine) and a complete blood count were assessed.

Anxiety disorders affect approximately 20% of the population, and women are twice as likely as men to develop anxiety disorders. Despite these findings, little is known about the effects of gender on tolerability and therapeutic efficacy of anxiolytic drugs. Sex differences are also observed in rodents, even though the majority of preclinical behavioral studies are conducted on males. The aim of this study was to investigate sex differences in anxiety-like behavior using the Vogel conflict test and the pharmacological responsiveness to a variety of psychoactive drugs in rats. Pharmacological treatments clinically used for the treatment of anxiety were tested in male and female rats. Overall, female rats accepted fewer punished responses, had lower levels of water intake even when matched for weight, and had a lower pain threshold for electrical footshock than males. Diazepam and chlordiazepoxide displayed anxiolytic-like effects in both genders. In contrast, buspirone, propranolol, fluoxetine and paroxetine showed activity only in male rats. Morphine had no anxiolytic-like activity in either gender. Analysis of the estrous cycle did not reveal any effect of cycle stage on behavioral or drug responses. This investigation highlights the importance of using female subjects in the preclinical research of anxiety and the screening of anxiolytic compounds in the drug development process.

This case report deals with the day care treatment of two seven- and eight-year-old siblings with elective mutism. Their treatment entails a combination of psychopharmacological and intensive behavior therapy. The multimodal therapeutic process is presented together with continuing psychosocial steps. Behavioral intervention focuses on building verbal expressive capacity, reducing speech anxiety in social situations and generalization to non-therapeutic situations. The case report is discussed in the context of the current literature on elective mutism.