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No evidence of benefit of selegiline for Alzheimer's disease

Despite its initial promise, i.e. the potential neuroprotective properties, and its role in the treatment of Parkinson's disease, selegiline for Alzheimer's disease has proved disappointing. Although there is no evidence of a significant adverse event profile, there is also no evidence of a clinically meaningful benefit for people with Alzheimer's disease. There would seem to be no justification, therefore, to use it for Alzheimer's disease, nor for any further studies of its efficacy in Alzheimer's disease.

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

Version: 2008

Drugs that increase alertness (psychostimulants) for excessive daytime sleepiness (hypersomnia) in myotonic dystrophy

Myotonic dystrophy is an inherited muscular dystrophy causing muscle weakness and wasting. Many people with myotonic dystrophy complain about excessive daytime sleepiness. This symptom is related to disordered central respiratory control. Psychostimulants are drugs that increase alertness and include caffeine, amphetamine, selegiline, methylphenidate and modafinil. In this updated review there were few randomized controlled trials which evaluated the efficacy and safety of psychostimulants in myotonic dystrophy. One randomized controlled trial of selegiline involving 11 participants did not demonstrate any benefit. Four studies of another drug modafinil suggested inconsistent and slight benefits. Only two of these studies used the gold standard test, a sleepiness scale, to evaluate hypersomnia and found non significant improvement. In these four studies modafinil seemed well tolerated. Further randomized trials are needed to determine the utility of psychostimulants for myotonic dystrophy.

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

Version: 2011

Monoamine oxidase B inhibitors compared with other treatments in early Parkinson's

Many of the symptoms of Parkinson's disease are due to the loss of certain groups of nerves in the brain, which results in the lack of a chemical called dopamine. Currently, there are several different treatments available for people with newly diagnosed Parkinson's including levodopa (Sinemet or Madopar) which is converted into dopamine in the brain, dopamine agonists (for example, ropinirole and pramipexole) which mimic the action of dopamine, and monoamine oxidase B (MAO‐B) inhibitors (selegiline or rasagiline) which reduce the breakdown of dopamine in the brain. Each of these types of drugs has theoretical advantages and disadvantages. For example, although a very good treatment, levodopa can cause involuntary movements (dyskinesia), painful cramps (dystonia) and a shortened response to each dose (motor fluctuations) after a while, whilst MAO‐B inhibitors and dopamine agonists may reduce the risk of these complications but are not so good at improving the symptoms of Parkinson's. At present, therefore, it is not clear which of these three groups of drugs should be prescribed when people with early Parkinson's first need treatment. We reviewed the trials that compared giving MAO‐B inhibitors with other types of medication in people with early Parkinson's to see if there was good evidence that MAO‐B inhibitors were the best treatment to offer. However, unfortunately we only identified two trials (593 patients) so there was only limited evidence. The results showed that MAO‐B inhibitors were less good at improving the symptoms of Parkinson's than either levodopa or dopamine agonists but that they may reduce motor fluctuations compared with levodopa, though not compared with dopamine agonists. MAO‐B inhibitors did, however, have fewer major side effects than some dopamine agonists.

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

Version: 2009

Monoamine oxidase B inhibitors for early Parkinson's disease

Parkinson's disease is a disabling condition of the brain characterized by slowness of movement, shaking, stiffness, and in the later stages, loss of balance. Many of these symptoms are due to the loss of certain nerves in the brain, which results in the lack of a chemical called dopamine. Current treatments for Parkinson's are designed to increase dopamine by using levodopa (Sinemet or Madopar), which is converted in the brain into dopamine, or drugs that mimic dopamine (dopamine agonists). Although useful, these treatments do not slow the progression of the disease and can be associated with side‐effects e.g. after a while levodopa use can cause involuntary movements (dyskinesia), painful leg cramps (dystonia) and a shortened response to each dose (motor fluctuations). Monoamine oxidase B (MAO‐B) inhibitors such as selegiline (Eldepryl or Selgene) boost the levels of dopamine by a different mechanism, which may reduce the risk of these complications and slow disease progression. We reviewed 11 controlled trials with a total of 2514 patients that compared giving MAO‐B inhibitors with not giving them in people with early Parkinson's to see if it was safe and effective. The results show that, although MAO‐B inhibitors do improve symptoms of Parkinson's and delay the need for levodopa by a few months, they are too weak to have a major effect and do not seem to delay the progression of the condition. They may, however, reduce motor fluctuations although more information is needed to be certain of this. Although they can cause some side‐effects, these are generally mild.

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

Version: 2011

Management of sexual problems due to antipsychotic drug therapy

Drugs commonly used to treat schizophrenia often cause sexual problems.This may affect erection, lubrication, orgasm, desire or libido, ejaculation, sexual arousal or overall sexual satisfaction. This may have serious negative consequences such as putting people off taking their medication or stopping taking drugs at an early stage. Sexual problems may limit a person’s quality of life, worsen self‐esteem and cause relationship problems.Strategies to manage these sexual problems are taking additional drugs (Viagra TM), short drug holidays when people temporarily stop antipsychotic medication, reduction of dose and switching to another antipsychotic drug. This review includes four pioneering studies with a total of 138 participants lasting between two weeks to four months, meaning all were small and quite short. Two of the studies compared the effects of drugs to treat sexual problems and two compared the effect of switching to a different antipsychotic drug (while remaining on a current antipsychotic). There is some evidence that sildenafil ((ViagraTM, RevatioTM)) may be a good treatment for men who have problems getting and maintaining an erection. It also seems to increase frequency and satisfaction of sexual intercourse. Switching to olanzapine may improve sexual functioning in men and women.

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

Version: 2012

Antioxidants as add‐on treatment for people with schizophrenia

Searches for randomised trials were run in 2010 and 2012, review authors found 22 relevant trials that randomised a total of 2041 people with schizophrenia. The trials compared the effects of taking a variety of antioxidants (allopurinol, Ginkgo biloba, N‐acetyl cysteine (NAC), selegiline, vitamins C and E) compared with placebo. Most results showed no real differences between the antioxidants and placebo although there was evidence Ginkgo biloba had a positive effect on psychotic symptoms in the short term. The quality of this evidence was moderate.

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

Version: 2016

Do medications used to treat depression help smokers who are trying to quit

Some medications and supplements that have been used to treat depression (antidepressants) have been tested to see whether they also help people who are trying to stop smoking. Two antidepressants, bupropion (Zyban) and nortriptyline, are sometimes prescribed to help with quitting smoking. This review set out to determine if using antidepressants increased people's likelihood of successfully quitting smoking at six months or longer and to determine the safety of using these medications to help quit smoking.

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

Version: 2016

Efficacy of psychostimulant drugs for cocaine dependence

We investigated whether psychostimulant substitution was safe and effective for treating patients with cocaine dependence.

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

Version: 2016

Antioxidants for treating amyotrophic lateral sclerosis

There is no cure for amyotrophic lateral sclerosis, also known as motor neuron disease, which is a progressively disabling and ultimately fatal disease. Antioxidants, including vitamins C, E, selegiline, selenium, methionineacetylcysteine, and coenzyme Q10, have been suggested as possible treatments and some of these are commonly advised by physicians treating people with amyotrophic lateral sclerosis. In this updated review, we identified 10 studies involving a total of 1015 participants. We did not find any well‐designed randomized controlled trial evidence to support the use of these medications. Trials of antioxidants identified in this review were generally of poor methodological quality and lacked statistical power. However, antioxidants are generally well tolerated without serious adverse effects.

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

Version: 2011

Are there any effective interventions to help individuals with depression to quit smoking?

People with depression are very often heavy smokers. We wanted to know whether treatments to help people quit smoking are effective for people with current depression or with a history of depression. In this review, treatments were divided into those with or without specific attention to handling depression. We found that smoking cessation treatments with specific attention to handling depression helped smokers who suffered from depression to quit. Psychosocial 'mood management' interventions, where participants learn how to handle depressive symptoms with psychological techniques, were effective in those with current depression and with a history of it. Bupropion, an antidepressant medication to help quit smoking, has been shown to be effective for smoking cessation in healthy smokers. Our findings show that bupropion may benefit smokers with a history of depression as well. However, this was not found for those with current depression. There was a lack of evidence for the effectiveness of other antidepressants to help smokers with a history of depression to quit. There was also not enough evidence for the use of antidepressants in smokers with current depression. Although treatments without specific attention to handling depression, such as nicotine replacement therapy and standard psychosocial smoking cessation interventions, have been shown to help other groups of people to quit smoking, there was not enough evidence to show that they were helpful in people with a history of or with current depression.

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

Version: 2013

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