RESUMO
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) show similar efficacy as treatments for anxiety, obsessive-compulsive, and stress-related disorders. Hence, comparisons of adverse event rates across medications are an essential component of clinical decision-making. We aimed to compare patterns of adverse events associated with SSRIs and SNRIs in the treatment of children and adults diagnosed with these disorders through a network meta-analysis. We searched MEDLINE, PsycINFO, Embase, Cochrane, websites of regulatory agencies, and international registers from inception to 09 September 2022, for randomized controlled trials assessing the efficacy of SSRIs or SNRIs. We analyzed the proportion of participants experiencing at least one adverse event and incidence rates of 17 specific adverse events. We estimated incidence rates and odds ratios through network meta-analysis with random effects and three-level models. We analyzed 799 outcome measures from 80 studies (n = 21 338). Participants in medication groups presented higher rates of adverse events (80.22%, 95% CI 76.13-83.76) when compared to placebo groups (71.21%, 67.00-75.09). Nausea was the most common adverse event (25.71%, CI 23.96-27.54), while weight change was the least common (3.56%, 1.68-7.37). We found higher rates of adverse events of medications over placebo for most medications, except sertraline and fluoxetine. We found significant differences between medications for overall tolerability and for autonomic, gastrointestinal, and sleep-related symptoms. Adverse events are a common reason that patients discontinue SSRIs and SNRIs. Results presented here guide clinical decision-making when clinicians weigh one medication over another. This might improve treatment acceptability and compliance.
Assuntos
Transtorno Obsessivo-Compulsivo , Inibidores da Recaptação de Serotonina e Norepinefrina , Adulto , Criança , Humanos , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Inibidores da Recaptação de Serotonina e Norepinefrina/efeitos adversos , Incidência , Norepinefrina , Serotonina , Metanálise em Rede , Ansiedade , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/epidemiologiaRESUMO
QUESTION: Randomised controlled trials assessing treatments for anxiety, obsessive-compulsive and stress-related disorders often present high placebo response rates in placebo groups. Understanding the placebo response is essential in accurately estimating the benefits of pharmacological agents; nevertheless, no studies have evaluated the placebo response across these disorders using a lifespan approach. STUDY SELECTION AND ANALYSIS: We searched MEDLINE, PsycINFO, Embase, Cochrane, websites of regulatory agencies and international registers from inception to 9 September 2022. The primary outcome was the aggregate measure of internalising symptoms of participants in the placebo arms of randomised controlled trials designed to assess the efficacy of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) in individuals diagnosed with anxiety, obsessive-compulsive or stress-related disorders. The secondary outcomes were placebo response and remission rates. Data were analysed through a three-level meta-analysis. FINDINGS: We analysed 366 outcome measures from 135 studies (n=12 583). We found a large overall placebo response (standardised mean difference (SMD)=-1.11, 95% CI -1.22 to -1.00). The average response and remission rates in placebo groups were 37% and 24%, respectively. Larger placebo response was associated with a diagnosis of generalised anxiety disorder and post-traumatic stress disorder, when compared with panic, social anxiety and obsessive-compulsive disorder (SMD range, 0.40-0.49), and with absence of a placebo lead-in period (SMD=0.44, 95% CI 0.10 to 0.78). No significant differences were found in placebo response across age groups. We found substantial heterogeneity and moderate risk of bias. CONCLUSIONS: Placebo response is substantial in SSRI and SNRI trials for anxiety, obsessive-compulsive and stress-related disorders. Clinicians and researchers should accurately interpret the benefits of pharmacological agents in contrast to placebo response. PROSPERO REGISTRATION NUMBER: CRD42017069090.
Assuntos
Longevidade , Transtorno Obsessivo-Compulsivo , Humanos , Transtornos de Ansiedade/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Ansiedade/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/tratamento farmacológicoRESUMO
BACKGROUND: Anxiety, obsessive-compulsive, and stress-related disorders frequently co-occur, and patients often present symptoms of several domains. Treatment involves the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), but data on comparative efficacy and acceptability are lacking. We aimed to compare the efficacy of SSRIs, SNRIs, and placebo in multiple symptom domains in patients with these diagnoses over the lifespan through a 3-level network meta-analysis. METHODS AND FINDINGS: We searched for published and unpublished randomized controlled trials that aimed to assess the efficacy of SSRIs or SNRIs in participants (adults and children) with diagnosis of any anxiety, obsessive-compulsive, or stress-related disorder in MEDLINE, PsycINFO, Embase, and Cochrane Library from inception to 23 April 2015, with an update on 11 November 2020. We supplemented electronic database searches with manual searches for published and unpublished randomized controlled trials registered in publicly accessible clinical trial registries and pharmaceutical companies' databases. No restriction was made regarding comorbidities with any other mental disorder, participants' age and sex, blinding of participants and researchers, date of publication, or study language. The primary outcome was the aggregate measure of internalizing symptoms of these disorders. Secondary outcomes included specific symptom domains and treatment discontinuation rate. We estimated standardized mean differences (SMDs) with 3-level network meta-analysis with random slopes by study for medication and assessment instrument. Risk of bias appraisal was performed using the Cochrane Collaboration's risk of bias tool. This study was registered in PROSPERO (CRD42017069090). We analyzed 469 outcome measures from 135 studies (n = 30,245). All medications were more effective than placebo for the aggregate measure of internalizing symptoms (SMD -0.56, 95% CI -0.62 to -0.51, p < 0.001), for all symptom domains, and in patients from all diagnostic categories. We also found significant results when restricting to the most used assessment instrument for each diagnosis; nevertheless, this restriction led to exclusion of 72.71% of outcome measures. Pairwise comparisons revealed only small differences between medications in efficacy and acceptability. Limitations include the moderate heterogeneity found in most outcomes and the moderate risk of bias identified in most of the trials. CONCLUSIONS: In this study, we observed that all SSRIs and SNRIs were effective for multiple symptom domains, and in patients from all included diagnostic categories. We found minimal differences between medications concerning efficacy and acceptability. This three-level network meta-analysis contributes to an ongoing discussion about the true benefit of antidepressants with robust evidence, considering the significantly larger quantity of data and higher statistical power when compared to previous studies. The 3-level approach allowed us to properly assess the efficacy of these medications on internalizing psychopathology, avoiding potential biases related to the exclusion of information due to distinct assessment instruments, and to explore the multilevel structure of transdiagnostic efficacy.
Assuntos
Ansiolíticos/uso terapêutico , Ansiedade/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Inibidores da Recaptação de Serotonina e Norepinefrina/uso terapêutico , Transtornos Relacionados a Trauma e Fatores de Estresse/tratamento farmacológico , Adulto , Idoso , Ansiolíticos/efeitos adversos , Ansiedade/diagnóstico , Ansiedade/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metanálise em Rede , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Inibidores da Recaptação de Serotonina e Norepinefrina/efeitos adversos , Transtornos Relacionados a Trauma e Fatores de Estresse/diagnóstico , Transtornos Relacionados a Trauma e Fatores de Estresse/psicologia , Resultado do TratamentoRESUMO
Caffeine acts by antagonizing the effect of the endogenous homeostatic sleep factor adenosine. In the current study we aimed to evaluate the pattern of caffeine-induced insomnia and its relation to age and sex in a general population sample derived from a web survey. The sample included 75,534 participants (28.1% men) from 18 to 75 years who answered self-report questionnaires by accessing a website in Brazilian Portuguese (BRAINSTEP project). In our sample, 3620 (17.0%) men and 9920 (18.3%) women reported insomnia due to caffeine intake. Caffeine-induced insomnia increased with aging in both men and women. This difference remained after adjusting for sociodemographic, psychiatric and sleep related variables as well as caffeine intake. Women showed higher proportion of caffeine-induced insomnia than men, but this difference did not remain after controlling for covariates. Also, individuals with caffeine-induced insomnia reported poorer sleep quality, higher latency to fall asleep and a higher proportion of psychiatric diagnoses and daily use of hypnotic drugs. In conclusion, our results show an age-associated increase in caffeine-induced insomnia and poorer mental health indicators among people with caffeine-induced insomnia complaints.
Assuntos
Cafeína/efeitos adversos , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Sono/efeitos dos fármacos , Adolescente , Adulto , Idoso , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
The association between childhood trauma and personality traits has been poorly characterized and reported. Our aim was to evaluate whether distinct types of childhood abuse and neglect are associated with various personality dimensions using data from a large web-based survey. A total of 12,225 volunteers responded anonymously to the Internet versions of the Temperament and Character Inventory-Revised (TCI-R) and the Childhood Trauma Questionnaire (CTQ) via our research website, but only 8,114 subjects (75.7% women, mean age 34.8±11.3yrs) who met the criteria for validity were included in the analysis. Childhood trauma was positively associated with harm avoidance and was negatively associated with self-directedness and, to a lesser extent, with cooperativeness. The associations were robust with emotional abuse and neglect but were non-significant or mild with physical trauma. Emotional neglect was associated with reduced reward dependence and persistence. All types of abuse, but not neglect, were associated with increased novelty seeking scores. Reporting of childhood trauma, especially of an emotional nature, was associated with maladaptive personality traits. Further investigation of the effects of different types of childhood trauma on psychological and neurobiological parameters is warranted.
Assuntos
Maus-Tratos Infantis/psicologia , Transtornos da Personalidade/etiologia , Adolescente , Adulto , Adultos Sobreviventes de Eventos Adversos na Infância/psicologia , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Aprendizagem da Esquiva , Criança , Comportamento Cooperativo , Emoções , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Autoimagem , Transtornos de Estresse Traumático/etiologia , Adulto JovemRESUMO
O transtorno de déficit de atenção e hiperatividade (TDAH) é um transtorno neuropsiquiátrico do desenvolvimento, que causa prejuízo escolar, ocupacional e social. Por isso, a fim de prevenir algumas consequências adversas, é importante sua identificação, avaliação e tratamento.
Attention deficit hyperactivity disorder (ADHD) is a developmental neuropsychiatric disorder, with academic, occupational and social impairments. Therefore, in order to prevent adverse consequences, it is important to identify, to evaluate and to treat the disorder.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , CriançaRESUMO
O trabalho a seguir visa resumir as diretrizes do tratamento farmacológico da depressão unipolar para orientar o manejo inicial destes pacientes.
The paper that follows has the intention to summarize the guidelines of the pharmacological treatment of unipolar depression to guide the initial management of these patients.
Assuntos
Depressão/tratamento farmacológico , Psiquiatria , Transtorno Depressivo , TerapêuticaRESUMO
O trabalho a seguir visa orientar e guiar médicos que se deparam com o primeiro atendimento a um paciente psiquiátrico.
The paper that follows has the intention to guide doctors that will face with the first assessment of a psychiatric patient.
Assuntos
Serviços de Emergência Psiquiátrica , Emergências , Serviços Médicos de EmergênciaRESUMO
BACKGROUND: The internet provides a research opportunity for psychiatry and psychology. This article presents the development and preliminary data of a large web-survey created to study how temperament relates to other psychological measures, behavior and psychiatric disorders. METHODS: We used the Affective and Emotional Composite Temperament Scale (AFECTS) to evaluate temperament and we selected several self-report instruments to evaluate behavior, psychological constructs and mental disorders. The system provides anonymous psychological (phase 1) and psychiatric (phase 2) feedback and includes questions to assess the validity of the answers. Each phase has around 450 questions. This system was broadcast utilizing Brazilian media. RESULTS: After the exclusion of 21.5% of the volunteers (those who failed the validation questions), 41,427 participants concluded the first part of the system (mean age=31.2±10.5 yrs, 26.9% males), and 21,836 (mean age=32.5±10.9 yrs, 25.1% males) completed phase 2. Around 25% have received a psychiatric diagnosis from a mental health professional. Demographic and temperament profiles of those who completed either only 80 questions, only phase 1, or the whole system were similar. The rate of non-serious answers (e.g. on bizarre behaviors) was very low and congruency of answers was very high. The internal consistency of classical trait scales (TCI-R and PANAS) was high (Cronbach's alpha>0.80) for all dimensions. LIMITATIONS: Relatively high dropout rate due to the length of the process and an overrepresentation of female, young and well-educated subjects. CONCLUSIONS: The BRAINSTEP provides valid and abundant data on psychological and psychiatric measures.