PubMed Health⌕ Search

Biomedical subjects

Matthew J Taylor

Publications and source records attributed to Matthew J Taylor.

12 recordsLinked to original sources
PubMed2006

Early onset of selective serotonin reuptake inhibitor antidepressant action: systematic review and meta-analysis.

CONTEXT: Selective serotonin reuptake inhibitors (SSRIs) are often described as having a delayed onset of effect in the treatment of depression. However, some trials have reported clinical improvement as early as the first week of treatment. OBJECTIVE: To test the alternative hypotheses of delayed vs early onset of antidepressant action with SSRIs in patients with unipolar depression. DATA SOURCES: Trials identified by searching CENTRAL, The Cochrane Collaboration database of controlled trials (2005), and the reference lists of identified trials and other systematic reviews. STUDY SELECTION: Randomized controlled trials of SSRIs vs placebo for the treatment of unipolar depression in adults that reported outcomes for at least 2 time points in the first 4 weeks of treatment (50 trials from >500 citations identified). Trials were excluded if limited to participants older than 65 years or specific comorbidities. DATA EXTRACTION: Data were extracted on trial design, participant characteristics, and outcomes by a single reviewer. DATA SYNTHESIS: Pooled estimates of treatment effect on depressive symptom rating scales were calculated for weeks 1 through 6 of treatment. In the primary analysis, the pattern of response seen was tested against alternative models of onset of response. The primary analysis incorporated data from 28 randomized controlled trials (n=5872). A model of early treatment response best fit the experimental data. Treatment with SSRIs rather than placebo was associated with clinical improvement by the end of the first week of use. A secondary analysis indicated an increased chance of achieving a 50% reduction in Hamilton Depression Rating Scale scores by 1 week (relative risk, 1.64; 95% confidence interval, 1.2-2.25) with SSRI treatment compared with placebo. CONCLUSIONS: Treatment with SSRIs is associated with symptomatic improvement in depression by the end of the first week of use, and the improvement continues at a decreasing rate for at least 6 weeks.

Adult↗
PubMed2006

Strategies for managing antidepressant-induced sexual dysfunction: a review.

Sexual dysfunction is a common side effect of most antidepressants. Lower rates are reported with some newer agents such as reboxetine and bupropion. The evidence base for its management is limited but growing, with most approaches only tested in a small number of trials. Available strategies include watchful waiting, the use of short drug holidays, and a change of antidepressant. Many specific antidotes have been trialed but with lack of convincing benefit in most cases. However, where antidepressants cause erectile dysfunction, the use of sildenafil has the largest and most consistent evidence base.

Antidepressive Agents↗
PubMed2006

Long-term prophylaxis in bipolar disorder.

Bipolar disorder is a major cause of disability, and the prevention of relapse is a key management goal. Pharmacological interventions, effectively delivered through enhanced clinical care, are central to long-term management. This article summarises the available evidence for a range of pharmacological options, and provides guidance on common issues in clinical management in line with current practice guidelines. The use of medications for long-term prophylaxis should be considered in all patients meeting criteria for bipolar I disorder. Increasing high-quality evidence from randomised trials informs management decisions relating to both novel agents, such as lamotrigine and olanzapine, and longer-established therapies, such as lithium and valproate, in monotherapy. Medications taken long-term in bipolar disorder differ in the extent to which they protect against manic and depressive relapse. Consequently, the emerging challenge is to understand how combination treatments can enhance efficacy and effectiveness based on data from controlled trials rather than random polypharmacy. Clinical care can be enhanced with effective education about the illness, and the use of strategies to improve treatment adherence and the recognition and management of stressors or prodromal symptoms. Where available, a range of specific psychological interventions can be effective as an adjunct to medication. When discontinuation of prophylaxis is necessary, gradual tapering of dose over weeks or months is recommended.

Age Factors↗
PubMed2005

Strategies for managing antidepressant-induced sexual dysfunction: systematic review of randomised controlled trials.

BACKGROUND: This review was undertaken to assess the effectiveness of management strategies for sexual dysfunction caused by antidepressant medication. METHODS: Electronic databases and reference lists were searched, and pharmaceutical companies and experts contacted to identify randomised controlled trials comparing management strategies for antidepressant-induced sexual dysfunction. RESULTS: Fifteen trials involving 904 people were included. One trial involving 75 people with sexual dysfunction due to sertraline assessed changing antidepressant. Switching to nefazodone was significantly less likely to result in the re-emergence of sexual dysfunction than restarting sertraline (RR 0.34, 95% CI 0.15 to 0.6). Meta-analysis of two trials involving 113 men with erectile dysfunction found that the addition of sildenafil resulted in less sexual dysfunction at endpoint on rating scales including the International Index of Erectile Function (IIEF) (WMD 19.36, 95% CI 15.00 to 23.72). Another trial found the addition of bupropion led to improved scores on the Changes in Sexual Functioning Questionnaire desire-frequency subscale (WMD 0.88, 95% CI 0.21 to 1.55). In a further study the addition of tadalafil was associated with greater improvement in the erectile function domain of the IIEF than placebo (WMD 8.10; 95% CI 4.62 to 11.68). Other augmentation strategies failed to show statistically significant improvements in sexual dysfunction compared with placebo. DISCUSSION: The currently available evidence is rather limited, with small numbers of trials assessing each strategy. However, while further randomised data is awaited, for men with antidepressant-induced erectile dysfunction, the addition of sildenafil appears to be an effective strategy.

Antidepressive Agents↗
PubMed2004

Strategies for managing sexual dysfunction induced by antidepressant medication.

BACKGROUND: Sexual dysfunction (including altered desire, orgasmic dysfunction, erectile and ejaculatory problems) is a relatively common side effect of antidepressant medication. These sexual side effects may compromise a person's lifestyle and result in a lack of compliance with the prescribed antidepressant to the detriment of the person's mental health. OBJECTIVES: The objective of this review was to assess the effectiveness of management strategies for sexual dysfunction caused by antidepressant medication. SEARCH STRATEGY: We searched the CCDANCTR (March 2003), the Cochrane Central Register of Controlled Trials (Cochrane Library issue 2, 2004), MEDLINE (1966 - June 2004), EMBASE (1980 - March 2004), CINAHL (1982 - March 2004), PsycINFO (1984 - March 2004) and the reference lists of articles. We also contacted pharmaceutical companies and experts in the field of sexology. SELECTION CRITERIA: Randomised controlled trials comparing the management strategies for antidepressant induced sexual dysfunction were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed trial quality. Study authors were contacted for additional information. Adverse effect information was collected from the trials. MAIN RESULTS: Fifteen trials involving 904 people were included. One trial involving 75 people with sexual dysfunction due to sertraline assessed changing antidepressant. Switching to nefazodone was significantly less likely to result in the re-emergence of sexual dysfunction than restarting sertraline (RR 0.34, 95% CI 0.15 - 0.6) and was not associated with any worsening of depression. Fourteen trials involving 829 people assessed the addition of other medication while continuing the same antidepressant. Meta-analysis of two trials involving 113 men with erectile dysfunction found that the addition of sildenafil resulted in less sexual dysfunction at endpoint on rating scales including the International Index of Erectile Function (IIEF; WMD 19.36, 95% CI 15.00 to 23.72). There was no significant difference in dropout rates between sildenafil and placebo. One trial found the addition of bupropion led to improved scores on the Changes in Sexual Functioning Questionnaire desire-frequency subscale (WMD 0.88, 95% CI 0.21 - 1.55). One trial found that the addition of tadalafil was associated with greater improvement in the erectile function domain of the IIEF than placebo (WMD 8.10; 95% CI 4.62 to 11.68). Other augmentation strategies failed to show statistically significant improvements in sexual dysfunction compared with placebo. REVIEWERS' CONCLUSIONS: The currently available evidence is rather limited, with small numbers of trials assessing each strategy. However, while further randomised data is awaited, for men with antidepressant-induced erectile dysfunction, the addition of sildenafil appears to be an effective strategy.

Antidepressive Agents↗
PubMed2004

Folate for depressive disorders: systematic review and meta-analysis of randomized controlled trials.

The objective of this review was to determine the effectiveness, adverse effects and acceptability of folate in the treatment of depression. Electronic databases (Cochrane Controlled Trials Register and the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register) and reference lists were searched, and authors, experts and pharmaceutical companies contacted to identify randomized controlled trials that compared treatment with folic acid or 5'-methyltetrahydrofolic acid to an alternative treatment, for patients with a diagnosis of depressive disorder. Three randomized trials (247 participants) were included. Two studies assessed the use of folate in addition to other treatment, and found that adding folate reduced Hamilton Depression Rating Scale (HDRS) scores on average by a further 2.65 points [95% confidence interval (CI) 0.38-4.93]. Fewer patients treated with folate experienced a reduction in their HDRS score of less than 50% at 10 weeks (relative risk 0.47, 95% CI 0.24-0.92). The remaining study found no statistically significant difference when folate alone was compared with trazodone. The identified trials did not find evidence of any problems with the acceptability or safety of folate. The limited available evidence suggests folate may have a potential role as a supplement to other treatment for depression. It is currently unclear if this is the case both for people with normal folate levels, and for those with folate deficiency.

Administration, Oral↗
PubMed2003

DNA binding hairpin polyamides with antifungal activity.

Eight-ring hairpin polyamides containing N-methylimidazole (Im) and N-methylpyrrole (Py) amino acids have been shown to bind with subnanomolar affinity to discrete DNA sites and to modulate a variety of DNA-dependent biological processes. We show here that addition of a second positive charge at the C terminus of an 8-ring hairpin polyamide confers activity against a number of clinically relevant fungal strains in vitro, and activity against Candida albicans in a mouse model. Control experiments indicate that the observed antifungal activity results from a DNA binding mechanism-of-action that does not involve DNA damage or disruption of chromosomal integrity. Hairpin activity is shown to be proportional to yeast DNA content (ploidy). Transcriptional interference is proposed as the likely explanation for fungal cytotoxicity. Experiments with sensitized yeast strains indicate the potential for discrete sites of action rather than global effects.

Animals↗
PubMed2003

Management of cerebrospinal fluid leaks involving the temporal bone: report on 92 patients.

OBJECTIVE: To investigate the success of different surgical and nonsurgical techniques in the management of cerebrospinal fluid otorrhea or otorhinorrhea. STUDY DESIGN: Retrospective case analysis. METHODS: Ninety-two patients with confirmed diagnosis of cerebrospinal fluid otorrhea or otorhinorrhea treated at our institution between 1976 and 1998 were followed up long-term by retrospective chart review and patient interviews. RESULTS: Conservative treatment was successful in most cases of cerebrospinal fluid otorrhea or otorhinorrhea resulting from head injury (26 of 29 patients). In contrast, surgical intervention was required in all but 1 of 53 patients with cerebrospinal fluid otorrhea or otorhinorrhea caused surgically. The primary operative success rate was 76.9%. When relapse occurred, the interval ranged from 0 days to 24 months (mean interval, 3.9 mo; median, 1.3 mo). All leaks requiring surgery eventually were closed successfully. Surgical results were chronologically dependent. Before 1989, 11 failures occurred in 37 primary procedures. After 1989, only 4 failures occurred in 28 primary procedures. Of seven patients undergoing primary dural closure alone, three (43%) had recurrence of the leak. Closure rates were highest among patients in whom a multilayer technique for leak closure was used: combining a primary graft or sealing material such as bone wax, free muscle, or fascia for closure of the defect with additional autologous free grafts or allogenic materials. This resulted in a 2-year closure rate of 100% compared with a 2-year rate of 75.4% for patients whose primary closure was supported by a single layer of autologous or allogenic material (P =.034). Fibrin glue with primary closure alone did not have additional benefit. Postoperative meningitis occurred in two patients and was treated without sequelae. CONCLUSIONS: Conservative treatment should be reserved for cerebrospinal fluid otorrhea or otorhinorrhea resulting from head injury. Postoperative and nontraumatic cerebrospinal fluid otorrhea or otorhinorrhea should have early operative intervention. A multilayer technique combining allogenic materials with free autologous grafts is recommended.

Adolescent↗
PubMed2003

Toward a neuropsychological theory of antidepressant drug action: increase in positive emotional bias after potentiation of norepinephrine activity.

OBJECTIVE: Antidepressants that increase serotonin or norepinephrine in the brain are effective in treating depression, but there is no neuropsychological account of how these changes relieve depressive states. Cognitive theories suggest that biases in information processing lead depressed patients to make unrealistically negative judgments about themselves and the world. METHOD: A single dose of the noradrenergic antidepressant reboxetine or placebo was administered to 24 healthy volunteers. Effects on emotional processing were assessed through facial expression recognition, emotional categorization, and emotional memory. RESULTS: On the three measures, reboxetine biased perception toward positive, rather than negative, information in the absence of changes in nonemotional performance or mood. CONCLUSIONS: These results suggest that a single dose of an antidepressant can increase the processing of positively valenced material in nondepressed volunteers. Antidepressants may therefore work in a manner similar to that of psychological treatments that aim to redress negative biases in information processing.

Adrenergic Uptake Inhibitors↗
PubMed2002

Detection of fungal organisms in eosinophilic mucin using a fluorescein-labeled chitin-specific binding protein.

BACKGROUND: The ability to identify fungal hyphae in patients with chronic rhinosinusitis (CRS) has been inconsistent. A new fluorescein-labeled staining method targets chitin found in fungal cell walls. OBJECTIVE: We hypothesize that this method would be able to more consistently detect fungi within the mucin of CRS patients. METHODS: Fifty-four consecutive CRS surgical patients were evaluated. After ensuring sensitivity and specificity of this new method, all specimens were stained with either fluorescein-labeled chitinase or Grocott methanamine silver stain for comparison. RESULTS: All 54 specimens contained eosinophilic mucin on hematoxylin and eosin staining. One or more fungal hyphae could be visualized within the mucin of 54 (100%) of 54 specimens stained using the fluorescein-labeled chitinase. Only 41 (76%) of 54 of the specimens stained with the Grocott methanamine silver stain technique demonstrated fungi. CONCLUSION: The fluorescein-labeled chitinase-staining technique has greater sensitivity in detecting fungal organisms within eosinophilic mucin. Fungal organisms are present in the mucin of CRS patients.

Adolescent↗
PubMed2002

Economics and decisions to end life: van Acht and Stooker revisited.

Debates about euthanasia have tended to exclude any economic arguments. This might be due to the narrow perspective of the economic arguments presented to date, most of which focus on the health care costs in the last year of life. This paper considers the wider economic aspects in decisions to end life, including potential methodological weaknesses in measuring costs in the last year of life, the costs of euthanasia itself, the value of patient preferences and the value (and problems) of choice. Suggestions are made on how these economic issues might be explored to take the economic arguments forward.

Decision Making↗