Atualmente, a quantidade de pacientes que são diagnosticados com alguma forma de depressão, entre elas, o transtorno depressivo maior, aumenta consideravelmente, quer seja em razão de diagnósticos mais precisos ou pela própria epidemiologia da doença. Acresça-se o fato de que muitos pacientes, apesar da quantidade de tipos de antidepressivos atualmente disponíveis para a terapêutica, são refratários ao tratamento prescrito, em razão dos efeitos adversos apresentados ou ainda em razão de simplesmente não se observar melhora com a prescrição. Em razão disso, novos tratamentos farmacológicos são disponibilizados. Para auxiliar na máxima eficácia em sua utilização, esse trabalho propôs o desenvolvimento de metodologia analítica para a determinação simultânea de antidepressivos tricíclicos e não tricíclicos, a saber: moclobemida, venlafaxina, citalopram, agomelatina, duloxetina, amitriptilina e sertralina em plasma humano por cromatografia líquida de alta eficiência (HPLC), para posteriormente ser aplicada na monitorização de pacientes depressivos. O método consistiu na extração líquido-líquido com recuperação entre 73% a 86%, exceto para a moclobemida (55%). A separação foi obtida usando uma coluna em fase reversa LiChrospher® 60 RP-select B em LichroCART 250mm x 4mm, 5 ?m de diâmetro interno, Merck sob condições isocráticas com detecção em UV em 230 nm, com fase móvel composta por 35% de uma mistura de acetonitrila/metanol 55/5 v/v e 65% de tampão acetato 0,25M pH 4,4. As curvas padrão foram lineares em uma faixa de trabalho de 2,5-1000 ng/mL para moclobemida, 5-2000 ng/mL para venlafaxina, citalopram, agomelatina, duloxetina e amitriptilina, 10-2000 ng/mL para sertralina. A precisão intra e interensaios foi efetuada em 3 concentrações (50, 200 e 500 ng/mL). Os coeficientes de variação para a precisão intraensaio foram menores que 8,8% para todos os compostos e os coeficientes de variação para a precisão interensaios foram menores que 8,6%. Os limites de quantificação foram de 2,5 ng/mL para a moclobemida, 5 ng/mL para venlafaxina, citalopram, duloxetina, agomelatina, amitriptilina e 10 ng/mL para sertralina com a etidocaína como padrão interno. Não se observou qualquer interferência das drogas normalmente associadas com antidepressivos. O método desenvolvido foi aplicado na monitorização de 79 pacientes em tratamento prolongado com amitriptilina, sertralina e venlafaxina. Paralelamente, foram avaliadas as concentrações plasmáticas de pacientes voluntários sadios submetidos a tratamento em dose única com agomelatina. A monitorização terapêutica se faz necessária para monitorar adesão ao tratamento já que a depressão está entre as principais causas mundiais de morbidade por incapacitação social e estimativa de prevalência crescente até 2030; caracterizando-se como um dos maiores e mais onerosos problemas de saúde pública. / Currently, the number of patients who are diagnosed with some form of depression, among them, major depressive disorder, increases considerably, either because of more accurate diagnosis or by the epidemiology of the disease. One should add the fact that many patients, despite the amount of types of antidepressants currently available for therapy are refractory to the treatment prescribed, because of the adverse effects appear, or their toxic effects, or by simply not observed improvement then the prescription. Therefore, new pharmacological treatments are available. To assist in maximum effectiveness in its use, this paper presents a methodology on HPLC for simultaneous determination of seven antidepressants, tricyclic and non-tricyclic, moclobemide, venlafaxine, citalopram, agomelatine, duloxetine, amitriptyline and sertraline in human plasma, later to be applied in monitoring depressed patients. The simple and accurate method of sample preparation consists of the liquid-liquid extraction with recovery between 73% to 86% (except for moclobemide, 55%). Separation was achieved using a reverse phase column Lichrospher® 60 RP-select B LiChroCART 4mm x 250mm, 5?m internal diameter, Merck, under isocratic conditions, with UV detection at 230nm, with a mobile phase consisting of a mixture of 35% acetonitrile:methanol 55/5 (v/v) and 65% 0.25M acetate buffer, pH 4.4. The standard curves were linear in the working range of 2,5-1000 ng/mL for moclobemide, 5-2000 ng/mL to venlafaxine, citalopram, agomelatine, duloxetine and amitriptyline and 10-2000ng/mL to sertraline. The intra and interassay precisions were performed at three concentrations (50, 200 and 500 ng/mL). The coefficients of variation for intra-assay precision were less than 8.6% for all compounds and the coefficients of variation for interassay precision were lower than 8.5%. The limits of quantification were 2.5 ng/mL for moclobemide, 5 ng/mL for venlafaxine, citalopram, duloxetine, agomelatine, amitriptyline and 10 ng/mL for sertraline. No interference of drugs normally associated with antidepressants was observed. The developed method was applied to the monitoring of 79 patients receiving prolonged treatment with amitriptyline, sertraline and venlafaxine. And, the plasma concentrations of healthy volunteer patients undergoing single dose agomelatine were evaluated. Therapeutic drug monitoring, is to ensure maximum clinical efficacy coupled with minimal adverse effects in patients undergoing long-term therapy is needed and to monitor adherence to treatment since depression is among the major causes of morbidity and social disability increasing prevalence estimate of 2030; characterized as one of the largest and most costly public health problems

Major depression is a serious mood disorder affecting more than 120 million people worldwide, irrespective of their race or socio-economic status. This psychiatric disorder is predicted to become the second leading cause of disability by the year 2020, second only to heart diseases in the global population, without distinguishing differences in the incidence within defined age groups. Depression is known to affect people across all age groups, including children, adolescents, adults and geriatrics, although older age is associated with an increased susceptibility to major depression and other psychiatric conditions. Until the 1970‘s depression during childhood and adolescence was thought to be uncommon or non-existent. Recent epidemiological studies have demonstrated that there is a persistent escalation in the prevalence of depression in children and adolescents. Accordingly, the number of prescriptions for drugs to treat this disorder in juveniles has escalated significantly. With our current limited understanding of the safety and long-term effects of treatment with antidepressants, the clinician is left making decisions without sound evidence of safety. In addition, psychotropic drugs may affect neurodevelopment during childhood and adolescence and may consequently modulate susceptibility to psychiatric disorders later in life. The objective of the current study was to investigate the effects of early-life (pre-natal and postnatal) chronic treatment with venlafaxine, a dual action serotonin-noradrenalin reuptake inhibitor, during the developmental phase of the serotonin and norepinephrine pathways in stress-sensitive rats on measures of cognition, anxiety-like and depressive-like behaviour later in life. The study also investigated which age shows optimal behavioural changes later in life, following the above mentioned administration of venlafaxine. In addition we also determined the effects that the administration of venlafaxine has on the levels of monoamines l-norepinephrine (l-NE) and serotonin (5-HT) in the prefrontal cortex and the hippocampus. A number of translational animal models of psychiatric disorders have been described and validated, and is suitable for such investigations. For the current study we used stress-sensitive Flinders Sensitive Line (FSL) rats and their controls, Flinders Resistant Line (FRL) rats. Pregnant dams were injected subcutaneously for 14 days with 10 mg/kg venlafaxine or saline from pre-natal day 15 (ND-15) to ND-01. New-born pups were then injected subcutaneously with 3 mg/kg venlafaxine or saline for 14 days from postnatal day 3 (ND+03) to ND+17. These doses were determined from previous studies reported in literature. Four rat treatment groups of both FSL and FRL rats received injections during pre-natal + postnatal ages as follows: saline + saline, venlafaxine + saline, saline + venlafaxine and venlafaxine + venlafaxine. Following the drug treatments, all rat groups were housed under normal conditions until the indicated time to be subjected to a battery of behavioural tests, including the novel object recognition test (nORT), locomotor activity test (Digiscan®), elevated plus maze (EPM) and forced-swim test (FST), scheduled on either ND+35, ND+60 or ND+90. Separate treatment groups were used for each age group. After the behavioural tests animals were decapitated, the brains removed and the prefrontal cortex and hippocampus dissected out. These were analysed at a later stage using an HPLC with electrochemical detection to determine the levels of the monoamines l-NE and 5-HT. All animal procedures were approved by the Ethics Committee of the North-West University (approval number: NWU-00045-10-S5), and are in accordance with the recommendations of the National Institutes of Health guide for the care and use of laboratory animals. The data from the current study suggest that in general FRL rats were not influenced by the early-life treatment with venlafaxine, as observed in the nORT, EPM or FST on ND+35, ND+60 or ND+90. There was minimal changes seen in the immobile behaviour in the FST of FRL rats that received prenatal venlafaxine. As expected, depressive-like behaviour in the FST was significantly enhanced in FSL rats relative to corresponding FRL rat groups as observed at ND+35 and ND+60, but not ND+90. Importantly, depressive-like behaviour was reversed following pre- and postnatal treatment with venlafaxine in FSL rats at ND+60, relative to the corresponding FRL rat groups. Reversal of depressive-like behaviour in FSL rats were not observed at ND+35 or ND+90, suggesting a delayed response that is reversed later in adulthood. The data from the nORT, Digiscan® or EPM did not reveal any significant differences between the various FSL treatment groups, including at ND+60. The current study therefore demonstrated that the treatment regimen employed had a transient effect on depressive-like behaviour later in life and suggested that genetic susceptibility plays an important role in the treatment of depression. This was suggested by the venlafaxine-induced decrease in immobile behaviour exhibited by FSL rats at ND+60 in the FST, and the subsequent increase in immobile behaviour at ND+90. In general, the most significant venlafaxine-induced effects were seen in FSL rats, suggesting genetic susceptibility plays an important role. / MSc (Pharmacology), North-West University, Potchefstroom Campus, 2014

Atlikta mokslinių literatūros šaltinių apžvalga. Tiriamųjų medžiagų identifikavimui ir kiekybinei analizei pritaikyta ir validuota efektyvioji skysčių chromatografija. Antidepresantų mišinys išskirtas iš kraujo plazmos kietos fazės ekstrakcijos metodu. KFE metodas optimizuotas keičiant eliuentą ir eliuento pH. Atliktas optimizacijos sąlygų palyginimas. Nustatyti 3 organiniai tirpikliai, kuriais efektyviausiai eliuuojamos sorbente sulaikytos tiriamosios medžiagos bei gauti statistiškai patikimi rezultatai (p>0,05) : 2 proc. etano rūgšties tirpalas 100 proc. metanolyje, 2 proc. etano rūgšties tirpalas 80 proc. metanolyje ir 2 proc. metano rūgšties tirpalas 100 proc. metanolyje. / In this thesis was performed research of scientific literature. Applied and validated high performance liquid chromatography for identification and quantification of target compounds. Antidepressant mixture extracted from blood plasma samples using LLE and SPE methods. SPE method was optimized by changing the elutor and its pH. Three organic solvents were determined, which best elute target compounds from sorbent and show statistical confidence (p>0,05): 2 proc. acetic acid in 100 proc. methanol solution, 2 proc. acetic acid in 80 proc. methanol solution and 2 proc. formic acid in 100 proc. methanol solution.

Made available in DSpace on 2014-07-29T16:11:46Z (GMT). No. of bitstreams: 1 Dissertacao Wilsione Jose Carneiro.pdf: 729740 bytes, checksum: 371aee359d81ba53af5b532357fc8f09 (MD5) Previous issue date: 2010-03-03 / The venlafaxine, 1-[2-dimethylamino-1-(4-methoxyphenyl)-ethyl] cyclohexanol, is a antidepressant drug of second generation. This is one of the most potent reuptake inhibitor of serotonin and noradrenaline, and its therapeutic effect is attributed to this activity. Venlafaxine is biotransformed in the liver to O-desmethylvenlafaxine (desvenlafaxine), N, O-desmethylvenlafaxine, N-desmethylvenlafaxine. Enzymes CYP2D6, CYP2C19 and CYP2C9 metabolize venlafaxine and major metabolite is the O-desmethylvenlafaxine. This is pharmacologically active and contributes significantly to the pharmacological effect of venlafaxine, as is found in plasma at high concentrations. The investigation of the formation of degradation products is of great importance, because the products formed may be less active, more active or toxic. Bioconversion or the application of microbial models is a strategy to mimic the mammalian metabolism produces significant quantities of metabolites for studies of pharmacological activity and toxicological. This work represents a forced degradation study of venlafaxine extended-release capsules in different stress conditions (acid and alkaline hydrolysis, oxidative and thermal) and select strains of filamentous fungi, to identify those able to metabolize venlafaxine and produce in a semi-preparative major metabolites. The filamentous fungi used were: Aspergillus candidus ATCC 2023, Beauveria bassiana ATCC 7159, Cunninghamella echinulata ATCC 9244, Cunningamella elegans ATCC 6169, Mortierella isabelina ATCC 1757 and Rhizopus arrhizus ATCC 11145. Was developed and validated method stability indicating HPLC using reverse phase for the analysis of venlafaxine in pharmaceutical formulation. The metabolites prepared by bioconversion were used for structural elucidation and later as a reference chemical in the analysis of stability studies and future studies of pharmacological and toxicological activity. The fungus Cunninghamella elegans ATCC 6169 was selected and produced O-desmethylvenlafaxine (desvenlafaxine) and dihydroxy-venlafaxine, similar to those found in mammals, reinforcing the application of microbial models for the study of animal metabolism. The study indicated the stability of the acid condition of venlafaxine, formed two degradation products, the products found were similar to those obtained by bioconversion. The O-desmethylvenlafaxine, corresponds to the active metabolite of venlafaxine in humans and was recently approved for the treatment of major depressive disorder. Those studies, one can get the O-desmethylvenlafaxine in bioconversion reactions by Cunninghamella elegans ATCC 6169 and forced degradation studies of venlafaxine. The method developed and validated HPLC method was considered indicative of stability analysis of venlafaxine extended-release capsules, it is sensitive, specific (interference < 2%), precise (RSD < 2%), linear (r > 0.99), accurate (98.0 to 102.0%) and reproducible (RSD < 2%). / A venlafaxina, (1-[2-dimetilamino)-1-(4-metoxifenil)etil]ciclohexanol), é um fármaco antidepressivo de segunda geração. É um dos mais potentes inibidores da recaptação de serotonina e noradrenalina, e o seu efeito terapêutico é atribuído a esta atividade. A venlafaxina é biotransformada no fígado pelas enzimas CYP2D6, CYP2C19 e CYP2C9 em O-desmetilvenlafaxina ou também chamado de desvenlafaxina (metabólito majoritário), N,O-desmetilvenlafaxina, N-desmetilvenlafaxina. O O-desmetilvenlafaxina é farmacologicamente ativo e contribui significativamente para o efeito farmacológico da venlafaxina, uma vez que é encontrado no plasma em altas concentrações. A investigação da formação de produtos de degradação é de grande importância, pois os produtos formados podem ser menos ativos, mais ativos ou tóxicos. Bioconversão ou a aplicação de modelos microbianos é uma estratégia para mimetizar o metabolismo dos mamíferos produzindo quantidades consideráveis de metabólitos para estudos de atividade farmacológica e toxicológica. Neste trabalho foi realizado um estudo de degradação forçada de venlafaxina em cápsulas de liberação prolongada em diferentes condições de estresse (hidrólise ácida e alcalina, oxidativa e térmica) e foram selecionadas cepas de fungos filamentosos com a finalidade de identificar aquelas capazes de metabolizar a venlafaxina e produzir em escala semi-preparativa os principais metabólitos. Os fungos filamentosos utilizados foram: Aspergillus candidus ATCC 2023, Beauveria bassiana ATCC 7159, Cunninghamella echinulata ATCC 9244, Cunningamella elegans ATCC 6169, Mortierella isabelina ATCC 1757 e Rhizopus arrhizus ATCC 11145. Foi desenvolvido e validado um método indicativo de estabilidade por cromatografia líquida de alta eficiência (CLAE) utilizando fase reversa para a análise de venlafaxina na formulação farmacêutica. Os metabólitos preparados por bioconversão foram utilizados para elucidação estrutural e posteriormente serão utilizados como substância química de referência em análises de estudos de estabilidade e futuros estudos de atividade biológica. A cepa Cunninghamella elegans ATCC 6169 foi selecionada e produziu O-desmetilvenlafaxina (desvenlafaxina) e dehidroxi-venlafaxina, similares aos encontrados em mamíferos, reforçando a aplicação dos modelos microbianos para o estudo do metabolismo animal. O estudo indicativo de estabilidade da condição ácida de venlafaxina, formou dois produtos de degradação similares aos obtidos por bioconversão. A O-desmetilvenlafaxina foi recentemente aprovado para o tratamento do transtorno depressivo maior. Como resultado do presente trabalho, foi possível obter a O-desmetilvenlafaxina nas reações de bioconversão por Cunninghamella elegans ATCC 6169 e em estudos de degradação forçada de venlafaxina. O método desenvolvido e validado por CLAE foi considerado método indicativo de estabilidade para análise de venlafaxina em cápsulas de libertação prolongada, pois é sensível/ específico (seletividade < 2%), preciso (D.P.R < 2%), linear (r > 0,99), exato (98,0 - 102,0%) e reprodutível (D.P.R < 2%).

Atualmente, a quantidade de pacientes que são diagnosticados com alguma forma de depressão, entre elas, o transtorno depressivo maior, aumenta consideravelmente, quer seja em razão de diagnósticos mais precisos ou pela própria epidemiologia da doença. Acresça-se o fato de que muitos pacientes, apesar da quantidade de tipos de antidepressivos atualmente disponíveis para a terapêutica, são refratários ao tratamento prescrito, em razão dos efeitos adversos apresentados ou ainda em razão de simplesmente não se observar melhora com a prescrição. Em razão disso, novos tratamentos farmacológicos são disponibilizados. Para auxiliar na máxima eficácia em sua utilização, esse trabalho propôs o desenvolvimento de metodologia analítica para a determinação simultânea de antidepressivos tricíclicos e não tricíclicos, a saber: moclobemida, venlafaxina, citalopram, agomelatina, duloxetina, amitriptilina e sertralina em plasma humano por cromatografia líquida de alta eficiência (HPLC), para posteriormente ser aplicada na monitorização de pacientes depressivos. O método consistiu na extração líquido-líquido com recuperação entre 73% a 86%, exceto para a moclobemida (55%). A separação foi obtida usando uma coluna em fase reversa LiChrospher® 60 RP-select B em LichroCART 250mm x 4mm, 5 ?m de diâmetro interno, Merck sob condições isocráticas com detecção em UV em 230 nm, com fase móvel composta por 35% de uma mistura de acetonitrila/metanol 55/5 v/v e 65% de tampão acetato 0,25M pH 4,4. As curvas padrão foram lineares em uma faixa de trabalho de 2,5-1000 ng/mL para moclobemida, 5-2000 ng/mL para venlafaxina, citalopram, agomelatina, duloxetina e amitriptilina, 10-2000 ng/mL para sertralina. A precisão intra e interensaios foi efetuada em 3 concentrações (50, 200 e 500 ng/mL). Os coeficientes de variação para a precisão intraensaio foram menores que 8,8% para todos os compostos e os coeficientes de variação para a precisão interensaios foram menores que 8,6%. Os limites de quantificação foram de 2,5 ng/mL para a moclobemida, 5 ng/mL para venlafaxina, citalopram, duloxetina, agomelatina, amitriptilina e 10 ng/mL para sertralina com a etidocaína como padrão interno. Não se observou qualquer interferência das drogas normalmente associadas com antidepressivos. O método desenvolvido foi aplicado na monitorização de 79 pacientes em tratamento prolongado com amitriptilina, sertralina e venlafaxina. Paralelamente, foram avaliadas as concentrações plasmáticas de pacientes voluntários sadios submetidos a tratamento em dose única com agomelatina. A monitorização terapêutica se faz necessária para monitorar adesão ao tratamento já que a depressão está entre as principais causas mundiais de morbidade por incapacitação social e estimativa de prevalência crescente até 2030; caracterizando-se como um dos maiores e mais onerosos problemas de saúde pública. / Currently, the number of patients who are diagnosed with some form of depression, among them, major depressive disorder, increases considerably, either because of more accurate diagnosis or by the epidemiology of the disease. One should add the fact that many patients, despite the amount of types of antidepressants currently available for therapy are refractory to the treatment prescribed, because of the adverse effects appear, or their toxic effects, or by simply not observed improvement then the prescription. Therefore, new pharmacological treatments are available. To assist in maximum effectiveness in its use, this paper presents a methodology on HPLC for simultaneous determination of seven antidepressants, tricyclic and non-tricyclic, moclobemide, venlafaxine, citalopram, agomelatine, duloxetine, amitriptyline and sertraline in human plasma, later to be applied in monitoring depressed patients. The simple and accurate method of sample preparation consists of the liquid-liquid extraction with recovery between 73% to 86% (except for moclobemide, 55%). Separation was achieved using a reverse phase column Lichrospher® 60 RP-select B LiChroCART 4mm x 250mm, 5?m internal diameter, Merck, under isocratic conditions, with UV detection at 230nm, with a mobile phase consisting of a mixture of 35% acetonitrile:methanol 55/5 (v/v) and 65% 0.25M acetate buffer, pH 4.4. The standard curves were linear in the working range of 2,5-1000 ng/mL for moclobemide, 5-2000 ng/mL to venlafaxine, citalopram, agomelatine, duloxetine and amitriptyline and 10-2000ng/mL to sertraline. The intra and interassay precisions were performed at three concentrations (50, 200 and 500 ng/mL). The coefficients of variation for intra-assay precision were less than 8.6% for all compounds and the coefficients of variation for interassay precision were lower than 8.5%. The limits of quantification were 2.5 ng/mL for moclobemide, 5 ng/mL for venlafaxine, citalopram, duloxetine, agomelatine, amitriptyline and 10 ng/mL for sertraline. No interference of drugs normally associated with antidepressants was observed. The developed method was applied to the monitoring of 79 patients receiving prolonged treatment with amitriptyline, sertraline and venlafaxine. And, the plasma concentrations of healthy volunteer patients undergoing single dose agomelatine were evaluated. Therapeutic drug monitoring, is to ensure maximum clinical efficacy coupled with minimal adverse effects in patients undergoing long-term therapy is needed and to monitor adherence to treatment since depression is among the major causes of morbidity and social disability increasing prevalence estimate of 2030; characterized as one of the largest and most costly public health problems

Comparing the efficacy of different treatments in psychiatry is difficult for many reasons, even when they are investigated in `head-to-head' studies. A consensus meeting was, therefore, held to produce best practice guidelines for such studies. This article presents the conclusions of this consensus and illustrates it using published data in the field of antidepressant treatment of generalized anxiety disorder.

Irritable bowel syndrome (IBS) är en av de vanligaste diagnostiserade GI-tillstånden idag och är en störning av gastrointestinalkanalen (GI-kanalen). Det finns inget botemedel mot IBS på grund av att patogenesen är oklar och därför är fokusen symtomlindring vid behandling.  De vanligaste symtom som förekommer är buksmärta, obehag i buk, uppblåsthet, utspänd buk och förändring av avföringens konsistens och frekvens. Patofysiologin är inte fullt klarlagd men en rubbning i tarm-hjärn-axeln kan leda till förändring i GI-rörelser. Neurotransmittorerna noradrenalin och serotonin (5-HT) är troligen viktiga faktorer för patofysiologin kopplad till tarm-hjärn-axeln. Syftet var att undersöka effektiviteten och säkerheten för de antidepressiva läkemedlen vid behandling av IBS. De antidepressiva som undersöktes i arbetet var tianeptin, amitriptylin, escitalopram, venlafaxin, vortioxetin och mirtazapin. De fem artiklarna som användes i detta arbete upptäcktes med hjälp av databaserna Pubmed och Onesearch. Sökord som användes var ”IBS” AND ”antidepressants” och ”IBS” AND ”SSRI”.  Alla antidepressiva visade en signifikant förbättring för livskvalitén hos deltagarna i studierna. Tianeptin, amitriptylin, escitalopram, venlafaxin och mirtazapin undersökte förändring av buksmärta och alla hade en signifikant förbättring förutom escitalopram. Escitalopram jämfördes mot rektal ballongutvidgning vid behandling hos IBS med förstoppning (IBS-C). Ballongutvidgningen visade bättre resultat än escitalopram och denna jämförelse gör det svårt att dra någon slutsats om escitalopram i arbetet. Amitriptylin, tianeptin och mirtazapin undersökte förändring av avföringskonsistensesn och frekvensen och visade en signifikant förbättring hos IBS med diarré (IBS-D). Venlafaxin visade signifikant förbättring för både lös och hård avföringsfrekvens och studerade ingen specifik IBS-grupp. Vortioxetin undersökte alla IBS-grupper och endast förändring av livskvalitén, depression och ångest vilket också gör det svårt att dra slutsats om effekt hos IBS. Det var inga av de depressiva medlen som gav allvarliga biverkningar, dock kan vissa biverkningar tolkas som mer obehagliga än andra. För vissa antidepressiva var det deltagare som avslutade studien på grund av biverkningar. Amitriptylin, tianeptin, venlafaxin vortioxetin och mirtazapin visade alla god effekt och säkerhet. Om effektiviteten ock säkerheten jämförs bland dessa har tianeptin det bästa resultatet. / Irritable bowel syndrome (IBS) is one of the most diagnosed conditions in the gastrointestinal (GI) tract today and is a disorder of the GI tract. There is no cure for IBS, which is probably due to the fact that the pathogenesis is unclear, and therefore the focus has been a symptom-relieving treatment. The most common symptoms that occur are abdominal pain, abdominal discomfort, bloating, distension of the abdomen, and change in the consistency and frequency of the stool. The pathophysiology is not fully understood, but a disorder of the gut-brain axis can lead to a change in GI movements. The neurotransmitters norepinephrine and serotonin (5-HT) are probably important factors for pathophysiology and linked to the gut-brain axis.  The aim was to investigate the effectiveness and safety of antidepressants used in IBS treatment. The antidepressants examined in this literature were tianeptine, amitriptyline, escitalopram, venlafaxine, vortioxetine, and mirtazapine. The five articles on which current litter tour work is based were obtained using the PubMed and OneSearch databases. Keywords used were "IBS" AND "antidepressants" and "IBS" AND "SSRI."  All the antidepressants examined showed a significant improvement in the participants' quality of life in the studies. The studies also examined changes in abdominal pain using tianeptine, amitriptyline, escitalopram, venlafaxine, and mirtazapine. All participants showed a significant improvement and reduced abdominal pain except when ingesting escitalopram. Intake of escitalopram was compared against rectal balloon enlargement as a treatment for IBS with constipation (IBS-C). The balloon expansion showed better results than escitalopram, and this comparison makes it difficult to draw any conclusion about escitalopram and its actual effect in different types of IBS. Amitriptyline, tianeptine, and mirtazapine investigated stool consistency and stool frequency changes and showed a significant improvement in these symptoms in IBS with diarrhea (IBS-D). Venlafaxine showed significant improvement for both loose and hard stool frequency; however, no specific IBS group was studied in this study. When ingesting vortioxetine, all different IBS groups and changes in quality of life, depression, and anxiety were examined, making it difficult to conclude about the effect of the drug in IBS. None of the antidepressant medicines produced severe side effects. However, some side effects can be interpreted as more unpleasant than others, and hence there was some loss during some studies.  Amitriptyline, tianeptine, venlafaxine vortioxetine, and mirtazapine showed good efficacy and safety. If the effectiveness and safety were to be compared between these drugs, tianeptine would be the first choice in treating IBS.

A venlafaxina (VEN), em razão de sua eficácia e brandos efeitos adversos, tem sido um dos antidepressivos mais prescritos no tratamento da depressão e ansiedade. Neste trabalho, um método analítico empregando as técnicas MISPE miniaturizada e cromatografia líquida acoplada à espectrometria de massas em Tandem, foi utilizado para a determinação de VEN e seus principais metabólitos em amostras de plasma para fins de monitorização terapêutica. A fase MIP foi sintetizada via polimerização radicalar por precipitação, fazendo uso de VEN (molécula molde), ácido metacrílico (monômero funcional), etileno glicol dimetacrilato, (reagente reticulante) e 2,2 azobisisobutironitrila (iniciador radicalar) em tolueno (solvente). Para controle utilizou-se o polímero não impresso (NIP), sintetizado por procedimento análogo ao do MIP, porém sem o uso da molécula molde. A caracterização química e estrutural dos polímeros foi realizada por espectroscopia no infravermelho com transformada de fourier e microscopia eletrônica de varredura. A otimização das variáveis de MISPE miniaturizada favoreceu a detectabilidade analítica e diminuiu o efeito de memória. As extrações realizadas com MIP apresentaram taxa de recuperação de 84% para VEN e de 2-28% para os antidepressivos (clorpromazina, fluoxetina, clomipramina, imipramina e sertralina). O polímero não impresso apresentou baixa recuperação para a VEN (taxa de recuperação: 49%) e para os demais antidepressivos (taxas de recuperação menores que 40%). Estes experimentos comprovam a seletividade da fase MIP desenvolvida. O método padronizado apresentou linearidade na faixa de 3 a 700 ng mL-1 para VEN, 5 a 700 ng mL-1 para O-desmetilvenlafaxina (ODV) e de 3 a 500 ng mL-1 para N-desmetilvenlafaxina (NDV), precisão com coeficientes de variação menores que 15% e exatidão com valores de erro padrão relativo na faixa de -11,8 a 16,01 %. As concentrações correspondentes aos limites inferiores de quantificação para VEN (3 ng mL-1) e ODV ( 5 ng mL-1) foram inferiores aos intervalos terapêuticos preconizados. O método desenvolvido, quando comparado a aos métodos da literatura para determinação de VEN e metabolitos, apresentou maior seletividade, menor consumo de amostra e de solventes orgânicos e permitiu a reutilização da fase extratora. Segundo os parâmetros de validação analítica avaliados e amostras de pacientes em terapia com VEN analisadas, o método proposto é adequado para determinação de VEN, ODV e NDV em amostras de plasma para fins de monitorização terapêutica. / Venlafaxine elicits a small number of adverse effects, so it is one of the most frequently prescribed drugs to treat major depression, generalized anxiety, and social anxiety disorders in adults. In this study, venlafaxine (VEN), O-desmethylvenlafaxine (ODV), and N-desmethylvenlafaxine (NDV) were pre-concentrated with the aid of miniaturized SPE based on MIPs as extraction phase. MIPs are synthetic polymers with cavities specifically designed to hold a target molecule or structurally similar compounds. The molecularly imprinted polymers were prepared by addition of VEN, metacrylic acid (MAA, monomer), ethylene glycol dimethacrylate (EGDMA, cross-linker), and 2,2-azobisisobutyronitrile (AIBN, initiator) to toluene (solvent). The non-imprinted polymer (NIP), used for comparison, was also synthesized by following exactly the same procedure, but excluding the template VEN from the formulation. The polymer was characterized by Fourier transform infrared spectroscopy and scanning electron microscopy (SEM). Optimization of the MIP phase extraction variables favored miniaturized analytical detectability and reduced the memory effect. The extractions performed with the synthesized MIP showed recovery rate of 84% for VEN and 2-28% for other antidepressants (chlorpromazine, fluoxetine, clomipramine, imipramine, and sertraline). The non-imprinted polymer provided low recovery of VEN (recovery rate: 49%) and other antidepressants (recovery rates lower than 40%). These experiments demonstrated the selectivity of the developed MIP phase. The standardized method was linear in the range of 300 - 700 ng mL-1 for VEN, 5-700 ng mL-1 for ODV, and 3 to 500 ng mL-1 for NDV. Precision had coefficients of variation smaller than 15%; the accuracy standard error values ranged from -11.8 to 16.01%. Compared with literature methods, the developed method was more selective for determination of VEN and metabolites, required lower consumption of sample and organic solvents, and enabled reuse of the extraction phase. According to the assessed analytical validation parameters and to the analysis of samples obtained from patients undergoing therapy with VEN, the proposed method is suitable to determine VEN, NDV, and ODV in plasma samples for therapeutic drug monitoring.

A venlafaxina (VEN), em razão de sua eficácia e brandos efeitos adversos, tem sido um dos antidepressivos mais prescritos no tratamento da depressão e ansiedade. Neste trabalho, um método analítico empregando as técnicas MISPE miniaturizada e cromatografia líquida acoplada à espectrometria de massas em Tandem, foi utilizado para a determinação de VEN e seus principais metabólitos em amostras de plasma para fins de monitorização terapêutica. A fase MIP foi sintetizada via polimerização radicalar por precipitação, fazendo uso de VEN (molécula molde), ácido metacrílico (monômero funcional), etileno glicol dimetacrilato, (reagente reticulante) e 2,2 azobisisobutironitrila (iniciador radicalar) em tolueno (solvente). Para controle utilizou-se o polímero não impresso (NIP), sintetizado por procedimento análogo ao do MIP, porém sem o uso da molécula molde. A caracterização química e estrutural dos polímeros foi realizada por espectroscopia no infravermelho com transformada de fourier e microscopia eletrônica de varredura. A otimização das variáveis de MISPE miniaturizada favoreceu a detectabilidade analítica e diminuiu o efeito de memória. As extrações realizadas com MIP apresentaram taxa de recuperação de 84% para VEN e de 2-28% para os antidepressivos (clorpromazina, fluoxetina, clomipramina, imipramina e sertralina). O polímero não impresso apresentou baixa recuperação para a VEN (taxa de recuperação: 49%) e para os demais antidepressivos (taxas de recuperação menores que 40%). Estes experimentos comprovam a seletividade da fase MIP desenvolvida. O método padronizado apresentou linearidade na faixa de 3 a 700 ng mL-1 para VEN, 5 a 700 ng mL-1 para O-desmetilvenlafaxina (ODV) e de 3 a 500 ng mL-1 para N-desmetilvenlafaxina (NDV), precisão com coeficientes de variação menores que 15% e exatidão com valores de erro padrão relativo na faixa de -11,8 a 16,01 %. As concentrações correspondentes aos limites inferiores de quantificação para VEN (3 ng mL-1) e ODV ( 5 ng mL-1) foram inferiores aos intervalos terapêuticos preconizados. O método desenvolvido, quando comparado a aos métodos da literatura para determinação de VEN e metabolitos, apresentou maior seletividade, menor consumo de amostra e de solventes orgânicos e permitiu a reutilização da fase extratora. Segundo os parâmetros de validação analítica avaliados e amostras de pacientes em terapia com VEN analisadas, o método proposto é adequado para determinação de VEN, ODV e NDV em amostras de plasma para fins de monitorização terapêutica. / Venlafaxine elicits a small number of adverse effects, so it is one of the most frequently prescribed drugs to treat major depression, generalized anxiety, and social anxiety disorders in adults. In this study, venlafaxine (VEN), O-desmethylvenlafaxine (ODV), and N-desmethylvenlafaxine (NDV) were pre-concentrated with the aid of miniaturized SPE based on MIPs as extraction phase. MIPs are synthetic polymers with cavities specifically designed to hold a target molecule or structurally similar compounds. The molecularly imprinted polymers were prepared by addition of VEN, metacrylic acid (MAA, monomer), ethylene glycol dimethacrylate (EGDMA, cross-linker), and 2,2-azobisisobutyronitrile (AIBN, initiator) to toluene (solvent). The non-imprinted polymer (NIP), used for comparison, was also synthesized by following exactly the same procedure, but excluding the template VEN from the formulation. The polymer was characterized by Fourier transform infrared spectroscopy and scanning electron microscopy (SEM). Optimization of the MIP phase extraction variables favored miniaturized analytical detectability and reduced the memory effect. The extractions performed with the synthesized MIP showed recovery rate of 84% for VEN and 2-28% for other antidepressants (chlorpromazine, fluoxetine, clomipramine, imipramine, and sertraline). The non-imprinted polymer provided low recovery of VEN (recovery rate: 49%) and other antidepressants (recovery rates lower than 40%). These experiments demonstrated the selectivity of the developed MIP phase. The standardized method was linear in the range of 300 - 700 ng mL-1 for VEN, 5-700 ng mL-1 for ODV, and 3 to 500 ng mL-1 for NDV. Precision had coefficients of variation smaller than 15%; the accuracy standard error values ranged from -11.8 to 16.01%. Compared with literature methods, the developed method was more selective for determination of VEN and metabolites, required lower consumption of sample and organic solvents, and enabled reuse of the extraction phase. According to the assessed analytical validation parameters and to the analysis of samples obtained from patients undergoing therapy with VEN, the proposed method is suitable to determine VEN, NDV, and ODV in plasma samples for therapeutic drug monitoring.

Background: Antidepressants are widely used in the treatment of chronic pain. Applied doses are lower than those needed to unfold an antidepressive effect. While efficacy of antidepressants for chronic pain has been reported in large randomized-controlled trials (RCT), there is inconsistent data on adverse effects and tolerability. We aimed at synthesizing data from RCT to explore adverse effect profiles and tolerability of antidepressants for treatment of chronic pain. Methods: Systematic literature research and meta-analyses were performed regarding side effects and safety of different antidepressants in the treatment of chronic pain according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The National Center for Biotechnology Information library and MEDLINE were searched. Randomized placebo-controlled trials were included in quantitative data synthesis. results: Out of 1,975 screened articles, 33 papers published between 1995 and 2015 were included in our review and 23 studies were included in the meta-analyses. A higher risk for adverse effects compared to placebo was observed in all antidepressants included in our analyses, except nortriptyline. The most prevalent adverse effects were dry mouth, dizziness, nausea, headache, and constipation. Amitriptyline, mirtazapine, desipramine, venlafaxine, fluoxetine, and nortriptyline showed the highest placebo effect-adjusted risk of adverse effects. Risk for withdrawal due to adverse effects was highest in desipramine (risk ratio: 4.09, 95%-confidence interval [1.31; 12.82]) followed by milnacipran, venlafaxine, and duloxetine. The most common adverse effects under treatment with antidepressants were dry mouth, dizziness, nausea, headache, and constipation followed by palpitations, sweating, and drowsiness. However, overall tolerability was high. Each antidepressant showed distinct risk profiles of adverse effects. conclusion: Our synthesized data analysis confirmed overall tolerability of low-dose antidepressants for the treatment of chronic pain and revealed drug specific risk profiles. This encompassing characterization of adverse effect profiles might be useful in defining multimodal treatment regimens for chronic pain which also consider patients’ comorbidities and co-medication.