Drugs are well known causes of eosinophilic lung disease. In many patients, drug-induced eosinophilic lung disease presents with transient eosinophilic infiltrates that disappear after discontinuation of the drug. Some patients, however, experience a fulminant, acute eosinophilia-like disease. Recently, we experienced a case of amitriptyline-associated acute eosinophilic pneumonia with respiratory failure in a diabetic hemodialysis patient. Eight days after treatment with amitriptyline, sudden fever, chill, dry cough and dyspnea developed. Subsequently, multiple patch consolidations appeared on the chest radiographs. Bronchoalveolar lavage (BAL), established a diagnosis of acute eosinophilic pneumonia. After immediate discontinuation of amitriptyline, a rapid clinical and radiological improvement was observed. The present case indicates that the possibility of acute eosinophilic pneumonia should be fully considered in dialysis patients developing unexplained respiratory symptoms while on amitriptyline therapy.
Acute Disease ; Adult ; Amitriptyline/*adverse effects ; Antidepressive Agents, Tricyclic/*adverse effects ; Female ; Human ; Pulmonary Eosinophilia/*etiology ; *Renal Dialysis

BACKGROUND: Some depressed patients receive acupuncture as an adjunct to their conventional medications. OBJECTIVE: This review aims to provide evidence on whether acupuncture can enhance the therapeutic effectiveness of antidepressants for treating depression, and explore whether acupuncture can reduce the adverse reactions associated with antidepressants. SEARCH STRATEGY: English and Chinese databases were searched for randomized controlled trials (RCTs) published until December 1, 2021. INCLUSION CRITERIA: RCTs with a modified Jadad scale score ≥ 4 were included if they compared a group of participants with depression that received acupuncture combined with antidepressants with a control group that received antidepressants alone. DATA EXTRACTION AND ANALYSIS: Meta-analysis was performed, and statistical heterogeneity was assessed based on Cochran's Q statistic and its related P-value. Primary outcomes were the reduction in the severity of depression and adverse reactions associated with antidepressants, while secondary outcomes included remission rate, treatment response, social functioning, and change in antidepressant dose. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to evaluate the overall quality of evidence in the included studies. RESULTS: This review included 16 studies (with a total of 1958 participants). Most studies were at high risk of performance bias and at low or unclear risk of selection bias, detection bias, attrition bias, reporting bias, and other bias. Analysis of the 16 RCTs showed that, compared with antidepressants alone, acupuncture along with antidepressants reduced the Hamilton Depression Rating Scale-17 (HAMD-17) scores (standard mean difference [SMD] -0.44, 95% confidence interval [CI] -0.55 to -0.33, P < 0.01; I² = 14%), Self-rating Depression Scale (SDS) scores (SMD -0.53, 95% CI -0.84 to -0.23, P < 0.01; I² = 79%), and the Side Effect Rating Scale (SERS) scores (SMD -1.11, 95% CI -1.56 to -0.66, P < 0.01; I² = 89%). Compared with antidepressants alone, acupuncture along with antidepressants improved World Health Organization Quality of Life-BREF scores (SMD 0.31, 95% CI 0.18 to 0.44, P < 0.01; I² = 15%), decreased the number of participants who increased their antidepressant dosages (relative risk [RR] 0.32, 95% CI 0.22 to 0.48, P < 0.01; I² = 0%), and resulted in significantly higher remission rates (RR 1.52, 95% CI 1.26 to 1.83, P < 0.01; I² = 0%) and treatment responses (RR 1.35, 95% CI 1.24 to 1.47, P < 0.01; I² = 19%) in terms of HAMD-17 scores. The HAMD-17, SDS and SERS scores were assessed as low quality by GRADE and the other indices as being of moderate quality. CONCLUSION: Acupuncture as an adjunct to antidepressants may enhance the therapeutic effectiveness and reduce the adverse drug reactions in patients receiving antidepressants. These findings must be interpreted with caution, as the evidence was of low or moderate quality and there was a lack of comparative data with a placebo control. SYSTEMATIC REVIEW REGISTRATION INPLASY202150008.
Acupuncture Therapy/methods* ; Antidepressive Agents/adverse effects* ; Depression/drug therapy* ; Drug-Related Side Effects and Adverse Reactions/drug therapy* ; Humans

Antidepressive Agents ; adverse effects ; toxicity ; Humans ; Lithium ; adverse effects ; toxicity ; Male ; Middle Aged ; Purpura ; chemically induced ; etiology

Acute Disease ; Antidepressive Agents, Second-Generation ; adverse effects ; Glaucoma, Angle-Closure ; chemically induced ; Humans ; Intraocular Pressure ; Venlafaxine Hydrochloride ; adverse effects

Depression has a high incidence in patients with cardiovascular diseases (CVD) and shows adverse effects on their life quality and prognosis. With the advent of new antidepressant drugs, oral antidepressant drugs are increasingly used in CVD patients with depression, and their efficacy and safety have attracted attention. Commonly used antidepressant drugs have many adverse reactions. When applying antidepressant drugs in CVD patients, we should pay special attention to their cardiovascular adverse reactions and their interaction drugs with commonly used CVD drugs. Clinicians should comprehensively evaluate and select appropriate antidepressant drugs for patients.
Antidepressive Agents/adverse effects* ; Cardiovascular Diseases/chemically induced* ; Cardiovascular System ; Humans ; Incidence ; Patients

Randomized trials have shown that selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have better safety profiles than classical tricyclic antidepressants (TCAs). However, an increasing number of studies, including meta-analyses, naturalistic studies, and longer-term studies suggested that SSRIs and SNRIs are no less safe than TCAs. We focused on comparing the common side effects of TCAs with those of newer generation antidepressants including SSRIs, SNRIs, mirtazapine, and bupropion. The main purpose was to investigate safety profile differences among drug classes rather than the individual antidepressants, so studies containing comparison data on drug groups were prioritized. In terms of safety after overdose, the common belief on newer generation antidepressants having fewer side effects than TCAs appears to be true. TCAs were also associated with higher drop-out rates, lower tolerability, and higher cardiac side-effects. However, evidence regarding side effects including dry mouth, gastrointestinal side effects, hepatotoxicity, seizure, and weight has been inconsistent, some studies demonstrated the superiority of SSRIs and SNRIs over TCAs, while others found the opposite. Some other side effects such as sexual dysfunction, bleeding, and hyponatremia were more prominent with either SSRIs or SNRIs.
Antidepressive Agents* ; Antidepressive Agents, Tricyclic ; Bupropion ; Depressive Disorder ; Drug-Related Side Effects and Adverse Reactions ; Hemorrhage ; Hyponatremia ; Mouth ; Seizures ; Serotonin and Noradrenaline Reuptake Inhibitors ; Serotonin Uptake Inhibitors

OBJECTIVETo compare the incidences of sexual dysfunction induced by mirtazapine and SSRI in the treatment of patients with depression.

METHODSUsing key-word retrieval from the compact disks of the Chinese biological medicine (CBM) data base, we analyzed the rates of sexual dysfunction from the published clinical control trials on depression treated with mirtazapine and SSRI by applying the fixed effects model (FEM) of evidence-based medicine (EBM).

RESULTSAmong 1108 cases in 14 studies, there were 5 cases of mirtazapine-induced and 106 cases of SSRI-induced sexual dysfunction, accounting for 0.90% and 19.2% respectively, OR = 0.07 (95% CI: 0.04-0.14), Z = 8.03, P < 0.01.

CONCLUSIONSSRI is far more likely to induce sexual dysfunction than mirtazapine in the treatment of depression.

Antidepressive Agents, Tricyclic ; adverse effects ; Depressive Disorder ; drug therapy ; Erectile Dysfunction ; chemically induced ; Humans ; Male ; Mianserin ; adverse effects ; analogs & derivatives ; Serotonin Uptake Inhibitors ; adverse effects

We report a case of severe hyponatremia related to duloxetine and ziprasidone. A 50-year-old woman on duloxetine and ziprasidone treatment for major depressive disorder developed polydipsia, polyuria, and two episodes of seizures, followed by admission to the emergency department on the 10th day of treatment. Laboratory investigations revealed elevated creatine kinase (CK) as well as hyponatremia, hypo-osmolality, and increased urine sodium. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) was considered, although urine osmolality was not measured. Duloxetine and ziprasidone were discontinued and the CK gradually normalized after correction of hyponatremia. Clinicians should be aware of the possibility of antipsychotic-induced hyponatremia, particularly in patients with symptoms of polydipsia.
Antidepressive Agents ; adverse effects ; Antipsychotic Agents ; adverse effects ; Creatine Kinase ; blood ; Depressive Disorder, Major ; drug therapy ; Duloxetine Hydrochloride ; Female ; Humans ; Hyponatremia ; chemically induced ; Middle Aged ; Piperazines ; adverse effects ; Thiazoles ; adverse effects ; Thiophenes ; adverse effects

OBJECTIVESTo evaluate the effects of antidepressant Seroxat on premature ejaculation.

METHODSAfter having taken Seroxat 20 mg every noon for four weeks, the patients were asked to fill the investigating questionaire about the effects and side effects before and after the treatment.

RESULTSAfter the treatment, 43 cases in our study had increased their ejaculation latency time, enhanced the quality of their sexy lives and their wives', and had significant difference compared with pre-treatment(P < 0.001). They had good effects on improving premature ejaculation after taking Seroxat (11.26 +/- 5.79) days; and after having stopped taking seroxat for (20.94 +/- 8.04) days, the situation of premature ejaculation in 32 cases were as same as that of before. There were seven cases whose sexuality and oomph increased, and two cases whose sexuality were decreased. A few patients had constipation, dry in mouth, insomnia and itch in skin, after taking the drugs.

CONCLUSIONSAntidepressant Seroxat has rather good effects on premature ejaculation and should be used and studied further.

Adult ; Antidepressive Agents ; adverse effects ; therapeutic use ; Ejaculation ; drug effects ; Humans ; Male ; Middle Aged ; Paroxetine ; adverse effects ; therapeutic use ; Sexual Dysfunction, Physiological ; drug therapy ; Time Factors ; Treatment Outcome

Venlafaxine is often considered to be safer than established antidepressants except the risk of hypertension. In terms of vaginal bleeding associated with venlafaxine, only one case has been reported. The author describes a vaginal bleeding occurred in a 38-year-old depressed patient who has been receiving additional venlafaxine during fluoxetine medication. Discontinuation of venlafaxine supported the assumption that the vaginal bleeding was an adverse drug reaction of venlafaxine. Physicians should be alerted to the possibility of bleeding tendency in patients who have taken venlafaxine.
Adult ; Antidepressive Agents ; Drug-Related Side Effects and Adverse Reactions ; Fluoxetine ; Hemorrhage ; Humans ; Hypertension ; Uterine Hemorrhage* ; Venlafaxine Hydrochloride