escitalopram + clonazepam (Citapure Forte)

Clonazepam-induced manic episode: A clinical vignette.

Yapar Fahrettin Sertaç FS, Doğan Aslı Ercan AE, Gürses Candan C

Antidepressant composition change before bipolar disorder diagnosis among patients initially diagnosed with major depressive disorder.

Liu Kuan-I KI, Bai Ya-Mei YM, Li Cheng-Ta CT, Tsai Shih-Jen SJ et al.

Some patients initially diagnosed with major depressive disorder (MDD) later receive a bipolar disorder (BD) diagnosis. We examined whether antidepressant composition shifted toward specific agents before BD diagnosis and whether identified signals were confined to the final 180 days. We conducted a matched case-control study using Taiwan's National Health Insurance Research Database. Cases were individuals diagnosed with MDD at ages 10-30 years who received a BD diagnosis at least 1 year later. Controls with MDD but no BD by the matched reference date were matched 1:4. Staged drug-level analyses addressed same-class burden, co-prescribing, composition change, and non-antidepressant treatment escalation. Temporal sensitivity analyses evaluated the final 180 days and the lagged days 181-365 window before the reference date. The sample included 8552 cases and 34,208 controls. Of 26 medications, 20 met leave-one-out screening criteria and 11 passed both post-leave-one-out checks. Paroxetine, duloxetine, and escitalopram showed composition-change signals in the main model. All three were associated with BD case status in the final-180-day analysis. After excluding the final 180 days, duloxetine remained associated (odds ratio, 1.04; 95% confidence interval, 1.01-1.07; false discovery rate-adjusted p = 0.043), whereas paroxetine and escitalopram did not. The duloxetine composition-change signal was not confined to the immediate 180-day prediagnostic period, whereas paroxetine and escitalopram signals were observed only in that period. These diagnosis-preceding prescribing patterns remain susceptible to protopathic bias and should not be interpreted as causal medication effects.

Association Between CYP450 Polymorphisms and Treatment Outcomes of Escitalopram and Venlafaxine in Patients with Post Stroke Depression.

Wang Yanyan Y, Sun Wenzhe W, Pan Chensheng C, Zhu Zhou Z et al.

Genetic polymorphisms in drug metabolism play an important role in the wide inter-individual variability in antidepressant efficacy. This study aimed to determine whether cytochrome P450 2C19 (CYP2C19) and cytochrome P450 2D6 (CYP2D6) genotypes predict treatment response to escitalopram (ESC) and venlafaxine (VEN), respectively, in patients with post-stroke depression (PSD). In this single-center prospective observational study, 313 acute stroke patients with PSD were consecutively enrolled and received ESC or VEN for 8 weeks. Efficacy was assessed using the 17-item Hamilton Depression Scale (HAMD-17). The primary outcome was the change in HAMD-17 score from baseline to week 8; secondary outcomes were response (≥50% reduction) and remission (score ≤7). Patients were stratified by CYP2C19 and CYP2D6 genotypes into fast- and slow-metabolizer subgroups. Subgroup comparisons utilized χ2 -tests and Mann-Whitney U-tests. At week 8, among 148 ESC-treated patients, CYP2C19 genotypes were distributed as poor/intermediate metabolizers (PM/IM) 82 (55.4%) and normal/rapid metabolizers (NM/RM) 64 (43.2%); among 113 VEN-treated patients, CYP2D6 genotypes showed marked imbalance (only 2 IM, 111 NM). No significant difference was found between ESC PM/IM and NM/RM subgroups in HAMD‑17 reduction (median: 10 vs 11, P=0.434), response (61.0% vs 69.7%, P=0.269), or remission (48.8% vs 51.5%, P=0.741). For patients treated with VEN, there was a significant imbalance in the distribution of CYP2D6 genotypes, which prevented us from further analyzing the association between CYP2D6 gene polymorphisms and the efficacy of VEN. No significant effect of CYP2C19 genetic polymorphism on ESC efficacy was observed in this study. These findings underscore the need for further exploration into the clinical utility of pharmacogenetics. Future antidepressant treatment should prioritize cost-effective, pragmatic approaches over costly genetic testing alone.

Drug utilisation and adverse drug reaction monitoring in schizophrenic patients: A tertiary care hospital study in India.

Jain Vipin Kumar VK, Kaore Shilpa N SN, Jain Megha M, Dubey Vaibhav V

Inadequate and poorly documented data on psychotropic drug utilization in schizophrenia in India necessitates systematic evaluation of prescribing patterns and associated adverse drug reactions. This prospective observational study assessed drug utilization, prescription rationality and adverse drug reactions among schizophrenia patients attending a tertiary care psychiatric outpatient department using WHO prescribing indicators. A total of 112 prescriptions comprising 285 drugs were analyzed, with atypical antipsychotics prescribed in 87% of first-visit cases, while combination therapies and polypharmacy were frequently observed. Significant dose variations were noted in commonly used antipsychotics such as risperidone, olanzapine and aripiprazole, as well as benzodiazepines like clonazepam and lorazepam (p<0.001). Atypical antipsychotics predominated due to better tolerability and lower extrapyramidal side effects, highlighting evolving prescribing trends. Thus, structured evidence on drug utilization patterns and variability in dosing, help in optimizing rational prescribing practices in schizophrenia management.