Tolerability of combined treatment with lithium and fluoxetine
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Abstract:
Fourteen cases of depression resistant to multiple treatments were treated by lithium augmentation of fluoxetine. Tolerability of the treatment was poor. Lithium and fluoxetine may be a possible treatment for resistant depression but there is caution regarding tolerability and toxicity with the relatively high doses of lithium used in this series.Keywords:
Tolerability
Depression
Fourteen cases of depression resistant to multiple treatments were treated by lithium augmentation of fluoxetine. Tolerability of the treatment was poor. Lithium and fluoxetine may be a possible treatment for resistant depression but there is caution regarding tolerability and toxicity with the relatively high doses of lithium used in this series.
Tolerability
Depression
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Moclobemide
Tolerability
Serotonin reuptake inhibitor
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Moclobemide
Tolerability
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Background Little is known about the effect of pharmacotherapy in the prevention of post-traumatic stress disorder (PTSD) relapse. Aims To assess the efficacy and tolerability of fluoxetine in preventing PTSD relapse. Method This was a double-blind, randomised, placebo-controlled study. Following 12 weeks of acute treatment, patients who responded were re-randomised and continued in a 24-week relapse prevention phase with fluoxetine ( n =69) or placebo ( n =62). The primary efficacy assessment was the prevention of PTSD relapse, based on the time to relapse. Results Patients in the fluoxetine/fluoxetine group were less likely to relapse than patients in the fluoxetine/placebo group ( P =0.027). There were no clinically significant differences in treatment-emergent adverse events between treatment groups. Conclusions Fluoxetine is effective and well tolerated in the prevention of PTSD relapse for up to 6 months.
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Relapse prevention
Pharmacotherapy
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The efficacy and tolerability of cephacetrile administered by the intravenous or intramuscular route was evaluated in an open-label study of 55 hospitalized females diagnosed as having mild to severe pelvic inflammatory disease. Rapid improvement was observed in most patients. All patients were classified as clinically cured or significantly improved. Pain was absent or mild in 86% of the patients who received cephacetrile by intramuscular injection. Seventy-two percent of the patients given the drug intravenously experienced no localized pain. Phlebitis occurred in 6 of the 53 patients (11%) who received intravenous cephacetrile and thrombosis was present in 3 (6%). Rash and puritus was reported in 1 patient. Results of this study suggest that cephacetrile is an important and useful drug in the treatment of pelvic inflammatory disease.
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Pelvic inflammatory disease
Intramuscular injection
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A re-analysis of the profile of adverse events observed in controlled clinical trials in summarized. The data confirm that the side-effects of fluoxetine therapy are different from those of the tricyclic antidepressants (TCAs), both in type and frequency. Moreover, the superior tolerability of fluoxetine compared with the TCAs is confirmed by the significantly lower rate of premature discontinuation in the fluoxetine-treated patients than in the TCA-treated patients.
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Tricyclic
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Moclobemide
Major depressive episode
Serotonin Uptake Inhibitors
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The review of clinical antidepressive efficacy of fluoxetine was made on the basis of various authors' reports. The results showed that clinical efficacy of fluoxetine and of classical antidepressive drugs in the treatment of depression was comparable. The meta-analysis revealed effect-size of fluoxetine to be similar to tricyclics. Also the clinical effects of fluoxetine in the treatment of depressive disorders of different severity (mild, moderate, severe) were similar to the effects of classic tricyclic agents. The tolerability of therapeutic doses of fluoxetine in the daily range 20 to 40 mg is comparable while the dosage augmentation to 60 mg per day causes increase in the percentage of patients demonstrating side effects. In comparison with placebo fluoxetine showed significantly better clinical efficacy in the treatment of depression.
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Tricyclic
Therapeutic effect
Depression
Clinical efficacy
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Summary: The efficacy and tolerability of moclobemide (300 or 600 mg daily) and fluoxetine (20 or 40 mg daily) were compared in a 6-week, double-blind study of 25 inpatients and 24 outpatients who had major depressive episodes without psychotic features (DSM-III-R). Although the clinical results of this study suggest better efficacy with moclobemide and better tolerability with fluoxetine, a statistically significant difference between treatment groups was noted only with respect to Clinical Global Impressions recorded after 10 days of therapy; these were significantly better in the moclobemide group. A daily dosage of 300 mg of moclobemide and 20 mg of fluoxetine would thus appear to be comparable both in antidepressant efficacy and tolerability.
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Tolerability
Clinical efficacy
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Background: Obsessive–compulsive disorder (OCD) is a common psychiatric illness in children and adolescents. Previous evidence suggests that fluoxetine is effective in the treatment of OCD in children and adolescents. However, those studies had small sample sizes. As a result, a systematic review, which is a more powerful method to calculate the true effect size, can be applied to examine the efficacy, acceptability and tolerability of fluoxetine in the treatment of OCD in children and adolescents.Objectives: The aims of this study were to review the efficacy, acceptability and tolerability of fluoxetine in the treatment of OCD in children and adolescents.Study appraisal and synthesis methods: The titles and abstracts collected from electronic databases were evaluated. Then, the full-text versions of relevant studies were thoroughly assessed and extracted.Results: A total of 188 randomized patients in three RCTs of fluoxetine versus placebo and one RCT of fluoxetine versus citalopram were included in this review. Considering efficacious outcomes, the pooled mean change score of the CY-BOCS in the fluoxetine-treated group was significantly greater than that in the placebo-treated group. Additionally, the CGI-S in the fluoxetine-treated group and the pooled mean change score of the NIMH-OC were also significantly different from those in the placebo-treated group.Limitation: This review included studies with small sample sizes.Conclusions and implications of key findings: Fluoxetine is associated with a significantly greater reduction in OCD severity, as measured by the CY-BOCS, NIMH-OC and CGI-S, in children and adolescents. Additionally, it is well tolerated in children and adolescents. The acceptability is comparable to that of the placebo-treated group. Nonetheless, further large prospective trials should be conducted to confirm these outcomes.
Tolerability
Sertraline
Citalopram
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