An Unusual Case of Chronic Diarrhea
Question: An 80-year-old man with a history of Henoch–Schonlein purpura at the age of 59 requiring partial jejunal resection, coronary artery disease, chronic kidney disease, gout, gastroesophageal reflux disease, and prior cholecystectomy was admitted for 2 weeks of guaiac-positive watery brown diarrhea and dehydration. Medications included aspirin 81 mg/d, clopidogrel, aldactazide, furosemide, hydralazine, isosorbide mononitrate, metoprolol, simvastatin, lansoprazole, allopurinol, trazodone, and tamsulosin. He had switched from citalopram to bupropion 2 weeks prior. He was afebrile and hemodynamically stable. His a...
Source: Gastroenterology - February 26, 2013 Category: Gastroenterology Authors: Gauree Gupta Konijeti, Vikram Deshpande, Cheryl J. Bunker Tags: Clinical Challenges and Images in GI Source Type: research

Is this Dementia or Alcohol Intoxication or Both?
I am presenting the case of an independent lady whose active alcohol abuse masked her new onset dementia. Ms. G is a 76 year old female who lives alone in a continuum of care retirement community. She has difficult-to-control hypertension, hypothyroidism, B12 deficiency, anxiety, and adjustment disorder which started after her husband, who was an alcoholic, committed suicide. She struggled with alcohol abuse herself through the years. She takes citalopram, amlodipine, B12 injections, and vitamin D supplements. She has lived in this community for 4 years. She has made new friends and currently has a new boyfriend, with who...
Source: Journal of the American Medical Directors Association - February 25, 2013 Category: Health Management Authors: Wanda Colón Cartagena, Wanda Colón Cartagena, Sandra Bellantonio Tags: Poster Abstracts Source Type: research

Dose-related QT prolongation not limited to citalopram
(Source: Reactions)
Source: Reactions - February 24, 2013 Category: Drugs & Pharmacology Tags: Research article Source Type: research

Altered brain concentrations of citalopram and escitalopram in P-glycoprotein deficient mice after acute and chronic treatment
Abstract: According to both in vitro and in vivo data P-glycoprotein (P-gp) may restrict the uptake of several antidepressants into the brain, thus contributing to the poor success rate of current antidepressant therapies. The therapeutic activity of citalopram resides in the S-enantiomer, whereas the R-enantiomer is practically devoid of serotonin reuptake potency. To date, no in vivo data are available that address whether the enantiomers of citalopram and its metabolites are substrates of P-gp. P-gp knockout (abcb1ab (−/−)) and wild-type (abcb1ab (+/+)) mice underwent acute (single-dose) and chronic (two dai...
Source: European Neuropsychopharmacology - February 21, 2013 Category: Psychiatry & Psychology Authors: Louise Karlsson, Björn Carlsson, Christoph Hiemke, Johan Ahlner, Finn Bengtsson, Ulrich Schmitt, Fredrik C. Kugelberg Tags: Basic Science Source Type: research

Increasing brain serotonin corrects CO2 chemosensitivity in methyl‐CpG‐binding protein 2 (Mecp2)‐deficient mice
New Findings • What is the central question of this study?Mice deficient in methyl‐CpG‐binding protein 2 (Mecp2; a model of Rett syndrome) display reduced CO2 chemosensitivity, which may contribute to their breathing abnormalities. Patients and mice show reduced levels of brain 5‐HT, which is important in central chemosensitivity. It is not known whether increasing 5‐HT in this mouse model would improve their respiratory response to CO2. • What is the main finding and its importance?We show, for the first time, that females heterozygous for the Mecp2 mutation have a higher hypocapnic threshold ...
Source: Experimental Physiology - February 20, 2013 Category: Physiology Authors: Marie A. Toward, Ana P. Abdala, Sharon J. Knopp, Julian F. R. Paton, John M. Bissonnette Source Type: research

Confounding control in a nonexperimental study of STAR*D data: logistic regression balanced covariates better than boosted CART
Conclusions: Comparing multiple PS estimates is a pragmatic way to optimize balance. Logistic regression remains valuable for this purpose. Simulation studies are needed to compare PS models under varying conditions. Such studies should consider more flexible estimation methods, such as logistic models with automated selection of interactions or hybrid models using main effects logistic regression instead of a constant log-odds as the initial model for BCART. (Source: Annals of Epidemiology)
Source: Annals of Epidemiology - February 18, 2013 Category: Epidemiology Authors: Alan R. Ellis, Stacie B. Dusetzina, Richard A. Hansen, Bradley N. Gaynes, Joel F. Farley, Til Stürmer Source Type: research

A Case Report of Dihydroergotamine Administration for Status Migrainosus in a Patient on Longstanding Citalopram Causing a Fatal Reversible Cerebral Vasoconstriction Syndrome (RCVS) (P02.027)
CONCLUSIONS: We report this case report of fatal RCVS of a patient on long standing citalopram who developed this after being administered Dihydroergotamine for status migrainosus. As this is thought to be a self-limiting in terms of clinical features. However, some patients may have more severe focal neurologic symptoms and signs, including ischemic or hemorrhagic strokes as described in our patient.Disclosure: Dr. Asi has nothing to disclose. Dr. Gomes has nothing to disclose. Dr. Dani has nothing to disclose. (Source: Neurology)
Source: Neurology - February 14, 2013 Category: Neurology Authors: Asi, K., Gomes, J., Dani, D. Tags: P02 Cerebrovascular Disease II Source Type: research

Citalopram/peginterferon--2b/ribavirin: Alopecia universalis in a patient with depression: case report
(Source: Reactions)
Source: Reactions - February 6, 2013 Category: Drugs & Pharmacology Tags: Short communication Source Type: research

Childhood Maltreatment Affects the Serotonergic System in Male Alcohol‐Dependent Individuals
BackgroundReduced central serotonergic neurotransmission has been demonstrated in individuals with excessive alcohol consumption and/or alcohol dependence. Childhood maltreatment has also been found to have a negative impact on central serotonergic neurotransmission. The aim of this study was to evaluate the impact of childhood maltreatment on central serotonergic dysfunction in alcohol‐dependent individuals. MethodsAdult men with a diagnosis of alcohol dependence (n = 18) were recruited from outpatient treatment units for alcoholism. Central serotonergic neurotransmission was assessed by a neuroendocrine metho...
Source: Alcoholism: Clinical and Experimental Research - February 5, 2013 Category: Addiction Authors: Kristina J. Berglund, Jan Balldin, Ulf Berggren, Arne Gerdner, Claudia Fahlke Tags: Original Article Source Type: research

Childhood Maltreatment Affects the Serotonergic System in Male Alcohol-Dependent Individuals.
Abstract BACKGROUND: Reduced central serotonergic neurotransmission has been demonstrated in individuals with excessive alcohol consumption and/or alcohol dependence. Childhood maltreatment has also been found to have a negative impact on central serotonergic neurotransmission. The aim of this study was to evaluate the impact of childhood maltreatment on central serotonergic dysfunction in alcohol-dependent individuals. METHODS: Adult men with a diagnosis of alcohol dependence (n = 18) were recruited from outpatient treatment units for alcoholism. Central serotonergic neurotransmission was assessed by a ...
Source: Alcoholism, Clinical and Experimental Research - February 5, 2013 Category: Addiction Authors: Berglund KJ, Balldin J, Berggren U, Gerdner A, Fahlke C Tags: Alcohol Clin Exp Res Source Type: research

Common genetic variation and antidepressant efficacy in major depressive disorder: a meta-analysis of three genome-wide pharmacogenetic studies.
CONCLUSIONS Despite increased statistical power accorded by meta-analysis, the authors identified no reliable predictors of antidepressant treatment outcome, although they did identify modest, direct evidence that common genetic variation contributes to individual differences in antidepressant response. PMID: 23377640 [PubMed - in process] (Source: The American Journal of Psychiatry)
Source: The American Journal of Psychiatry - February 1, 2013 Category: Psychiatry Authors: GENDEP Investigators, MARS Investigators, STAR*D Investigators Tags: Am J Psychiatry Source Type: research

Oestradiol modulation of serotonin reuptake transporter and serotonin metabolism in the brain of monkeys
Abstract Serotonin (5‐HT) is an important brain neurotransmitter implicated in mental and neurodegenerative diseases that is modulated by ovarian hormones. Nevertheless, the effect of oestrogens on 5‐HT neurotransmission in the primate caudate nucleus, putamen and nucleus accumbens, major components of the basal ganglia, and the anterior cerebral cortex, mainly the frontal and cingulate gyrus is not well documented. We therefore evaluated the response of the 5‐HT reuptake transporter (SERT) and 5‐HT metabolism in these brain regions to a one‐month treatment with 17β‐oestradiol in short‐term (one month) o...
Source: Journal of Neuroendocrinology - February 1, 2013 Category: Endocrinology Authors: Maria Gabriela Sánchez, Marc Morissette, Thérèse Di Paolo Tags: Original Article Source Type: research

Selective Serotonin Reuptake Inhibitor Exposure
Abstract: Many antidepressants inhibit serotonin or norepinephrine reuptake or both to achieve their clinical effect. The selective serotonin reuptake inhibitor class of antidepressants (SSRIs) includes citalopram, escitalopram (active enantiomer of citalopram), fluoxetine, fluvoxamine, paroxetine, and sertraline. The SSRIs are as effective as tricyclic antidepressants in treatment of major depression with less significant side effects. As a result, they have become the largest class of medications prescribed to humans for depression. They are also used to treat obsessive-compulsive disorder, panic disorders, alcoholism, o...
Source: Topics in Companion Animal Medicine - February 1, 2013 Category: Veterinary Research Authors: Kevin T. Fitzgerald, Alvin C. Bronstein Source Type: research

Serotonin 2A Receptors, Citalopram and Tryptophan-Depletion: a Multimodal Imaging Study of their Interactions During Response Inhibition
& James B Rowe Keywords: 5-HT2A receptor; altanserin; Behavioral Science; citalopram; fMRI; Imaging; Clinical or Preclinical; inhibition; Neuropharmacology; Serotonin (Source: Neuropsychopharmacology)
Source: Neuropsychopharmacology - January 30, 2013 Category: Neurology Authors: Julian MacoveanuBettina HornbollRebecca ElliottDavid ErritzoeOlaf B PaulsonHartwig SiebnerGitte M KnudsenJames B Rowe Tags: 5-HT2A receptor altanserin Behavioral Science citalopram fMRI Imaging Clinical or Preclinical inhibition Neuropharmacology Serotonin Source Type: research

Effects of serotonin-norepinephrine reuptake inhibitors on locomotion and prefrontal monoamine release in spontaneously hypertensive rats.
In this study, we examined the effects of acute treatment with serotonin-norepinephrine reuptake inhibitors on locomotion and the extracellular levels of monoamines in the prefrontal cortex in spontaneously hypertensive rats (SHR), an animal model of ADHD. Adolescent male SHR exhibited greater horizontal locomotion in an open-field test than male WKY control rats. Psychostimulant methylphenidate (0.3 and 1mg/kg), the selective norepinephrine reuptake inhibitor atomoxetine (1 and 3mg/kg), and serotonin-norepinephrine reuptake inhibitors duloxetine (10mg/kg), venlafaxine (10 and 30mg/kg) and milnacipran (30mg/kg) reduced the...
Source: European Journal of Pharmacology - January 30, 2013 Category: Drugs & Pharmacology Authors: Umehara M, Ago Y, Fujita K, Hiramatsu N, Takuma K, Matsuda T Tags: Eur J Pharmacol Source Type: research

Citalopram/NSAIDs interaction: Bruising: case report
(Source: Reactions)
Source: Reactions - January 28, 2013 Category: Drugs & Pharmacology Tags: Short communication Source Type: research

Evidence for the involvement of 5-HT(1A) receptor in the acute antidepressant-like effect of creatine in mice.
In this study, the mechanisms underlying its antidepressant-like effect were further evaluated by investigating the involvement of the serotonergic system in its effect. The anti-immobility effect of creatine (1mg/kg) was prevented by the pretreatment of mice with p-chlorophenylalanine methyl ester (PCPA; 100mg/kg, i.p., for 4 consecutive days, an inhibitor of serotonin (5-HT) synthesis). Creatine (0.01mg/kg, sub-effective dose) in combination with sub-effective doses of WAY100635 (0.1mg/kg, s.c., a 5-HT(1A) receptor antagonist), 8-OH-DPAT (0.1mg/kg, i.p., a 5-HT(1A) receptor agonist) or selective serotonin reuptake inhibi...
Source: Brain Research Bulletin - January 24, 2013 Category: Neurology Authors: Cunha MP, Pazini FL, Oliveira A, Machado DG, Rodrigues AL Tags: Brain Res Bull Source Type: research

New onset hypertension following abrupt discontinuation of citalopram.
We present a 48-year-old woman who developed sustained hypertension closely associated with abrupt cessation of citalopram (40 mg twice daily), in addition to the known withdraw symptoms. Re-initiation of the medication completely abolished the symptoms and normalized her blood pressure. Pre-clinical studies show that chronic citalopram use inhibits the activity of noradrenergic neurons, and abrupt removal of such inhibition could cause adrenergic hyperactivation. We postulate this mechanism might account for or contribute to the hypertension observed in our patient. As illustrated in this case, the degree of hypertension ...
Source: Clinical Nephrology - January 15, 2013 Category: Urology & Nephrology Authors: Astorne Figari WJ, Herrmann S, Akogyeram C, Qian Q Tags: Clin Nephrol Source Type: research

Predictive socioeconomic and clinical profiles of antidepressant response and remission
ConclusionsHierarchical profiles of demographic and clinical baseline variables categorized patients according to the likelihood they would benefit from a single antidepressant trial. Socioeconomic factors had greater predictive power than symptoms or other clinical factors, and profiles combining multiple factors were stronger predictors than individual factors alone. (Source: Depression and Anxiety)
Source: Depression and Anxiety - January 3, 2013 Category: Psychiatry Authors: Felipe A. Jain, Aimee M. Hunter, John O. Brooks, Andrew F. Leuchter Tags: Research Article Source Type: research

Pharmacotherapy Considerations in Patients with HIV and Psychiatric Disorders: Focus on Antidepressants and Antipsychotics.
CONCLUSIONS: Larger controlled studies are needed to validate the current findings as well as expand knowledge for non-SSRI antidepressants and second-generation antipsychotics for use in HIV-infected patients. PMID: 23341158 [PubMed - in process] (Source: The Annals of Pharmacotherapy)
Source: The Annals of Pharmacotherapy - January 1, 2013 Category: Drugs & Pharmacology Authors: Hill L, Lee KC Tags: Ann Pharmacother Source Type: research

Contributory and Incidental Blood Concentrations in Deaths Involving Citalopram.
Abstract All cases presenting to the New South Wales Department of Forensic Medicine between January 1, 2001 and December 31, 2010 in which citalopram was detected were retrieved. A total of 348 cases were identified. Citalopram contributed to death in 21.0%, and was incidental in 79.0%. Cases in which citalopram was contributory to death had significantly higher blood citalopram concentrations than incidental cases (0.50 mg/L vs. 0.30 mg/L). Citalopram concentrations varied significantly by contributory status: sole citalopram toxicity (median = 1.30 mg/L), citalopram/other drug toxicity ...
Source: Journal of Forensic Sciences - December 27, 2012 Category: Forensic Medicine Authors: Darke S, Torok M, Duflou J Tags: J Forensic Sci Source Type: research

Chronic Antidepressant Treatment Impairs the Acquisition of Fear Extinction
Conclusions: These results provide further evidence that chronic antidepressant treatment can impair amygdala-dependent learning. Our findings are consistent with a role for glutamatergic neurotransmission in the final common pathway of antidepressant treatment. (Source: Biological Psychiatry)
Source: Biological Psychiatry - December 20, 2012 Category: Psychiatry Authors: Nesha S. Burghardt, Torfi Sigurdsson, Jack M. Gorman, Bruce S. McEwen, Joseph E. LeDoux Tags: Archival Reports Source Type: research

Selective Serotonin Reuptake Inhibitors Inhibit Human Osteoclast and Osteoblast Formation and Function
Conclusions: These data demonstrate that SSRIs differentially inhibit bone cell function via apoptosis. This may explain the mechanisms of bone loss with chronic use and aid clinical choices. (Source: Biological Psychiatry)
Source: Biological Psychiatry - December 20, 2012 Category: Psychiatry Authors: Jason M. Hodge, Yiming Wang, Michael Berk, Fiona M. Collier, Tania J. Fernandes, Matthew J. Constable, Julie A. Pasco, Seetal Dodd, Geoffrey C. Nicholson, Richard L. Kennedy, Lana J. Williams Tags: Archival Reports Source Type: research

Citalopram at the recommended human doses after long-term treatment is genotoxic for male germ cell.
Abstract The present study was aimed to examine if multiple oral administration of citalopram, an antidepressant drug, has any genotoxic potential on germ cells of male mice. Mice were treated with citalopram for 4 or 8weeks at the doses of 6, 12 and 24mg/kg/day and were sacrificed 24h after the last dose. Multiple exposures to 12 and 24mg/kg/day citalopram significantly increased sperm DNA strand breaks (14.0 and 16.0, respectively, compared to the concurrent control of 6.8 at week 4 and 15.2 and 20.7, respectively, compared to the concurrent control of 7.2 at week 8) and aberrant primary spermatocytes (6.6% and ...
Source: Food and Chemical Toxicology - December 8, 2012 Category: Food Science Authors: Attia SM, Bakheet SA Tags: Food Chem Toxicol Source Type: research

TPH1, MAOA, Serotonin Receptor 2A and 2C Genes in Citalopram Response: Possible Effect in Melancholic and Psychotic Depression
Neuropsychobiology 2013;67:41–47 (DOI:10.1159/000343388) (Source: Neuropsychobiology : Last 20 articles)
Source: Neuropsychobiology : Last 20 articles - December 4, 2012 Category: Psychiatry & Psychology Source Type: research

Multiple Regulatory Variants Modulate Expression of 5-Hydroxytryptamine 2A Receptors in Human Cortex
Conclusions: Regulatory polymorphisms modulate HTR2A mRNA expression in an isoform-specific manner, directing the usage of novel untranslated regions and alternative exons. These results provide a foundation for delineating the role of HTR2A and serotonin signaling in central nervous system disorders. (Source: Biological Psychiatry)
Source: Biological Psychiatry - November 15, 2012 Category: Psychiatry Authors: Ryan M. Smith, Audrey C. Papp, Amy Webb, Cara L. Ruble, Leanne M. Munsie, Laura K. Nisenbaum, Joel E. Kleinman, Barbara K. Lipska, Wolfgang Sadee Tags: Archival Reports Source Type: research

Playing it safe but losing anyway—Serotonergic signaling of negative outcomes in dorsomedial prefrontal cortex in the context of risk-aversion
Abstract: Risk avoidance is an important determinant of human behavior. The neurotransmitter serotonin has been implicated in processing negative outcomes caused by risky decisions. However, it is unclear whether serotonin provides a neurobiological link between making a risk aversive decision and the response to a negative outcome. Using pharmacological fMRI, we manipulated the availability of serotonin in healthy volunteers while performing a gambling task. The same group of participants was studied in three fMRI sessions: (i) during intravenous administration of the SSRI citalopram to increase the serotonergic tone, (ii...
Source: European Neuropsychopharmacology - October 9, 2012 Category: Psychiatry & Psychology Authors: Julian Macoveanu, James B. Rowe, Bettina Hornboll, Rebecca Elliott, Olaf B. Paulson, Gitte M. Knudsen, Hartwig R. Siebner Tags: Clinical Science Source Type: research

Monomorphic ventricular tachycardia after intentional citalopram overdose
A 19-year-old man arrived at the emergency department via ambulance after ingesting a large dose of citalopram at an unknown time in a self-harm attempt. The patient presented with altered mental status (nonsensical 1-word answers to questions), profound nystagmus, tremor, hyperreflexia, tachycardia, and hyperthermia. Electrocardiogram evaluation revealed a prolonged QRS with a right bundle-branch block pattern and intermittent monomorphic ventricular tachycardia (MVT). The patient was treated with sodium bicarbonate boluses, magnesium, and lidocaine with subsequent resolution of his electrocardiogram abnormalities. His se...
Source: The American Journal of Emergency Medicine - August 6, 2012 Category: Emergency Medicine Authors: Joseph K. Maddry, Klementyna Breyer, Kelly M. Cook, Kennon Heard Tags: Case Reports Source Type: research

Acute pharmacologically induced shifts in serotonin availability abolish emotion-selective responses to negative face emotions in distinct brain networks
Abstract: Pharmacological manipulation of serotonin availability can alter the processing of facial expressions of emotion. Using a within-subject design, we measured the effect of serotonin on the brain's response to aversive face emotions with functional MRI while 20 participants judged the gender of neutral, fearful and angry faces. In three separate and counterbalanced sessions, participants received citalopram (CIT) to raise serotonin levels, underwent acute tryptophan depletion (ATD) to lower serotonin, or were studied without pharmacological challenge (Control). An analysis designed to identify distributed brain res...
Source: European Neuropsychopharmacology - June 28, 2012 Category: Psychiatry & Psychology Authors: Cheryl L. Grady, Hartwig R. Siebner, Bettina Hornboll, Julian Macoveanu, Olaf B. Paulson, Gitte M. Knudsen Tags: Clinical Science Source Type: research

Severe symptomatic hyponatremia during citalopram therapy - a case report
Hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone is an uncommon complication of treatment with the new class of antidepressant agents, the selective serotonin reuptake ... (Source: BMC Nephrology)
Source: BMC Nephrology - January 16, 2004 Category: Urology & Nephrology Authors: Guillermo Flores, Santiago Perez-Patrigeon, Carolina Cobos-Ayala and Jesus Vergara Source Type: research

Effects of citalopram, a synthetic serotonin uptake inhibitor, on indoleamine and catecholamine concentrations in the cerebrospinal fluid of freely moving rats
SummaryWe studied changes in the concentrations of 5-hydroxytryptamine (5-HT), other indoleamines, and catecholamines in the cerebrospinal fluid (CSF) of freely-moving rats that had been administered citalopram, ±1-[3-(Dimethylamino)propyl)-1-(4-fluorophenyl)-1, 3-dihydro-5-isobenzofurancarbonitrile hydrobromide), a selective inhibitor of 5-HT uptake. In a microdialysis experiment, the intracerebral extracellular free 5-HT increased significantly, peaking 60 to 90 min after citalopram (30 mg/kg p.o.) was a dministerd. The 5-HT concentrations in CSF from the cisterna magna increased significantly, reaching a maximum ...
Source: Journal of Neural Transmission - June 1, 1995 Category: Neurology Source Type: research

Indoleamine concentrations in cerebrospinal fluid from patients with Alzheimer type and Binswanger type dementias before and after administration of citalopram, a synthetic serotonin uptake inhibitor
SummaryWe studied changes in the concentrations of serotonin (5-HT), kynurenine, and other indoleamines in the cerebrospinal fluid of patients with Alzheimer type dementia (ATD) and those with Binswanger type vascular dementia (VDBT), and changes in these indoleamine concentrations 2 weeks after administration of citalopram, a 5-HT uptake inhibitor. The concentrations of total 5-HT (p
Source: Journal of Neural Transmission - June 1, 1995 Category: Neurology Source Type: research