PubMed · 16425753
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Bupropion.. https://pubmed.ncbi.nlm.nih.gov/16425753/
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We use the concept of latent variables to derive the joint distribution of bivariate ordinal outcomes, and then extend the model to allow for longitudinal data. Specifically, we relate the observed ordinal outcomes using threshold values to a bivariate latent variable, which is then modelled as a linear mixed model. Random effects terms are used to tie all together repeated observations from the same subject. The cross-sectional association between the two outcomes is modelled through the correlation coefficient of the bivariate latent variable, conditional on random effects. Assuming conditional independence given random effects, the marginal likelihood, under the missing data at random assumption, is approximated using an adaptive Gaussian quadrature for numerical integration. The model provides fixed effects parameters that are subject-specific, but retain the population-averaged interpretation when properly scaled. This is particularly well suited for the situation in which population comparisons and individual level contrasts are of equal importance. Data from a psychiatric trial, the Fluvoxamine (an antidepressant drug) study, are used to illustrate the methodology.
Acute dystonia is commonly associated with high-potency antipsychotics. Some cases of acute dystonia had been reported to be associated with antidepressant. However, only few reported cases are related to bupropion. As reported herein, the patient with major depression suffered from acute dystonia twice, which resulted from abrupt bupropion discontinuation. The first episode occurred when medicament was shifted from bupropion to duloxetine abruptly. The patient was requested with nothing per mouth (NPO) due to panendoscopic examination. Therefore, the second one emerged after the patient was suspended from two doses of bupropion. The symptoms of dysphagia, trismus and torticollis in these two episodes were resolved after bupropion reinstitution or biperiden injection. So far as we know by our documents, this is the first report concerning an acute dystonia resulting from bupropion discontinuation.
This article examines evidence for the potential benefit of genetic testing for SSRI response, as well as potential ethical and practical implications of the implementation of this test into standard psychiatric practice. We reviewed three areas of the literature: the burden of treatment-resistant and treatment-intolerant major depressive disorders, the evidence for the value of genetic testing to predict drug response, and the ethical and practical issues of genetic testing in usual care. Treatment resistance and treatment intolerance are common for persons treated with selective serotonin reuptake inhibitors (SSRIs) and are associated with both financial and quality-of-life costs. There is strong evidence from association studies that some polymorphisms are associated with SSRI response. However, no randomized trials have yet tested the efficacy of genetic tests to improve outcome in those with treatment resistance or treatment intolerance to SSRIs. Given the nonspecific nature of the test proposed, several ethical concerns are also involved with administering the genetic tests to patients. A randomized trial comparing response in those treated with standard psychiatric care and in those treated with psychiatric care tailored as a result of genetic test results should be completed before the implementation of these tests can be considered. Additionally, the ethical and practical questions concerning the tests must be addressed now, so that the potential impact of these tests on patient care can be well understood prior to adoption in standard practice.