Background: Serotonin-noradrenaline reuptake inhibitors (SNRI) are widely used in medical practice. Their discontinuation has been associated with a wide range of symptoms. The aim of this paper is ...to identify the occurrence, frequency, and features of withdrawal symptoms after SNRI discontinuation. Methods: PRISMA guidelines were followed to conduct a systematic review. Electronic databases included PubMed, the Cochrane Library, Web of Science, and MEDLINE from the inception of each database to June 2017. Titles, abstracts, and topics were searched using a combination of the following terms: “duloxetine” OR “venlafaxine” OR “desvenlafaxine” OR “milnacipran” OR “levomilnacipran” OR “SNRI” OR “second generation antidepressant” OR “serotonin norepinephrine reuptake inhibitor” AND “discontinuation” OR “withdrawal” OR “rebound.” Only published trials in the English language were included. Results: Sixty-one reports met the criteria for inclusion. There were 22 double-blind randomized controlled trials, 6 studies where patients were treated in an open fashion and then randomized to a double-blind controlled phase, 8 open trials, 1 prospective naturalistic study, 1 retrospective study, and 23 case reports. Withdrawal symptoms occurred after discontinuation of any type of SNRI. The prevalence of withdrawal symptoms varied across reports and appeared to be higher with venlafaxine. Symptoms typically ensued within a few days from discontinuation and lasted a few weeks, also with gradual tapering. Late onset and/or a longer persistence of disturbances occurred as well. Conclusions: Clinicians need to add SNRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with other types of psychotropic drugs. The results of this study challenge the use of SNRI as first-line treatment for mood and anxiety disorders.
Background: The aim of this paper was to perform a systematic review and, when feasible, a meta-analysis of randomized controlled trials (RCT) which used benzodiazepines (BZD) as a monotherapy versus ...placebo, antidepressant drugs (AD), or both. Methods: Keyword searches were conducted for identifying RCT comparing BZD and AD, and/or placebo in the treatment of depression, using electronic databases from their inception up to April 2017. We selected reports of RCT in which BZD were compared to AD and/or placebo in the treatment of adult patients with a primary diagnosis of depressive disorder or anxious depression. When feasible, data were subjected to meta-analysis. Results: A total of 38 studies met the criteria for inclusion and were then included in the systematic review. Only 1 study concerned a newer AD, fluvoxamine. For the meta-analysis, we submitted data on response rate from 22 RCT, considering BZD versus placebo (8 comparisons) and BZD versus tricyclic antidepressants (TCA) (20 comparisons). There was a lack of significant differences as to response rate between BZD and placebo, as well as between BZD and TCA. Analysis of individual studies disclosed that, in more than half of the studies comparing BZD to TCA and/or placebo, BZD were significantly more effective than placebo and as effective as TCA. Conclusions: BZD are a therapeutic option in anxious depression and there are no indications that AD are preferable. There is a pressing need for RCT of adequate methodological quality and follow-up comparing BZD to second-generation AD and placebo in anxious depression.
Abstract
Introduction
Sleep, diet, and physical activity are key to cardiovascular health (CVH). Recent immigrants have healthier habits than native-born US adults, and greater acculturation is ...linked to poorer diets, less physical activity, and worse CVH. However, little is known about sleep in immigrant women. We aimed to investigate prospective associations between immigration status, acculturation, and sleep in a diverse sample of women from a New York City community-based cohort.
Methods
This prospective cohort study of 447 women (60.4% racial/ethnic minority, mean age=36.37±15.43 y) evaluated whether immigration and/or acculturation predicted sleep patterns at 1y follow-up. Immigration status, region of origin (Asia, Caribbean, Latin America, other), and acculturation measures including language preference, length of US residency, and age at immigration were self-reported at baseline. Sleep duration, quality, and sleep-onset latency were measured using the Pittsburgh Sleep Quality Index at baseline and 1y follow-up. Linear and logistic regression models were adjusted for age, health insurance, education, BMI, and corresponding baseline sleep measure.
Results
Among all participants, being born in the US was associated with poorer sleep quality (β:0.57, SE:0.25, p=0.022) at 1y. Among immigrant women, longer residency in the US (β:-0.02, SE:0.01 p=0.008), younger age at immigration (β:0.02, SE:0.01, p=0.012), and being from the Caribbean (β:-0.46, SE:0.19 p=0.017) were associated with shorter sleep duration at 1y. In logistic regression models adjusted for confounders, women who were from the Caribbean vs. other regions (OR:3.09, CI:1.13-8.51, p=0.029) and who had a longer US residency (OR:1.06, CI:1.02-1.10, p=0.002) had higher odds of sleeping < 7h/night. A lower risk of short sleep (< 7h/night) was observed among those who had been in the US for < 10y vs. ≥10y (OR:0.33, CI:0.11-0.96, p=0.042) and with an older age at immigration (OR:0.94, CI:0.90-0.98, p=0.003).
Conclusion
Poorer sleep quality was reported by US born women, while shorter sleep was observed among immigrant women from the Caribbean compared to other regions, those with a younger age at immigration, and those with a longer residency in the US. These findings may help to identify women at greater risk for poor sleep and, consequently, at increased risk for poor CVH.
Support (if any)
American Heart Association (AHA16SFRN27960011).
Abstract only
Introduction:
The Covid-19 pandemic had a negative impact on mental health and lifestyle behaviors, including dietary habits. Negative psychological factors are known to adversely ...impact lifestyle behaviors, but the influence of positive psychological well-being on dietary intakes is relatively unknown.
Hypothesis:
We assessed the hypothesis that psychological factors related to both negative emotional states and positive psychological well-being would have an impact on dietary intakes among adults reporting poor sleep quality and at least moderate perceived stress during the Covid-19 pandemic.
Methods:
Thirty-one individuals (age 40.2±13.0 y, 81% women, 55% White, BMI 23.2±2.6 kg/m
2
) were enrolled in a pilot study testing the efficacy of a well-being and sleep hygiene intervention to improve sleep, diet, and mental health. Questionnaires were administered at baseline to assess diet (single-day food recall), psychological well-being (Psychological Well-Being scales of autonomy, environmental mastery, personal growth, purpose in life, positive relations with others, and self-acceptance) and negative emotional states (Symptom Questionnaire scales of anxiety, depression, hostility, and somatization). Separate linear regression models were estimated for each psychological variable that was significantly correlated with diet at baseline, controlling for age, sex, and BMI.
Results:
Linear regression models showed that, at baseline, higher depression and hostility were associated with higher energy (
B
= 77.6±20.3 (
SE
),
p
< 0.001 and
B
= 65.2±25.7,
p
= 0.01, respectively) and fat (
B
= 4.6±1.5,
p
= 0.004 and
B
= 4.9±1.7,
p
= 0.008, respectively) intakes. Higher depression was also associated with higher intakes of protein (
B
= 3.0±1.0,
p
= 0.006), carbohydrate (
B
= 6.5±2.5,
p
= 0.01), sugar (
B
= 3.9±1.1,
p
= 0.001), and sodium (
B
= 130.7±36.6,
p
= 0.001). Higher positive relations was associated with lower carbohydrate (
B
= -5.1±2.4,
p
= 0.04) and sugar (
B
= -3.6±1.0,
p
= 0.001) intakes, and higher purpose in life was associated with lower sugar (
B
= -3.3±1.2,
p
= 0.008), cholesterol (
B
= -14.7±5.9,
p
= 0.01), and saturated fat (
B
= -1.2±0.4,
p
= 0.008) intakes. When controlling for baseline levels of depression, hostility and purpose in life were no longer associated with dietary intakes, while positive relations remained associated with sugar intakes (
B
= -2.3±1.2,
p
= 0.04).
Conclusions:
Under stressful circumstances, both negative emotional states and positive psychological well-being are associated with dietary intakes. Despite depression having the strongest overall impact on dietary intakes, positive relations with others independently affected sugar intakes. Personalized approaches focused on positive psychological well-being, along with distress reduction, should be considered in interventions aimed at promoting healthy dietary behaviors.
Abstract
Introduction
Psychological distress has been associated with sleep problems. Emerging evidence suggests positive psychological well-being is associated with better sleep. However, most of ...these studies are cross-sectional and do not provide information on the effect that changes in psychological outcomes have on sleep. The aim of this secondary analysis was to test whether changes in distress and well-being following a 7-week intervention to improve sleep and mental health were associated with changes in sleep among adults reporting poor sleep quality (Pittsburgh Sleep Quality Index PSQI>5) and moderate distress (Perceived Stress Scale PSS≥14) during the COVID-19 pandemic.
Methods
Thirty individuals (age 40.7±12.9y, 80% female, 50% racial/ethnic minority) completed a pilot study testing a well-being and sleep hygiene intervention vs. sleep hygiene alone. Questionnaires were administered at baseline and post-intervention to assess distress (PSS and the Symptom Questionnaire), well-being (Psychological Well-Being scales), and sleep (PSQI and Insomnia Severity Index). A sleep diary was administered to collect information on total sleep time (TST), variability in TST, sleep onset latency, wake time after sleep onset, bedtime, and variability in bedtime. Change scores were calculated for each variable as the difference between post-intervention and baseline. Separate linear regression models were estimated with psychological variables as predictors and sleep variables as outcomes. Analyses were adjusted for intervention group, baseline scores of predictors and outcomes, age, and sex.
Results
Reductions in anxiety were associated with improvements in insomnia (B=0.6±0.2 (SE), p=0.008) and TST (B=-10.1±3.5, p=0.009); reductions in depression, somatization, and hostility were each associated with improvements in sleep quality (B=0.2±0.1, p=0.007), TST (B=-10.3±4.5, p=0.03), and earlier bedtime (B=8.8±3.0, p=0.008), respectively; and reductions in perceived stress were associated with improvements in sleep quality (B=0.2±0.1, p=0.005) and insomnia (B=0.3±0.1, p=0.02). No associations were found between changes in well-being and sleep.
Conclusion
Our findings suggest that reductions in distress following well-being and sleep hygiene or sleep hygiene alone interventions predict improvements in sleep. Focusing interventions on improving distress may be relevant to ameliorate sleep quality in the context of psychological distress. The association between well-being and sleep should be further delineated to determine the role of well-being in sleep promotion.
Support (If Any)
Women are disproportionally affected by psychological distress and lack of social support and are more vulnerable to the negative impact of chronotype on mental health. This study evaluates ...cross-sectional associations between chronotype and mental health, while assessing the mediating role of social support among women from diverse racial/ethnic backgrounds. Women from the American Heart Association Go Red for Women Research Network were included (
= 506, mean age = 37 ± 15.7, 61% racial/ethnic minority). Chronotype, depression, perceived stress, health-related quality of life, and social support were assessed at baseline using validated self-reported questionnaires. Linear regression and causal mediation analyses were performed. Depression and negative emotionality were higher among women with evening vs. morning/intermediate chronotypes (all
< 0.05). Multivariable analyses adjusted for sociodemographic and clinical confounders showed associations between evening chronotype and higher depression (
= 0.004) and negative emotionality (
= 0.010). However, these associations were no longer significant after adjusting for social support (depression:
= 0.12; negative emotionality:
= 0.18). Social support significantly mediated 44.6% and 45.8% of the total effect of chronotype on depression and negative emotionality, respectively. Social support represents a potential mechanism underlying the associations between eveningness and poor mental health. Chronotype and social support should be considered in interventions for the promotion of mental health in women.
Appraisal of prodromal symptoms of unipolar depression may complement the traditional cross-sectional approach and provide a longitudinal perspective, according to a staging model of the illness.
To ...provide an updated systematic review of clinical studies concerned with prodromal symptoms of unipolar depression, according to PRISMA guidelines.
Keyword searches were conducted in PubMed, Scopus, and Web of Science. Longitudinal studies on prodromal symptoms and signs in adult patients primarily diagnosed with unipolar depression were selected. Findings were examined separately according to study design (i.e., retrospective or prospective).
Twenty-five studies met the criteria for inclusion in this systematic review. Findings indicate that a distinct prodromal symptomatology - commonly characterized by anxiety, tension, irritability, and somatic complaints - exists before the onset of unipolar depression. The duration of the prodromal phase was highly variable across studies, ranging from less than a month to several years. Prodromal symptoms profile and duration were consistent within individuals across depressive episodes. There was a close relationship between prodromal and residual symptoms of the same depressive episode.
The present systematic review addresses an important, and yet relatively neglected, clinical issue that deserves further investigation and may be of immediate practical value. The findings provide challenging insights into the pathogenesis and course of unipolar depression, which may result in more timely and effective treatment of recurrences. The definition of a prodromal phase in depression would benefit from the joint use of symptom identification, biomarkers, and neuroimaging.
Patient-reported outcomes (PROs) are of increasing importance in clinical medicine. However, their evaluation by classic psychometric methods carries considerable limitations. The clinimetric ...approach provides a viable framework for their assessment.
The aim of this paper was to provide a systematic review of clinimetric properties of the Symptom Questionnaire (SQ), a simple, self-rated instrument for the assessment of psychological symptoms (depression, anxiety, hostility, and somatization) and well-being (contentment, relaxation, friendliness, and physical well-being).
The PRISMA guidelines were used. Electronic databases were searched from inception up to March 2019. Only original research articles, published in English, reporting data about the clinimetric properties of the SQ, were included.
A total of 284 studies was selected. The SQ has been used in populations of adults, adolescents, and older individuals. The scale significantly discriminated between subgroups of subjects in both clinical and nonclinical settings, and differentiated medical and psychiatric patients from healthy controls. In longitudinal studies and in controlled pharmacological and psychotherapy trials, it was highly sensitive to symptoms and well-being changes and discriminated between the effects of psychotropic drugs and placebo.
The SQ is a highly sensitive clinimetric index. It may yield clinical information that similar scales would fail to provide and has a unique position among the PROs that are available. Its use in clinical trials is strongly recommended.
Abstract only
Introduction:
Psychological distress has been linked to obesity through its impact on health behaviors, including sleep, while resilience has shown a protective effect on health. ...However, limited evidence is available on the role of sleep and resilience on the association between psychological distress and obesity, especially among women.
Hypothesis:
We hypothesized that sleep would be a significant mediator of the positive association between psychological distress and obesity markers, while higher resilience would attenuate this association in a community-sample of racially/ethnically diverse women.
Methods:
This was a cross-sectional analysis of baseline data collected from 237 women from the AHA Go Red for Women cohort (69% 163 of 237 racial/ethnic minority, 34.1±13.5y). Psychological and sleep variables were assessed using validated self-reported questionnaires, including psychosocial questionnaires (Perceived Stress Scale, Global Perceived Stress Scale, Life Events Checklist, Patient Health Questionnaire, Brief Resilience Scale) and sleep questionnaires (Pittsburgh Sleep Quality Index, Insomnia Severity Index). Sleep outcomes included sleep duration, sleep quality, and insomnia severity. Anthropometric measures of obesity were collected by a trained study staff member and included BMI and waist circumference. Linear regression models, causal mediation, and moderation analyses were performed, adjusting for age and insurance status.
Results:
There was a trend for a positive association between perceived stress and waist circumference (β=0.22±0.12, p=0.069). All measures of psychological distress were associated with poorer sleep outcomes (all p<0.05). Having shorter sleep, poor quality sleep, and higher insomnia severity was associated with higher BMI (β=-1.12±0.30, β=0.23±0.11, β=0.17±0.07, respectively; all p<0.05) and waist circumference (β=-1.08±0.27, β=0.29±0.10, β=0.19±0.06, respectively; all p<0.05). Sleep duration (Natural Indirect Effect NIE=0.11±0.04, p=0.012), sleep quality (NIE=0.10±0.05, p=0.037), and insomnia severity (NIE=0.13±0.05, p=0.020) mediated the association between perceived stress and waist circumference. Resilience attenuated the association between perceived stress and waist circumference (interaction effects: -0.78±0.34, p=0.021), such that those with higher resilience had a lesser influence of perceived stress on waist circumference.
Conclusions:
These findings suggest that promoting better sleep health and resilience among women reporting psychological distress may help reduce the risk of obesity and should be considered within interventions for the promotion of cardiometabolic health. However, the temporality and causality of the relationships between psychological factors, sleep, and obesity should be further investigated in longitudinal and clinical studies.
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