Osteoporosis and depression are prevalent among older postmenopausal women 65 years or older. Bisphosphonates (BPs) and selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) are commonly used medications to treat these conditions. Inhibitory effects of BPs on osteoclasts are responsible for the reduction in fracture risk. SSRIs, however, are associated with increased fracture risk through decreasing osteoblasts and increasing osteoclastic activity. These effects of SSRIs could attenuate the beneficial effects of BPs. This dissertation describes the concomitant use of BPs and SSRIs among postmeopausa women and reports findings from examining the association between concomitant use of BPs and SSRIs and fracture risk. Separate cross-sectional analyses were performed using data from the 2004-2008 Medical Expenditure Panel Survey (MEPS) and Medicare Part D prescriptions claims data (2008-2010) to examine usage patterns of BPs and SSRIs/SNRIs for women aged ≥45 years and ≥65 years, respectively. For our second objective, a nested-case control was conducted using Medicare claims data (2008-2010). Data from Medicare inpatient claims were linked to Medicare Part D data for all female BP users 65 years or older. We used Cox proportional hazards model to assess the increased risk of osteoporotic-related fractures among propensity score matched (1:1 ratio) cohorts of concomitant users of BPs and SSRIs and BP alone users. Concomitant use of BPs and SSRIs was prevalent and increased with age for each timeframe examined. Findings showed that approximately 12% (using MEPS) and 28% (using Medicare data) of women on BPs were also on SSRIs. For the second objective, 4,214 propensity score matched pairs (average age=80.4 years) of subjects were analyzed. Findings showed that concomitant use of BPs and SSRIs was associated with statistically significant increased risk for any fracture (HR=1.29, 95% CI, 1.07-1.57), but statistically non-significant increased risk for hip (HR=1.16, 95% CI, 0.92-1.47) and vertebral fractures (HR=1.55, 95% CI, 0.97-2.48). Current findings indicate that concomitant use of BPs and SSRIs is not uncommon among postmenopausal women and suggest potential attenuation of antifracture efficacy of BPs by SSRIs. Further studies are needed to understand the clinical impact of concomitant use of these medications among older postmenopausal women.

Although extensive evidence suggests antidepressants are a non-effective treatment for the majority of depressive cases where they are prescribed and despite other developed countries taking steps to provide alternative treatments, Canada's prescription rates continue rising and no state action is being taken. The primary purpose of this study is to explore whether the media in English-speaking Canada, represented by its "newspaper of record," The Globe and Mail, has been performing its essential role in informing Canadians about the controversy surrounding antidepressants and the pharmaceutical system that that has made them central to treating depression. Data was collected in the form of newspaper articles from between 2000 and 2015 in order to analyze media coverage to ensure the essential facts were reported and to qualify to what degree a patient advocacy role challenging the norms of contemporary treatment has been adopted. / February 2017

Il existe une comorbidité entre douleur et dépression. Si les antidépresseurs inhibiteurs de recapture de monoamines représentent le traitement de première intention des troubles dépressifs unipolaires, certains d’entre eux sont également recommandés en première ligne de traitement des douleurs neuropathiques. L’objectif de ce travail a été d’étudier les propriétés analgésiques de ces antidépresseurs dans des modèles animaux co-exprimant des éléments de phénotypes douloureux et dépressifs. Pour cela nous avons développé des tests d’évaluation comportementale de la douleur chez la souris. Ces tests permettent de décrire la sensibilité douloureuse des animaux et d’évaluer les effets pharmacologiques de substances de référence et innovantes.Nous avons ainsi démontré que la fluoxétine, inhibiteur sélectif de la recapture de sérotonine (ISRS), possède des effets antalgiques sur les altérations de sensibilité d’un modèle d’anxiété/dépression chez la souris : le modèle CORT. La caractérisation d’un phénotype douloureux chronique chez ces souris renforce la pertinence de ce modèle neuropsychopharmacologique, puisqu’il exprime une des comorbidités fréquentes des pathologies dépressives. De plus, l’efficacité antalgique de la fluoxétine dans ce modèle plaide en faveur d’une modulation de la composante affective de la douleur par les ISRS.De plus, nous avons caractérisé l’effet antalgique d’une nouvelle classe d’antidépresseurs monoaminergiques, les triples inhibiteurs de recapture des monoamines capables d’augmenter à la fois les concentrations intracérébrales de sérotonine, noradrénaline et dopamine. Pour ce faire, nous avons développé un modèle de douleurs induites par injections répétées d’oxaliplatine chez la souris et comparé l’efficacité de différents traitements sur ces douleurs. Les souris « oxaliplatine » développent une hyperalgie mécanique, ainsi qu’une allodynie et hyperalgie au froid. Ces altérations de la sensibilité douloureuse sont corrigées par l’administration aigüe d’un triple bloqueur (indatraline) en faisant intervenir des mécanismes probablement supra-spinaux. La composante dopaminergique de ces substances apporte un intérêt dans le profil antalgique. Par ailleurs, les souris « oxaliplatine » développent des traits caractéristiques d’un phénotype anxio-dépressif et l’indatraline semble avoir des effets antidépresseurs dans ce modèle, ouvrant la possibilité d’une participation de la DA à la composante affective de la douleur et plus d’effets sur l’influx somatosensoriel. L’ensemble de nos travaux fait ressortir l’importance du développement et de l’utilisation de modèles animaux co-exprimant douleurs et anxiété/dépression afin de mieux définir les mécanismes liant ces pathologies et d’optimiser les critères de développement des futurs antidépresseurs et analgésiques. / High comorbidity is described between depression and pain disorders. Monoaminergic reuptake inhibitors represent the first choice of treatment for depression and serotonin and norepinephrin reuptake inhibitors are also recommended for the treatment of neuropathic pain disorders. We aims at evaluating analgesic effects of these drugs in animal models sharing anxio-depressive and painful phenotype. We first developed tests to assess pain sensitivity in mice and analgesic properties of pharmacological compounds. Depressive phenotype was assessed using various behavioural paradigms of anxiety/depression.We thus show that fluoxetine, a selective serotonin reuptake inhibitor (SSRI), provide antinociceptive effects in a mice model of anxiety-depression: the CORT model. Fluoxetine may thus exert its analgesic effect by modulating the affective aspect of pain in addition to a putative influence on sensory mechanisms. Moreover we characterized analgesic effects of a new generation of antidepressant, the triple reuptake inhibitors, which simultaneously potentialisate serotoninergic, noradrenergic and dopaminergic neurotransmission, in a mice model of oxaliplatin-induced neuropathy. Our results support that indatraline provide a better analgesic profile than escitalopram and venlafaxine in pain relief in oxaliplatin-treated mice. Although other investigations are required to quantify the putative involvement of DA in the therapeutic action of indatraline, the benefit can be attributed to this additional component. Indeed, reinforcement of descending control pathways though 5-HT and NE systems has been proposed to participate in the analgesic properties of dual reuptake inhibitors. The fact that indatraline was able to enhance dopaminergic transmission in the Anterior Cingulate Cortex argues in favor of a more potent action upon this inhibitory descending control of pain. Results with indatraline in the depression paradigm cannot rule out the possibility that the antidepressant property of the TRI accounts for its analgesic effect.This work provides a support for the need of animal models sharing anxio/depressive and painful phenotype in order to define mechanism responsible for such co-mobidity and optimize the development of newer antidepressants and pain killers.

Fluoxetine (FLX), the active ingredient of Prozac™, is a member of the selective serotonin reuptake inhibitor (SSRI) class of anti-depressant drugs and is present in aquatic environments worldwide. Previous studies reported that FLX is an endocrine disruptor in fish, bioconcentrating in tissues including the brain. Evidence implicates that serotonin influences the activity of the hypothalamo-pituitary-interrenal (HPI) stress axis, thus exposure to FLX may disrupt the teleost stress response. This study examined in vitro cortisol production in rainbow trout (Oncorhynchus mykiss) head kidney/interrenal cells exposed to FLX and 14C-pregnenolone metabolism in head kidney microsome preparations of FLX-exposed trout. Results indicated that cells exposed in vitro to increasing concentrations of FLX had lower cortisol production and cell viability (versus control) and microsomes isolated from trout exposed to 54 μg/L FLX had higher pregnenolone metabolism versus those of control and low FLX-exposed (0.54 μg/L) trout.

Fluoxetine (FLX), the active ingredient of Prozac™, is a member of the selective serotonin reuptake inhibitor (SSRI) class of anti-depressant drugs and is present in aquatic environments worldwide. Previous studies reported that FLX is an endocrine disruptor in fish, bioconcentrating in tissues including the brain. Evidence implicates that serotonin influences the activity of the hypothalamo-pituitary-interrenal (HPI) stress axis, thus exposure to FLX may disrupt the teleost stress response. This study examined in vitro cortisol production in rainbow trout (Oncorhynchus mykiss) head kidney/interrenal cells exposed to FLX and 14C-pregnenolone metabolism in head kidney microsome preparations of FLX-exposed trout. Results indicated that cells exposed in vitro to increasing concentrations of FLX had lower cortisol production and cell viability (versus control) and microsomes isolated from trout exposed to 54 μg/L FLX had higher pregnenolone metabolism versus those of control and low FLX-exposed (0.54 μg/L) trout.

Evidence suggests that selective serotonin reuptake inhibitors (SSRIs, a class of antidepressant medications) may contribute to increased breast cancer risk by stimulating the secretion of prolactin, a potential tumour promoter. The main objective of this study was to determine breast cancer risk associated with the duration, dosage and timing of SSRI use among women, with control for a limited set of confounders. This thesis project, conducted within the context of a population-based two-stage case-control study, consisted of a record linkage study utilizing three Saskatchewan health services databases. Cases included 1,273 women with primary breast cancer diagnosed between January 1, 2003 and December 31, 2005, and controls consisted of 12,730 subjects randomly selected from the province’s population registry. Data on SSRI use was compiled from the Saskatchewan prescription drug plan database. Information on a limited set of established risk factors for breast cancer that may confound this relationship was ascertained from the population registry and the prescription database. Cases and controls were similar in terms of age, total number of consecutive years eligible for prescription coverage and indicators of socioeconomic status. Compared to controls, cases were more likely to be married and to have used hormone therapy and/or oral contraceptives. Compared to nonusers, results indicated that the use of SSRIs for three or more years (as estimated by having filled 36 or more prescriptions for all SSRIs combined during the main exposure window more than two years prior to index date) was not associated with an increased risk of breast cancer (OR= 1.08, 95% CI: 0.74-1.58), controlling for age, marital status, oral contraceptive and hormone therapy use. In addition, no suggestion of increased risk was detected for long-term exposures to individual SSRIs (24 or more prescriptions filled during the main exposure window) and in relation to total combined SSRI use 2-7 years and more than seven years prior to index date. However, these risk estimates may have been affected by potential sources of information bias and confounding. In summary, these results do not provide evidence to suggest that the risk of breast cancer is increased with the use of SSRIs. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2008-01-08 13:51:38.74

Fluoxetine (FLX), the active ingredient of Prozac™, is a member of the selective serotonin reuptake inhibitor (SSRI) class of anti-depressant drugs and is present in aquatic environments worldwide. Previous studies reported that FLX is an endocrine disruptor in fish, bioconcentrating in tissues including the brain. Evidence implicates that serotonin influences the activity of the hypothalamo-pituitary-interrenal (HPI) stress axis, thus exposure to FLX may disrupt the teleost stress response. This study examined in vitro cortisol production in rainbow trout (Oncorhynchus mykiss) head kidney/interrenal cells exposed to FLX and 14C-pregnenolone metabolism in head kidney microsome preparations of FLX-exposed trout. Results indicated that cells exposed in vitro to increasing concentrations of FLX had lower cortisol production and cell viability (versus control) and microsomes isolated from trout exposed to 54 μg/L FLX had higher pregnenolone metabolism versus those of control and low FLX-exposed (0.54 μg/L) trout.

Hohenheim, Univ., Diss., 2007.

Techn. Universiẗat, Diss., 2005--Darmstadt.

Fluoxetine (FLX), the active ingredient of Prozac™, is a member of the selective serotonin reuptake inhibitor (SSRI) class of anti-depressant drugs and is present in aquatic environments worldwide. Previous studies reported that FLX is an endocrine disruptor in fish, bioconcentrating in tissues including the brain. Evidence implicates that serotonin influences the activity of the hypothalamo-pituitary-interrenal (HPI) stress axis, thus exposure to FLX may disrupt the teleost stress response. This study examined in vitro cortisol production in rainbow trout (Oncorhynchus mykiss) head kidney/interrenal cells exposed to FLX and 14C-pregnenolone metabolism in head kidney microsome preparations of FLX-exposed trout. Results indicated that cells exposed in vitro to increasing concentrations of FLX had lower cortisol production and cell viability (versus control) and microsomes isolated from trout exposed to 54 μg/L FLX had higher pregnenolone metabolism versus those of control and low FLX-exposed (0.54 μg/L) trout.