This paper is a brief review which deals with research findings, clinical issues, and strategies ... more This paper is a brief review which deals with research findings, clinical issues, and strategies in the pharmacotherapy of clinical depression. The author introduces antidepressants which are currently available in the United States. They include heterocyclic antidepressants (tricyclic antidepressants and second-generation antidepressants), monoamine oxidase inhibitors, lithium, carbamazepine, and others. Under the description of each drug category, therapeutic and side effects are briefly discussed in the context of psychiatric practice in America. Then, the author gives a birds eye view of American pharmacotherapy of using antidepressants in acute, maintenance, and prophylactic treatments of depression.
Background: Trazodone in clinical use is ineffective because of its sedation to let patient recei... more Background: Trazodone in clinical use is ineffective because of its sedation to let patient receive an adequate dose for treating a patient with major depressive disorder. We are report a case report to demonstrate this clinical efficacy issue in the treatment with trazodone. Case Report: A 83-year old male Taiwanese patient had suffered from MDD for six months. He did not response to the treatment of trazodone 150 mg/day for four months, but consequently, he responded to the treatment of milnacipran 100 mg/day or mirtazapine 30 mg/day. Conclusion: Psychiatrists in Taiwan should be alert to the fact that trazodone is not as effective as other antidepressants, and that trazodone should not be prescribed as a single antidepressant in treating an MDD patient.
This is a review paper covering the American current status of pharmacotherapy of schizo phrenia.... more This is a review paper covering the American current status of pharmacotherapy of schizo phrenia. The author lists all available antipsychotic agents on the market in the United States and describes the American prescribing pattern of antipsychotic agents. This includes a brief history of antipsychotic use in America, acute treatment and chronic maintenance with antipsychotic drugs, the recent advent of atypical antipsychotic agents, and management of antipsychotic-induced side-effects. The characteristics of prescribing American antipsychotics in America are described, and they are then compared with Japanese prescribing practices. The author also makes brief remarks about the uncovered issues in antipsychotic pharmacotherapy and about atypical antipsychotic agents in the context of the future pharmaceutical development.
Aim: Paroxetine is a drug of choice in the treatment of major depressive disorder (MDD). Its meta... more Aim: Paroxetine is a drug of choice in the treatment of major depressive disorder (MDD). Its metabolism has recently been reported to be mediated through the CYP enzymes 1A2 and 2D6. In our current study, we tested whether genetic polymorphisms in CYP1A2 are associated with the treatment efficacy and side effects of paroxetine. Materials & methods: A total of 241 MDD patients who had taken paroxetine continually for 8 weeks were recruited, and their steady state paroxetine concentrations were measured at weeks 2, 4 and 8. The genotypes of these patients were then assessed for the presence of nine SNPs, which were selected from either the HapMap Chinese ethnic group, the literature report or through their functional role in the CYP1A2 gene. Results: The allele types for SNPs rs4646425 (permutation p = 0.03), rs2472304 (permutation p = 0.01) and rs2470890 (permutation p = 0.004) demonstrated significant associations with paroxetine treatment remission at week 8. Response rates in the Hamilton Rating Scale for Depression (HAM-D) and for The Hamilton Rating Scale for Anxiety (HAM-A) were significantly associated with the SNPs rs4646425 (p = 0.0126 and 0.0088 for HAM-D and HAM-A, respectively) and rs4646427 (p = 0.0067 and 0.0196 for HAM-D and HAM-A, respectively). The inducible SNP rs762551 had a significant association with paroxetine dose at week 4 (permutation p = 0.012). We did not find an association between these SNPs and the side effects or serum concentrations of paroxetine. Conclusion: Genetic variants in the CYP1A2 region may be indicators of treatment response in MDD patients to paroxetine.
Background: The prevalence of major depressive disorder (MDD) by DSM criteria among cancer patien... more Background: The prevalence of major depressive disorder (MDD) by DSM criteria among cancer patients is about 14%-15% in oncological, hematological, and palliative services and the number is risen up to 20%-25% when other depressive disorders are also included. Like MDD patients in general, patients with cancer are thought to be underdiagnosed and undertreated. Untreated depression in cancer patients may lead to having distressed symptoms and signs, decreased quality of life, higher suicide risk, greater psychological burden on the family, longer hospital stays, poorer anticancer treatment compliance, as well as even increased risk for mortality. Methods: In this review, the authors reviewed published articles on the use of antidepressant use for patients with cancer, to familiarize the readers with the use of antidepressants. Results: Antidepressants have been found to be more effective than placebo in relieving depressive symptoms in patients with cancer, and the efficacy is positively associated with length of treatment. Although the rate of antidepressant prescription is increasing, still about 75% of cancer patients with depression have not yet received antidepressant treatment. Besides the use in treating mood and anxiety symptoms, antidepressants have also been found to have versatile rôles as palliative treatment for cancer-related symptoms-pain, hot flushes, nausea, anorexia/cachexia, and fatigue. Furthermore, antidepressants have been studied for their anticancer potentials. They can inhibit tumor growth through either indirectly regulating immunity by enhancing cytotoxic activity and modulating cytokine production, or directly initiating cancer cell death and arresting cancer cell proliferation. We also found important drug-drug interaction between antidepressants and tamoxifen. Conclusion: Besides treating depressive and anxiety disorders, antidepressants are effective in treating cancer-related symptoms (pain, hot flushes, nausea, anorexia/cachexia, and fatigue). Cancer patients are eager to receive more effective treatment against their cancer as well as comorbid depression, and physicians should be more aggressive in providing every beneficial regimen-including an antidepressant.
Journal of Experimental & Clinical Medicine, Apr 1, 2013
ABSTRACT Objective In Taiwan, patients' low adherence to medication needs immediate a... more ABSTRACT Objective In Taiwan, patients' low adherence to medication needs immediate attention and rectification. This study was intended to evaluate patients' capability in comprehending a Mandarin- and Taiwanese-language Taiwan version of the eight-item Morisky Medication Adherence Scale (MMAS-8), and to explore the possible factors influencing patients' ability to understand. Methods Sixty-five participants, recruited from the neurology clinics of two Taipei Medical University-affiliated hospitals, received semi-structured, one-on-one, in-depth interviews (using the Taiwan version of the MMAS-8 combined with open questions to ask the patients what they had heard and what their opinion was on the Taiwan version of the MMAS-8). A cross-sectional survey method was used to analyze the data. The original Taiwan version of the MMAS-8 was then modified according to the patients' and experts' opinion and was validated by expert review. Results Lower comprehension of the response choices was related significantly to (1) age over 65 years (p < 0.05), (2) education lasting less than 12 years (p < 0.05), and (3) complex comorbid conditions (p < 0.05). Many patients were confused by the dichotomous response choices in Question 1 to 7 and the wordings of Questions 2 and 8 of the original version of the Taiwan MMAS-8. Therefore, these were modified into more specified sentences according to patients' and experts' suggested opinion. Conclusion The modified Taiwan version of the eight-item MMAS was validated by experts. Future research is needed to validate its psychometric properties.
Obsessive-compulsive symptoms (OCS) occur in a substantial portion of schizophrenia patients and ... more Obsessive-compulsive symptoms (OCS) occur in a substantial portion of schizophrenia patients and have significant impacts on clinical course. This study was intended to investigate the relationships of OCS with pharmacological parameters of olanzapine, psychopathology, and quality of life. Totally 151 schizophrenia patients were recruited, and rated using Yale-Brown Obsessive-Compulsive scale (YBOCS), Positive and Negative Syndrome Scale (PANSS), Montgomery-Åsberg Depression Rating Scale (MADRS), and World Health Organization Questionnaire on Quality of Life: Short Form (WHOQOL-BREF). The concentrations of olanzapine and N-desmethylolanzapine were determined by HPLC. Twenty-five patients (16.6%) revealed the presence of OCS. OCS group had significantly higher olanzapine dose, more numbers of past hospitalizations, higher PANSS total, positive, negative, and general psychopathology scores, and higher MADRS score than those in non-OCS group. The WHOQOL-BREF physical subscale score in schizophrenia patients with OCS was significantly lower. Olanzapine dose, PANSS score, and MADRS score were significantly correlated with YBOCS score. Our findings highlight that OCS is highly prevalent in schizophrenia patients under olanzapine treatment, especially those at high doses. Schizophrenia patients with OCS had higher severity of psychotic and depressive symptoms and poorer quality of life. Clinicians should monitor OCS
... Login to save citations to My List. Citation. Database: PsycINFO. [Journal Article]. Thiorida... more ... Login to save citations to My List. Citation. Database: PsycINFO. [Journal Article]. Thioridazine-induced inhibition of female orgasm. Shen, Winston W.; Park, Sanghae. Psychiatric Journal of the University of Ottawa, Vol 7(4), Dec 1982, 249-251. Abstract. ...
As of 1989, the psychotropic drugs that have been reported to inhibit female orgasm include antip... more As of 1989, the psychotropic drugs that have been reported to inhibit female orgasm include antipsychotic agents (thioridazine, trifluoperazine and fluphenazine), the combination drug perphenazine/amitriptyline, antidepressants (phenelzine, isocarboxazid, tranylcypromine, amoxapine, clomipramine, imipramine, nortriptyline and desipramine) and anxiolytic agents (diazepam, flurazepam and alprazolam). The management of psychotropic-drug-induced female anorgasmia includes discontinuation of the offending drug, reduction of the dosage level, a wait for spontaneous remission while the patient remains on the agent and substitution of another medication. The use of bethanechol chloride and cyproheptadine has been successful in resolving anorgasmia while patients continue to receive antidepressants.
This paper is a brief review which deals with research findings, clinical issues, and strategies ... more This paper is a brief review which deals with research findings, clinical issues, and strategies in the pharmacotherapy of clinical depression. The author introduces antidepressants which are currently available in the United States. They include heterocyclic antidepressants (tricyclic antidepressants and second-generation antidepressants), monoamine oxidase inhibitors, lithium, carbamazepine, and others. Under the description of each drug category, therapeutic and side effects are briefly discussed in the context of psychiatric practice in America. Then, the author gives a birds eye view of American pharmacotherapy of using antidepressants in acute, maintenance, and prophylactic treatments of depression.
Background: Trazodone in clinical use is ineffective because of its sedation to let patient recei... more Background: Trazodone in clinical use is ineffective because of its sedation to let patient receive an adequate dose for treating a patient with major depressive disorder. We are report a case report to demonstrate this clinical efficacy issue in the treatment with trazodone. Case Report: A 83-year old male Taiwanese patient had suffered from MDD for six months. He did not response to the treatment of trazodone 150 mg/day for four months, but consequently, he responded to the treatment of milnacipran 100 mg/day or mirtazapine 30 mg/day. Conclusion: Psychiatrists in Taiwan should be alert to the fact that trazodone is not as effective as other antidepressants, and that trazodone should not be prescribed as a single antidepressant in treating an MDD patient.
This is a review paper covering the American current status of pharmacotherapy of schizo phrenia.... more This is a review paper covering the American current status of pharmacotherapy of schizo phrenia. The author lists all available antipsychotic agents on the market in the United States and describes the American prescribing pattern of antipsychotic agents. This includes a brief history of antipsychotic use in America, acute treatment and chronic maintenance with antipsychotic drugs, the recent advent of atypical antipsychotic agents, and management of antipsychotic-induced side-effects. The characteristics of prescribing American antipsychotics in America are described, and they are then compared with Japanese prescribing practices. The author also makes brief remarks about the uncovered issues in antipsychotic pharmacotherapy and about atypical antipsychotic agents in the context of the future pharmaceutical development.
Aim: Paroxetine is a drug of choice in the treatment of major depressive disorder (MDD). Its meta... more Aim: Paroxetine is a drug of choice in the treatment of major depressive disorder (MDD). Its metabolism has recently been reported to be mediated through the CYP enzymes 1A2 and 2D6. In our current study, we tested whether genetic polymorphisms in CYP1A2 are associated with the treatment efficacy and side effects of paroxetine. Materials & methods: A total of 241 MDD patients who had taken paroxetine continually for 8 weeks were recruited, and their steady state paroxetine concentrations were measured at weeks 2, 4 and 8. The genotypes of these patients were then assessed for the presence of nine SNPs, which were selected from either the HapMap Chinese ethnic group, the literature report or through their functional role in the CYP1A2 gene. Results: The allele types for SNPs rs4646425 (permutation p = 0.03), rs2472304 (permutation p = 0.01) and rs2470890 (permutation p = 0.004) demonstrated significant associations with paroxetine treatment remission at week 8. Response rates in the Hamilton Rating Scale for Depression (HAM-D) and for The Hamilton Rating Scale for Anxiety (HAM-A) were significantly associated with the SNPs rs4646425 (p = 0.0126 and 0.0088 for HAM-D and HAM-A, respectively) and rs4646427 (p = 0.0067 and 0.0196 for HAM-D and HAM-A, respectively). The inducible SNP rs762551 had a significant association with paroxetine dose at week 4 (permutation p = 0.012). We did not find an association between these SNPs and the side effects or serum concentrations of paroxetine. Conclusion: Genetic variants in the CYP1A2 region may be indicators of treatment response in MDD patients to paroxetine.
Background: The prevalence of major depressive disorder (MDD) by DSM criteria among cancer patien... more Background: The prevalence of major depressive disorder (MDD) by DSM criteria among cancer patients is about 14%-15% in oncological, hematological, and palliative services and the number is risen up to 20%-25% when other depressive disorders are also included. Like MDD patients in general, patients with cancer are thought to be underdiagnosed and undertreated. Untreated depression in cancer patients may lead to having distressed symptoms and signs, decreased quality of life, higher suicide risk, greater psychological burden on the family, longer hospital stays, poorer anticancer treatment compliance, as well as even increased risk for mortality. Methods: In this review, the authors reviewed published articles on the use of antidepressant use for patients with cancer, to familiarize the readers with the use of antidepressants. Results: Antidepressants have been found to be more effective than placebo in relieving depressive symptoms in patients with cancer, and the efficacy is positively associated with length of treatment. Although the rate of antidepressant prescription is increasing, still about 75% of cancer patients with depression have not yet received antidepressant treatment. Besides the use in treating mood and anxiety symptoms, antidepressants have also been found to have versatile rôles as palliative treatment for cancer-related symptoms-pain, hot flushes, nausea, anorexia/cachexia, and fatigue. Furthermore, antidepressants have been studied for their anticancer potentials. They can inhibit tumor growth through either indirectly regulating immunity by enhancing cytotoxic activity and modulating cytokine production, or directly initiating cancer cell death and arresting cancer cell proliferation. We also found important drug-drug interaction between antidepressants and tamoxifen. Conclusion: Besides treating depressive and anxiety disorders, antidepressants are effective in treating cancer-related symptoms (pain, hot flushes, nausea, anorexia/cachexia, and fatigue). Cancer patients are eager to receive more effective treatment against their cancer as well as comorbid depression, and physicians should be more aggressive in providing every beneficial regimen-including an antidepressant.
Journal of Experimental & Clinical Medicine, Apr 1, 2013
ABSTRACT Objective In Taiwan, patients' low adherence to medication needs immediate a... more ABSTRACT Objective In Taiwan, patients' low adherence to medication needs immediate attention and rectification. This study was intended to evaluate patients' capability in comprehending a Mandarin- and Taiwanese-language Taiwan version of the eight-item Morisky Medication Adherence Scale (MMAS-8), and to explore the possible factors influencing patients' ability to understand. Methods Sixty-five participants, recruited from the neurology clinics of two Taipei Medical University-affiliated hospitals, received semi-structured, one-on-one, in-depth interviews (using the Taiwan version of the MMAS-8 combined with open questions to ask the patients what they had heard and what their opinion was on the Taiwan version of the MMAS-8). A cross-sectional survey method was used to analyze the data. The original Taiwan version of the MMAS-8 was then modified according to the patients' and experts' opinion and was validated by expert review. Results Lower comprehension of the response choices was related significantly to (1) age over 65 years (p < 0.05), (2) education lasting less than 12 years (p < 0.05), and (3) complex comorbid conditions (p < 0.05). Many patients were confused by the dichotomous response choices in Question 1 to 7 and the wordings of Questions 2 and 8 of the original version of the Taiwan MMAS-8. Therefore, these were modified into more specified sentences according to patients' and experts' suggested opinion. Conclusion The modified Taiwan version of the eight-item MMAS was validated by experts. Future research is needed to validate its psychometric properties.
Obsessive-compulsive symptoms (OCS) occur in a substantial portion of schizophrenia patients and ... more Obsessive-compulsive symptoms (OCS) occur in a substantial portion of schizophrenia patients and have significant impacts on clinical course. This study was intended to investigate the relationships of OCS with pharmacological parameters of olanzapine, psychopathology, and quality of life. Totally 151 schizophrenia patients were recruited, and rated using Yale-Brown Obsessive-Compulsive scale (YBOCS), Positive and Negative Syndrome Scale (PANSS), Montgomery-Åsberg Depression Rating Scale (MADRS), and World Health Organization Questionnaire on Quality of Life: Short Form (WHOQOL-BREF). The concentrations of olanzapine and N-desmethylolanzapine were determined by HPLC. Twenty-five patients (16.6%) revealed the presence of OCS. OCS group had significantly higher olanzapine dose, more numbers of past hospitalizations, higher PANSS total, positive, negative, and general psychopathology scores, and higher MADRS score than those in non-OCS group. The WHOQOL-BREF physical subscale score in schizophrenia patients with OCS was significantly lower. Olanzapine dose, PANSS score, and MADRS score were significantly correlated with YBOCS score. Our findings highlight that OCS is highly prevalent in schizophrenia patients under olanzapine treatment, especially those at high doses. Schizophrenia patients with OCS had higher severity of psychotic and depressive symptoms and poorer quality of life. Clinicians should monitor OCS
... Login to save citations to My List. Citation. Database: PsycINFO. [Journal Article]. Thiorida... more ... Login to save citations to My List. Citation. Database: PsycINFO. [Journal Article]. Thioridazine-induced inhibition of female orgasm. Shen, Winston W.; Park, Sanghae. Psychiatric Journal of the University of Ottawa, Vol 7(4), Dec 1982, 249-251. Abstract. ...
As of 1989, the psychotropic drugs that have been reported to inhibit female orgasm include antip... more As of 1989, the psychotropic drugs that have been reported to inhibit female orgasm include antipsychotic agents (thioridazine, trifluoperazine and fluphenazine), the combination drug perphenazine/amitriptyline, antidepressants (phenelzine, isocarboxazid, tranylcypromine, amoxapine, clomipramine, imipramine, nortriptyline and desipramine) and anxiolytic agents (diazepam, flurazepam and alprazolam). The management of psychotropic-drug-induced female anorgasmia includes discontinuation of the offending drug, reduction of the dosage level, a wait for spontaneous remission while the patient remains on the agent and substitution of another medication. The use of bethanechol chloride and cyproheptadine has been successful in resolving anorgasmia while patients continue to receive antidepressants.
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