Psychiatry - December 2008 - (Page 33)

TABLE 2. Evidence for DID associated with drug groups DRUG CLASS/DRUG LEVEL OF EVIDENCE AVAILABLE LITERATURE COMMENTS REFERENCES Beta blockers +/- Case reports, RCTs, large scale meta-analyses Evidence is conflicting—propranolol may have the strongest association with symptoms after starting or increasing dose. 13, 16, 30–41 Calcium channel blockers +/- Case reports, case series, prescription symmetry analysis, cohort study examining suicide rates Prescription symmetry analysis Results are conflicting—newer agents 42–48 have fewer reports. Some reports have found antidepressant effects. Preliminary data suggest some ARBs may have antidepressant effects. Neither agent approved in US. Taranabant is no longer being developed due to psychiatric side effects. No comment No comment Evidence of DID only exists for men treated for alopecia; no evidence for BPH, but caution warranted, given high doses ACE inhibitors +/- 46, 49–51 ARBs +/- Case reports 52, 53 Antiobesity drugs: rimonabant, taranabant ++ Case reports, meta-analyses 54–56 Alpha interferons Beta interferons ++ Uncontrolled and controlled studies 4 RCTs and 1 naturalistic study 57–61 62–67 Finasteride + Case series, prospective noncontrolled trial 69, 70 Isotretinoin +++ Over 400 case reports, prescription symmetry analysis, case-crossover study No comment 71–74 Progesterone inserts (Norplant®) + Case reports, case series, large trials Large trials suggest that women with higher baseline depressive scores may be at risk as well as women with relationship dissatisfaction 75–81 Leukotriene antagonists (montelukast) +/- Collection of single case reports; 3 double-blind RCTs Conflicting data—cases suggest association; recent analysis of 3 RCTs 82–84 found no association Results of trials are suggestive of DID, especially in patients aged >65, but not conclusive Corticosteroids + Case control study, cross-sectional analysis 85–88 Varenicline + Case reports, case series Enhanced FDA warnings—banned by the FAA; increased anxiety reported in 89–91, 92 1 placebo RCT. **Reflects authors’ global assessment of evidence; little or no convincing evidence; +/- limited evidence; + moderately strong evidence; ++ strong evidence; +++ very strong/unequivocal evidence KEY: ACE = angiotensin-converting enzyme; ARBs = angiotensin II blockers; BPH = benign prostatic hyperplasia; DID = drug-induced depression; FAA = Federal Aviation Administration; FDA = US Food and Drug Administration; RCT = randomized, controlled trial [VOLUME 5, NUMBER 12, DECEMBER] Psychiatry 2008 33

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Psychiatry - December 2008 Editor’s Message Contents Editorial Advisory Board Antidepressant Prescribing by Specialty and Treatment of Premenstrual Dysmorphic Disorder Pain, Pain, Go Away: Antidepressants and Pain Management Why Psychotherapy Helps the Patient in Chronic Pain General Medical Drugs Associated with Depression Katatonia: A New Conceptual Understanding of Catatonia and a New Rating Scale Thermoregulation and the Role of Calcium Signalling in Neurotransmission Cognition and Schizophrenia: Is There a Role for Cognitive Assessments in Diagnosis and Treatment? Journal Watch Information for Authors

Psychiatry - December 2008

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