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ANTIDEPRESSIVE AGENTS --- ANTIDEPRESSIVE AGENTS

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Objective : To review scientific literature about antidepressant poisoning, more precisely about mechanisms and management.
Sources : This review is based on several researches in medical books and the Pubmed database.
Methods : Medical books and papers have been first consulted. Then more specific analysis, such as case reports, have been reviewed.
Analysis: Depending on their mechanism of action, antidepressant drugs will produce several symptoms in poisoning. Clinical signs observed with tricyclic antidepressants are cardiovascular, neurological and anticholinergic. Selective serotonin reuptake inhibitors (SSRI), alone or associated with other drugs increasing the transmission of this molecule, might cause in overdose, a serotonin syndrome. This leads to neuromuscular abnormalities, altered mental status and autonomic dysfunction. The diagnosis of this syndrome is not obvious, especially as it shared characteristics with other syndromes, such as neuroleptic malignant syndrome. The treatment of poisoning is mainly symptomatic. Administration of activated charcoal can, in some case, reduce plasmatic concentration of the molecule. Other more specific agents such antibody anti-antidepressant for tryciclic or serotonin antagonists for SSRI might contribute to patient’s remission.
Conclusion: Caring antidepressant poisoning is mainly supportive but new treatments are tested thanks to a better understanding of the physiopathology Objectif : Revoir la littérature scientifique concernant les intoxications aux antidépresseurs, plus précisément, leur mécanisme et prise en charge.
Sources de données : Cette revue de la littérature a été réalisée au moyen d’une recherche dans différents ouvrages médicaux ainsi que dans la base de données Pubmed.
Sélection des études et extraction des données : Les ouvrages médicaux et revues ont d’abord été consultés. Les études plus spécifiques, telles que les rapports de cas, ont été analysées dans un deuxième temps.
Analyse des données : Selon leur mécanisme d’action, les antidépresseurs vont produire différents symptômes lors des intoxications. Les signes cliniques observés avec les antidépresseurs tricycliques sont d’ordre cardio-vasculaire, neurologique et anticholinergique. Les inhibiteurs sélectifs de la sérotonine (ISRS), seuls ou en interaction avec d’autres agents augmentant la transmission de cette molécule, peuvent, en cas d’overdose, donner lieu à un symptôme sérotoninergique. On pourra alors observer des anomalies neuromusculaires, une altération de la conscience et un dysfonctionnement du système autonome. Le diagnostic de ce syndrome n’est pas toujours aisé, d’autant plus qu’il partage des caractéristiques communes à d’autres syndromes tels que le syndrome malin des neuroleptiques. La prise en charge des intoxications est surtout sumptomatiques. L’administration de charbn activé permet, dans certains cas, de réduire les taux de la molécule en cause. D’autres agents plus spécifiques tels que les anticorps anti-antidépresseurs tricycliques dans le cas des tricycliques ou les antagonistes de la sérotonine pour les ISRS peuvent également aider à la rémission du patient.
Conclusion : La prise en charge des intoxications aux antidépresseurs est surtout symptomatique mais elle évolue grâce à une meilleure compréhension de la physiopathologie

Antidepressive Agents

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Depression. --- Dépression --- Antidepressive agents

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Background. Antidepressant use in older people has been associated with multiple adverse outcomes. In this context, special attention should be given to nursing home residents who appeared particularly concerned by antidepressant prescription. Objectives. This work aimed i) to examine the prevalence and the appropriateness of antidepressant prescribing in nursing home residents, with details on drug choices, dosages and potential indications, ii) to describe drug-related problems (DRP) most frequently associated with antidepressant prescription and iii) to assess the impact of a complex intervention on the use of this specific medication class. Methods. Sub-analysis of data from the Collaborative approach to Optimize Medication use for older people in Nursing homes (COME-ON) intervention. Study sample included 901 residents from 54 Belgian nursing homes. Cross-sectional analyses were done to complete the above objectives. Detection of antidepressant-related Potentially Inappropriate Prescribing (PIP) was based on Beers 2015 and STOPP v2 explicit criteria. Results. At study baseline, the overall prevalence of antidepressant use was 46%. The most commonly prescribed subclass was "other antidepressants" (ATC_N06AX, 52% of prescriptions), mainly represented by trazodone (28% of prescriptions). With an exception for trazodone, the great majority of prescriptions (90%) met drug-dosing recommendations. Regarding potential indications, 28% of users were found with no relevant indication for antidepressant prescription (i.e. depression, anxiety or neuropathic pain). Remarkably, 42% of users appeared concerned by at least one PIP. DRP were identified in 63% of users from the intervention group and were commonly related to overprescribing practices, representing 34% of all-causes DRP. Consistently, 38% of ail-causes DRP were proposed to be solved by treatment interruption. Overall prevalence of antidepressant prescribing remained relatively stable over the study period, with no significant variations in bath intervention and control groups. Nevertheless, treatment amendments undertaken in the intervention group varied significantly from those made in the control group. Conclusions. Antidepressant use in nursing home is extensive and often at odds with current recommendations. The implementation of the COME-ON intervention appeared to have limited effects quantitatively speaking. However, antidepressants appeared as a major concern addressed in many aspects and in several occasions throughout the intervention, thereby constituting preliminary evidence for the awareness and the interest of healthcare providers into the problematic of antidepressant prescribing in nursing home residents.

Antidepressive Agents --- Nursing Homes

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Antidepressive Agents --- Maprotiline