PubMed · 10418539
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
J J Gallo. TCAs vs SSRIs. Same bang for whose buck?. https://doi.org/10.1001/archfami.8.4.326
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
Vulvar vestibulitis syndrome, which represents one of the major cause of dyspareunia, is a puzzling clinical entity. Although many treatment options have been employed, a rationale therapeutic strategy is still not stated. The present article reviews the most popular medical approaches of such entity (biofeedback, tricyclic antidepressants, interferon psychologic-behavioural therapy, diet modification), as well as those to avoid. Tricyclic antidepressants and biofeedback of the pelvic floor muscles represents the first line effective therapy. Moreover, psychological counselling must support any treatment options.
Tricyclic overdose can be a medical emergency, and therapy with intravenous bicarbonate is not always successful in preventing cardiac toxicity or coma. Mortality in patients developing these complications is from 1% to 15%. Extracorporeal detoxification with sorbents has been used in treatment of patients with very high drug levels and declining clinical condition. Ten patients with serious drug overdose caused by tricyclics failed to respond quickly to standard therapy and were in stage 3-4 encephalopathy. Nine of these patients were on respirator support, 5 had hypotension, and 6 had QRS widening. Average level was 1,423 microg/L at presentation. Enteral activated charcoal and intravenous (IV) bicarbonate were initiated in the emergency room. The patients were treated for 3 to 4 hours with the Liver Dialysis Unit, a hemodiabsorption device using a cellulosic plate dialyzer and sorbent suspension as dialysate. Inflow and outflow blood levels indicated that the hemodetoxifier removed modest amounts of the tricyclics, metabolites, and other consumed drugs. The clinical improvement of the patients was dramatic, with patients reaching stage 0 or 1 encephalopathy during the treatment. Ventilator support was removed at the end of treatment for 3 patients who had not already developed pneumonia, and for others was prolonged up to 48 hours because of pneumonia, rather than mental status. Average length of stay in the intensive care unit (ICU) was 4.8 days (range 1 to 7 days). None of the patients died despite their high risk for ventricular arrhythmias, seizures, and death. Clinical improvement may have been attributable to removal of free drug from the blood or to removal of drug metabolites.
Explore the source record for details and available documents.