Psychopharmacology bulletin最新文献

{"title":"Lasmiditan for the Treatment of Migraines With or Without Aura in Adults.","authors":"Amnon A Berger, Ariel Winnick, Daniel Popovsky, Alicia Kaneb, Kevin Berardino, Adam M Kaye, Elyse M Cornett, Alan D Kaye, Omar Viswanath, Ivan Urits","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Migraines are a common form of primary headache, affecting women more than men (17.4% and 5.7% of US population, respectively, a total of 12%) that carry significant morbidity and disability, as well as a hefty healthcare price tag. They are most prevalent in women of reproductive ages and are estimated to be the 6th disease in order of causing global burden. They are estimated to cause 45.1 million years lived with disability, or 2.9% of global years lost to disability. Migraine treatment divides into acute, abortive treatment for relief of an ongoing migraine attack, and prophylactic therapy to reduce the occurrence of migraines, specifically for patients suffering from chronic and frequent episodic migraines. Traditional abortive treatment usually begins with NSAID and non-specific analgesics that are effective in curbing mild to moderate attacks. 5HT₁-agonists, such as triptans, are often used for second-line and for severe attacks. Triptans are generally better tolerated in the longterm than NSAIDs and other analgesics, though they carry a significant side-effect profile and are contraindicated in large parts of the population. Prophylactic therapy is usually reserved for patients with frequent recurrence owing to medication side effects and overall poor adherence to the medication schedule. Importantly, medication overuse may actually lead to the development of chronic migraines from previously episodic attacks. Recent research has shed more light on the pathophysiology of migraine and the role of CGRP in the trigeminovascular system. Recent pharmacological advances were made in developing more specific drugs based on this knowledge, including CGRP neutralizing antibodies, receptor antagonists, and the development of ditans. These novel drugs are highly specific to peripheral and central 5-HT_1F receptors and effective in the treatment of acute migraine attacks. Binding these receptors reduces the production of CGRP and Glutamate, two important ligands in the nociceptive stimulus involved with the generation and propagation of migraines. Several large clinical studies showed Lasmiditan to be effective in the treatment of acute migraine attacks. Importantly, due to its receptor specificity, it lacks the vasoconstriction that is associated with triptans and is thus safer is larger parts of the population, specifically in patients with cardiac and vascular disease. Though more research is required, specifically with aftermarket surveillance to elucidate rare potential side effects, Lasmiditan is a targeted anti-migraine drug that is both safe and effective, and carries an overall superior therapeutic profile to its predecessors. It joins the array of medications that target CGRP signaling, such as gepants and CGRP-antibodies, to establish a new line of care for this common disabling condition.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4 Suppl 1","pages":"163-188"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901123/pdf/PB-50-4S1-163.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25405669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcomes of Post Dural Puncture Headache Treated With Epidural Blood Patch: A Pilot Study.","authors":"Jamal Hasoon,&nbsp;Ivan Urits,&nbsp;Rana Al-Jumah,&nbsp;Mark Burroughs,&nbsp;Viet Cai,&nbsp;Omar Viswanath,&nbsp;Musa Aner,&nbsp;Paragi H Rana,&nbsp;Thomas Simopoulos,&nbsp;Alan D Kaye,&nbsp;Jatinder Gill","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Post dural puncture headache (PDPH) is a known complication which may occur in the setting of patients undergoing lumbar punctures (LP) for diagnostic or therapeutic purposes. The gold standard for treating a PDPH is an epidural blood patch (EBP). There have been few publications evaluating the long-term outcomes of PDPH treated with EBP. The aim of this pilot study was to examine the incidence of chronic headaches in dural puncture patients who received EBP versus those who did not.</p><p><strong>Methods: </strong>A retrospective case control study was performed at a single large center institution. Forty-nine patients who had intentional dural puncture were identified on chart review and completed a survey questionnaire via phone interview: twenty-six of these patients required a subsequent EBP, while twenty-three did not. The primary outcomes were the development and prevalence of chronic headaches after the procedures. There was no statistically significant difference in the prevalence of current headaches between the EBP group and Non-EBP group (54% vs. 52% p = 0.91). There were no significant differences in the rates of severity and descriptive qualities of headache between the EBP and non-EBP groups. There was higher incidence of tinnitus in the PDPH patients.</p><p><strong>Summary: </strong>This pilot study demonstrates that patients who received an EBP for treatment of a PDPH following LP are no more likely to experience chronic headaches compared to patients who do not receive an EBP. However, both the EBP group and Non-EBP group had high incidence of chronic headaches which may be related to dural puncture or a baseline trait of this cohort given the recall bias. There is a suggestion that tinnitus could be a long-term residual symptom of PDPH treated with EBP.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4 Suppl 1","pages":"25-32"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901131/pdf/PB-50-4S1-25.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25413441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Muscle Relaxants for the Treatment of Chronic Pain Associated with Cerebral Palsy.","authors":"Jacki Peck,&nbsp;Ivan Urits,&nbsp;Joshua Crane,&nbsp;Alexandra McNally,&nbsp;Nazir Noor,&nbsp;Megha Patel,&nbsp;Amnon A Berger,&nbsp;Elyse M Cornett,&nbsp;Hisham Kassem,&nbsp;Alan D Kaye,&nbsp;Omar Viswanath","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose of review: </strong>This is a comprehensive literature review of the available for treatment of oral muscle relaxants for cerebral palsy (CP) and associated chronic pain. It briefly describes the background and etiology of pain in CP and proceeds to review and weigh the available evidence for treatment for muscle relaxants.</p><p><strong>Recent findings: </strong>CP is a permanent, chronic, non-progressive neuromuscular and neurocognitive disorder of motor dysfunction that is diagnosed in infancy and is frequently (62% of patients) accompanied by chronic or recurrent muscular pain. Treatment of pain is crucial, and focuses mostly on treatment of spasticity through non-interventional techniques, surgery and medical treatment. Botulinum toxin injections provide temporary denervation, at the cost of repeated needle sticks. More recently, the use of oral muscle relaxants has gained ground and more evidence are available to evaluate its efficacy. Common oral muscle relaxants include baclofen, dantrolene and diazepam. Baclofen is commonly prescribed for spasticity in CP; however, despite year-long experience, there is little evidence to support its use and evidence from controlled trials are mixed. Dantrolene has been used for 30 years, and very little current evidence exists to support its use. Its efficacy is usually impacted by non-adherence due to difficult dosing and side-effects. Diazepam, a commonly prescribed benzodiazepine carries risks of CNS depression as well as addiction and abuse. Evidence supporting its use is mostly dated, but more recent findings support short-term use for pain control as well as enabling non-pharmacological interventions that achieve long term benefit but would otherwise not be tolerated. More recent options include cyclobenzaprine and tizanidine. Cyclobenzaprine carries a more significant adverse events profile, including CNS sedation; it was found to be effective, possible as effective as diazepam, however, it is not currently FDA approved for CP-related spasticity and further evidence is required to support its use. Tizanidine was shown to be very effective in a handful of small studies.</p><p><strong>Summary: </strong>Muscle relaxants are an important adjunct in CP therapy and are crucial in treatment of pain, as well as enabling participation in other forms of treatments. Evidence exist to support their use, however, it is not without risk and further research is required to highlight proper dosing, co-treatments and patient selection.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4 Suppl 1","pages":"142-162"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901132/pdf/PB-50-4S1-142.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25405668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidural Analgesia in Ventral Hernia Repair: An Analysis of 30-day Outcomes.","authors":"Mark R Jones,&nbsp;Ethan Y Brovman,&nbsp;Amy E Wagenaar,&nbsp;Samuel P Ang,&nbsp;Edward E Whang,&nbsp;Alan D Kaye,&nbsp;Richard D Urman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Ventral hernia repair (VHR) is a common procedure associated with significant postoperative morbidity and prolonged hospital length of stay (LOS). The use of epidural analgesia in VHR has not been widely evaluated.</p><p><strong>Purpose: </strong>To compare the outcomes of general anesthesia plus epidural analgesia (GA + EA) versus general anesthesia alone (GA) in patients undergoing ventral hernia repair.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program database was used to identify elective cases of VHR. Propensity score-matched analysis was used to compare outcomes in GA vs GA + EA groups. Cases receiving transverse abdominus plane blocks were excluded.</p><p><strong>Results: </strong>A total of 9697 VHR cases were identified, resulting in two matched cohorts of 521 cases each. LOS was significantly longer in the GA + EA group (5.58 days) vs the GA group (5.20 days, p = 0.008). No other statistically significant differences in 30-day outcomes were observed between the matched cohorts.</p><p><strong>Conclusion: </strong>Epidural analgesia in VHR is associated with statistically significant, but not clinically significant increase in LOS and may not yield any additional benefit in cases of isolated, elective VHR. Epidural analgesia may not be beneficial in this surgical population. Future studies should focus on alternative modes of analgesia to optimize pain control and outcomes for this procedure.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4 Suppl 1","pages":"33-47"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901129/pdf/PB-50-4S1-33.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25413442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrathecal Morphine Delivery at Cisterna Magna to Control Refractory Cancer-Related Pain: A Prospective Cohort Study.","authors":"Chang Sun,&nbsp;Yu-Tong Wang,&nbsp;Yu-Jie Dai,&nbsp;Zhi-Hui Liu,&nbsp;Jing Yang,&nbsp;Zhu-Qiang Cheng,&nbsp;Dao-Song Dong,&nbsp;Cheng-Fu Wang,&nbsp;Guo-Li Zhao,&nbsp;Gui-Jun Lu,&nbsp;Tao Song,&nbsp;Yi Jin,&nbsp;Li-Li Sun,&nbsp;Alan D Kaye,&nbsp;Ivan Urits,&nbsp;Omar Viswanath,&nbsp;Yong-Hai Sun","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>For patients suffering from primary or metastatic cancer above the middle thoracic vertebrae, refractory pain management still remains a great challenge. Theoretically, inserting a catheter tip into the cisterna magna may be a promising solution. However, at present, there have been no reliable data regarding this novel technique. We therefore investigated the efficacy and safety of an advanced approach for pain relief in a specific population.</p><p><strong>Methods: </strong>Thirty participants from two hospitals received the intrathecal deliveries of opioid to either one of two sites: cisterna magna (n = 15) or lower thoracic region (n = 15). Pain relief (visual analogue scale, VAS), quality of life (short form (36) health survey, SF-36) as well as depression (self-rating depression scale, SDS) were assessed in the follow-up visits and compared between the two groups.</p><p><strong>Results: </strong>Patients receiving intrathecal morphine delivery to cisterna magna achieved greater pain improvement indicated as significant decrease of VAS scores at day 1 and 7, and achieved better improvement in physical function (day 7 and 30), role physical (day 7 and 30), body pain (day 7, 30 and 90), general health (day 7, 30 and 90), vitality (day 7, 30 and 90), social function (day 90), role emotional (day 7 and 90), mental health (day 7, 30 and 90) and SDS (day 1 and 7).</p><p><strong>Conclusions: </strong>Intrathecal morphine delivery to cisterna magna might be an effective and safe technique for patients suffering from cancer at the middle thoracic vertebrae or above to control refractory pain. Trial registration: No. ChiCTR-ONN-17010681.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4 Suppl 1","pages":"48-66"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901124/pdf/PB-50-4S1-48.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25405662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous Lidocaine Infusion for the Management of Early Postoperative Pain: A Comprehensive Review of Controlled Trials.","authors":"Robert Chu,&nbsp;Nelly Umukoro,&nbsp;Tiashi Greer,&nbsp;Jacob Roberts,&nbsp;Peju Adekoya,&nbsp;Charles A Odonkor,&nbsp;Jonathan M Hagedorn,&nbsp;Dare Olatoye,&nbsp;Ivan Urits,&nbsp;Mariam Salisu Orhurhu,&nbsp;Peter Umukoro,&nbsp;Omar Viswanath,&nbsp;Jamal Hasoon,&nbsp;Alan D Kaye,&nbsp;Vwaire Orhurhu","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Previously used as anti-arrhythmic, intravenous lidocaine infusion is becoming popular for use in management of acute pain. There is still much to be understood about its pharmacokinetics and pharmacodynamics, especially with regard to optimal dosing to avoid side effects. In this article, we selected and reviewed randomized controlled trials to summarize the pharmacokinetics, antinociceptive effects, anti-hyperalgesic effects, anti-inflammatory effects, side effects, and role of intravenous lidocaine in the management of early postoperative pain. The mechanisms of action of lidocaine are still unclear but there are many theories postulated. Optimal dosing of lidocaine is not known but general consensus indicates that a loading dose of 1-2 mg/kg, followed by 1-2 mg/kg/hr continuous infusion during early postoperative pain control while recovering from anesthesia to achieve therapeutic levels of 0.5-5 mcg/kg clearly improves analgesia in the immediate postoperative period. Although lidocaine was initially studied and proven to have clear analgesic effects following laparoscopic and open abdominal surgeries, it has now been shown to be applicable in different clinical settings perioperatively including following spinal, breast, ENT and other surgeries. It is generally safe, with hypotension, headache and vomiting being the more common side effects. Serious adverse effects include cardiovascular block and arrhythmias, neuro-excitability and hypersensitivity, although the frequency of these are not known.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4 Suppl 1","pages":"216-259"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901134/pdf/PB-50-4S1-216.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25405590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidural Blood Patch does not Contribute to the Development of Chronic Low Back Pain in Patients who Undergo Lumbar Punctures: A Pilot Study.","authors":"Jamal Hasoon,&nbsp;Ivan Urits,&nbsp;Mark Burroughs,&nbsp;Viet Cai,&nbsp;Vwaire Orhurhu,&nbsp;Musa Aner,&nbsp;Cyrus Yazdi,&nbsp;Thomas Simopoulos,&nbsp;Omar Viswanath,&nbsp;Alan D Kaye,&nbsp;Philip E Hess,&nbsp;Jatinder Gill","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose of review: </strong>Post dural puncture headache (PDPH) is a known and relatively common complication which may occur in the setting of patients undergoing lumbar punctures (LP) for diagnostic or therapeutic purposes, and is commonly treated with an epidural blood patch (EBP). There have been few publications regarding the long-term safety of EBP for the treatment of PDPH.</p><p><strong>Recent findings: </strong>The aim of this pilot study was to examine any association of chronic low back pain (LBP) in patients who experienced a PDPH following a LP, and were treated with an EBP. A total of 49 patients were contacted and completed a survey questionnaire via telephone. There was no increased risk of chronic LBP in the dural puncture group receiving EBP (percentage difference 1% [95% CI -25% - 26%], RR: 0.98 [95% CI 0.49 - 1.99]) compared to the dural puncture group not receiving EBP. There were no significant differences in the severity and descriptive qualities of pain between the EBP and non-EBP groups. Both groups had higher prevalence of back pain compared to baseline.</p><p><strong>Summary: </strong>Our findings suggest that dural puncture patients undergoing EBP do not experience low back pain with increased frequency compared to dural puncture patients not undergoing EBP. Higher prevalence of LBP compared to baseline and compared to general population was seen in both groups. However, this pilot study is limited by a small sample size and no definitive conclusion can be drawn from this observation. The findings of this study should spur further prospective research into identifying potential associations between LP, EBP and chronic low back pain.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4 Suppl 1","pages":"17-24"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901133/pdf/PB-50-4S1-17.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25413440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Long-Term Efficacy of Radiofrequency Ablation With and Without Steroid Injection.","authors":"Alaa Abd-Elsayed,&nbsp;Michael Loebertman,&nbsp;Peter Huynh,&nbsp;Ivan Urits,&nbsp;Omar Viswanath,&nbsp;Nalini Sehgal","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency ablation (RFA) has been proven to be an effective option for treating chronic low back pain. In addition to RFA as a treatment modality, the administration of concomitantly to minimize the effect of hyperalgesia is common practice. However, there is insufficient evidence about the long-term outcomes of their use.</p><p><strong>Methods: </strong>This was a retrospective study that examined 239 patients who received spine, knee joint, and sacroiliac joint RFA between June 2014 and June 2018. Pre- and post-procedure pain scores, percent improvements, and duration of relief were included in our review.</p><p><strong>Subjects: </strong>This study included 239 patients of which 191 patients received steroids with their RFA.</p><p><strong>Results: </strong>These 191 patients experienced an average improvement of 48.48% relief for an average of 137.52 days. Forty-eight patients did not receive steroids with RFA and had an average improvement of 46.36% for an average of 126.10 days. The statistical analysis revealed there was no significant difference between the two groups for percent improvement (p = 0.71) and duration of relief (p = 0.67).</p><p><strong>Conclusions: </strong>Patients who received steroids with RFA compared to RFA alone did not differ significantly in percent improvement in pain and duration of relief.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4 Suppl 1","pages":"11-16"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901125/pdf/PB-50-4S1-11.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25413439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Evidence-Based Review of Elagolix for the Treatment of Pain Secondary to Endometriosis.","authors":"Ivan Urits, Leena Adamian, Paulo Miro, Jessica Callan, Parth M Patel, Megha Patel, Amnon A Berger, Hisham Kassem, Alan D Kaye, Omar Viswanath","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose of review: </strong>This is a review of elagolix use for pain related to endometriosis. It summarizes the background and recent data available about the pathogenesis of endometriosis and pain that is secondary to this syndrome. It then reviews the evidence to support the use of elagolix and the indications for use.</p><p><strong>Recent findings: </strong>Endometriosis occurs in 10% of reproductive-age women and is a common source of chronic pelvic pain, infertility, and co-morbid disorders. It usually presents with some combination of dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. Treatment options may be surgical or hormonal. Traditional treatment is divided into medical and surgical. The latter, though effective, is reserved for surgical emergencies and patients failing medical management. Medical management with NSAIDs is usually limited in efficacy. It is generally based on hormonal suppression leading to atrophy of endometrial lesions. Elagolix (Orlissa) is a GnRH antagonist that suppressed the entire hypophysis-gonadal axis. Reduced levels of estrogen and progesterone lead to involution of the endometrial lesions and improvement in symptoms. Clinical trials showed that elagolix is effective in treating dysmenorrhea and non-menstrual pain that is secondary to endometriosis. It is well tolerated and has a relatively safe usage profile. Studies up to 12 months long showed continued efficacy and reduction in dysmenorrhea of up to 75%, with 50%-60% reduction in non-menstrual pain. Elagolix was found effective when compared to both placebo and alternative treatments.</p><p><strong>Summary: </strong>Endometriosis is a common syndrome that causes significant pain, morbidity, and disability, as well as financial loss. Elagolix is an effective drug in treating the symptoms of endometriosis and is a relatively safe option. Phase 4 studies will be required to evaluate the safety and efficacy of long term chronic use.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4 Suppl 1","pages":"197-215"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901127/pdf/PB-50-4S1-197.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25405588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Update on the Efficacy and Tolerability of Oral Ketamine for Major Depression: A Systematic Review and Meta-Analysis.","authors":"Nicolas A Nuñez,&nbsp;Boney Joseph,&nbsp;Mehak Pahwa,&nbsp;Ashok Seshadri,&nbsp;Larry J Prokop,&nbsp;Simon Kung,&nbsp;Kathryn M Schak,&nbsp;Jennifer L Vande Voort,&nbsp;Mark A Frye,&nbsp;Balwinder Singh","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Intravenous Ketamine has shown robust antidepressant efficacy although other routes of administration are currently needed. We conducted a systematic review and meta-analysis of studies evaluating the efficacy and tolerability of oral ketamine for depression.</p><p><strong>Methods: </strong>A comprehensive search of major electronic databases from inception to April 2020 was performed. Studies of oral ketamine for depression, from case series to randomized clinical trials, were eligible. Randomized controlled trials were included in a meta-analysis, focusing on response, remission, time to effect, and side effects.</p><p><strong>Results: </strong>A total of 917 articles were identified with 890 studies screened, yielding a total of 10 studies included in our systematic review.Three randomized controlled trials (RCTs) (N = 161, mean age 37.9 ± 9.5 years, 58.6% females) were included in the meta-analysis. Pooled analysis suggested a significant antidepressant effect of oral ketamine (SMD: -0.75; 95% CI: -1.08, -0.43; p<0.0001; I² = 0%) although remission rates (RR:2.77; 95% CI:0.96, 8.00; p = 0.06) and response rates (RR:2.58; 95% CI:0.94,7.08; p = 0.07) were marginal compared to placebo at the endpoint. Oral ketamine antidepressant effects seemed to take effect at the 2nd week (SMD: -0.71; 95% CI: -1.08, -0.35; p = 0.001; I² = 0%). There were no significant differences in the overall side-effects between oral ketamine and the placebo group (RR 1.28, 95% CI: 0.89-1.83; p = 0.19).</p><p><strong>Conclusion: </strong>This focused meta-analysis of oral ketamine suggests a marginal efficacy for major depressive disorder without increased risk of adverse events. Further larger sample studies are needed to confirm these preliminary findings, analyzing differential response/remission rates by affective disorder, optimal dosing strategies, and its long-term effects.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4","pages":"137-163"},"PeriodicalIF":0.0,"publicationDate":"2020-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511150/pdf/PB-50-4-137.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38450794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}