High blood pressure. Causes, symptoms, treatments

Tadalafil treatment had a modest effect on endothelial cell damage and repair ability markers in men with erectile dysfunction and vascular risk.

2017-04-27

Women and men with GAD showed similar clinical presentations, with the exception that women had an earlier age of onset and reported more somatic anxiety symptoms. Sertraline was an effective and well tolerated treatment for GAD in both men and women.

Once widely regarded as a rare psychodynamic illness, obsessive-compulsive disorder (OCD) is now recognized as a common neurobiological condition affecting 1 in 50 US citizens. The etiology of the illness is still not clearly understood, but the observed therapeutic response in OCD patients to the potent serotonin uptake inhibitor clomipramine hydrochloride (CMI), guided research in the direction of neuronal brain function, and abnormalities of postsynaptic serotonin receptors are currently the leading hypotheses in the pathophysiology of OCD. Clomipramine, an analog of the tricyclic antidepressant imipramine, was the first effective antiobsessional agent available in the US. Clomipramine was, for some time, the treatment of choice for OCD given its superiority over other TCAs which lack potent serotonergic effects. Attention has now shifted to the selective serotonin reuptake inhibitors (SSRIs) whose potent and highly selective serotonin uptake properties account for their antiobsessional efficacy and favorable side effect profiles. The benefits of fluvoxamine, fluoxetine and sertraline have been shown in a number of clinical trials. This paper reviews the epidemiology, etiology, diagnosis and pharmacologic treatment studies of OCD. It summarizes two studies evaluating the efficacy of the SSRI sertraline, which is shown to be effective and well tolerated for both short- and long-term treatment of OCD.

Intermittent luteal-phase dosing with low doses of sertraline (25 and 50 mg/day) produced significant improvement across 2 menstrual cycles, based on total DSR scores, compared with placebo. Continuous and symptom-onset dosing were also effective in treating PMS symptoms, particularly at the lower dose of 25 mg/day.

Neurophysiologic findings indicate an inhibition of dopaminergic neurotransmission by selective serotonin reuptake inhibitors (SSRIs). This article highlights the relationships between changes in dopaminergic neurotrans-mission induced by SSRIs and the occurrence of certain side effects such as hyperprolactinemia, extrapyramidal symptoms, sexual and cognitive dysfunction, galactorrhea, mammary hypertrophy, and, more rarely, gynecomastia.

Current evidence does not warrant the choice of one second-generation antidepressant over another on the basis of differences in efficacy and effectiveness. Other differences with respect to onset of action and adverse events may be relevant for the choice of a medication.

Effective treatment with two antidepressants improves gratification in the maternal role but not self-efficacy or maternal-infant interaction in women with PPD. Results of the study can help women and their healthcare providers to weigh the benefits of short-term antidepressant treatment in the postpartum period. Future studies should consider outcomes related to a longer duration of treatment.

Thirty-three patients finished the trial (16 in the sertraline group and 17 in the placebo group), showing an odds ratio of 7.94 (95% confidence interval 1.3-57.3), p = 0.0038 for the sertraline group, in spite of the prominent effect of placebo.

Interpreting the concentrations of drugs determined in post-mortem blood is not an easy task owing to poly-drug use, adverse drug-drug interactions, as well as a host of pre-analytical factors and various artefacts in post-mortem toxicology. Highly sensitive and specific methods (GC-FID, GC-NPD. GC-MS and LC-MS) were used to determine the concentrations of drugs in femoral blood from 24,876 autopsies representing all causes of death. Ethanol topped the list of psychoactive substances (N=8108 or 33%) at mean, median and highest concentrations of 1.43 g/L, 1.20 g/L and 8.0 g/L, respectively. In second place was paracetamol (N=2741 or 11%). Amphetamine and cannabis were the major illicit drugs at 13th and 15th positions, respectively. Newer antidepressants, citalopram (no 3), sertraline (no 14), venlafaxine (no 16) were prominent as were sedative-hypnotics, such as diazepam (no 4), zopiclone (no 5) and zolpidem (no 18). This compilation of drugs and their concentration distributions will be useful to identify and flag for a likely overdose or drug-related poisoning death. The drug concentration together with the findings at autopsy and the police report can then be used to reach a conclusion about the cause and manner of death.

Fluoxetine, orlistat, and sibutramine can achieve statistically significant weight loss over 12 to 57 weeks. The magnitude of weight loss is modest, however, and the long-term health benefits remain unclear. The safety of sibutramine is uncertain. There is a paucity of data on other drugs for weight loss or control in persons with type 2 diabetes.

The goal of this article was to review the current literature on clinically relevant pharmacokinetic drug interactions with second-generation antidepressants.