Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review

Wang, Sheng-Min,Han, Changsu,Bahk, Won-Myoung,Lee, Soo-Jung,Patkar, Ashwin A.,Masand, Prakash S.,Pae, Chi-Un Chonnam National University Medical School 2018 CMJ Vol.54 No.2

<P>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.</P>

Current Understanding on Psilocybin for Major Depressive Disorder: A Review Focusing on Clinical Trials

Sheng-Min Wang,Sunghwan Kim,Won-Seok Choi,Hyun Kook Lim,Young Sup Woo,Chi-Un Pae,Won-Myong Bahk 대한정신약물학회 2024 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.22 No.2

Previous studies suggested effectiveness of psilocybin in the field of mental health. FDA designated psilocybin as a “breakthrough therapy” for the treatment of treatment-resistant depression (TRD) in 2018. This paper provided a review of psilocybin’s potential role in treatment of depression by focusing on published clinical trials. Studies showed that psilocybin, an agonist on 5-HT2A receptors, manifests antidepressant and anxiolytic effects by increasing glutamate transmission, reducing brain inflammation, decreasing default mode network activity. In terms of clinical trials, eleven studies (six open-label and five double blinded randomized clinical trials, DB-RCTs) trials exploring psilocybin’s impact on depression were found. Among open-label studies, a pilot study on TRD patients demonstrated significant reductions in depressive symptoms after two psilocybin sessions. Psilocybin also improved cognitive bias associated with depression. Extension studies confirmed sustained improvements and high remission rates. Among five DB-RCTs, two showed that psilocybin led to significant reductions in anxiety and depression in cancer patients, and the improvements sustained for over 6 months. In MDD, psilocybin showed rapid reductions in depression, with higher remission rates compared to escitalopram in a DB-RCT. Another DB-RCT showed that psilocybin induced higher decrease in depression around 6 hours after their administrations than placebo. The last DB-RCT showed that in patients with TRD, a single dose of psilocybin 25 mg, but not psilocybin 10 mg, resulted in superior antidepressant effect than psilocybin 1 mg. Overall, psilocybin showed promise in treating depression and anxiety, with notable safety profiles. Further research should explore optimal dosages and long-term effects.

The Impact of COVID-19 on Psychiatric Health in the Korean Population

Sheng Min Wang,Sung-Hwan Kim,Won-Seok Choi,Hyun Kook Lim,Young Sup Woo,Chi-Un Pae,Won-Myong Bahk 대한정신약물학회 2023 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.21 No.3

Coronavirus disease 2019 (COVID-19) has multiple negative impacts on the psychiatric health of both those previously infected and not infected with severe acute respiratory syndrome coronavirus 2. Moreover, the negative impacts of COVID-19 are closely associated with geographical region, culture, medical system, and ethnic background. We summarized the evidence of the impact of COVID-19 on the psychiatric health of the Korean population. This narrative review included thirteen research articles, which investigated the impact of COVID-19 on the psychiatric health of Koreans. COVID-19 survivors were reported to have a 2.4 times greater risk of developing psychiatric disorders compared to members of a control group, and anxiety and stress-related disorders were the most common newly diagnosed psychiatric illnesses. Studies also reported that COVID-19 survivors had a 3.33-fold higher prevalence of insomnia, a 2.72-fold higher prevalence of mild cognitive impairment, and a 3.09-fold higher prevalence of dementia compared to the control group. In addition, more than four studies have highlighted that the medical staff members, including nurses and medical students, exhibit a greater negative psychiatric impact of COVID-19. However, none of the articles investigated the biological pathophysiology or mechanism linking COVID-19 and the risk of diverse psychiatric disorders. Moreover, none of the studies were actual prospective studies. Thus, longitudinal studies are needed to more clearly elucidate the effect of COVID-19 on the psychiatric health of the Korean population. Lastly, studies focusing on preventing and treating COVID-19–associated psychiatric problems are needed to provide a benefit in real clinical settings.

Second Generation Antipsychotics in the Treatment of Major Depressive Disorder: An Update

Wang, Sheng-Min,Han, Changsu,Lee, Soo-Jung,Jun, Tae-Youn,Patkar, Ashwin A,Masand, Prakash S,Pae, Chi-Un Chonnam National University Medical School 2016 CMJ Vol.52 No.3

<P>Less than one third of patients who suffer from major depressive disorder (MDD) report remission following antidepressant treatments requiring more diverse treatment approaches. Augmentation of second generation antipsychotics (SGAs) has been increasingly recognized as an important treatment option. The authors have previously provided a comprehensive review of SGAs for the treatment of MDD in 2013. Since then, numerous additional clinical trials have been conducted to investigate diverse issues regarding the utility of SGAs in MDD. Moreover, a new SGA, brexpiprazole, was recently approved by the Food and Drug Administration in July 2015 for the treatment of MDD as an augmentation agent to antidepressants. Thus, the aim of this study was to provide a concise update of all the available SGAs for the treatment of MDD, in particular on the additional clinical trials which have been published since 2013.</P>

Second Generation Antipsychotics in the Treatment of Major Depressive Disorder: An Update

Sheng Min Wang,한창수,이수정,전태연,Ashwin A. Patkar,Prakash S Masand,배치운 전남대학교 의과학연구소 2016 전남의대학술지 Vol.52 No.3

Less than one third of patients who suffer from major depressive disorder (MDD) report remission following antidepressant treatments requiring more diverse treatment approaches. Augmentation of second generation antipsychotics (SGAs) has been increasingly recognized as an important treatment option. The authors have previously provided a comprehensive review of SGAs for the treatment of MDD in 2013. Since then, numerous additional clinical trials have been conducted to investigate diverse issues regarding the utility of SGAs in MDD. Moreover, a new SGA, brexpiprazole, was recently approved by the Food and Drug Administration in July 2015 for the treatment of MDD as an augmentation agent to antidepressants. Thus, the aim of this study was to provide a concise update of all the available SGAs for the treatment of MDD, in particular on the additional clinical trials which have been published since 2013.

Fibromyalgia diagnosis: a review of the past, present and future

Wang, Sheng-Min,Han, Changsu,Lee, Soo-Jung,Patkar, Ashwin A,Masand, Prakash S,Pae, Chi-Un Informa UK, Ltd 2015 Expert review of neurotherapeutics Vol.15 No.6

<P>Diagnosis of fibromyalgia (FM) remains controversial even though diverse diagnostic criteria have been developed. This review looks at the history, evolution of diagnostic criteria, endless controversy, recent trends and future perspectives regarding FM diagnosis. Some have criticized that diagnosis of FM could lead to medicalization, whereas others have raised concerns of under-diagnosing FM. With the evolution of diagnosis criteria from American College of Rheumatology 1990 to modified American College of Rheumatology 2010, diagnosis of FM has become simpler. The recent trend of applying patient-reported questionnaires has also increased a simpler FM diagnosis. Reliable biomarkers will not be available for the foreseeable future, so diverse assessment tools will have to be used more pro-actively. After initial diagnosis, multiple and comprehensive assessment measures are needed during the course of treatment in order to better understand type and severity of FM symptoms. These, in turn, could help classify FM based on symptom domain, symptom severity, and comorbidity which would enable more personalized treatment.</P>

Association of Alcohol Intake and Fracture Risk in Elderly Varied by Affected Bones: A Nationwide Longitudinal Study

Sheng-Min Wang,Kyung-Do Han,Nak-Young Kim,Yoo Hyun Um,Dong Woo Kang,Hae-Ran Na,Chang Uk Lee,Hyun Kook Lim 대한신경정신의학회 2020 PSYCHIATRY INVESTIGATION Vol.17 No.10

Objective Previous studies investigating association of alcohol intake and fracture risk in elderly yielded conflicting results. We first examined the association between alcohol intake and total fracture risk in elderly subjects and further analyzed whether the association varied by fracture locations.Methods This is a nationwide population-based cohort study which included all people aged 66 (n=1,431,539) receiving the National Screening Program during 2009-2014. Time-to-event were defined as duration from study recruitment, the day they received health screening, to the occurrence of fracture.Results Total fracture was significantly lower in mild drinkers [adjusted hazard ratio (aHR)=0.952; 95% confidence interval (95% CI) =0.931-0.973] and higher in heavy drinkers (aHR=1.246; 95% CI=1.201-1.294) than non-drinkers. Risk pattern of alcohol consumption and fracture differed according to affected bones. Similar J-shaped trends were observed for vertebra fractures, but risk of limb fracture showed a linear relationship with alcohol intake. For hip fracture, risk decrement was more pronounced in mild and moderate drinkers, and significant increment was noted only in very severe drinkers [≥60 g/day; (aHR)=1.446; 1.162-1.801].Conclusion Light to moderate drinking generally lowered risk of fractures, but association between alcohol and fracture risk varied depending on the affected bone lesions.

Suicide Risk Assessments: Which Suicide Risk Factors Psychiatric Residents Consider Significant?

WANG SHENG MIN,황선영,연보라,최경호,오영민,이해국,권용실,이정태,이경욱 대한신경정신의학회 2015 PSYCHIATRY INVESTIGATION Vol.12 No.3

ObjectiveaaPatients visiting the emergency department (ED) after a suicide attempt are generally assessed for suicide risk by psychiatric residents. Psychiatric residents’ competence in evaluating the risk posed by the patients who attempted suicide is critical to preventing suicide. MethodsaaWe investigated factors considered important by psychiatric residents when evaluating suicide risk. This study included 140 patients admitted to the ED after attempting suicide. Psychiatric residents rated patients’ severity of current and future suicide risk as low/moderate/high using the Brief Emergency Room Suicide Risk Assessment (BESRA). The association between each BESRA variable and level of suicide risk was analyzed. ResultsaaMany factors were commonly considered important in evaluating the severity of current and future suicide risk. However, the following factors were only associated with future suicide risk: female gender, having no religion, family psychiatric history, history of axis I disorders, having a will, harboring no regrets, and social isolation. ConclusionaaPsychiatric residents use diverse factors when assessing suicide risk. Psychiatric residents might put more emphasis on non-modifiable demographic and clinical factors, concrete evidence showing suicide determination, and social isolation to assess the risk of future suicide.

The Efficacy and Safety of Clonazepam in Patients with Anxiety Disorder Taking Newer Antidepressants: A Multicenter Naturalistic Study

Sheng-Min Wang,Jung-Bum Kim,Jeong Kyu Sakong,Ho-Suk Suh,Kang Seob Oh,Jong-Min Woo,Sang-Woo Yoo,Sang Min Lee,Sang-Yeol Lee,Se-Won Lim,Seong Jin Cho,Ik-Seung Chee,Jeong-Ho Chae,Jin Pyo Hong,Kyoung-Uk Le 대한정신약물학회 2016 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.14 No.2

Objective: This study compared the efficacy and tolerability of clonazepam with other benzodiazepines in patients with anxiety disorders. Methods: Inclusion criteria were as follows: age >20 years, diagnosis of anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (DSM-IV-TR) criteria, taking only one type of antidepressant, and prescribed one of three oral benzodiazepines (alprazolam, clonazepam, or lorazepam). At baseline and week 6, clinical benefit was evaluated using the Clinical Global Impression-Severity Scale (CGI-S), Clinical Global Impression-Anxiety Scale (CGI-anxiety), and Clinical Global Impression-Sleep Scale (CGI-sleep). Results: Among 180 patients, no differences in demographic characteristics among the three benzodiazepine groups were noted. After six weeks of treatment, all benzodiazepine groups showed significant improvements in CGI-S, CGI-anxiety, and CGI-sleep scores ( p <0.001). There were no differences in mean changes in CGI-S, CGI-anxiety and CGI-sleep among the three benzodia-zepine groups. The incidence of side effects was significantly lower in the clonazepam group than with the other benzodiazepines. The incidences of adverse events for the clonazepam, alprazolam, and lorazepam groups were 26.7% (n=20), 48.4% (n=31), and 43.9% (n=18), respectively. Conclusion: The present study suggests that clonazepam is as efficacious as other benzodiazepines for the treatment of various anxiety disorders. Furthermore, the safety profile of clonazepam was superior to the other benzodiazepines in this study.

A review of current evidence for vilazodone in major depressive disorder

Wang, Sheng-Min,Han, Changsu,Lee, Soo-Jung,Patkar, Ashwin A.,Masand, Prakash S.,Pae, Chi-Un Informa Healthcare 2013 International journal of psychiatry in clinical pr Vol.17 No.3

<P><I>Objectives.</I> This review is to inform clinicians of currently available data on vilazodone for treating patients with major depressive disorder (MDD), focusing on its differential action mechanism and extended clinical utility. <I>Methods.</I> A data search was conducted in June 2012 using the PubMed/ MEDLINE/relevant clinical trial databases with the key terms “vilazodone” or “Viibryd.” <I>Results.</I> The efficacy, safety, and tolerability of vilazodone have been demonstrated in two pivotal 8-week, randomized, double-blinded, placebo-controlled studies. Certain pharmacological characteristics of vilazodone were observed, including early onset of action, fewer sexual side effects, the absence of known cardiac toxicity, and minimal effect on weight gain, that may provide potential clinical advantages compared with currently available antidepressants. However, such possibilities should be replicated and confirmed in more well-designed and adequately powered clinical trials. Vilazodone requires dose titration up to 2 weeks to reach a target dose of 40 mg/d due to high rate of gastrointestinal side effects. No direct comparative studies with other antidepressants are currently available to confirm the aforementioned potential clinical utility. <I>Conclusion.</I> Vilazodone is a newer antidepressant possessing different action mechanisms compared to currently available antidepressants but whether it has superiority to other class of antidepressants in terms of efficacy and safety should still warrant further evaluation through more well-controlled and direct comparison clinical trials.</P>