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Results: 11

Tricyclic antidepressant medication for treating children and adolescents with an autism spectrum disorder

Autism spectrum disorders (ASD) are characterised by problems with social interaction and verbal and non‐verbal communication, as well as restricted and repetitive interests and behaviours. Tricyclic antidepressants (TCAs) are medications that alter the level of the neurotransmitter serotonin and have been used in the treatment of autistic symptoms, anxiety and obsessive‐compulsive type behaviours. We found three trials that studied two different TCAs ‐ clomipramine and tianeptine. One of the clomipramine studies involved children and young adults; the other two studies enrolled only children. All three trials were small, with between 12 and 32 participants. There is only limited evidence to support the use of clomipramine or tianeptine in the treatment of individuals with ASD, and some evidence of side effects that would limit their usefulness. Clinicians considering the use of TCAs in ASD need to be aware of the limited and conflicting evidence of effect and the side effect profile of TCAs when discussing this treatment option with patients with ASD and their carers. More research is required before TCAs can be recommended for use in ASD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Drugs as treatment for self‐injurious behaviour in adults with intellectual disabilities

Self‐injurious behaviour (SIB) among people with intellectual disability is relatively common and often persistent. It is difficult to treat, and presents challenges to those with caring responsibilities and to clinicians. Several types of drugs have been used by clinicians to help with this problem but none is licensed for self injury.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Drug treatment for myotonia (delayed muscle relaxation after contraction) in muscle diseases such as myotonic dystrophy and myotonia congenita

Myotonia is an abnormal delay in the relaxation of muscles after contraction. It is a key symptom in a number of muscle diseases called myotonic disorders. It can be mild or severe, interfering with daily activities such as walking, climbing stairs or opening and closing the eyelids. It can be worse after periods of rest or triggered by cold or fatigue. People with mild myotonia can manage their disease without medication but in severe cases treatment is usually necessary. Drugs that have been used to treat myotonia include sodium channel blockers such as procainamide, phenytoin and mexiletine, tricyclic antidepressant drugs such as clomipramine or imipramine, benzodiazepines, calcium antagonists, taurine and prednisone. This review describes ten randomised controlled trials which tested the effectiveness of twelve different drug treatments. The review was updated in July 2009 and no new trials were found. The ten trials included a total of 143 participants of which 113 had myotonic dystrophy and 30 had myotonia congenita. The trials were generally small and of poor quality. Meta‐analysis was not possible due to a lack of appropriate trials and data. Two small studies suggested that clomipramine and imipramine might have a short‐term beneficial effect on the myotonia in myotonic dystrophy and one small study suggested that taurine might have a long‐term beneficial effect in myotonic dystrophy. Minor side effects such as dry mouth and dizziness were reported with clomipramine and imipramine, but not with taurine. It was not possible to determine whether drug treatment is safe and effective for myotonia in people with a myotonic disorder based on the evidence from the ten trials included in this review. Larger, well‐designed randomised controlled trials are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Tramadol for neuropathic pain

Neuropathic pain is frequently caused by damage to the peripheral nerves. Symptoms may include burning or shooting sensations, and abnormal sensitivity to normally non‐painful stimuli. Neuropathic pain is difficult to treat. Anticonvulsants and antidepressants are frequently used but their use is limited by side effects. Tramadol is a unique pain killing drug with mild opiate properties.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Drug treatments for chronic hair‐pulling (trichotillomania)

Trichotillomania (TTM) (hair‐pulling disorder) is a common and disabling condition characterised by repeated hair‐pulling leading to hair loss. TTM can be associated with much distress and impairment for people with the condition. This systematic review of randomised controlled trials (RCTs) set out to review the evidence for medication in treating TTM. The findings are based on eight studies (which included a total of 204 people). Not enough evidence was found to conclude definitively that any particular medication is effective in the treatment of TTM. Furthermore, side effects related to medications were not well‐documented in the majority of the studies. Because of differences in the way the included studies were carried out, we were unable to combine their results to draw more conclusive evidence. However, an early trial found some evidence for the efficacy of clomipramine, and two recent trials reported statistically significant treatment outcomes with olanzapine and N‐acetylcysteine. More research is needed to find an optimal treatment for TTM.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Medication, psychotherapy, or a combination of both, in treating body dysmorphic disorder

Body dysmorphic disorder (BDD) is a condition characterised by a distressing and disabling preoccupation with an imagined or slight defect in appearance. This causes people with this disorder either significant distress or disrupts their daily functioning (or both). There has been a growing recognition that BDD is common, and is associated with significant illness and disability. There is also some evidence that it may respond to pharmacotherapy and psychotherapy. Our systematic review of randomised controlled trials assesses the effects of drug treatment or psychotherapy when used on their own or in combination. We found five eligible trials, including three of psychotherapy (cognitive behavioural therapy (CBT) and exposure and response prevention (ERP)) and two of medication (the serotonin reuptake inhibitors (SRIs) fluoxetine and clomipramine). In the only placebo‐controlled medication trial included in our review, people with BDD treated with fluoxetine were more likely to respond (56%, 19 out of 34) than those allocated placebo (18%, 6 out of 33). Symptoms became less severe after treatment with both medication and psychotherapy. Adverse events were mild to moderate in severity and none of the people in the active treatment groups were reported to have dropped out of the studies because of treatment‐emergent adverse events. There is preliminary evidence from one trial of CBT that the effects of CBT may persist once treatment has ended. Treatment response in the medication trials was not effected by the degree to which people had insight into their condition. Although few controlled trials have been done, and those that have been conducted were small, indicating that our findings should be used with caution unless confirmed by larger studies (some of which are ongoing), the results suggest that treatment with both medication or psychotherapy can be effective in treating the symptoms of body dysmorphic disorder.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Fluvoxamine versus other anti‐depressive agents for depression

Major depression is a severe mental illness characterised by a persistent and unreactive low mood and loss of all interest and pleasure, usually accompanied by a range of symptoms including appetite change, sleep disturbance, fatigue, loss of energy, poor concentration, psychomotor symptoms, inappropriate guilt and morbid thoughts of death. Although pharmacological and psychological interventions are both effective for major depression, antidepressant (AD) drugs remain the mainstay for treatment of moderate or severe depression. Fluvoxamine is one of the oldest selective serotonin reuptake inhibitors (SSRIs) and is prescribed to patients with major depression in many countries. This review reports trials comparing fluvoxamine with other antidepressants for treatment of major depression. We found no strong evidence that fluvoxamine was either superior or inferior to any other antidepressants in terms of efficacy and tolerability in the acute phase treatment of depression. However, there is evidence of differing side‐effect profiles, especially when comparing gastrointestinal side effects between fluvoxamine and tricyclic antidepressants (TCAs). Based on these findings, we conclude that clinicians should focus on practical or clinically relevant considerations including these differences in side effect profiles.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Tricyclic drugs for bedwetting in children

Night‐time bedwetting is common in childhood, and can cause stigma, stress and inconvenience. The review examined 58 trials of tricyclic drugs which included 3721 children. Tricyclics are antidepressants, but probably work because of one of their side effects (affecting the messages sent to the bladder by the nerves). The one most commonly used is imipramine, which can be used for up to three months. Tricyclic drugs reduce bedwetting by about one wet night per week while being used and about a fifth of the children become dry. However, they do not work once the children stop using them. Compared with the other commonly used drug, desmopressin, tricyclics are less expensive but have more side‐effects. A particular concern is tricyclic overdose, which can be serious. Bed alarms are more expensive than tricyclics and more bother to families to use but about half the children remain dry after alarm treatment has finished, and they do not have the side‐effects of the drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Psychosocial interventions for premature ejaculation

Premature ejaculation is a frequent sexual dysfunction. It is characterized by ejaculation that always or nearly always occurs prior to or within about one minute of vaginal penetration. It is also characterized by the inability to delay ejaculation on all or nearly all vaginal penetrations, and its personal consequences are distress, bother, frustration and/or the avoidance of sexual intimacy. Although psychological issues are present in most of patients with PE, as a cause or as a consequence, research on the effects of psychological approaches for PE is not clear. The early success reports (97.8%) of Masters and Johnson have not be replicated. This review assessed the efficacy of psychosocial interventions for PE and found four trials involving 253 PE patients. Overall, there is weak and inconsistent evidence regarding the effectiveness of psychological interventions for the treatment of premature ejaculation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Desipramine for neuropathic pain in adults

Neuropathic pain is pain coming from damaged nerves. It is different from pain messages carried along healthy nerves from damaged tissue (a fall, cut, or arthritic knee). Neuropathic pain is treated by different medicines than pain from damaged tissue. Medicines like paracetamol or ibuprofen are not usually effective in neuropathic pain, while medicines that are sometimes used to treat depression or epilepsy can be very effective in some people with neuropathic pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Tricyclic antidepressants for attention deficit hyperactivity disorder (ADHD) in children and adolescents

ADHD affects a large number of children and adolescents, giving rise to problems with inattention, hyperactivity, and impulsivity. A variety of medications, including tricyclic antidepressants (TCAs), may be used to treat the core symptoms of ADHD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

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