High blood pressure. Causes, symptoms, treatments

Do Different Cyclooxygenase Inhibitors Impair Rotator Cuff Healing in a Rabbit Model?


The objective of this study was to demonstrate the cost effectiveness of long term maintenance treatment with citalopram versus standard therapy (defined as short term antidepressant treatment) in patients with major depression in Germany. We chose doxepin, amitriptyline and trimipramine as standard therapy because these drugs are the leading antidepressants in that country. A Markov process analysis was used to model health status and economic outcomes as they accrued over a 1-year follow-up period. The main outcome measures were time without depression, direct costs and indirect costs (work days lost). All costs were in 1993 Deutsche marks. The clinical data were obtained from the published literature and US clinical practice guidelines; the associated unit costs of the medical resources used were derived from official German tariff lists. The results show that, compared with standard therapy, long-term maintenance treatment with citalopram is associated with a mean increase in time without depression of 7.9% (8.2 vs 7.6 months). The total costs of maintenance treatment with citalopram were substantially lower than with standard therapy (DM7985 vs DM11,948 per patient per year. In addition, both the direct and indirect costs of maintenance treatment with citalopram (DM3764 vs DM4221 per patient, respectively) were lower than with standard therapy (DM4577 vs DM7371 per patient, respectively). In conclusion, the study demonstrates that one year's maintenance treatment with citalopram is both more effective and less costly than standard therapy in the treatment of patients with major depression.

The tricyclic antidepressant drug imipramine may cause ventricular arrhythmias and intraventricular conduction disturbances in clinical use, particularly in patients who have ingested toxic doses or who have preexisting heart disease. Such effects have not been reported with doxepin, another tricylic antidepressant drug. In this study, the electrophysiologic effects of these two drugs on normal and depressed canine Purkinje fibers were examined. Fiber depression was achieved by elevating potassium concentration [K+] in the perfusate to 10 mM. In normal Purkinje fibers both imipramine and doxepin were tested in concentrations of 50, 250, 500 and 1,000 ng/ml. Both drugs had no effect on resting membrane potential but caused similar, dose-related reductions in action potential amplitude, maximal velocity of phage O depolarization (Vmax), action potential duration, conduction velocity and effective and functional refractory periods. Depressed fibers were exposed to only 250 ng/ml of imipramine and doxepin. Both drugs reduced conduction velocity and failed to alter the refractory periods of the depressed fiberts whereas at the same concentration in normal fibers they caused no change in conduction velocity but shortened the refractory periods. The other electrophysiologic effects of the two drugs on depressed fibers were similar to those on normal fibers. These observations indicate that depressed fibers are more sensitive than normal fibers to certain electrophysiologic effects of both imipramine and doxepin, and that the different incidence rates of arrhythmias and conduction disturbances associated with the clinical use of these drugs is probably not due to differences in their direct electrophysiologic effects on the ventricular specialized conduction system.

Trimipramine differs from other antidepressant drugs in a number of ways. Although trimipramine shares equivalent efficacy with doxepin, imipramine, maprotiline and amitriptyline, as evidenced by double-blind studies, it possesses a different side-effect profile. Trimipramine is considered to be less cardiotoxic, and data presented in this paper support its minimal effect on orthostatic hypotension, as compared with clomipramine. In addition, trimipramine has less epileptogenic potential than other antidepressants such as imipramine, amitriptyline and maprotiline. Besides this different side-effect profile, trimipramine exerts differing effects on neurotransmitter functions and their reuptake. For example, trimipramine does not inhibit reuptake of noradrenaline and serotonin, and does not down-regulate beta 1-adrenoceptors. Furthermore, in common with lithium, trimipramine produces enhancement of antidepressant action in treatment-resistant depressed patients. There is evidence that trimipramine enhances the sensitivity of cortical neurons to noradrenaline after prolonged administration and may also increase the activity of serotonin neurons.

Chronic urticaria, a major health problem causing patient's distress, induces often physicians' dilemma while dealing with its etiology, investigations and management. Clinical approach of such cases should include apart from clinical history and physical examination laboratory investigations like routine blood test, thyroid profile, etc. as well as sometimes special test like autologous serum skin test. Management includes reassurance, avoidance of precipitating factors, treatment of underlying disorders, and non-pharmacological approach along with pharmacotherapy. First line drug therapy comprises non-sedative and sedative antihistamines, second line doxepin, nifedipine, leukotriene-inhibitors, sulfasalazine, etc. and third line cyclosporine, dapsone, colchicin, etc.