Depression sulpiride

Compared to antipsychotics, there are even fewer studies on the prescribing patterns of antidepressants done in Asian countries. Pi etal. (1985) conducted a survey of psychotropic prescribing practices reported by psychiatrists in 29 medical schools in 9 Asian countries. Daily dose range of tricyclic antidepressants (TCAs) such as amitriptyline, imipramine, and nortriptyline in Asian countries was comparable to the practice in USA. This is despite differences found between Asian and non-Asian populations in the pharmacokinetics of TCAs (Pi et al, 1993). A questionnaire on the practical prescribing approaches in mood disorders administered to 298 Japanese psychiatrists was reported by Oshima et al. (1999). As first-line treatment, the majority of respondents chose newer TCAs or non-TCAs for moderate depression and older TCAs for severe depression. Combination of antidepressants and anxiolytics was preferred in moderate depression, while an antidepressant and antipsychotic combination was common in severe psychotic depression. Surprisingly, sulpiride was the most favored drug for dysthymia. In a naturalistic, prospective follow-up of 95 patients with major depression in Japan, the proportion of patients receiving 125 mg/day or less of imipramine was 69% at one month and 67% at six months (Furukawa et al., 2000). 

In an uncontrolled retrospective study of 63 patients with TS, ages 10-68 years, many of whom were on other medications, sulpiride produced a positive response in 60% of subjects (Robertson et ah, 1990). The modal daily dose of responders was 400 mg (dose range 200-1000 mg/day). Drowsiness, depression, ak-athisia, and weight gain were common side effects. 

As opposed to the disorders of the preceding paragraph, a decrease in dopaminergic transmission may be one of the neurochemical alterations in depression (Dailly et al. 2004). The selective antagonists at D2-like receptors sulpiride and amisulpride, when given at low doses, reduce depression symptoms, presumably by blockade of D2-autoreceptors and enhancement of dopamine release (Racagni et al. 2004). Sulpiride in fact increased the release of [3H]-dopamine in human neocortex slices... 

Trendelenburg AU, Meyer A, Klebroff W, Guimaraes S, Starke K (2003) Crosstalk between presynaptic angiotensin receptors, bradykinin receptors and a2-autoreceptors in sympathetic neurons a study in a2-adrenoceptor-deficient mice. Br J Pharmacol 138 1389-1402 Uchida H, Takeuchi H, Suzuki T, Nomura K, Watanabe K, Kashima H (2005) Combined treatment with sulpiride and paroxetine for accelerated response in patients with major depressive disorder. J Clin Psychopharmacol 25 545-51... 

CNS effects may be increased if sulpiride is used with other CNS depressants... 

Of 524 inquiries received by the National Poisons Information Service concerning new neuroleptic drugs over 9 months, only 45 cases involved overdose with a single agent (olanzapine, n — 10 clozapine, n — 8 risperidone, n — 10 sulpiride, n = 16) (503). There were no deaths or cases of convulsions. Cardiac dysrhythmias occurred only with sulpiride. Symptoms were most marked with clozapine most patients had agitation, dystonia, central nervous system depression, and tachycardia. Most of the patients who had taken risperidone were asymptomatic. 

Antipsychotics can be divided by chemical class phenothiazines, e.g. chlorpromazine. fluphazine and thioridazine butyrophenones, e.g. haioperidol thioxanthines, e.g. nupenthixol benzamides, e.g. sulpiride diphenylbutyl-piperazines, e.g. pimozide dibenzazepines, e.g. clozapine. None is entirely selective, but in schizophrenia they act mainly at dopamine D2 receptors, though clozapine has important actions at D4 receptors. Those antipsychotics with markedly depressant side-effects are also, somewhat misleadingly, known as major tranquillizers. 

Levosulpiride is the (-) enantiomer of sulpiride, an antiemetic, antidyspeptic, and antipsychotic drug. However, levosulpiride is a more potent antiemetic compound than sulpiride. Levosulpiride (50 to 300 mg/day) is effective in depressive and somatoform disorders, as well as in the treatment of negative symptoms in schizophrenic patients. 

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