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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study describes the effect of fibre supplementation on the gastrointestinal symptoms and general wellbeing of patients with constipated irritable bowel syndrome. In a single centre, double blind, placebo controlled trial of 3 months duration, a daily supplement of 4.1 g fibre produced no greater change in gastrointestinal symptoms than placebo. Pretreatment constipation was related to baseline fibre intake. Overall outcome was the same in treated and control groups; a considerable placebo response was evident. This level of fibre supplementation is not a useful treatment; improving neither constipation nor other symptoms. At the outset pain severity correlated with depression score on psychometric testing. Those who felt better at the end of the study scored significantly lower for depression at outset than those who felt no better. In irritable bowel syndrome a depressive emotional state profile is a powerful determinant of outcome, shaping the response to treatment, which includes a considerable placebo element.
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PMID:Irritable bowel syndrome: assessment of psychological disturbance and its influence on the response to fibre supplementation. 131 75

In the treatment of IBS best results could be obtained by implementing a comprehensive program for the patients. This might include a through examination, an explanation of the condition to the patients, psychologic managements, and correction of any bad habits, as well as drug therapy. The aim of drug therapy of IBS is the relief of the symptoms: such as abdominal pain, disturbed bowel function, anxiety or depression. As there is no drug which is effective in relieving the entire range of symptoms, drug should be chosen according to specific symptoms. Tranquilizers and antispasmodics may be the most commonly used drugs, however their efficacy is limited. To postprandial pain antispasmodics or trimebutine are most effective when prescribed before meal. Antidepressant are beneficial for the depressive state. Bulking agents are preferable mainly in relieving constipation, and loperamide is effective in treating diarrhea.
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PMID:[Pharmaceutical treatment of irritable bowel syndrome]. 136 24

Depression is a heterogeneous disease state characterised by complex alterations in several CNS neurotransmitter and receptor systems. All antidepressants are thought to act by causing postsynaptic adaptive changes (e.g. in transducers or second messengers) within these systems. Thus, the mechanism of action of selective serotonin reuptake inhibitors (SSRIs) cannot simply be explained in terms of inhibition of serotonin (5-hydroxytryptamine) [5-HT] reuptake. Fluvoxamine, sertraline and fluoxetine downregulate central beta-adrenoceptors, and all SSRIs are believed to normalise central 5-HT1A- and 5-HT2-receptor density and function in patients with depression. SSRIs are as effective as tricyclic antidepressants in the treatment of depression, but have distinct tolerability advantages--they are not associated with anticholinergic adverse effects, cardiotoxicity, sedation or weight gain. However, gastrointestinal reactions (e.g. nausea, diarrhoea/loose stools, constipation) are relatively common during SSRI therapy. Additionally, in contrast to tricyclic antidepressants, SSRI dosage adjustments appear to be unnecessary in elderly depressed patients. Fluvoxamine has a much shorter elimination half-life than fluoxetine and its active metabolite, norfluoxetine, and therefore a reduced potential for drug interactions. Only small amounts of fluvoxamine and fluoxetine, but large quantities of paroxetine, are secreted in breast milk. Furthermore, genetic polymorphism has not been documented for fluvoxamine metabolism, whereas slow and fast metabolisers of paroxetine, and fast metabolisers of fluoxetine have been identified. SSRIs have a better tolerability profile than tricyclic antidepressants, as indicated by lower mean rank scores for behavioural toxicity. Moreover, SSRIs are associated with a much lower incidence of fatal toxicity than tricyclics, and appear to be relatively safe in overdosage.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pharmacological differences of serotonin reuptake inhibitors and possible clinical relevance. 137 71

Ondansetron is a 5-HT3 receptor antagonist which is effective and well tolerated as an antiemetic for emesis induced by cancer chemotherapy and radiation therapy, and in the prevention and treatment of postoperative nausea and vomiting. Ondansetron is rapidly absorbed after oral administration (tmax 1.9 h) with an absolute bioavailability of around 60%. Its terminal elimination half-life is 3.5 h and it is extensively hepatically metabolized. Plasma clearance is 0.38 litre h-1 kg-1 and volume of distribution is 1.8 litre kg-1. Plasma clearance is reduced by age (31% reduction) and hepatic failure (80% reduction in severe failure). In patients undergoing general anaesthesia there is a slight prolongation of terminal half-life, which is not of clinical significance. Ondansetron is very well tolerated in volunteer studies. Headache, mild abdominal pain, and constipation occur infrequently. There is no evidence for effects of ondansetron on cardiac function (electrocardiogram, cardiac output, blood pressure and heart rate), and haemostatic function in volunteers and patients. Respiratory depression induced during general anaesthesia is not potentiated by ondansetron. No drug interactions have been noted with temazepam, atracurium, alfentanil and alcohol in man. There are also no interactions seen in animal studies using pentobarbitone, morphine, neostigmine, prednisolone and diazepam.
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PMID:Clinical pharmacology of ondansetron in postoperative nausea and vomiting. 142 20

The pharmacology and pharmacokinetics, adverse effects, drug interactions, efficacy, and dosage and administration of the new selective serotonin reuptake inhibitors paroxetine, sertraline, and fluvoxamine are reviewed. Paroxetine, sertraline, and fluvoxamine all have large volumes of distribution and are highly bound to plasma proteins. In contrast to fluoxetine, these three drugs possess shorter elimination half-lives of approximately one day and are metabolized to clinically inactive compounds. Nausea was the most commonly reported adverse effect for all three agents. Other reported adverse effects are headache, sedation, dry mouth, insomnia, sexual dysfunction, and constipation. Because of their favorable pharmacokinetic profiles, paroxetine, sertraline, and fluvoxaetine are less likely than fluoxamine to interact with other drugs. Paroxetine has been found to be superior to placebo and equivalent to amitriptyline, imipramine, clomipramine, and doxepin in treatment of depression. Sertraline has been found to be superior to placebo and equivalent to amitriptyline in treatment of depression. Fluvoxamine has been found to be superior to placebo and equivalent to imipramine, clomipramine, desipramine, mianserin, and maprotiline in the treatment of depression. Fluvoxamine and sertraline have been shown to be superior to placebo in the treatment of obsessive-compulsive disorder. Clinical experience has demonstrated all three drugs to be effective in treatment of depression. They may be especially useful in elderly patients, in those who cannot tolerate alternative treatments, and in those who do not respond to adequate trials of other antidepressant therapies.
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PMID:Paroxetine, sertraline, and fluvoxamine: new selective serotonin reuptake inhibitors. 146 19

Previous research has demonstrated a number of conditions, such as sleep disturbance, fatigue, depression, spastic colon and mitral valve prolapse, associated with fibromyalgia. The present report describes additional symptoms and medical conditions that appear to be associated with the syndrome based on a survey of 554 individuals with fibromyalgia compared with a group of 169 controls. Individuals with fibromyalgia self report a greater incidence of bursitis, chondromalacia, constipation, diarrhea, temporomandibular joint dysfunction, vertigo, sinus and thyroid problems. Symptomatic complaints found statistically more prevalent in fibromyalgia patients included concentration problems, sensory symptoms, swollen glands and tinnitus. Other associations occurring with significant increased frequency were chronic cough, coccygeal and pelvic pain, tachycardia and weakness. Our previous report on inheritance patterns in fibromyalgia was reaffirmed with 12% reporting symptomatic children and 25% reporting symptomatic parents. Of the respondents, 70% noted that their symptoms were aggravated by noise, lights, stress, posture and weather.
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PMID:Fibromyalgia syndrome. New associations. 146 72

This study describes the short-term morbidity associated with cesarean delivery and women's knowledge of the reasons it was performed. It was conducted in a university teaching hospital that delivers approximately 4000 women per year. During 1986, 619 women (16%) were delivered by cesarean, 588 of whom were sent a questionnaire three months after delivery. The response rate was 76 percent. General questions were asked about the women's recovery and health state after the birth, and whether they had experienced more specific types of morbidity, including infection, backache, and depression, and the reasons for the cesarean delivery. Women's answers were then compared with the obstetric case record. In their comprehension of why the cesarean was necessary, 87 percent of women were right or partially right, 35 percent believed they had still not fully recovered, and 28 percent felt less healthy than before the pregnancy. Women experienced a wide variety of postnatal morbidity, most commonly backache (55%), constipation (49%), and depression (38%). The study showed that considerable maternal morbidity is associated with cesarean delivery, and it can persist long after the woman is discharged from hospital. Much more information is necessary about the health of women after delivery, and research is urgently required to determine the comparative rates of morbidity associated with different delivery methods.
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PMID:Short-term morbidity associated with cesarean delivery. 147 66

The selective serotonin reuptake inhibitors (SSRIs) are a tribute to the ingenuity of pharmacologists and designers of molecules. Not only do these drugs have remarkable selectivity for the reuptake of serotonin compared with other monoamines, but also they have a commendable lack of affinity for receptors including the serotonin receptor. In contrast, the classical tricyclic antidepressants (TCAs) are less specific in their pharmacological action. In addition to inhibiting the reuptake of serotonin, TCAs inhibit the uptake of noradrenaline, dopamine and tyramine, and antagonize cholinergic (muscarinic), adrenergic and histaminergic receptors. Moreover, TCAs have quinidine-like anti-arrhythmic activity and lower the seizure threshold. Clinical investigations have shown that the SSRIs have equivalent therapeutic efficacy compared with the TCAs in the treatment of depression. However, the pharmacological specificity of the SSRIs is a clinical advantage since they lack the propensity to cause dry mouth, blurred vision, urinary hesitancy, constipation, hypotension and arrhythmia. Furthermore, the SSRIs are relatively safe in overdosage. The similarities between the SSRIs are more obvious than their differences: all are highly potent and selective inhibitors of serotonin reuptake with efficacy in the treatment of depression. Nevertheless, each has a distinctive pharmacological profile. In this review the characteristics desired in an "ideal" antidepressant are examined, and the ways in which the TCAs and SSRIs fit this ideal are compared.
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PMID:Clinical implications of the pharmacology of serotonin reuptake inhibitors. 148 74

A multicenter study was conducted to determine the patient and physician acceptability of transdermal fentanyl in the management of cancer-related pain. In this study, 10 cancer patients at the University of Iowa received transdermal fentanyl after discontinuing their prior opioid analgesic; 7 patients completed questionnaires before and at 2 and 4 wk following transdermal fentanyl application. There was no significant difference in visual analogue scale scores for pain or mood. Verbal pain descriptor scores improved at 2 wk (P less than .05). There was a nonsignificant tendency toward increased depression and nausea; however, patients spent less time thinking about their illness and felt their cancer was less disruptive to their closest friends/relatives. Constipation, appetite, drowsiness, and concentration were not statistically different. Patients reported improved sleep habits at 2 wk (P less than .05) and tended to require less help with eating, dressing, washing, and using the bathroom. All patients completing the study chose to continue transdermal fentanyl for their cancer pain management. In summary, these data demonstrate the analgesic efficacy of the transdermal fentanyl system and suggest that some patients with cancer-related pain could benefit from its use.
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PMID:Management of cancer pain with transdermal fentanyl: phase IV trial, University of Iowa. 151 36

Considerable research shows that serotonin dysfunction is implicated in major depression. Paroxetine is an investigational antidepressant that appears to act by selectively blocking neuronal serotonin uptake. Seventy-two outpatients with moderate-to-severe major depression entered this 6-week, double-blind comparison of paroxetine and placebo. The results showed clear and significant superiority of paroxetine on all of the major outcome variables. These included physician-rated measures such as the Hamilton Rating Scale for Depression and its four factor scores, the Clinical Global Impressions scale, the Montgomery and Asberg Depression Rating Scale, and the Raskin Depression Scale. Results on these agreed well with patient-rated measures like the Hopkins Symptom Checklist and Patient Global Evaluation Scale. Paroxetine was also very well tolerated. Nausea and constipation occurred significantly more often with paroxetine, but only 9% of paroxetine patients dropped out of the study due either in whole or in part to an adverse effect. This compares to 8% of the placebo patients who were discontinued for the same reason. This study suggests that paroxetine is a safe and effective medication for the treatment of major depression.
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PMID:The safety and efficacy of paroxetine compared with placebo in a double-blind trial of depressed outpatients. 153 21


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