Escitalopram oxalate
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Publication
Journal: JAMA network open
June/22/2020
Abstract
Importance: Despite the high prevalence and potential outcomes of major depressive disorder, whether and how patients will respond to antidepressant medications is not easily predicted.
Objective: To identify the extent to which a machine learning approach, using gradient-boosted decision trees, can predict acute improvement for individual depressive symptoms with antidepressants based on pretreatment symptom scores and electroencephalographic (EEG) measures.
Design, setting, and participants: This prognostic study analyzed data collected as part of the International Study to Predict Optimized Treatment in Depression, a randomized, prospective open-label trial to identify clinically useful predictors and moderators of response to commonly used first-line antidepressant medications. Data collection was conducted at 20 sites spanning 5 countries and including 518 adult outpatients (18-65 years of age) from primary care or specialty care practices who received a diagnosis of current major depressive disorder between December 1, 2008, and September 30, 2013. Patients were antidepressant medication naive or willing to undergo a 1-week washout period of any nonprotocol antidepressant medication. Statistical analysis was conducted from January 5 to June 30, 2019.
Exposures: Participants with major depressive disorder were randomized in a 1:1:1 ratio to undergo 8 weeks of treatment with escitalopram oxalate (n = 162), sertraline hydrochloride (n = 176), or extended-release venlafaxine hydrochloride (n = 180).
Main outcomes and measures: The primary objective was to predict improvement in individual symptoms, defined as the difference in score for each of the symptoms on the 21-item Hamilton Rating Scale for Depression from baseline to week 8, evaluated using the C index.
Results: The resulting data set contained 518 patients (274 women; mean [SD] age, 39.0 [12.6] years; mean [SD] 21-item Hamilton Rating Scale for Depression score improvement, 13.0 [7.0]). With the use of 5-fold cross-validation for evaluation, the machine learning model achieved C index scores of 0.8 or higher on 12 of 21 clinician-rated symptoms, with the highest C index score of 0.963 (95% CI, 0.939-1.000) for loss of insight. The importance of any single EEG feature was higher than 5% for prediction of 7 symptoms, with the most important EEG features being the absolute delta band power at the occipital electrode sites (O1, 18.8%; Oz, 6.7%) for loss of insight. Over and above the use of baseline symptom scores alone, the use of both EEG and baseline symptom features was associated with a significant increase in the C index for improvement in 4 symptoms: loss of insight (C index increase, 0.012 [95% CI, 0.001-0.020]), energy loss (C index increase, 0.035 [95% CI, 0.011-0.059]), appetite changes (C index increase, 0.017 [95% CI, 0.003-0.030]), and psychomotor retardation (C index increase, 0.020 [95% CI, 0.008-0.032]).
Conclusions and relevance: This study suggests that machine learning may be used to identify independent associations of symptoms and EEG features to predict antidepressant-associated improvements in specific symptoms of depression. The approach should next be prospectively validated in clinical trials and settings.
Trial registration: ClinicalTrials.gov Identifier: NCT00693849.
Publication
Journal: Birth Defects Research
February/20/2020
Abstract
Selective serotonin reuptake inhibitors (SSRIs), which include paroxetine (Paxil), sertraline (Zoloft), fluoxetine (Prozac), citalopram (Celexa), and escitalopram (Lexapro), are the most common antidepressants prescribed to pregnant women. There is considerable debate in the literature regarding the developmental toxicities of SSRIs individually, and as a class.It is considered unethical to perform developmental toxicity studies on pregnant women, but rodent and nonrodent species provide laboratory-controlled experimental models to examine the toxicity of SSRI exposure during pregnancy. The Embryo-Fetal Developmental Toxicity Study was conducted with sertraline in mice, Crl:CD1 (lCR), during the period of organogenesis.Increased resorption rates, lower fetal weight, and increased percentage of fetuses with visceral and skeletal abnormalities were found in the intermediate and high sertraline dose groups. In addition to incomplete ossification of treated animals, eleven sertraline exposed fetuses, two in group 2 (5 mg/kg), five in group 3 (25 mg/kg), and four in group 4 (60 mg/kg), had cleft palate (CP). This malformation was not observed in any controls. Only the highest dose of sertraline was found to be maternally toxic, as evidenced by significantly lower weight gain during pregnancy.These data indicate that in utero exposure to sertraline at 25 and 60 mg/kg was embryotoxic, teratogenic, and fetotoxic in mice. The incidence of CP observed in groups 3 and 4 (2.99% and 2.5%, respectively) were higher than the maximum range value noted in historical controls and indicate sertraline is a teratogen in ICR mice.
Publication
Journal: Canadian Journal of Microbiology
January/21/2021
Abstract
Bacterial resistance has propelled one of the most serious public health problems in the world. In this sense, drug repurposing has emerged for faster identification of effective drugs. The aim of this study was to investigate the repurposing of escitalopram oxalate and clonazepam drugs individually and in combination with antibiotics ciprofloxacin and sulfamethoxazole-trimethoprim to treat multidrug-resistant microorganisms (MDR) and to evaluate the chemical nuclease capacity. The minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), fractional inhibitory concentration index (FICI) and tolerance level were determined against each microorganism tested. In vitro antibacterial activity was evaluated against forty-seven multidrug-resistant clinical isolates and eleven standard bacterial strains of the American Type Culture Collection (ATCC). Escitalopram oxalate was active mainly against Gram-positive and clonazepam against Gram-positive and Gram-negative bacteria. When associated with the two antibiotics mentioned, they had a significant synergistic effect. Clonazepam was able to cleave plasmid DNA and the mechanisms involved were oxidative and hydrolytic. These results allow us to suggest repurposing these non-antibiotic drugs to treat bacterial infections. However, further studies on the mechanism of action of these drugs should be performed, including to increase safety in use.
Publication
Journal: Drug Design, Development and Therapy
December/1/2020
Abstract
Purpose: This study compared the bioequivalence of two formulations of escitalopram oxalate 20 mg tablets in terms of bioavailability and tolerability in healthy Chinese male and female subjects.
Patients and methods: A randomized, single-blind, two-period, two-sequence crossover study was performed under fasting and fed conditions, with a 21-day washout period. In total, 24 healthy subjects (18 males and 6 females) were enrolled in the fasting test and the fed test, respectively. Blood samples were collected over 168 h post-dose in each period. The concentrations of escitalopram in plasma were determined by high-performance liquid chromatography coupled with a tandem mass spectrometry. Pharmacokinetic parameters used for bioequivalence assessment were determined from the drug concentration data using noncompartmental analysis.
Results: All subjects showed good medication compliance. The 90% confidence intervals (CIs) for the geometric mean ratios of AUC0-t, AUC0-∞, and Cmax were within the bioequivalence acceptance criteria (80.00% to 125.00%). Adverse events were recorded and no deaths or serious adverse events (SAEs) occurred.
Conclusion: Escitalopram oxalate 20 mg tablets produced in China were bioequivalent to the reference formulation (Lexapro®) in healthy Chinese male and female subjects under fasting and fed conditions.
Keywords: LC-MS/MS; bioequivalence; clinical trials; escitalopram; escitalopram oxalate tablets; pharmacokinetics.
Publication
Journal: Clinical Pharmacology and Therapeutics
April/22/2020
Abstract
During the last decade, the problem of suicide has become more serious in individuals with depression. Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for major depressive disorder (MDD). This study aims to investigate the efficacy of MRI-based neuronavigation-guided daily high-dose rTMS for rapidly improving suicidal ideation in treatment-naive MDD patients. In the present 1-week double-blind study, 42 treatment-naive MDD patients with suicidal ideation were randomly assigned to the treatment of escitalopram oxalate tablets (10 mg/d) in combination with either active (n = 21) or sham (n = 21) rTMS. The TMS coil was positioned over a specified target location (-44, 40, 29) in left dorsolateral prefrontal cortex(DLPFC)based on MRI data. The severity of suicidal ideation was measured by the Beck Scale for Suicide Ideation (BSI). The 24-item Hamilton Depression Rating Scale (HAMD-24) and Montgomery-Asberg Depression Rating Scale (MADRS) were utilized to assess the severity of depression. The Wisconsin Card Sorting Test (WCST), Continuous Performance Test (CPT) and Stroop Color-Word Test (SCWT) were adopted to assess executive function. In contrast to the sham group, the active rTMS group showed a significantly greater BSI score reduction at the third day and the seventh day (p < 0.001). Moreover, the active rTMS group showed a significantly greater HAMD (p < 0.001) and MADRS (p < 0.001) score reduction at the seventh day in comparison with the sham group. The present findings suggested that the neuronavigation-guided high-dose rTMS may be a novel method to rapidly reduce suicidal ideation and mitigate depressive symptom.
Publication
Journal: Zhen ci yan jiu = Acupuncture research / [Zhongguo yi xue ke xue yuan Yi xue qing bao yan jiu suo bian ji]
January/7/2021
Abstract
Objective: To observe the effect of round magnetic needle tapping along meridians on the back plus acupuncture at "Qi Shen Zhen"(including Shenting [GV24], Benshen [GB13], Sishenchong [EX-HN1]), and Baihui (GV20), Shenmen (HT7) on gastrointestinal function, daily living activities and anxiety status in post-stroke anxiety disorder (PSAD) patients.
Methods: Fifty-seven PSAD patients were randomly divided into acupuncture group (28 cases) and medication group (29 cases). On the basis of routine treatment and physical therapy, patients of the acupuncture group were treated by applying round magnetic needle to mildly tapping the second line→the first line of the Bladder Meridian→Jiaji acupoints→Governor Meridian on the back from outside to the inside in sequence for 20 min, followed by needling GV24, GV20, GB13, EX-HN1 and HT7, respectively, with the needles retained for 30 min after one minute's twisting. The treatment was conducted once daily, 5 times a week, for 6 weeks. Patients of the medication group were asked to take Escitalopram Oxalate tablets (5-20 mg/d) for 6 weeks. The Hamilton Anxiety Rating Scale (HAMA) was used to assess the patient's severity of anxiety, cognition, somatic sensation, symptoms of cardiovascular, respiratory, gastrointestinal, urogenital, automatic and muscular systems, the Barthel Index (BI) used to evaluated the activities of daily living (ADL), and the gastrointestinal function (Spleen-stomach Symptom Score [SSS]) assessed according to the "Standards for Diagnosis and Curative Effect Evaluation of Syndromes of Traditional Chinese Medicine". The adverse reactions were observed at the end of treatment.
Results: After the treatment, the HAMA scores at the 2nd, 4th and 6th week and the SSS scores at the 4th and 6th week were significantly decreased (P<0.05), and the BI scores at the 2nd, 4th and 6th week were considerably increased in both acupuncture and medication groups compared with their own pre-treatment (P<0.05). The HAMA score at the 2nd week, and the SSS scores at the 2nd, 4th and 6th week were obviously lower(P<0.05), and the BI score at the 6th week was notably higher in the acupuncture group than in the medication group (P<0.05). No significant diffe-rence was found between the two groups in the therapeutic effect of anxiety state (P>0.05). The acupuncture group had fewer adverse reactions than the medication group (P<0.05).
Conclusion: The round magnetic needle tapping plus "Qi Shen Zhen" needling has a significant therapeutic effect in improving PSAD patients' anxiety state, being similar to Escitalopram Oxalate tablets in reducing anxiety state and being superior to Escitalopram in improving gastrointestinal function and daily living activities.
目的:观察采用背部循经叩刺结合“七神针”针刺方法干预卒中后焦虑障碍对患者焦虑情绪、脾胃症候积分和日常生活活动功能(Barthel指数)的影响。方法:将57例卒中后焦虑障碍患者随机分为针刺组28例和西药组29例。在常规康复训练基础上,针刺组患者取磁圆梅针在背部按膀胱经二侧线→膀胱经一侧线→华佗夹脊穴→督脉由外向内循经扣刺20 min,同时给予“七神针”(神庭、本神、四神聪)加百会、神门针刺干预,西药组予以草酸艾司西酞普兰片以起始剂量5 mg口服作为对照,疗程为6周。于第2、4、6周进行汉密尔顿焦虑量表(HAMA)、脾胃症候积分及Barthel指数的评分,并在治疗结束后观察两组的临床疗效和不良反应。结果:与治疗前比较,两组治疗各时点的HAMA评分及治疗第4、6周时的脾胃症候积分均显著降低(P<0.05),治疗各时点的Barthel指数均显著升高(P<0.05)。与西药组比较,针刺组治疗第2周时的HAMA评分、各时点的脾胃症候积分均降低(P<0.05),治疗第6周时的Barthel指数升高(P<0.05)。治疗结束后两组临床疗效比较,差异无统计学意义(P>0.05),针刺组患者出现不良反应的例数较西药组少(P<0.05)。结论:背部循经叩刺结合“七神针”针刺对卒中后焦虑情绪具有明显改善作用,其疗效与艾司西酞普兰片相当,在促进患者脾胃功能恢复和提高Barthel指数上优于艾司西酞普兰片,且安全性好。.
Keywords: Anxietya; Daily living ability; Gastrointestinal functiona; Post-stroke anxiety disordera; Tapping along meridiansa; “Qi Shen Zhen” needlinga.
Publication
Journal: Medical Letter on Drugs and Therapeutics
April/22/2020
Publication
Journal: Frontiers in Human Neuroscience
July/7/2021
Abstract
Objectives: To investigate the improvement effect of occipital repetitive transcranial magnetic stimulation (rTMS) combined with escitalopram oxalate tablets on pre-attentive processing in patients with first-episode, medication-naive depression.
Methods: Patients who were hospitalized between January and December 2019 were selected. They were randomly allocated to real occipital rTMS stimulation group with 27 cases receiving intermittent theta-burst (iTBS) and sham stimulation group with 24 cases over 20 days. The rTMS treatment target is located at the Oz point of the occipital region. Both groups took escitalopram oxalate tablets, and the average daily drug dose was 15.294 ± 5.041 mg. Hamilton Depression Rating Scale (HAMD) was used to assess the symptoms of depression before and after treatment, and mismatch negativity (MMN) was used to assess the improvement of pre-attentive processing before and after treatment.
Results: After 20 days of treatment, the total score of HAMD (13.495 ± 3.700) in both groups was significantly lower than that before treatment [21.910 ± 3.841, F(1, 49) = 46, 3.690, p < 0.001]. After treatment, the latency of MMN in the real stimulation group (182.204 ± 31.878 ms) was significantly lower than that in the sham stimulation group (219.896 ± 42.634 ms, p < 0.001), and the amplitude of MMN in the real stimulation group (-7.107 ± 3.374 ms) was significantly higher than that in the sham stimulation group (-2.773 ± 3.7 32 ms, p < 0.001).
Conclusion: Occipital rTMS treatment can enhance the early therapeutic effect and effectively improve the pre-attentive processing of patients with depression and provide a scientific basis for the new target of rTMS therapy in clinical patients with depression.
Keywords: event-related potentials; major depressive disorder; mismatch negativity; occipital lobe; repetitive transcranial magnetic stimulation.
Publication
Journal: Journal of Ethnopharmacology
August/27/2021
Abstract
Ethnopharmacological relevance: Sceletium tortuosum (L.) N.E.Br. (ST) has been used by the Khoisan people of South Africa as a mood elevator. Its various pharmacological mechanisms of action suggest distinct potential as an antidepressant. Clinical studies in healthy individuals suggest beneficial effects on mood, cognition, and anxiety.
Aim of the study: To obtain a chromatographic fingerprint of a standardized extract of S. tortuosum (Zembrin®), and to evaluate the acute antidepressant-like properties of Zembrin® versus the reference antidepressant, escitalopram, in the Flinders Sensitive Line (FSL) rat, a genetic rodent model of depression.
Materials and methods: The chemical profile of Zembrin® was determined by ultra-performance liquid chromatography-mass spectrometry (UPLC-MS) chromatogram method using alkaloid standards. Twelve saline treated FSL and six Flinders Resistant Line (FRL) control rats were used to confirm face validity of the FSL model using the forced swim test (FST). Thereafter, FSL rats (n = 10) received either 5, 10, 25, 50 or 100 mg/kg of Zembrin®, or 5, 10 or 20 mg/kg escitalopram oxalate (ESC), both via oral gavage, and subjected to the open field test (OFT) and FST.
Results: Four main ST alkaloids were identified and quantified in Zembrin® viz. mesembrenone, mesembrenol, mesembrine, and mesembranol (47.9%, 32%, 13.2%, and 6.8% of the total alkaloids, respectively). FSL rats showed significantly decreased swimming and climbing (coping) behaviours, and significantly increased immobility (despair), versus FRL controls. ESC 5 mg/kg and Zembrin® 25 mg/kg and 50 mg/kg showed significant dose-dependent reversal of immobility in FSL rats and variable effects on coping behaviours. Zembrin® 50 mg/kg was the most effective antidepressant dose, showing equivalence to ESC 5.
Conclusions: Zembrin® (25 and 50 mg/kg) and ESC (5 mg/kg) are effective antidepressants after acute treatment in the FST. Moreover, Zembrin® 50 mg/kg proved equivalent to ESC 5. Further long-term bio-behavioural studies on the antidepressant properties of Zembrin® are warranted.
Keywords: And adjunctive medicine; Antidepressant; Complementary; Escitalopram; FST; OFT; Sceletium tortuosum.
Publication
Journal: International Journal of Geriatric Psychiatry
August/24/2020
Abstract
Introduction: Bright light therapy (BLT) is known to treat depression and sleep disorders in clinical practice, but its efficacy on poststroke depression (PSD) has not been studied.
Objective: To investigate the therapeutic effects and safety of BLT combined with escitalopram oxalate (ESC) on insomnia in patients with poststroke depression.
Methods: Ischemic stroke patients with depressive symptoms and a score of ≥ 8 on the Hamilton Depression Scale (HAMD-17) while meeting DSM-IV criteria were diagnosed as having PSD. A total of 112 PSD patients with symptoms of insomnia were randomly assigned to polytherapy (BLT plus ESC) and monotherapy (ESC only) groups. Each regimen continued for six weeks. The primary outcomes were a change in scores on the Pittsburgh Sleep Quality Index (PSQI) and a remission rate (PSQI ≤ 7 at the endpoint). The secondary outcomes included changes in the HAMD-17 and Barthel Index (BI) scores. Adverse effects were assessed by the Adverse Events Scale.
Results: The endpoint assessment included 106 patients (monotherapy, 54; polytherapy, 52). The mean changes in the PSQI scores for the monotherapy and polytherapy groups were 4.85 (1.47) and 5.87 (1.72) (P = 0.001), respectively. Compared to monotherapy, polytherapy improved PSQI remission rate (71.4% vs 50.0%; χ2 = 5.390; P = 0.020), and HAMD-17 score (6.70 [2.12] vs 4.75 [1.98]; P < 0.001). Both treatments improved BI score, with no statistical difference, and were well-tolerated, with few significant differences in treatment-associated adverse events.
Conclusion: BLT combined with ESC is effective and well-tolerated for the treatment of PSD-associated insomnia. This article is protected by copyright. All rights reserved.
Keywords: Bright light therapy; Escitalopram oxalate; Insomnia; Pittsburgh Sleep Quality Index; Poststroke depression.
Publication
Journal: Journal of Chromatographic Science
July/20/2020
Abstract
Application of capillary electrophoresis (CE) has become a rapidly growing analytical technique for the estimation of drugs in pharmaceutical dosage forms and biological fluids. In this study, an effective and sensitive method was developed for the determination of escitalopram oxalate (ESC-OX) by CE with diode-array detection at 200 nm. The separation was achieved by a fused silica capillary with 40 cm effective length (48.5 cm total, 75 μm i.d.). The background electrolyte was composed of 15 mM phosphate buffer (pH 2.5). The applied potential was 22.5 kV, and the samples were injected at 50 mbar pressure for 10 s. Metoprolol was used as an internal standard (IS). The migration time under these optimum conditions was 6.51 ± 0.07 and 6.73 ± 0.08 min for ESC-OX and IS, respectively, with total run time 7 min. The method was validated for linearity, precision, accuracy, specificity and sensitivity. The limit of detection was calculated as 3.85 and 5.07 ng mL-1 for standard and urine samples, respectively. The developed method was employed successfully for the determination of ESC-OX in different pharmaceutical dosage forms and spiked human urine after simple liquid-liquid extraction with good recovery.
Publication
Journal: Journal of Developmental and Behavioral Pediatrics
January/9/2020
Abstract
Thomas is a 13-year-old boy with autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), generalized anxiety disorder, separation anxiety disorder, and major depressive disorder who presented for a follow-up to his developmental and behavioral pediatrician (DBP). His mother describes an increase in symptoms of anxiety and depression for the last 6 weeks, accompanied by suicidal ideation and thoughts of self-mutilation.Before this increase in symptoms, he had been doing well for the last several months with the exception of increasing weight gain, and Abilify was decreased from 5 mg to 2.5 mg at his last visit. Other medications at that time included Zoloft 100 mg twice daily, Focalin XR 40 mg every morning, and Focalin 5 mg every night. Without seeking the guidance of our developmental and behavioral pediatrics clinic, his mother increased his intake of Zoloft to 150 mg each morning and continued 100 mg each evening because of worsening anxiety and depression.Religion is very important to Thomas and his family. He acknowledges that he does not want to die and feels badly because "suicide is against our religion."Helping Thomas receive appropriate care has been a challenge. He was diagnosed with ADHD and Asperger disorder at the age of 5. Thomas is homeschooled and is very attached to his mother. His parents have very different parenting styles, with his mother being more permissive and his father more authoritarian. At the time of initial diagnosis, the behavioral health services (BHS) in Thomas' community, which is about an hour away from the DBP, were limited to older children, and he was followed by a DBP for ADHD medication management. At the age of 11, he expressed passive suicidal ideation and described that he imagined his mother as "the devil with fire coming out of her eyes" when she corrected him. He was evaluated by BHS, diagnosed with anxiety disorder, and started on Lexapro. BHS linked to the DBP were out of network for his insurance. The family was unable to pay out of pocket, so care was subsequently transferred to a DBP clinic that was in network. Soon after, Thomas developed auditory hallucinations, and Abilify was added after consultation with BHS.Over the last few years, Thomas' symptoms have waxed and waned. He did well for a short time and then again developed auditory hallucinations, worsening symptoms of anxiety and depression, and increasing somatic symptoms including vomiting and penile pain. Medications were adjusted with input from BHS, and further attempts were made to link him to local BHS but were unsuccessful. With his current concerns of suicidal ideation and self-mutilation, what would be your next steps?
Publication
Journal: Journal of Separation Science
December/26/2021
Abstract
Normal-phase and reversed-phase high-performance liquid chromatography methods for the separation of the active pharmaceutical ingredient Escitalopram from its (R)-enantiomer impurity have been developed on the cellulose-based Chiralcel OJ-H chiral stationary phase. Both methods share two features: they use ethanol as a cosolvent and are able to give a complete enantioseparation without interference from other associated chiral impurities. With the green eluent mixture ethanol-water-diethylammine 70:30:0.1 (v/v/v) the resolution between escitalopram and (R)-enantiomer was 2.09 at 30°C. The limits of quantification for the (S) and (R) enantiomers were 4.5 μg mL-1 and 3.8 μg mL-1 , respectively. This article is protected by copyright. All rights reserved.
Keywords: Citalopram; Escitalopram; absolute configuration; cellulose tris(4-methylbenzoate); green HPLC.
Publication
Journal: Journal of AOAC International
March/21/2021
Abstract
Background: Determination of emerging pollutants including pharmaceuticals, pesticides, industrial chemicals and hormones in different environmental samples is very important for human health.
Objective: Experimental design enabled parameters to be evaluated for their effects onextraction output as well as their interactive effects.
Method: A multivariate experimental design was used to attain optimum conditions of a dispersive liquid-liquid microextraction method for preconcentration of pesticides and pharmaceuticals for determination by GC-MS.
Results: The optimum parameters suggested by the design model were 200 µL of chloroform, 1.96 mL of ethanol, and 40 s vortexing period. LOD and LOQ were calculated using linear calibration plots of the analytes developed in the standard concentration range of 2.0 μg/L-2.0 mg/L.
Conclusions: Enhancement in detection power of the analytes recorded by the optimized method with respect to direct GC-MS determination (based on LOD values) was in the range of 3.6 and 539 folds. Spiked recovery experiments for municipal, medical, and synthetic wastewater samples yielded low recovery results when calculated against aqueous standard solutions. Matrix matched calibration standards were used to mitigate interferences from the waste samples and the percent recoveries obtained were close to 100%. This established accuracy and applicability of the developed method.
Highlights: The detection limits were found between 0.50 ng/mL and 37 ng/mL. An accurate, simple and sensitive analytical method was developed for the analytes.
Publication
Journal: Zhen ci yan jiu = Acupuncture research / [Zhongguo yi xue ke xue yuan Yi xue qing bao yan jiu suo bian ji]
December/4/2021
Abstract
Objective: To compare the therapeutic results and the occurrence of adverse reactions of medicine between the combined therapy of warm acupuncture at back-shu points of five zang organs and the western medicine and the simple wes-tern medication, and observe the therapeutic effect and attenuating effect of this combined therapy in treatment on depression of yang deficiency pattern.
Methods: A total of 80 patients with depression of yang deficiency pattern were randomly divided into an observation group and a control group (39 cases/group). In the control group, escitalopram oxalate tablets were administered orally every day. In the observation group, on the base of the medication as the control group, warm acupuncture therapy was exerted at back-shu points of five zang organs, for 30 min each time, 5 times a week. The duration of treatment was 6 weeks in two groups. Before and after treatment, the scores of Hamilton depression scale (HAMD) and the antidepressant side effect scale (SERS) were evaluated and electroencephalogram (EEG) was detected; and the curative effect was assessed according to HAMD reduction rate in patients of the two groups.
Results: After treatment, the HAMD and SERS scores were lower than those before treatment in both groups. Compared with the control group, the HAMD and SERS scores were lower (P<0.05, P<0.01), and the EEG result was improved (P<0.01) in the observation group. The clinical total effective rate of the observation group was 97.43% (38/39), higher than 92.30% (36/39) of the control group (P<0.05).
Conclusion: The combined therapy of warm acupuncture at back-shu points of five zang organs and western medicine effectively relieves depression of yang deficiency pattern in the patients and its overall therapeutic effect is better than simple western medication, besides, the combined therapy alleviates the adverse reactions induced by simple western medication.
目的:比较五脏背俞穴温针灸结合西药治疗与单纯西药治疗阳虚型郁证的疗效差异及减毒效应。方法:将80例阳虚型郁证患者随机分为对照组和观察组,每组39例。对照组予每天口服草酸艾司西酞普兰;观察组在对照组的基础上行五脏背俞穴温针灸,每天治疗30 min,每周治疗5次。两组均治疗6周。分别于治疗前后评定两组患者汉密尔顿抑郁量表(HAMD)、抗抑郁药副反应量表(SERS)评分,进行脑电图检测记录异常脑电图患者的例数,并根据HAMD评分减分率来评定两组的疗效。结果:与本组治疗前比较,两组治疗后HAMD、SERS评分显著降低(P<0.01);治疗后与对照组比较,观察组HAMD、SERS评分降低(P<0.05,P<0.01),脑电图检测结果优于对照组(P<0.05)。观察组临床总有效率为97.43%(38/39),高于对照组的92.30%(36/39,P>0.05)。结论:五脏背俞穴温针灸结合西药治疗能有效改善阳虚型郁证患者的抑郁程度,总体疗效优于单纯西药治疗,并可减少单纯西药治疗所带来的药物不良反应。.
Keywords: Attenuating effect; Back-shu points of five zang organs; Depression; Escitalopram oxalate; Warming acupuncture; Yang deficiency pattern.
Publication
Journal: PLoS ONE
March/31/2021
Abstract
Patient access and adherence to chronic medications is critical. In this work, we evaluate whether disruptions related to Covid-19 have affected new and existing patients' access to pharmacological therapies without interruption. We do so by performing a retrospective analysis on a dataset of 9.4 billion US prescription drug claims from 252 million patients from May, 2019 through August, 2020 (about 93% of prescriptions dispensed within those months). Using fixed effect (conditional likelihood) linear models, we evaluate continuity of care, how many days of supply patients received, and the likelihood of discontinuing therapy for drugs from classes with significant population health impacts. Findings indicate that more prescriptions were filled in March 2020 than in any prior month, followed by a significant drop in monthly dispensing. Compared to the pre-Covid era, a patient's likelihood of discontinuing some medications increased after the spread of Covid: norgestrel-ethinyl estradiol (hormonal contraceptive) discontinuation increased 0.62% (95% CI: 0.59% to 0.65%, p<0.001); dexmethylphenidate HCL (ADHD stimulant treatment) discontinuation increased 2.84% (95% CI: 2.79% to 2.89%, p<0.001); escitalopram oxalate (SSRI antidepressant) discontinuation increased 0.57% (95% CI: 0.561% to 0.578%, p<0.001); and haloperidol (antipsychotic) discontinuation increased 1.49% (95% CI: 1.41% to 1.57%, p<0.001). In contrast, the likelihood of discontinuing tacrolimus (immunosuppressant) decreased 0.15% (95% CI: 0.12% to 0.19%, p<0.001). The likelihood of discontinuing buprenorphine/naloxone (opioid addiction therapy) decreased 0.59% (95% CI: 0.55% to 0.62% decrease, p<0.001). We also observe a notable decline in new patients accessing these latter two therapies. Most US patients were able to access chronic medications during the early months of Covid-19, but still were more likely to discontinue their therapies than in previous months. Further, fewer than normal new patients started taking medications that may be vital to their care. Providers would do well to inquire about adherence and provide prompt, nonjudgmental, re-initiation of medications. From a policy perspective, opioid management programs seem to demonstrate a robust ability to manage existing patients in spite of disruption.