Department of Psychiatry Faculty Publications

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    Reduction in Mortality Risk With Opioid Agonist Therapy: a Systematic Review and Meta‐Analysis
    (Wiley, 2019) Bahji, A.; Cheng, B.; Gray, S.; Stuart, H.
    Introduction Opioid agonist therapies are effective medications that can greatly improve the quality of life of individuals with opioid use disorder. However, there is significant uncertainty about the risks of cause‐specific mortality in and out of treatment. Objective This systematic review and meta‐analysis explored the association between methadone and buprenorphine with cause‐specific mortality among opioid‐dependent persons. Methods We searched six online databases to identify relevant cohort studies, calculating all‐cause and overdose‐specific mortality rates during periods in and out of treatment. We pooled mortality estimates using multivariate random effects meta‐analysis of the crude mortality rate per 1000 person‐years of follow‐up as well as relative risks comparing mortality in vs. out of treatment. Results A total of 32 cohort studies (representing 150 235 participants, 805 423.6 person‐years, and 9112 deaths) met eligibility criteria. Crude mortality rates were substantially higher among methadone cohorts than buprenorphine cohorts. Relative risk reduction was substantially higher with methadone relative to buprenorphine when time in‐treatment was compared to time out‐of‐treatment. Furthermore, the greatest mortality reduction was conferred during the first 4 weeks of treatment. Mortality estimates were substantially heterogeneous and varied significantly by country, region, and by the nature of the treatment provider. Conclusion Precautions are necessary for the safer implementation of opioid agonist therapy, including baseline assessments of opioid tolerance, ongoing monitoring during the induction period, education of patients about the risk of overdose, and coordination within healthcare services.
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    Steroids and antidepressant response
    (Wiley, 2019-05-24) Baldessarini, Ross J.; Vázquez, Gustavo H.
    The recent meta-analytic review of trials involving anti-inflammatory agents to treat or to supplement treatment of patients with major depressive disorder (MDD) or depressive symptoms by Köhler-Forsberg and colleagues [1] includes data derived from 36 controlled trials. Treatments included glucocorticoids as well as cytokine inhibitors, minocycline, nonsteroidal anti-inflammatory drugs (NSAIDs), pioglitazone, and statins. There were 14 randomized, controlled trials involving addition of one of these agents versus placebo to standard antidepressants to treat acute episodes of MDD in 597 subjects. The resulting data analyzed by random-effects meta-analysis yielded a highly significant standardized mean drug-placebo difference (SMD) of –0.64 (95% CI: –0.88 to –0.40; z=5.17, p<0.00001) in which 9/14 trials (64.3%) individually yielded statistically significant differences, with moderate heterogeneity (I2 = 51%). This article is protected by copyright. All rights reserved.
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    Pharmacological Treatment for Insomnia in Patients with Major Depressive Disorder
    (Taylor and Francis, 2019-05-16) Brietzke, Elisa; Vazquez, Gustavo; Kang, Melody J. Y.; Soares, Claudio
    Introduction: Insomnia in Major Depressive Disorder (MDD) is highly prevalent and associated with increased suffering and functional impairment. Effective, evidence-based treatments for insomnia in MDD are an unmet need in clinical practice.Areas covered: Herein, the authors provide a review of the clinical correlates, putative neurobiological mechanisms and treatment options for the management of insomnia in individuals with MDD.Expert opinion: Sleep disturbances in MDD should be recognized as at least one of the following: (1) a domain of depressive psychopathology; (2) a consequence of rhythm disruptions; (3) a manifestation of comorbidities of sleep disturbances; (4) a manifestation of the influence of sex hormones in the brain in MDD; (5) a general medical comorbidity; and (6) a side effect of antidepressant medications. Assessment of insomnia in clinical practices is routinely performed with the use of non-structured interviews. Other methods such as standardized questionnaires and sleep diaries, along with complementary methods such as actigraphy and polysomnography are more scarcely applied. Smartphones and personal devices offer a promising strategy with the use of passive, long lasting, and ecologically valid assessments despite the lack of studies specifically targeting insomnia in individuals with MDD. New therapeutic approaches are essential, including novel targets such as orexins/hypocretins and the endocannabinoid system.