Publications by authors named "Padideh Ghaeli"

44 Publications

A Case Series of Severe Hyperammonemia Encephalopathy Related to Valproate: Can Antipsychotics Increase the Risk?

Iran J Psychiatry 2019 Jul;14(3):248-252

Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran; Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Valproate-induced hyperammonemia is a common side effect of valproate, which may occur either without any symptoms or may rarely cause symptoms of encephalopathy. Different risk factors have been defined for this side effect, including some nutritional deficiencies and polypharmacy (eg, other anticonvulsants). Three cases with psychiatric disorder who showed symptoms of severe hyperammonemia encephalopathy and had taken valproate with antipsychotics, especially risperidone, are presented here. In all cases, the symptoms were improved by discontinuation of valproate. Administration of antipsychotic may be considered as a risk factor for hyperammonemic encephalopathy related to valproate, specifically in some prone populations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778604PMC
July 2019

Methylphenidate-Induced Psychotic Symptoms in 65-Year-Old Female with ADHD.

Iran J Psychiatry 2018 Oct;13(4):310-313

Pharmacy Services, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Methylphenidate, a stimulant, is prescribed commonly in the treatment of attention deficit hyperactivity disorder (ADHD) in children and adults. Methylphenidate is generally considered a safe medication, however, some rare adverse effects, such as psychotic symptoms, may occur with its therapeutic or high doses. Additionally, this medication has a potential of abuse, especially among teenagers. There are several published cases regarding methylphenidate-induced psychosis in young adults. However, psychosis due to methylphenidate has been rarely reported in the elderly. This case presents psychotic manifestations due to methylphenidate in a 65-year-old female who was taking this medication for ADHD. She consumed 3 to 4 methylphenidate hydrochloride tablets per day for several months and thought that they were sleeping pills. Antipsychotic medication was initiated and methylphenidate was discontinued which resulted in improvement of her psychosis. Alternative diagnoses, including bipolar mood disorder with psychotic feature or mood disorder due to general medical condition, were ruled out because her psychotic symptoms appeared after taking several methylphenidate tablets and disappeared after discontinuation of this medication.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320382PMC
October 2018

Preventive Intervention to Prevent Delirium in Patients Hospitalized in Intensive Care Unit.

Iran J Psychiatry 2018 Apr;13(2):142-147

Director of Neuropsychiatry Section of Iranian Psychiatry Association, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Delirium is a clinical syndrome associated with multiple short- and long-term complications; therefore, prevention is an essential part of its management. This study was conducted to review the effective non-pharmacological interventions that can reduce the incidence or duration of delirium in critically ill patients. A search was made in PubMed, Scopus, Psych INFO and Google Scholar databases without any time constraints. The information available was collected and sorted, and a secondary study of narrative review was done. The views of specialists on this topic were received via email and included in the texts and recommendations. Delirium is a common, costly and potentially damaging illness in patients who are staying in hospitals, especially older patients in ICU. Thus, preventing delirium could be one of the most effective methods in preventing the complications. The present study aimed at conducting a review-validity study to generate a general view on the activities which might be effective in preventing delirium in patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6037578PMC
April 2018

Adaptation of the Pharmacological Management of Delirium in ICU Patients in Iran: Introduction and Definition.

Iran J Psychiatry 2018 Jan;13(1):65-79

Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Delirium is a brain dysfunction syndrome. In most cases, this syndrome is neither diagnosed accurately nor treated properly. The incidence of delirium by itself increases hospitalization period, mortality rate and the cost in health spectrum. If appropriate attempts are not made to treat this complication, the outcomes could become worse. Thus, the present study aimed at conducting a review on medications which are prescribed to treat delirium and establishing a general view on their advantages and disadvantages. By searching Google Scholar, PsycINFO, Scopus, and PubMed databases as well as hand searching in key journals, data were collected without time and language limitation. After collecting the data, comparing the similar or contradictory information, and sorting them, the views of specialists were inquired and duly received via email. By acquiring consensus of opinions, the secondary manuscript was written in a narrative review form. This narrative review paper aimed at providing a general view on defining delirium, the pathologic factors that create it, and treating this syndrome based on its development. Authentic evidence regarding delirium management was reviewed and a treatment strategy was suggested for Iranian patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994234PMC
January 2018

Comparison of the Effects of Melatonin and Oxazepam on Anxiety Levels and Sleep Quality in Patients With ST-Segment-Elevation Myocardial Infarction Following Primary Percutaneous Coronary Intervention: A Randomized Clinical Trial.

Ann Pharmacother 2018 10 11;52(10):949-955. Epub 2018 May 11.

1 Tehran University of Medical Sciences, Tehran, Iran.

Background: Anxiety and sleep disorders are prevalent problems in patients presenting with ST-segment-elevation myocardial infarction (STEMI). Usually, these problems are managed by benzodiazepines, which-albeit effective-could cause adverse effects and drug interaction.

Objective: This study was designed to compare the effects of melatonin and oxazepam in the management of anxiety and insomnia on patients following primary percutaneous coronary intervention (PCI) with a view to providing a safer alternative.

Methods: This study was designed as a randomized clinical trial. STEMI patients managed with primary PCI were enrolled and randomized into 2 groups through the permuted block randomization. The patients received either oxazepam (10 mg) or melatonin (3 mg) every night. Autoimmune disease or previous use of psychoactive medications was considered the exclusion criterion. Levels of anxiety and sleep quality were evaluated using the Hamilton Anxiety Rating Scale (HAM-A) and the Groningen Sleep Quality Score and compared between the groups.

Results: Each group contained 20 patients. Melatonin showed a significant advantage over oxazepam in improving sleep quality ( P = 0.040). Comparisons of the efficacy of both medications in lowering the anxiety levels when considering all the items of the HAM-A, including those related to cardiovascular disease, were significantly in favor of melatonin ( P = 0.019).

Conclusions And Relevance: The results of this study suggest that melatonin, a drug with more favorable drug interaction and adverse effect profile, could be more effective than oxazepam in improving the sleep quality and anxiety levels of patients presenting with STEMI, and it could be considered a new alternative to benzodiazepines in this setting.
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http://dx.doi.org/10.1177/1060028018776608DOI Listing
October 2018

Craving and Drug Reward: A Comparison of Celecoxib and Ibuprofen in Detoxifying Opiate Addicts.

Iran J Psychiatry 2017 Oct;12(4):229-235

Department of Clinical Pharmacy, Roozbeh Hospital, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Craving for substance abuse is a usual and complicated problem in patients, with opioid addiction who are in opioid detoxifying process. Craving has been added as one of the diagnostic criteria of substance use disorders in DSM-5. The present trial aimed at comparing the effects of celecoxib versus ibuprofen in reducing pain and decreasing the desire to use opiates in patients undergoing opiate detoxification (n = 32). A total of 32 patients (both inpatients and outpatients), who were undergoing opiate detoxification procedure and met the inclusion criteria entered this 4- week study. Participants who suffered from pain due to opiate withdrawal were randomized into 2 groups: Group 1 received celecoxib 200 milligrams once per day and group 2 received ibuprofen 400 milligrams 4 times per day. Self-reported Desire for Drug Questionnaire (DDQ) and 0-10 numeric pain scale were used at baseline and at the end of the study to evaluate changes in opiate craving and pain, respectively. Data analysis was done by SPSS-21 statistical software. In this study, 16 patients received celecoxib 200 milligrams once daily, and 16 received ibuprofen 400 milligrams 4 times daily. After 4 weeks of treatment with both ibuprofen and celecoxib, the results revealed that celecoxib and ibuprofen equally reduced the pain symptoms. After 4 weeks of treatment, with either ibuprofen or celecoxib, significant improvement was observed in decreasing the craving in the celecoxib group, but not in the ibuprofen group. The study revealed a significant difference between the celecoxib and ibuprofen group in reducing craving in patients with opiate craving after 4 weeks of treatment. However there were no significant differences between these two groups in reducing pain.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816911PMC
October 2017

Effect of memantine on post-operative cognitive dysfunction after cardiac surgeries: a randomized clinical trial.

Daru 2017 Nov 21;25(1):24. Epub 2017 Nov 21.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Post-operative cognitive dysfunction (POCD) is an important complication of cardiac surgeries. Glutamate plays a critical role in physiologic and pathologic conditions in the brain. Due to the role of glutamate in ischemia, this study is designed to identify the effect of memantine in prevention of POCD early and late after cardiac surgeries.

Methods: In this randomized clinical trial, 172 patients with ages 45-75 years old who underwent elective cardiac surgery were enrolled. For patients in memantine group, 5 mg of memantine per day administered at least 48 h before surgery and increased to 10 mg per day during the first 24 h after surgery and continued for 3 months. A brief Wechsler memory test (WMT) was administered before, three to 5 days after, and 3 months after surgery for both groups.

Results: Both groups demonstrate standard pattern of cognitive dysfunction after surgery and in follow up. Pre- and post-operative WMT score showed significant improvement in memantine compared to control group (P < 0.001) both in unadjusted and adjusted with confounding factor analysis. Unadjusted pre-, post-operative, and follow up WMT score improved significantly after 3 months in memantine group (P = 0.006).

Conclusion: Pre-operative administration of memantine protects patients from POCD following cardiac surgeries. In addition, it improves cognitive function 3 months after surgery.

Trial Registration: The trial was registered in the Iranian Registry of Clinical Trials (registration number: IRCT201303168698N12 ). Memantin effect on POCD.
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http://dx.doi.org/10.1186/s40199-017-0190-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5696736PMC
November 2017

The Potential Role of Naltrexone in Borderline Personality Disorder.

Iran J Psychiatry 2017 Apr;12(2):142-146

Psychiatry and Psychology Research Center, Roozbeh Hospital and Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Management of borderline personality disorder (BPD) is a difficult challenge due to the complex features of this disorder. This article reviews the use of naltrexone in the treatment of BPD. Published articles and clinical trials were searched in Google Scholar, MedLine, ELSEVIER, and Cochrane database of systematic reviews abstracts in English language between 1990 and 2017. Naltrexone (NTX), a nonspecific competitive opiate antagonist, has been noted to be helpful in controlling self-injurious behavior (SIB) and dissociative symptoms in patients with BPD. Further studies should be conducted on the effects of naltrexone to confirm the role of this medication in the treatment of BPD.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483240PMC
April 2017

Effect of Valerian in Preventing Neuropsychiatric Adverse Effects of Efavirenz in HIV-Positive Patients: A Pilot Randomized, Placebo-Controlled Clinical Trial.

Ann Pharmacother 2017 Jun 1;51(6):457-464. Epub 2017 Feb 1.

1 Tehran University of Medical Sciences, Tehran, Iran.

Background: Several neuropsychiatric adverse effects of efavirenz are known. Preventing these adverse effects may improve patients' adherence to antiretroviral therapy (ART).

Objectives: To evaluate the efficacy and safety of valerian in preventing neuropsychiatric adverse effects of efavirenz in HIV-positive patients.

Method: In this pilot randomized, double-blinded, placebo-controlled, clinical trial, 51 HIV-positive patients who were receiving efavirenz were recruited into the valerian (n = 25) or placebo (n = 26) group. Patients received valerian (530 mg) or placebo nightly 1 hour before sleep for 4 weeks. The neuropsychiatric status (sleep, anxiety, depression, suicidal thought, and psychosis) of patients was assessed at baseline and week 4 using validated questionnaires.

Results: Sleep ( P ≤ 0.001) and anxiety ( P = 0.001) significantly improved in the valerian group compared with the placebo group. Dizziness was the most common complaint of patients in first days of the intervention. In the valerian and placebo groups, 92% and 84.6% of patients experienced dizziness, respectively ( P = 0.35). Nausea was the second common adverse effect that 84% and 76.9% of patients in the valerian and placebo groups experienced ( P = 0.39).

Conclusion: In the first 4 weeks of ART including efavirenz, valerian significantly improved sleep and anxiety in HIV-positive patients. Valerian may be considered as a potential option in preventing neuropsychiatric adverse effects of efavirenz in HIV-positive patients.
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http://dx.doi.org/10.1177/1060028017696105DOI Listing
June 2017

Effects of Passion Flower Extract, as an Add-On Treatment to Sertraline, on Reaction Time in Patients ‎with Generalized Anxiety Disorder: A Double-Blind Placebo-Controlled Study.

Iran J Psychiatry 2016 Jul;11(3):191-197

Psychiatric and Psychology Research Centre, Roozbeh Psychiatric Hospital, Tehran University of ‎Medical Sciences, Tehran, Iran.

Because of functional impairment caused by generalized anxiety disorder and due to cognitive side ‎effects of many anti-anxiety agents, in this study we aimed to evaluate the influence of Passion ‎flower standardized extract on reaction time in patients with generalized anxiety disorder.‎ Thirty patients aged 18 to 50 years of age, who were diagnosed with generalized anxiety disorder and ‎fulfilled the study criteria, entered this double-blind placebo-controlled study. Reaction time was ‎measured at baseline and after one month of treatment using computerized software. Correct ‎responses, omission and substitution errors and the mean time of correct responses (reaction time) in ‎both visual and auditory tests were collected. The analysis was performed between the two groups ‎and within each group utilizing SPSS PASW- statics, Version 18. P-value less than 0.05 was ‎considered statistically significant.‎ All the participants were initiated on Sertraline 50 mg/day, and the dosage was increased to 100 ‎mg / day after two weeks. Fourteen patients received Pasipy (Passion Flower) 15 drops three times ‎daily and 16 received placebo concurrently. Inter-group comparison proved no significant difference ‎in any of the test items between assortments while a significant decline was observed in auditory ‎omission errors in passion flower group after on month of treatment using intra-group analysis.‎‎ This study noted that passion flower might be suitable as an add-on in the treatment of generalized ‎anxiety disorder with low side effects. Further studies with longer duration are recommended to ‎confirm the results of this study.‎.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139955PMC
July 2016

Effect of Omega-3 Fatty Acids on Depressive Symptoms in HIV-Positive Individuals: A Randomized, Placebo-Controlled Clinical Trial.

Ann Pharmacother 2016 10 20;50(10):797-807. Epub 2016 Jun 20.

Tehran University of Medical Sciences, Tehran, Iran.

Background: The antidepressant effect of omega-3 fatty acids has been described in the non-HIV population. The effect of omega-3 fatty acid supplementation on the mood status of HIV-positive patients has not been evaluated yet.

Objective: In this study, the effect of omega-3 fatty acids on depressive symptoms was evaluated in HIV-positive individuals.

Method: A total of 100 HIV-positive patients with Beck Depression Score ≥16, were assigned to receive either omega-3 fatty acids or placebo twice daily for 8 weeks. Depressive symptoms of each participant were evaluated at baseline (month 0) and at the end of months 1 and 2 of the study. Beck Depression Inventory Second Edition, depression subscale of the Hospital Anxiety and Depression Scale, and Patient Health Questionnaire were used for assessment of depressive symptoms.

Results: Reduction in mean ± SD of all depression scores during the study period was statistically significant within the omega-3 group and when compared with the placebo group (for both comparisons, P < 0.001). Also, the mean differences of all depression scores were decreased significantly during the intervals: months 0, 1, and 2 (P < 0.001 for all comparisons). Among the participants, 7 (7%) and 4 (4%) patients in the omega-3 and the placebo group, respectively, experienced mild gastrointestinal problems, but the incidence of adverse drug reactions related to the interventions was not statistically different between the groups (P = 0.09).

Conclusion: Omega-3 fatty acids improved depressive symptoms in HIV-positive individuals without any significant adverse reaction.
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http://dx.doi.org/10.1177/1060028016656017DOI Listing
October 2016

Comparing Efficacy and Side Effects of Memantine vs. Risperidone in the Treatment of Autistic Disorder.

Pharmacopsychiatry 2017 Jan 14;50(1):19-25. Epub 2016 Jun 14.

Faculty of Pharmacy and Pharmaceutical Sciences, and Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of).

This study was aimed to compare the efficacy and side effects of memantine, an antagonist of the NMDA receptor of glutamate, with risperidone given the fact that glutamate has been noted for its possible effects in the pathogenesis of autism. Risperidone, an atypical antipsychotic, has been approved by FDA for the management of irritability associated with autism. 30 children, aged 4-17 years, entered an 8-week, randomized trial. Patients were randomly assigned to receive either risperidone or memantine. Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Clinical Global Impressions - Improvement (CGI-I) and Clinical Global Impression-Severity (CGI-S) scales were used to assess behavioral symptoms of the patients. Both risperidone and memantine reduced the scores of 4 subscales of ABC as well as the 10-item and the total score of CARS significantly. However, differences between the 2 drugs in the scores of each evaluating scale were not found to be significant. Relatively, larger number of patients on risperidone showed "very much improvement" when assessed by CGI-I scale when compared with those on memantine. The present study suggests that memantine may have beneficial effects in the treatment of many core symptoms of autism. Therefore, memantine may be considered as a potential medication in the treatment of those autistic children who do not respond or cannot tolerate side effects of risperidone.
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http://dx.doi.org/10.1055/s-0042-108449DOI Listing
January 2017

Evaluating the Potential Effect of Melatonin on the post-Cardiac Surgery Sleep Disorder.

J Tehran Heart Cent 2015 Jul;10(3):122-8

Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Background: Postoperative neurological injuries, including cognitive dysfunction, sleep disorder, delirium, and anxiety, are the important consequences of coronary artery bypass graft surgery (CABG). Evidence has shown that postoperative sleep disturbance is partly due to disturbed melatonin secretion in the perioperative period. The aim of this study was to evaluate the effect of melatonin on postoperative sleep disorder in patients undergoing CABG.

Method: One hundred forty-five elective CABG patients participated in a randomized double-blind study during the preoperative period. The patients were randomized to receive either 3 mg of melatonin or 10 mg of Oxazepam one hour before sleep time. Each group received the medication from 3 days before surgery until the time of discharge. Sleep quality was evaluated using the Groningen Sleep Quality Score (GSQS), and the incidence of delirium was evaluated by nursing records. Sleep quality and anxiety scores were compared before and after surgery through the Wilcoxon signed-rank test. The analysis of covariance (ANCOVA) and independent t-test were used to compare the sleep and anxiety scores between the groups. P values ≤ 0.05 were considered statistically significant.

Results: Totally, 137 patients at a mean age of 60 years completed the study (76% male). The analysis of the data showed that sleep was significantly disturbed after surgery in both groups. The patients in the Oxazepam group demonstrated significantly higher disturbance in their mean postoperative GSQS score than did their counterparts in the melatonin group (p value < 0.001). A smaller proportion of the participants experienced delirium in the melatonin group (0.06%) than in the Oxazepam group (0.12%); however, this difference was not statistically significant.

Conclusion: The result of the present study revealed that melatonin improved sleep in post-cardiac surgery patients more than what was observed with Oxazepam. Therefore, melatonin may be considered an effective alternative for Benzodiazepines in the management of postoperative sleep disorder.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685367PMC
July 2015

Effect of Melatonin on Cardiac Injury after Primary Percutaneous Coronary Intervention: a Randomized Controlled Trial.

Iran J Pharm Res 2015 ;14(3):851-5

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. ; Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Several studies have reported that the antioxidant properties of melatonin can provide cardiac protection through scavenging of free radicals. This study sought to investigate the efficacy of melatonin on cardiac biomarkers, myocardial-specific protein high sensitive troponin-T (hs-TnT) and creatine kinase-MB (CK-MB), in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). In this randomized clinical trial, a total of 40 patients with STEMI planned to undergo pPCI were randomly assigned to two groups of receiving melatonin plus standard treatment [n=20] and control group, receiving only standard therapy [n=20]. The following parameters including hsTnT and CK-MB were assessed preoperatively (baseline) and at 6 hours after procedure. Melatonin could significantly reduce the level of CK-MB (118.2 ± 21.09 IU/L in the treated group versus 198.24 ± 20.94 IU/L in the control group; p-value = 0.01). However, there was no difference in the mean hs-TnT level between two groups (2491 ± 664 μg/L vs. 2801 ± 620 μg/L; p value = 0.73). Our results revealed that melatonin can be considered as a safe adjunctive medication to the standard regimen after pPCI for the aim of decreasing cardiovascular events. Meanwhile, this was a pilot study with a small number of patients and further studies are needed to confirm the beneficial effect of melatonin in patients with STEMI.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518113PMC
September 2015

Comparing the Efficacy of 8 Weeks Treatment of Cipram® and its Generic Citalopram in Patients With Mixed Anxiety-Depressive Disorder.

Iran J Psychiatry Behav Sci 2015 Jun 23;9(2):e230. Epub 2015 Jun 23.

Psychiatry and Psychology Research Center, Faculty of Pharmacy, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, IR Iran.

Background: Patients with mixed anxiety-depressive disorder (MADD) suffer both anxiety and depression. Antidepressants, especially, selective serotonin reuptake inhibitors are among agents of choice for treating this condition.

Objectives: This study compared the efficacy of Cipram® with its generic, citalopram.

Patients And Methods: Forty adult outpatients (between 18 to 55 years of age) with a diagnosis of MADD who met the trial criteria, entered this double-blind, randomized study. Subjects were assigned to receive either generic citalopram or Cipram® for 8 weeks. Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) were utilized to assess depression and anxiety at baseline, weeks 4 and 8 of the study. Statistical analysis was performed using SPSS 14.0.

Results: Twenty patients received citalopram (mean dosages of 22 mg/day during the first 4 weeks and 33 mg/day during weeks 4 to 8) and 20 received Cipram® (mean dosages of 22 mg/day during the first 4 weeks and 29 mg/day during weeks 4 to 8). Both treatments were noted to be effective in improving the symptoms of MADD at weeks 4 and 8. The mean differences of HAM-D and HAM-A between Citalopram and Cipram® groups were significantly different at the end of week 4 (HAM-D: P = 0.038, HAM-A: P = 0.025), but not at the end of week 8 (HAM-D: P = 0.239, HAM-A: P = 0.204). Both medications were tolerated well by the patients.

Conclusions: This study suggests that the efficacy of citalopram is similar to that of Cipram® in the treatment of MADD after 8 weeks. Meanwhile, Cipram® may reduce depression and anxiety quicker than its generic, citalopram.
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http://dx.doi.org/10.17795/ijpbs230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539397PMC
June 2015

Association between Perioperative Parameters and Cognitive Impairment in Post-Cardiac Surgery Patients.

J Tehran Heart Cent 2015 Apr;10(2):85-92

Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran.

Background: Postoperative cognitive dysfunction (POCD) has been an important complication of cardiac surgery over the years. Neurocognitive dysfunction can affect quality of life and lead to social, functional, emotional, and financial problems in the patient's life. To reduce POCD, we sought to identify the association between cognitive dysfunction and perioperative factors in patients undergoing cardiac surgery.

Methods: One hundred one patients aged between 45 and 75 years undergoing elective cardiac surgery were enrolled in this study. All the surgeries were performed on-pump by the same medical team. A brief Wechsler Memory Test (WMT) was administered before surgery, 3 to 5 days after the surgery, and 3 months after discharge. All related perioperative parameters were collected in order to study the effect of these parameters on the postoperative WMT scores and WMT score change.

Results: The study population consisted of 101 patients, comprising 14 (13.8%) females and 87 (86.2%) males aged between 45 and 75 years. In univariate analysis, the baseline WMT score, serum levels of lactate dehydrogenase and T3, cross-clamp time, and preexistence of chronic obstructive pulmonary disease showed significant effects on the postoperative WMT score (p value < 0.05), whereas only the baseline WMT score and chronic obstructive pulmonary disease showed strong effects on the postoperative WMT score in the multiple regression model. In addition, the multiple regression model demonstrated a significant association between the baseline WMT score, serum creatinine level, and nitrate administration and the WMT score change.

Conclusion: Our study showed that preexisting chronic obstructive pulmonary disease and preoperative high serum creatinine levels negatively affected cognitive function after surgery. In addition, there was a strong relationship between the patients' basic cognition and POCD. Preoperative nitrate administration led to a significant improvement in POCD. It is also concluded that the preoperative administration of specific medicines like nitrates can reduce neurological complications after cardiac surgery.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477092PMC
April 2015

Non-addictive opium alkaloids selectively induce apoptosis in cancer cells compared to normal cells.

Daru 2015 Feb 20;23:16. Epub 2015 Feb 20.

Department Toxicology & Pharmacology, Faculty of Pharmacy, Toxicology & Poisoning Research Center, Tehran University of Medical Sciences, 14155/6451, Tehran, Iran.

Background: Cytotoxic effects of some of the members of papaveraceae family have been reported in Iranian folk medicine. Recent reports has indicated that alkaloids fraction of opium may be responsible for its cytotoxic effect; however, the mechanism of this effect is not fully understood. This study has been designed to investigate the selective cytotoxic, genotoxic and also apoptosis induction effects of noscapine, papaverine and narceine, three non-addictable opium alkaloids, on HT29, T47D and HT1080 cancer cell lines. Mouse NIH3T3 cell line was chosen to present non-cancerous cells and Doxorubicin was selected as the positive control.

Methods: Cells were treated by different concentrations of Noscapine, Papaverine, Narceine and doxorubicin; viability was assessed by MTT assay. The genotoxicity and apoptosis induction were tested with comet assay and Annexin-V affinity when the concentration of each these drugs is less than its IC50. In addition, the DNA damage and caspase activity of the T47D cells were examined and the results were compared.

Results: This study noted the cytotoxicity and genotoxicity of noscapine and papaverine, specifically on cancerous cell lines. Furthermore, papaverine induces apoptosis in all studied cancer cell lines and noscapine showed this effect in T47D and HT29 cells but not in NIH-3 T3 cells as noncancerous cell line. narceine also showed genototoxicity in the studied cell lines at its IC50 concentration.

Conclusions: This experiment suggests that noscapine and papaverine may be of use in cancer treatment due to their specific cytotoxicity and genotoxicity. However, further in vivo studies are needed to confirm its usefulness in cancer treatment.
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http://dx.doi.org/10.1186/s40199-015-0101-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341877PMC
February 2015

Assessing cognition, depression and anxiety in hospitalized patients during pre and post-Bone Marrow Transplantation.

Iran J Psychiatry 2014 Apr;9(2):64-8

Pharmaceutical Care Department, Shariati hospital and, Tehran University of Medical Science (TUMS), Tehran, Iran.

Objective: Bone Marrow Transplantation is considered one of the main procedures used in the treatment of both malignant and non-malignant diseases. Psychological factors after Bone Marrow Transplantation have an important role in the survival of the patients undergoing this procedure.

Method: In the present study, some parameters including depression, anxiety and cognition were assessed during both pre and post-transplantation in patients undergoing Bone Marrow Transplantation. The evaluations were performed by utilizing several questionnaires including Hospital Anxiety and Depression Scale and Wechsler Memory Scale within 72 hours after hospitalization (pre-transplantation) and one month after transplantation (post-transplantation). All patients received intensive chemotherapy during the first 72 hours after hospitalization. Paired t test was used to compare pre and post values. SPSS (version 18) was used to analysis the data. The significance level was defined as p < 0.05.

Results: Twenty one patients who were not receiving any antianxiety agents at least for two weeks prior to and during this study were included. It was noted that anxiety was significantly less at post-transplantation compared to its pre-transplantation level (P = 0.008). However, no significant difference was found between pre and post-transplantation depression. Memory function was significantly improved at post-transplantation compared to pre-transplantation (P = 0.001).

Conclusion: The authors suggest that the improvement of anxiety and memory status of the patients one month after the bone marrow transplantation is expected even in the absence of consumption of any antianxiety agents. However, antidepressants may be needed to help those patients who undergo bone marrow transplantation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300467PMC
April 2014

A Randomized Placebo-controlled Trial of Clonidine Impact on Sedation of Mechanically Ventilated ICU Patients.

Iran J Pharm Res 2015 ;14(1):167-75

Department of Medicine, Pulmonary and Critical Care Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Clonidine has sedative and analgesic properties. Randomized studies examining these properties in mechanically ventilated ICU patients are scarce. This study was designed to assess the impact of clonidine on sedative agent use in mechanically ventilated patients. In a prospective, randomized, double blind, placebo-controlled study in a general ICU of a university medical center in Tehran, Iran, 40 patients, over 18 years on mechanical ventilation for 3 days or more randomized into 2 equal groups of clonidine and placebo. Clonidine arm received usual sedation and enteral clonidine 0.1 mg TID and escalated to 0.2 mg TID on the second day if hemodynamics remained stable. Ramsay Sedation Score was used to assess sedation. Opioids and midazolam were used in all patients. 10 patients in clonidine and 3 in placebo arms had history of drug abuse (P = 0.018). The mean of sedatives used in the clonidine/placebo arms (mg/day) were; MED (Morphine Equivalent Dose) 91.4 ± 97.9/112.1 ± 98.8 P=0.39, midazolam 7.1 ± 7.9/8.3 ± 9.2 P=0.66 and propofol 535.8 ± 866.7/139.1 ± 359.9 P=0.125. After adjusting for addiction and propofol, clonidine reduced MED use by 79.6 mg/day (P=0.005) and midazolam by 5.41 mg/day (P = 0.05). Opioids and midazolam need reduced by clonidine co-administration regardless of history of drug abuse. Acceptable side effect profile and the lower cost of clonidine could make it an attractive adjunct to sedative agents in ICU.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4277630PMC
January 2015

Effects of risperidone on core symptoms of autistic disorder based on childhood autism rating scale: an open label study.

Indian J Psychol Med 2014 Jan;36(1):66-70

Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Background: The aim of the present study was to evaluate the effect of risperidone in patients afflicted by autistic disorder especially with regards to its three core symptoms, including "relating to others", "communication skills", and "stereotyped behaviors" based on Childhood Autism Rating Scale (CARS).

Materials And Methods: An 8-week open-label study of risperidone for treatment of autistic disorder in children 4-17 years old was designed. Risperidone dose titration was as follow: 0.02 mg/kg/day at the first week, 0.04 mg/kg/day at the second week, and 0.06 mg/kg/day at the third week and thereafter. The outcome measures were scores obtained by CARS, Aberrant Behavior Checklist (ABC), and Clinical Global Impression-Improvement (CGI-I) scale.

Results: Fifteen patients completed this study. After 8 weeks, CARS total score decreased significantly, (P=0.001). At the end of the study, social interactions and verbal communication skills of the patients were significantly improved (P<0.001, P=0.03, respectively). However, stereotypic behaviors did not show any significant change in this study. Increase in appetite and somnolence were the most reported side effects.

Conclusion: This study suggests that risperidone may be an effective treatment for the management of core symptoms of autistic disorder.
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http://dx.doi.org/10.4103/0253-7176.127254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959023PMC
January 2014

Effects of celecoxib on inflammatory markers in bipolar patients undergoing electroconvulsive therapy: a placebo-controlled, double-blind, randomised study.

Swiss Med Wkly 2014 Feb 19;144:w13880. Epub 2014 Feb 19.

Tehran University of medical sciences;

Principal: Electroconvulsive therapy (ECT) is a treatment option for patients with bipolar disorder (BD). Alterations of markers have been reported following ECT.

Aim: the aim of the present study was to assess the effect of adjunctive celecoxib on the serum cytokines of patient with BD who were undergoing ECT.

Methods: This study was a randomised, double-blind, placebo-controlled trial in 48 patients who were diagnosed with BD and ordered to undergo six or more ECT sessions. Patients were randomly assigned to receive either placebo or celecoxib (200 mg twice daily) starting a day before the first ECT and continuing throughout the end of the sixth ECT. Blood levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hsCRP) were measured before the first ECT and repeated after the first, the third and the sixth ECT sessions. Data were analysed by using SPSS version 13.

Results: Twenty-five patients (mean ± standard deviation age of 33.64 ± 9.97 years) were assigned to the celecoxib group and 23 patients (mean age of 32.61 ± 9.82 years) to the placebo group. This study found that the level of TNF-α was significantly lower (p = 0.04, t = 2.14, degrees of freedom 46) in patients receiving celecoxib compared with those on placebo at the last session of ECT. However, the other factors studied did not show any significant changes throughout the trial.

Conclusions: Celecoxib was concluded to reduce TNF-α levels significantly in the patients at the end of the study. However, the differences in IL-1β, IL-6 and hsCRP between the two groups were not significant.

Trial Registration Number: IRCT201201247202N2.
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http://dx.doi.org/10.4414/smw.2014.13880DOI Listing
February 2014

Analysis of the antiepileptic, ethosuximide impacts on neurogenesis of rat forebrain stem cells.

Fundam Clin Pharmacol 2014 Oct 21;28(5):512-8. Epub 2014 Jan 21.

Department of Pharmacology, Pharmaceutical Sciences Branch, Islamic Azad University (IAU), Tehran, Iran.

Specific GABAergic interneurons in the hilus are lost in animal models with temporal-lobe epilepsy (TLE). Some preclinical evidence has indicated that GABAergic cells may provide relief from seizures in these models. This study was aimed to examine the ability of ethosuximide, an anticonvulsant drug, to promote neurogenesis in 3-day-old rat forebrain cortex stem cells. Most of the cells were found to be nestin-positive undifferentiated neural stem cells prior to their exposure to ethosuximide. It was noted that the number and percentage of tubulin β-III immunopositive neurons were increased after 6 days treatment with ethosuximide. Upon bFGF withdrawal, exposure to ethosuximide differentiated the stem cells to MAP2 positive neural cells (7.18 ± 0.43, 21.766 ± 0.55 and 41.57 ± 0.5 for control, 0.1 and 1 μM, respectively). GABA immunofluorescence images illustrated that ethosuximide increased GABAergic neurons (7.19 ± 0.32, 23.23 ± 0.55, and 46.30 ± 0.44 for control, 0.1 and 1 μM, respectively). Additionally, BrdU immunofluorescence assay showed that ethosuximide-enhanced nucleus proliferation in the neuronal stem cells. Therefore, the results of this study suggest that ethosuximide may compensate damage caused by seizure attacks and possibly other neuronal loss disorders.
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http://dx.doi.org/10.1111/fcp.12061DOI Listing
October 2014

Sertraline decreases serum level of interleukin-6 (IL-6) in hemodialysis patients with depression: results of a randomized double-blind, placebo-controlled clinical trial.

Int Immunopharmacol 2013 Nov 11;17(3):917-23. Epub 2013 Oct 11.

Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Background: This study was designed to assess the effect of sertraline on serum concentrations of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), IL-10 and high-sensitivity C-reactive protein (hs-CRP) of depressed hemodialysis (HD) patients.

Methods: During a randomized, double-blind, placebo-controlled trial, fifty depressed HD patients were allocated to receive sertraline or placebo for 12 weeks. Patients' depression was assessed using Beck Depression Inventory-second edition (BDI-II). Biochemical parameters (hemoglobin, serum albumin, iron stores, etc.) and serum IL-6, IL-10, TNF-α, and hs-CRP levels were measured at baseline and at weeks 6 and 12 of the study.

Results: Sertraline significantly improved depression symptoms in 47.5% of the patients. Compared with placebo, serum levels of IL-6 significantly decreased (P<0.01) in the sertraline group at week 12 of the study. Although serum level of TNF-α decreased and serum level of IL-10 increased in sertraline group at week 12 versus initiation of the study, no significant differences were found between sertraline and placebo groups. Serum hs-CRP did not display differences neither for inter- nor intra-group comparisons. Hemoglobin and serum albumin concentrations were significantly lower at week 12 in the placebo versus sertraline group (P=0.012 and P=0.006, respectively). No significant differences were observed in the inflammatory mediators between responders and non-responders to sertraline.

Conclusions: Compared with placebo, sertraline significantly decreased serum level of IL-6. The anti-inflammatory effect of sertraline was independent to its efficacy for depression treatment. Sertraline could be a promising strategy to reduce the systemic inflammation and to treat depression in HD patients.
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http://dx.doi.org/10.1016/j.intimp.2013.09.020DOI Listing
November 2013

Comparing effects of ketamine and thiopental administration during electroconvulsive therapy in patients with major depressive disorder: a randomized, double-blind study.

J ECT 2014 Mar;30(1):15-21

From the *Department of Anesthesiology, Amir Alam Hospital, †Department of Clinical Pharmacy, Faculty of Pharmacy, ‡Research Center for Rational Use of Drugs, Department of Clinical Pharmacy, §Psychiatric and Psychology Research Centre, Roozbeh Hospital, ∥Department of Psychiatry, Roozbeh Hospital, and ¶Department of Statistics and Mathematics, Tehran University of Medical Sciences; #Department of Psychology, University of Applied Science and Technology; **Faculty of Pharmacy and Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Recently, ketamine has attracted attention for induction of anesthesia during electroconvulsive therapy (ECT). This study compared the effects of thiopental and ketamine in patients undergoing this procedure.

Method: This randomized, double-blind clinical trial included inpatients, with major depressive disorder, undergoing ECT. Subjects were randomly allocated to receive either ketamine or thiopental. Mini-Mental State Examination and Hamilton Depression Rating Scale were used to assess memory and depression, respectively, before the first and second ECT sessions as well as a few days and 1 month after the sixth session. The electrical charge, seizure duration, blood pressure, and heart rate were also recorded.

Results: Of the 31 patients, 17 met the criteria for the ketamine group but 2 dropped out of the study. Therefore, 15 patients received ketamine and 14 received thiopental. Each patient underwent 6 ECT sessions. At the end of the study, depression improved significantly in both groups. However, a significant difference in depression improvement was noted only before the second ECT with ketamine compared with thiopental. Despite a significant decline in Mini-Mental State Examination scores in both groups after the first ECT, cognitive function improved afterward but was only significant in ketamine group. Seizure duration was found to be significantly longer with ketamine. Stimulus intensity used for each ECT increased gradually and linearly with a greater increase observed in thiopental group.

Conclusions: Ketamine administration during ECT is well tolerated and patients may experience earlier improvement in depressive symptoms, longer seizure duration, and better cognitive performance when compared with thiopental.
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http://dx.doi.org/10.1097/YCT.0b013e3182a4b4c6DOI Listing
March 2014

Sleep Quality and Its Correlates in HIV Positive Patients Who Are Candidates for Initiation of Antiretroviral Therapy.

Iran J Psychiatry 2013 Oct;8(4):160-4

Psychiatry and psychology Research center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Objective: Based on Pittsburg Sleep Quality Index, it has been reported that most human immunodeficiency virus (HIV) positive patients suffer from various degrees of sleep problems. Sleep disorders can affect quality of life, physical and social functioning and can also cause chronic fatigue. Some psychological and physiological factors are related to sleep quality. The purpose of the present study was to evaluate sleep quality and its related psychological and physiological factors in Iranian human immunodeficiency virus positive patients who were candidates for initiation of antiretroviral therapy.

Method: This was a cross- sectional study of 59 HIV positive out-patients in stages 2 or 3 of HIV disease who were candidates for initiation of antiretroviral therapy. Pittsburg Sleep Quality Index (PSQI), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS) and Somatization Subscale of Symptom Checklist 90 (SCL-90) were used to assess the patients' sleep quality, depression, anxiety and physiological factors, respectively. SPSS software version 12 was used for data analysis. The Pearson correlation coefficient was utilized to analyze the correlation between PSQI and other quantitative variables.

Results: Based on the sleep quality assessment, 47.5 % of the patients had PSQI > 5 that was defined as sleep disturbances. A significant correlation was found between sleep quality and HDRS (r = 0.531, p = 0.0001), HARS (r = 0.627, p = 0.0001) and somatization subscale of SCL-90 (r = 0.36, p = 0.05).

Conclusion: This study showed that human immunodeficiency virus positive individuals suffer from sleep disorders at least as same as the general population, and that psychological variables including depression and anxiety and physiological variables including physical morbidities in different systems of the body lead to sleep disturbance in this population.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281649PMC
October 2013

Memantine-induced speech problems in two patients with autistic disorder.

Daru 2013 Jul 2;21(1):54. Epub 2013 Jul 2.

Research Center for Rational Use of Drugs and Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Stuttering is a complex speech disorder. There are two forms of stuttering: developmental stuttering and acquired stuttering. Developmental stuttering is a disorder of early childhood but acquired stuttering can develop at any age. Some medications can induce or deteriorate stuttering as an adverse effect. There are several reports of stuttering due to psychotropic drugs. Memantine, a glutamate antagonist used in the treatment of Alzheimer's disease, has also been studied for the treatment of autism spectrum disorders. This report presents deterioration of stuttering and speech problem in two children with autistic disorder who were receiving memantine. Based on our knowledge, this is the first time these adverse drug reactions have been attributed to memantine. In conclusion clinicians should consider that speech problems including stuttering may be due to the consumption of memantine, especially, in children may be a side effect of memantine especially in children.
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http://dx.doi.org/10.1186/2008-2231-21-54DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711986PMC
July 2013

Cyproheptadine for prevention of neuropsychiatric adverse effects of efavirenz: a randomized clinical trial.

AIDS Patient Care STDS 2013 Mar 26;27(3):146-54. Epub 2013 Feb 26.

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Cyproheptadine prevention of the neuropsychiatric adverse effects of an antiretroviral regimen including efavirenz has been evaluated in a randomized clinical trial. Twenty-five patients (16 males and 9 females with mean±SD ages of 36±9 years) in a cyproheptadine group, and 26 patients (17 males and 9 females with mean±SD ages of 34±7 years) in a control group completed the trial. Sexual contact and injection drug use were the main routs of HIV infection in both groups. The patients' neuropsychiatric adverse effects were evaluated based on the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale, Beck Depression Scale, Pittsburgh Sleep Quality Inventory, Positive and Negative Suicide Ideation, and Somatization Subscale of Symptom Checklist 90 at baseline and 4 weeks after treatment. Cyproheptadine significantly decreased the scores of Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale, Beck Depression Scale, Pittsburgh Sleep Quality Inventory, Positive and Negative Suicide Ideation of the patients after 4 weeks in comparison with control group. All of the scores increased in control group following antiretroviral therapy. Although short duration of the patients' follow-up was a major limitation of the study, the results of the study showed that cyprohepradine is effective in prevention of depression, anxiety, hallucination, aggressive behaviors, emotional withdrawal, poor rapport, poor impulse control, active social avoidance, suicidal ideation, and improved sleep quality of HIV-positive patients after initiation of antiretroviral therapy including efavirenz.
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http://dx.doi.org/10.1089/apc.2012.0410DOI Listing
March 2013

Effects of cigarette smoking on priapism induced by quetiapine: a case report.

Daru 2012 Oct 15;20(1):55. Epub 2012 Oct 15.

Research Center for Rational Use of drugs, Faculty of Pharmacy, and Roozbeh Hospital, Tehran University of medical Sciences (TUMS), South Kargar St, 1333795914, Tehran, Iran.

Priapism is defined as an unwanted, prolonged, and painful erection which is unrelated to sexual stimulation. Some case studies suggest that priapism is an adverse effect of antipsychotic medications. In our case study a 30 year-old Iranian male with schizophrenia was experiencing recurrent priapism associated with quetiapine use. There are three interesting facts about this case: Firstly, the patient suffered priapism after even low dose consumption of quetiapine. Secondly, this case had experienced priapism with risperidone, olanzapine, and even clozapine in the past, suggesting a possible pharmacodynamic interaction of antipsychotics and inner biological traits in this particular case. Thirdly, priapism induced by low dose quetiapine was resolved after cigarette smoking.
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http://dx.doi.org/10.1186/2008-2231-20-55DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555757PMC
October 2012

Comparing the effects of fluoxetine and imipramine on total cholesterol, triglyceride, and weight in patients with major depression.

Daru 2013 Jan 5;21(1). Epub 2013 Jan 5.

Roozbeh Hospital, Tehran University of Medical Sciences (TUMS), Tehran, IRAN.

Unlabelled:

Background: There are some reports on the effects of antidepressants on metabolic syndrome. However, our search in the previously published literature showed a lack of information on the comparison of the effects of different classes of antidepressants on lipid profile. Therefore, this study was aimed to compare the effects of fluoxetine and imipramine on serum total cholesterol (TC) and triglyceride (TG) as well as body weight (BW) in patients with major depressive disorder.

Methods: Fifty one patients, 18 to 70 years of age, with major depressive disorder complied with the criteria of this preliminary, open-label clinical trial. Subjects received either imipramine (75-200 mg/day) or fluoxetine (20-40 mg/day) for 8 weeks. Total cholesterol and TG levels, as well as BW were compared at baseline with those at weeks 4 and 8. Data was analyzed by SPSS software version 16.0.

Results: In the fluoxetine group, TC levels decreased from 165.71 mg/dL to 156.71 mg/dL at week 4 (P = 0.07), and to 143.94 mg/dL at week 8 (P = 0.16); TG levels decreased from 129.35 mg/dL to 115.88 mg/dL at week 4 (P <0.001), and to 110.41 mg/dL at week 8 (P = 0.56). In the imipramine group, TC levels increased from 169.10 mg/dL to 178.69 mg/dL at week 4 (P = 0.07), and to 208.69 mg/dL at week 8 (P < 0.001) while TG levels increased from 111.73 mg/dL to 128.83 mg/dL at week 4 (P = 0.005), and to 160.90 mg/dL at week 8 (P < 0.001). BW was significantly increased in the imipramine group at weeks 4 and 8. In the fluoxetine group, BW was non-significantly decreased from 75.69 ± 7.97 Kg (baseline) to 75.67 ± 8.01 Kg at week 4 (P = 0.88), and to 75.22 ± 8.67 Kg at week 8 (P = 0.20), while in the imipramine group, BW had significant increases from 72.53 ± 8.55 Kg (baseline) to 73.95 ± 8.61 mg/dL at week 4 (P < 0.001), and to 75.13 ± 8.34 mg/dL at week 8 (P < 0.001).Repeated measures ANOVA showed significant effects on both TC and TG levels as well as on BW in all patients receiving imipramine. However, in patients on fluoxetine, repeated measures ANOVA showed significant effects of this medication only on TC levels in males.

Conclusions: Monitoring TC and TG and BW is recommended before starting imipramine in depressed patients with increased risk for cardiovascular disease. Fluoxetine may be the preferred agent in those with high or borderline high lipid levels.
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http://dx.doi.org/10.1186/2008-2231-21-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556056PMC
January 2013

Role of Omega-3 fatty acids in preventing metabolic disturbances in patients on olanzapine plus either sodium valproate or lithium: a randomized double-blind placebo-controlled trial.

Daru 2012 Oct 4;20(1):43. Epub 2012 Oct 4.

Faculty of Pharmacy, Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.

Unlabelled:

Background: Metabolic and cardiovascular side effects have been noted with the use of second generation antipsychotics (SGAs) and mood stabilizers. Since Omega-3 fatty acids have been known to prevent some cardiovascular risks, this preliminary study was designed to evaluate the cardiovascular benefits of omega-3 when added to the combinations of olanzapine with mood stabilizers.

Methods: This study was a randomized, double-blind, placebo-controlled, within-subject trial in adult psychiatric patients who were receiving olanzapine combined with lithium (Li) or valproate sodium (VPA). Omega-3 as fish oil with less than 1 g/day of EPA/DHA or its placebo was added to patients' olanzapine and mood stabilizer regimens for 6 weeks. Metabolic parameters including anthropometric variables, lipid profile, metabolic syndrome indices, C-reactive protein, fibrinogen and lipoprotein (a) [(Lp) (a)] were assessed for participants.

Results: Forty one participants completed this study; 20 patients received omega-3 and 21 patients received placebo, added to their regimen of SGA and mood stabilizer. Omega-3 addition did not modulate anthropometric, metabolic syndrome and lipid parameter changes in 6 weeks. However, fibrinogen levels significantly decreased, Lp (a) did not increase and non-high-density lipoprotein cholesterol (non-HDL-C) did not go beyond its target level after omega-3 supplementation. Additionally, a significant inter-group effect was noted for Lp(a).

Conclusions: This study suggests that use of short-term omega-3 supplementation added to a combined regimen of olanzapine and mood stabilizer may have a small modulating effect on some cardiovascular risk factors. Trials in longer periods of time and with larger number of patients are needed to further evaluate the effects of omega-3 supplements on preventing cardiovascular risk factors.This trial is registered at irct.ir and its Identifier is as following: IRCT138712231764N1.
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http://dx.doi.org/10.1186/2008-2231-20-43DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555734PMC
October 2012