Dysphoria, treatment

An abstinence syndrome after long-term, low-dose treatment has also been described (Busto et al. 1986a Covi et al. 1973 Petursson and Lader 1981b Tyrer et al. 1981). Reported symptoms include muscle twitching, abnormal perception of movement, depersonalization or derealization, anxiety, headache, insomnia, diaphoresis, difficulty concentrating, tremor, fear, fatigue, lowered threshold to perception of sensory stimuh, and dysphoria. 

THC is effective in several chemotherapy regimens, including methotrexate and the doxorubicin/cyclophosphamide/fluorouracil combination. Cisplatin treatment, however, is more resistant. Side effects of THC are generally well tolerated, and use may be limited in the elderly or with higher doses. Nabilone is a synthetic cannabinoid that is more effective than prochlorperazine in chemotherapy-induced emesis, including cisplatin. Its side effects are similar to THC. Levonantradol is another synthetic cannabinoid with antiemetic effects, and may be administered orally or intramuscularly. The side effect of dysphoria may limit its use. 

The most common side effects are Raynaud s phenomenon with cold or even cyanotic distal extremities and digits, tiredness or weakness, bradycardia, and sexual impotence. Less common side effects are depression and dysphoria, bronchoconstriction, congestive heart failure, hallucinations, hypotension, vomiting or nausea, diarrhea, insomnia and nightmares, dizziness, and hypoglycemia. When due attention is paid to contraindications and the treatment is carefully monitored, the side effects of beta-blocker treatment are generally mild. 

Wikander I, Sundblad C, Andersch B, et al Citalopram in premenstrual dysphoria is intermittent treatment during luteal phases more effective than continuous medication throughout the menstrual cycle J Clin Psycho-pharmacol 18 390-398, 1998... 

A three-arm trial during six menstrual cycles evaluating the efficacy and safety of fluoxetine treatment of premenstrual dysphoria. Both 20 and 60 mg/day were significantly more effective than placebo, without any salient benefit of the higher dose however, the women on 60mg/daj of fluoxetine reported significantly more side effects than those at the lower dose or placebo. Based on the results of this three-arm fixed-dose and similar trials, the recommended dose in this indication is 20 mg of fluoxetine (Steiner et ti/., 1995). 

Miotto K, McCann M, Basch J, Rawson R ling W (2002). Naltrexone and dysphoria fact or myth American Journal of Addictions, 11, 151-60 Mitchell TB, White JM, Somogyi AA Bodmer F (2003). Comparative pharmacodynamics and pharmacokinetics of methadone and slow-release oral morphine for maintenance treatment of opioid dependence. Drug and Alcohol Dependence, 11, 85-94 Mitchell TB, White JM, Somogyi AA Bochner F (2004). Slow-release oral morphine versus methadone a crossover comparison of patient outcomes and acceptability as maintenance pharmacotherapies for opioid dependence. Addiction, 99, 940-5 Mitka M (2003). Office-based primary care physicians called on to treat the new addict. Journal of the American Medical Association, 290, 735-6... 

Harrison WM, Endicott J, Nee J. Treatment of premenstrual dysphoria with alprazolam. Arch Gen Psychiatry 1990 47 270-275. 

Dronabinol (A9-tetrahydrocannabinol THC Marinol) is FDA approved for treatment of nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetics. With mildly or moderately emetogenic chemotherapy, it is more effective than placebo and equivalent or superior to oral prochlorperazine. Dry mouth, sedation, orthostatic hypotension, ataxia, dizziness, and dysphoria occur frequently, particularly in middle-aged and older patients. 

There are two features of the cannabinoids which may ultimately be of therapeutic importance. THC lowers intraocular pressure, which may be of benefit in the treatment of glaucoma. There is also evidence that THC is a moderately effective antiemetic agent. Such a discovery has led to the development of nabilone, a synthetic cannabinoid, as an antiemetic agent, but its use is limited because of the dysphoria, depersonalization, memory disturbance and other effects which are associated with the cannabinoids. Whether the bronchodilator action of THC will ever find therapeutic application in the treatment of asthma remains an open question. 

This chapter will describe some of the most common, reversible, drug-induced neurological reactions acute dystonia acute akathisia parkinsonism and a broad, ill-defined category called dysphoria. All of them tend to begin early in treatment but can start later on as well. Chapters 4 and 5 will review the sometimes delayed and often persistent adverse reactions, including irreversible forms of akathisia and dystonia. 

The capacity for SSRIs to induce akathisia—and for akathisia to cause suicidality, aggression, and a worsening mental condition—is also recognized in the DSM-IV and the DSM-IV-TR in the section dealing with neuroleptic-induced akathisia. The DSM-IV-TR observes, Akathisia may be associated with dysphoria, irritability, aggression, or suicide attempts. It also mentions worsening of psychotic symptoms or behavioral dyscontrol. It then states, Serotonin-specific reuptake inhibitor antidepressant medications may produce akathisia that appears identical in phenomenology and treatment response to Neuroleptic-Induced Acute Akathisia (p. 801). 

In studies of its use in treating alcohol, opioid, and nicotine dependence, naltrexone has not been reported to cause depression or dysphoria. Patients who complain of naltrexone-associated dysphoria often have co-morbid depressive disorders or depression resulting from opioid or alcohol withdrawal states (549). Co-morbid depression is not a contraindication to naltrexone. Small pilot studies have supported the use of naltrexone in combination with antidepressants for the treatment of patients with co-mor-bid depression. The risk of non-fatal overdose is significantly increased after naltrexone treatment, as a result of reduced tolerance, compared with patients taking substitution methadone (550). 

In a prospective study, 50 patients with chronic hepatitis B or C who received 18-30 MU/week of natural or recombinant interferon alfa were followed for 12 months (144). The SCID before starting interferon alfa identified 16 patients with a current psychiatric diagnosis and eight with a previous psychiatric disorder 26 patients free of any psychiatric history constituted the control group. Psychiatric manifestations during treatment occurred in 11 patients (five from the control group), major depression in five, depressive disorders in three, severe dysphoria in two, and generalized... 

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