pregabalin and Depressive-Disorder--Major

The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011.. The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The recommendations were based on level of evidence, efficacy (meta-analysis of the outcomes pain, sleep, fatigue and health-related quality of life), acceptability (total dropout rate), risks (adverse events) and applicability of treatment modalities in the German health care system. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies.. Amitriptyline and-in case of comorbid depressive disorder or generalized anxiety disorder-duloxetine are recommended. Off-label use of duloxetine and pregabalin can be considered in case of no comorbid mental disorder. Strong opioids are not recommended. The English full-text version of this article is available at SpringerLink (under "Supplemental").

Topics: Amitriptyline; Analgesics; Analgesics, Opioid; Antidepressive Agents; Anxiety Disorders; Combined Modality Therapy; Comorbidity; Cooperative Behavior; Depressive Disorder, Major; Duloxetine Hydrochloride; Fibromyalgia; gamma-Aminobutyric Acid; Germany; Humans; Interdisciplinary Communication; Off-Label Use; Patient Care Team; Pregabalin; Somatoform Disorders; Thiophenes

This study tests the efficacy of pregabalin versus placebo as adjunctive treatment in patients with generalized anxiety disorder (GAD) comorbid with unipolar major depression (UMD) and with an early nonresponse to escitalopram.. This is a double-blind, placebo-controlled 8-week add-on study of pregabalin, 75-600 mg/day (n=31) versus placebo (n=29) on open-label escitalopram in outpatients meeting the DSM-IV-TR criteria for GAD and UMD. The main outcome measures were change from baseline to endpoint in total STAI-S, Trail-Making Test B (TMT-B) and the Center of Epidemiological Studies Depression Scale (CES-D). Also changes in the parameters of the pupil's reaction to light stimuli.. There was no significant difference in any of the primary or secondary outcomes or response and remission rates concerning any analysis (last observation carried-forward of at least visit 2 or completers) between the 2 treatment arms. One additional finding of the current study is that adding pregabalin does not have a significant effect on autonomic function.. This study does not support the usefulness of adding pregabalin in patients with GAD and UMD and with an early nonresponse to escitalopram (EudraCT Number: 2012-004062-17, Sponsor's Protocol Code Number: WS1702721).

Topics: Adult; Anxiety Disorders; Citalopram; Depressive Disorder, Major; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Pregabalin; Psychiatric Status Rating Scales

We aimed to investigate the prescription pattern of pregabalin augmentation of antidepressants in major depressive disorder (MDD) and to explore variables associated with add-on pregabalin treatment.. 1410 MDD patients participated in this naturalistic European multicenter study with retrospective assessment of treatment response. Analyses of covariance, chi-squared tests, and binary logistic regressions were accomplished to determine differences in socio-demographic and clinical characteristics between MDD patients with and without pregabalin augmentation.. Add-on pregabalin was established in 102 (7.23%) MDD patients. Compared to those without receiving pregabalin, pregabalin-treated patients were characterized by a significantly higher likelihood for older age (mean: 54.74 ± 13.08 vs 49.93 ± 14.13 years), unemployment (78.43% vs 51.23%), melancholic features (83.33% vs 58.94%), inpatient treatment (72.55% vs 31.65%), previous psychiatric hospitalizations (13.52 ± 24.82 vs 4.96 ± 19.93 weeks), any somatic comorbidity (68.63% vs 44.57%), comorbid hypertension (37.25% vs 17.51%), more severe depressive symptom severity at the onset of the current episode (mean MADRS: 37.55 ± 9.00 vs 33.79 ± 7.52), receiving augmentation/combination treatment strategies in general (mean number of psychotropic drugs: 3.64 ± 0.92 vs 2.07 ± 1.17), and with antidepressants (50.00% vs 27.91%) and antipsychotics (46.08% vs 24.08%) in particular.. Due to its observational cross-sectional study design, our patient sample might not be fully representative for MDD patients in primary care settings.. Our findings suggest that add-on pregabalin is particularly administered in more severe/difficult-to-treat MDD conditions, whereas no association between the prescription of adjunctive pregabalin and comorbid anxiety symptoms could be determined.

Topics: Aged; Antidepressive Agents; Cross-Sectional Studies; Depression; Depressive Disorder, Major; Humans; Pregabalin; Retrospective Studies

Complex regional pain syndrome (CRPS) is a painful and disabling neurovascular condition. There is no consensus on the etiopathogenesis or the treatment. We present a patient with CRPS type 1 accompanied by a psychiatric disorder to discuss the relationship between CRPS and psychiatric disease and to emphasize the response of this case to treatment with pregabalin.. A 15-year-old girl presented with swelling, severe pain, edema, hyperesthesia, allodynia, and sweating changes in the left arm and was diagnosed as CRPS type 1. The presence of disturbed family relations was revealed on psychiatric examination, and a diagnosis of major depression was made. Her symptoms did not respond to selective serotonin reuptake inhibitors and noradrenergic and specific serotonergic antidepressives, gabapentin, or stellate ganglion blockage, but the patient's pain resolved with pregabalin. Symptom-oriented measures and psychiatric support enabled ongoing treatment. A social services evaluation led to her being placed in the care of social services to protect her from the chaotic and traumatic family life.. Detailed psycological and psychiatric evaluation is recommended in individuals with CRPS because psychiatric support and improvement of associated psychosocial concerns in addition to pregabalin seems to facilitate treatments in some patients.

Topics: Adolescent; Analgesics; Complex Regional Pain Syndromes; Depressive Disorder, Major; Diagnosis, Differential; Female; Hand; Humans; Pregabalin; Treatment Outcome

Pregabalin is a gamma-aminobutyric acid (GABA) analogue approved for the treatment of neuropathic pain, partial seizure and generalized anxiety disorder. As a GABA analogue, there is a raising concern regarding the abuse potential of this drug.. We present a first case of pregabalin dependence in a 26-year-old woman without a previous history of illicit drug abuse.. Physician should be aware about the addictive potential of pregabalin even in patients without a previous history of substance abuse.

Topics: Adult; Analgesics; Anxiety; Bipolar Disorder; Craving; Depressive Disorder, Major; Female; Humans; Pregabalin; Substance-Related Disorders

Anxiety symptoms in depression result often in treatment resistance, residual symptoms, and persistent functional impairment.. To assess the effectiveness and safety of adjunctive pregabalin to antidepressants for residual anxiety in patients with major depressive disorder (MDD).. A retrospective chart review was conducted to identify partial responders among patients with MDD with residual anxiety. Twenty such patients (age, 58.4 ± 11.2 years; 15 women; baseline Hamilton Depression Rating Scale [HDRS], 17.1 ± 3.5) who received adjunctive pregabalin for residual anxiety were included. Antidepressants augmented were the selective serotonin reuptake inhibitors (n = 12), mirtazapine (n = 2), and selective serotonin-norepinephrine reuptake inhibitors (n = 6).. Twenty patients received at least 4 weeks of pregabalin treatment after 8 weeks of antidepressant therapy. At week 1 (9 weeks after initiating treatment), pregabalin was prescribed at a mean ± SD dose of 71.2 ± 31.7 mg, and the mean maximum pregabalin dose prescribed was 156.2 ± 76.5 mg (range, 75-300 mg). At week 8, there were 13 responders (13/20 [65%]), and 7 of these 13 patients achieved remission (HDRS17 < 8). There were significant decreases in HDRS scores (13.5 ± 3.1 vs 9.1 ± 2.9, P < 0.000), and HDRS anxiety/somatization subscale scores (6.3 ± 2 to 3.6 ± 1.7, P < 0.000). Adverse effects included somnolence (n = 7), weight gain (n = 3), dizziness (n = 4), dry mouth (n = 6), edema (n = 3), blurred vision (n = 3), difficulty with concentration/attention (n = 8), headache (n = 6), and diarrhea (n = 5).. The results suggest a possible augmentation role for pregabalin when used in conjunction with conventional antidepressants for residual anxiety in MDD.

Topics: Adrenergic Agents; Aged; Anti-Anxiety Agents; Anxiety; Depressive Disorder, Major; Female; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Pregabalin; Psychiatric Status Rating Scales; Retrospective Studies; Selective Serotonin Reuptake Inhibitors; Time Factors; Treatment Outcome

Topics: Antidepressive Agents; Depressive Disorder, Major; gamma-Aminobutyric Acid; Humans; Pregabalin

Topics: Adult; Analgesics; Antidepressive Agents; Depressive Disorder, Major; Drug Synergism; Female; gamma-Aminobutyric Acid; Humans; Middle Aged; Pregabalin