Irritable bowel syndrome in psychiatric perspectives: a comprehensive review : IBS in psychiatric perspectives

Pae, C. U.,Masand, P. S.,Ajwani, N.,Lee, C.,Patkar, A. A. Medicom International 2007 INTERNATIONAL JOURNAL OF CLINICAL PRACTICE -HOVE- Vol.61 No.10

Dilemma for enhancing psychiatrists' adherence to guideline (evidence)-based practice.

Han, Changsu,Wang, Sheng-Min,Lee, Soo Jung,Patkar, Ashwin A,Masand, Prakash S,Pae, Chi-Un Future Drugs Ltd 2013 Expert review of neurotherapeutics Vol.13 No.7

<P>Bipolar disorder (BD) is a prevalent and chronic devastating disorder that is associated with considerable psychosocial and economic morbidity. However, its complexity in the clinical course and manifestation of bipolar disorder is still a significant barrier to accurate differential diagnosis from unipolar depression (UD), by which it is still underdiagnosed and undertreated in clinical practice. In community studies, first onset of BD is usually in the adolescent ages, and the occurrence of UD is usually its first clinical manifestation. In addition, reliable criteria for differentiating UD from BD along with validated treatment guidelines for BD are currently not sufficient or adequate, commonly resulting in misdiagnosis and mismanagement of both clinical conditions. Therefore, the study under evaluation results from clinician practice patterns in the real world will substantially enhance the current understanding on the actual situation and unmet needs for accurate and proper diagnosis and management of bipolar depression.</P>

Atypical antipsychotics as a possible treatment option for irritable bowel syndrome

Pae, Chi-Un,Lee, Soo-Jung,Han, Changsu,Patkar, Ashwin A,Masand, Prakash S Informa UK, Ltd. 2013 Expert opinion on investigational drugs Vol.22 No.5

<P><B><I>Introduction:</I></B> Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder (FGID) that is characterised by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits. Although the pathophysiology of IBS is not fully understood, it is believed that psychiatric comorbidities are highly common in such patients. A variety of psychotropic medications are widely used in the treatment of IBS, particularly older antidepressants such as tricyclic antidepressants (TCAs).</P><P><B><I>Areas covered:</I></B> With the advent of newer antidepressant classes with better safety and tolerability compared with TCAs, such as serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), clinicians now have more advanced treatment options for treating IBS. Additionally, some atypical antipsychotics (AAs) have recently received approval for treatment of major depressive disorder (MDD). Some AAs may have potentials based on their pharmacodynamic profile and proven benefit for mood symptoms, pain, anxiety and sleep disturbances. This article describes the potential rationale, clinical data and practical aspects involved in the use of AAs for patients with IBS.</P><P><B><I>Expert opinion:</I></B> Atypical antipsychotics (AAs) may have a role in the treatment of irritable bowel syndrome (IBS) based on the currently available findings, although there is no clear evidence, and a number of clinical issues to be addressed in the use of AAs for the treatment of IBS.</P>

Vilazodone for the Treatment of Major Depressive Disorder: Focusing on Its Clinical Studies and Mechanism of Action

ShengMin Wang,Changsu Han,SooJung Lee,Ashwin A Patkar,Prakash S Masand,Chi-Un Pae 대한신경정신의학회 2015 PSYCHIATRY INVESTIGATION Vol.12 No.2

We tried to review and update clinical and preclinical studies evaluating vilazodone’s role as an antidepressant for patients with major depressive disorder (MDD). In terms of its mechanism of actions, we sought to elaborate them mainly through preclinical animal studies. A data search was conducted in November 1, 2013, using the key terms “vilazodone” or “Viibryd,” in PubMed and Medline databases. All published and unpublished studies are included and citations from publications were also reviewed for additional references. Five unpublished, phase-II and two pivotal published phase-III clinical trials with nearly identical design (8-week, double-blind, randomized, and placebo-controlled) investigated efficacy of vilazodone, were found for the treatment of patients with MDD. Two post-hoc studies and one long-term open study were also included. Data were thoroughly reviewed to incorporate the pharmacology, action mechanism, efficacy and safety for the vilazodone in the treatment of major depressive disorder. Vilazodone is an antidepressant with novel mechanism of action because its chemical structure is unrelated to conventional antidepressant, and it has a selective serotonin (5-HT) reuptake inhibitor and 5-HT1A receptor partial agonist profile. Vilazodone is an effective and safe treatment option with its novel action mechanisms for patients with depression. Its putative benefits compared with other antidepressants must be thoroughly studied in adequately-powered and well-designed future clinical trials.

Desvenlafaxine succinate: a newer antidepressant for the treatment of depression and somatic symptoms.

Seo, Ho-Jun,Sohi, Manmohandeep Singh,Patkar, Ashwin A,Masand, Prakash S,Pae, Chi-Un McGraw-Hill] 2010 Postgraduate medicine Vol.122 No.1

<P>Desvenlafaxine succinate (DVS) is one of several serotonin-norepinephrine reuptake inhibitors (SNRIs). Others are venlafaxine hydrochloride, milnacipran, and duloxetine. Desvenlafaxine has been approved by the US Food and Drug Administration (FDA) for the treatment of major depressive disorder (MDD) based on a number of randomized, placebo-controlled clinical trials. Clinical studies have investigated the efficacy of DVS in doses ranging from 50 to 400 mg/day for the treatment of MDD in adult outpatients. The effects of DVS 50 mg/day have been clearly distinguished from placebo in the reduction of MDD symptoms in such clinical trials. No additional therapeutic benefits were found at doses > 50 mg/day. The recommended dose of DVS ranges from 50 to 100 mg. Desvenlafaxine is currently the third SNRI approved by the FDA for this indication. Preliminary evidence also suggests the clinical usefulness of DVS in the treatment of vasomotor symptoms of menopause, anxiety symptoms, and painful physical symptoms. The modified pharmacokinetic and pharmacodynamic profiles of DVS differentiate this drug from the original product, venlafaxine. Significant points of difference, compared with venlafaxine, are once-daily dosing and the achievement of steady-state plasma concentrations within 4 to 5 days. To summarize, current evidence indicates that DVS has proven efficacy, acceptable safety and tolerability profiles, convenient dosing, and minimal impact on the cytochrome P450 enzyme system. A reduced risk for pharmacokinetic drug interactions is a potential advantage over other selective serotonin noradrenaline reuptake inhibitors. Desvenlafaxine succinate has demonstrated its efficacy for treating MDD but its variable efficacy, as shown in individual studies, limited long-term data, and its different risk-to-benefit ratio compared with earlier antidepressants, means that further investigation of this drug is necessary.</P>

Aripiprazole augmentation for treatment of patients with inadequate antidepressants response

Pae, Chi-Un,Patkar, Ashwin A.,Jun, Tae-Youn,Lee, Chul,Masand, Prakash S.,Paik, In-Ho Wiley Subscription Services, Inc., A Wiley Company 2007 Depression and Anxiety Vol.24 No.7

<P>This study evaluated whether or not augmentation with aripiprzazole is beneficial and tolerable to patients with an inadequate response to antidepressants (ADs). Thirteen patients with nonpsychotic major depression, who had failed to respond to an adequate trial of at least one AD, were prescribed aripiprazole (dose, 5–30 mg) for 8 weeks. The dose of their preexisting ADs was not changed. The treatment response was defined as the mean changes in the scores of the Hamilton Depression Rating Scale (HAM-D) from the baseline to the end of treatment. Eleven (84.6%) patients returned for at least one follow-up visit, and 7 (53.8%) patients completed the study. The HAM-D and Clinical Global Impression—Severity (CGI-S) scores decreased significantly from the baseline to the end of treatment by 53.8% and 56.0%, respectively (Z = −2.937, P =.003; Z = −2.961, P =.003). Seven (63.6%) patients showed a ≥ 50% reduction in the HAM-D score at the end of treatment. Three (27.3%) patients met the remission criteria at the end of treatment. There were no serious side effects. Despite the high dropout rate in this open study, aripiprazole appears to be reasonably effective and tolerated as an augmentation strategy in conjunction with conventional ADs treatment in patients with an inadequate AD response. These results highlight the potential benefits of aripiprazole for these patients. However, adequately powered, randomized, controlled trials are needed to confirm these results. Depression and Anxiety 24:522–526, 2007. © 2006 Wiley-Liss, Inc.</P>

Second Generation Antipsychotics in the Treatment of Major Depressive Disorder: An Update

Sheng Min Wang,한창수,이수정,전태연,Ashwin A. Patkar,Prakash S Masand,배치운 전남대학교 의과학연구소 2016 전남의대학술지 Vol.52 No.3

Less than one third of patients who suffer from major depressive disorder (MDD) report remission following antidepressant treatments requiring more diverse treatment approaches. Augmentation of second generation antipsychotics (SGAs) has been increasingly recognized as an important treatment option. The authors have previously provided a comprehensive review of SGAs for the treatment of MDD in 2013. Since then, numerous additional clinical trials have been conducted to investigate diverse issues regarding the utility of SGAs in MDD. Moreover, a new SGA, brexpiprazole, was recently approved by the Food and Drug Administration in July 2015 for the treatment of MDD as an augmentation agent to antidepressants. Thus, the aim of this study was to provide a concise update of all the available SGAs for the treatment of MDD, in particular on the additional clinical trials which have been published since 2013.

Adjunctive Brexpiprazole as a Novel Effective Strategy for Treating Major Depressive Disorder: A Systematic Review and Meta-Analysis

Yoon, Seoyoung,Jeon, Sang Won,Ko, Young-Hoon,Patkar, Ashwin A.,Masand, Prakash S.,Pae, Chi-Un,Han, Changsu Wolters Kluwer Health, Inc. All rights reserved. 2017 JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Vol.37 No.1

<P>Implications/Conclusions: Although our results suggest that brexpiprazole could be an effective adjunctive agent for MDD, they should be cautiously translated into clinical practice because the meta-analysis was based on only a handful of randomized controlled trials.</P>

Atypical depression: a comprehensive review.

Pae, Chi-Un,Tharwani, Haresh,Marks, David M,Masand, Prakash S,Patkar, Ashwin A Adis International 2009 CNS drugs Vol.23 No.12

<P>Despite several decades of research, the characteristics distinguishing atypical depression from other depressive subtypes remain ambiguous. Multiple lines of evidence support the designation of atypical depression as a scientifically and clinically relevant subtype, including differences in hormonal responses, brain laterality, psychological profile and psychiatric co-morbidity and differential treatment response. The evolution of the diagnostic criteria for atypical depression has led to the designation of mood reactivity as the cardinal feature, and the research supporting this conclusion is reviewed. This paper also reviews the evidence for the drug treatment of atypical depression, with a particular focus on research related to the superior efficacy of monoamine oxidase inhibitors (MAOIs) compared with tricyclic antidepressants (TCAs). Data relevant to the efficacy of newer antidepressants, including selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline (norepinephrine) reuptake inhibitors, transdermal selegiline and other new agents for atypical depression, are discussed. In summary, the diagnostic reliability and validity of atypical depression still remain elusive and open to further evolution. Currently available findings suggest that atypical depression has preferential response to MAOIs over TCAs. More data are required to determine the efficacy of newer agents relative to MAOIs and TCAs, although limited studies have shown a non-inferior efficacy and better tolerability of newer agents such as SSRIs compared with those of MAOIs and TCAs. Finally, future directions for research include further refinement of the diagnostic criteria for atypical depression, and clarification of the role of newer antidepressants in the treatment of this subtype with evidence from randomized, controlled trials.</P>

Erratum: Correction of Acknowledgements Second Generation Antipsychotics in the Treatment of Major Depressive Disorder: An Update

왕승민,한창수,이수정,전태연,Ashwin A. Patkar,Prakash S. Masand,배치운 전남대학교 의과학연구소 2019 전남의대학술지 Vol.55 No.1