Occurrence of Milnacipran-Associated Morbilliform Rash and Serotonin Toxicity.

Occurrence of milnacipran-associated morbilliform rash and serotonin toxicity.

Ann Pharmacother. 2013 Jul; 47(7-8): e32
Huskey AM, Thomas CC, Waddell JA

To report the development of morbilliform rash and serotonin toxicity after the addition of milnacipran to a patient’s medication therapy.A 57-year-old white female presented to the emergency department because of a full-body morbilliform rash, which appeared 9 days after initiation of milnacipran 50 mg twice daily. In the emergency department the patient’s vital signs were: heart rate 121 beats/min, blood pressure 180/100 mm Hg, and temperature 38.9 °C. The patient reported diarrhea, nausea, dizziness, restlessness, and increased muscle pain. Her history included recurrent breast cancer first diagnosed in 1999, hypertension, fibromyalgia, depression, osteopenia, gastroesophageal reflux disease, insomnia, and endometriosis. Her home medications included milnacipran, fluoxetine, alprazolam, zolpidem, zoledronic acid, anastrozole, doxepin, ranitidine, levocetirizine, doxazosin, tramadol, vitamin D, and ferrous gluconate. The patient’s increased heart rate, blood pressure, and temperature, as well as restlessness, self-reported diarrhea and nausea, and self-reported increase in muscle pain, indicated serotonin toxicity. Milnacipran, fluoxetine, and tramadol were discontinued, while doxepin was continued. Treatment consisted of acetaminophen, diphenhydramine, methylprednisolone, promethazine, and hydralazine 10 mg intravenously. The following morning all vital signs were within normal limits and the patient’s diarrhea, nausea, dizziness, restlessness, and muscle pain resolved. She was discharged the following morning. The rash had resolved after day 2 of hospital discharge, which was the fourth day after discontinuation of milnacipran.Given the patient’s symptoms, the timing of symptom onset, the patient’s history, and findings on physical examination, as well as use of the Naranjo probability scale, milnacipran was deemed the probable cause of the morbilliform reaction and serotonin toxicity. Only 1 case report of rash and 2 case reports of serotonin syndrome associated with milnacipran have been reported.It is important to increase awareness of the possibility of developing morbilliform rash and serotonin toxicity with milnacipran therapy, as both conditions can be associated with poor outcomes if not detected early and treated appropriately. HubMed – depression


Health in the long-term unemployed.

Dtsch Arztebl Int. 2013 Jun; 110(23-24): 413-9
Herbig B, Dragano N, Angerer P

Although the unemployment rate in Germany is currently low, more than a million persons in the country have been out of work for more than a year. In this review article, we address these persons’ state of health, the effect of unemployment on health, and the influence of macroeconomic factors and social policy.This article is based on a selective review of pertinent literature in the PubMed database.Large-scale meta-analyses and systematic reviews have shown that the long-term unemployed have an at least twofold risk of mental illness, particularly depression and anxiety disorders, compared to employed persons. Their mortality is 1.6-fold higher. Unemployment seems to be not only an effect of illness, but also a cause of it (i.e., there is evidence for both selection and causality). Learned helplessness is an important psychological explanatory model. Limited evidence indicates that the long-term unemployed have a moderately elevated prevalence of alcoholism; unemployment can be both an effect and a cause of alcoholism. Unemployment also seems to be associated with higher risks of heart attack and stroke. Cancer can lead to loss of employment. The link between unemployment and poorer health is strengthened by macroeconomic crises and weakened by governmental social interventions.The long-term unemployed carry a markedly higher burden of disease, particularly mental illness, than employed persons and those who are unemployed only for a short time. The burden of disease increases with the duration of unemployment. The vicious circle of unemployment and disease can be broken only by the combined effects of generally available health care, special health-promoting measures among the unemployed, and social interventions. HubMed – depression


Efficacy of hyperbaric oxygen treatment for depression in the convalescent stage following cerebral hemorrhage.

Exp Ther Med. 2013 Jun; 5(6): 1609-1612
Cao H, Ju K, Zhong L, Meng T

The present study aimed to evaluate the clinical efficacy of hyperbaric oxygen (HBO) treatment for depression in the convalescent stage following cerebral hemorrhage. A total of 60 cases of patients with depression in the convalescent stage following cerebral hemorrhage (2-6 months) were randomly divided into the treatment group (treated with HBO, 30 cases) and the control group (treated with Deanxit, 30 cases). Prior to treatment and at 4 weeks post-treatment, efficacy was evaluated by the Hamilton Depression Scale (HAMD) and nerve function defect scores. There was a significant difference in the total efficacy between the two groups (P<0.05), and a significant difference in the HAMD scores (P<0.05). There were also significant differences between the pre- and post-treatment HAMD scores within the two groups (both P<0.05). HBO is able to significantly improve the degree of depression in the convalescent stage following cerebral hemorrhage and also promote nerve function recovery. HubMed – depression


Three types of self-efficacy associated with medication adherence in patients with co-occurring HIV and substance use disorders, but only when mood disorders are present.

J Multidiscip Healthc. 2013; 6: 229-37
Reif S, Proeschold-Bell RJ, Yao J, Legrand S, Uehara A, Asiimwe E, Quinlivan EB

Adherence with medication regimens for human immunodeficiency virus (HIV) is a life-saving behavior for people with HIV infection, yet adherence is challenging for many individuals with co-occurring substance use and/or mood disorders. Medication-taking self-efficacy, which is the confidence that one can take one’s medication as prescribed, is associated with better adherence with HIV medication. However, little is known about the influence that other kinds of self-efficacy have on adherence with HIV medication, especially among HIV-infected individuals with co-occurring substance use and/or mood disorders. We sought to examine the relationship between adherence with HIV medication among substance users and three specific kinds of self-efficacy, ie, one’s confidence that one can communicate with medical providers, get support, and manage one’s mood. We further sought to examine whether symptoms of depression and anxiety moderate these relationships.Patients were recruited from three HIV clinics in the southeastern United States as part of an integrated study of treatment for HIV and substance use.We interviewed 154 patients with HIV and substance use who reported taking HIV medications. Based on symptoms of depression and anxiety using the Patient Health Questionnaire-9 and the Hospital Anxiety and Depression Scale-Anxiety, 63% had probable depression and/or anxiety. Higher levels of self-efficacy in provider communication (? = 3.86, P < 0.01), getting needed support (? = 2.82, P < 0.01), and mood management (? = 2.29, P < 0.05) were related to better self-reported adherence with HIV medication among study participants with probable depression and/or anxiety. The three kinds of self-efficacy were not associated with medication adherence among participants with HIV and substance use only.In the search for mutable factors to improve medication adherence among individuals triply diagnosed with HIV, substance use, and mood disorders, these findings support previous research indicating the benefit of enhancing self-efficacy, and further point to three specific kinds of self-efficacy that may benefit medication adherence, ie, provider communication, getting support, and mood management. HubMed – depression


Is placebo useful in the treatment of major depression in clinical practice?

Neuropsychiatr Dis Treat. 2013; 9: 915-20
Marchesi C, De Panfilis C, Tonna M, Ossola P

For many years, placebo has been defined by its inert content and use in clinical trials. In recent years, several studies have demonstrated its effect in the treatment of major depression. The aim of this paper is to present the conclusions of recent meta-analyses of the placebo effect in major depression, to explain the mechanism by which placebo exerts its effect, and to discuss whether placebo can be used in the treatment of patients with major depression in clinical practice. Recent meta-analyses have demonstrated that the placebo effect is estimated to account for 67% of the treatment effect in patients receiving antidepressants, and furthermore that placebo is as effective as antidepressants in patients with mild to moderate major depression (reporting a Hamilton Depression Rating Scale score lower than 25), whereas placebo is less effective than antidepressants in severely depressed patients. However, several limitations make the translation of these conclusions into clinical practice impracticable. Clinicians should learn from the “placebo lesson” to maximize the nonspecific effects of treatment when they prescribe an antidepressant, particularly in less severely depressed patients, who show a higher placebo response in randomized controlled trials. This strategy can increase the antidepressant effect and may reduce nonadherence with treatment. HubMed – depression