Gangguan fungsi ereksi adalah salah satu kesan sampingan metadon yang paling lazim. Gangguan ini menjejaskan lebih daripada separuh populasi pesakit metadon dari segi fungsi seksual mereka. Masalah ini dikaitkan dengan penurunan kualiti hidup yang ketara. Gangguan fungsi ereksi boleh menyebabkan masalah yang lebih besar jika tidak dirawat kerana pesakit mungkin memilih untuk menggunakan rawatan sendiri yang berbahaya seperti menyalahgunakan methamphetamine. Penggunaan dadah untuk mengatasi kesan sampingan metadon boleh menyebabkan gangguan penggunaan dadah ganda yang dapat mengganggu rawatan ketagihan dadah. Untuk mengatasi masalah ini, pengamal dan pesakit memainkan peranan yang penting dalam pengurusan gangguan fungsi ereksi. Kesedaran pesakit mengenai gangguan fungsi ereksi dan impaknya serta intervensi aktif oleh doktor untuk mengesan gangguan fungsi ereksi, adalah penting untuk meningkatkan tingkat pengesanan dan pengurusan gangguan fungsi ereksi. Saringan gangguan fungsi ereksi yang kerap dan faktor risikonya akan membantu mengenalpasti pesakit yang menderita gangguan fungsi ereksi. Pelbagai pilihan rawatan seperti rawatan bupropion, trazodone dan banyak lagi tersedia untuk merawat gangguan fungsi ereksi yang akan diterokai lebih lanjut dalam kajian ini.
The first objective of the present study was to determine the appropriate dose of methamphetamine (Meth) to induce a successful conditioned place preference (CPP) in mice. The next objective was to examine the effect of a methanolic extract of M. citrifolia unripe fruit (MMC) against Meth-induced CPP in mice. In answering to the first objective, following the preconditioning test, an intraperitoneal injection of a fixed dose of Meth (0.5 or 1 or 2 mg/kg, i.p.) or saline (10 ml/kg, i.p.) was given on alternate days during the 10 days conditioning period followed by a postconditioning test conducted in Meth-free state. The first experiment revealed that 0.5 mg/kg of Meth could be an appropriate fixed low dose to induce CPP in mice. Meanwhile, in other experiments, the effect of MMC and bupropion (BUPR) against the expression, extinction, and reinstatement of Meth (0.5 mg/kg)-induced CPP in mice, respectively, was investigated. In a separate set of studies on each phase, an oral administration of MMC (1, 3 and 5 g/kg, p.o.) or BUPR (20 mg/kg, p.o.) was given 60 min prior to CPP postconditioning testing or extinction testing or reinstatement testing in mice. Extinction trials were conducted in Meth-free state to weaken CPP over the next 5 days. Reinstatement test was conducted by a single low dose priming injection of Meth (0.1 mg/kg, i.p.). The present study, however, failed to establish a successful extinction and reinstatement of Meth-CPP in mice. Further studies using other doses of Meth are warranted for a successful establishment of all phases of Meth CPP in mice. This study also demonstrates that MMC (3 and 5 g/kg, p.o.) and BUPR (20 mg/kg, p.o.) could attenuate the expression of Meth-induced CPP in mice.
Methadone is largely recognized as an effective treatment for opiate-dependent patients; however, it causes reduced brain dopaminergic action resulting in significant sexual dysfunction. Bupropion is a dopamine reuptake inhibitor which can potentially improve erectile function among male patients on methadone (MMT). This is a phase II, randomized, double-blind, parallel-group, placebo-controlled trial, involving 80 MMT male patients (73.4%) with mean age of 42.83 years ±9.68. These MMT male patients were randomly assigned into two groups to receive bupropion and placebo, respectively. The primary efficacy outcome measure was the difference between the two groups in end-point mean improvement scores using the measurement of Clinical Global Impression Scale adapted for Sexual Function (CGI-SF) at baseline (week 0) and at weeks 2, 4, and 6. Malay version of the sexual desire inventory-2 (SDI-2-BM) and Malay version of International Index of Erectile Function 15 (Mal-IIEF-15) domain scores were evaluated as secondary parameters. Improvement of the end-point mean from baseline were seen across the scores of SDI-2-BM (mean difference = 11.77 ± 2.90, 95% confidence interval (CI) [3.89, 19.54], p < .001) and Mal-IIEF-15 (mean difference = 8.37 ± 2.71, 95% CI [15.75, 0.99], p = .02), and the total plasma testosterone level (mean difference = 4.03, 95% CI [0.90, 7.15], p = .01). A categorical improvement of "much/very much improved" (CGI-SF score = 2) was reported by 58.3% ( n = 21/36) of bupropion SR-assigned versus 27.7% ( n = 10/36) placebo-assigned patient. Bupropion was well tolerated with no serious adverse events reported other than insomnia (17.7%). Six weeks of bupropion SR treatment reported significant improvement in key aspects of sexual function among male opiate-dependent patients on methadone maintenance treatment with emergent sexual dysfunction.
Attention deficit hyperactive disorder (ADHD), a hyperactivity disorder prevalent among children may continue as an adulthood attention deficit. To date, treating an individual with an adult ADHD may be an arduous task as it involves numerous challenges, which include a need for high index of suspicion to diagnose this medical condition. Many psychiatric disorders masquerade as ADHD and delay the necessary assessment and proper treatment for this debilitating medical disorder. Adult ADHD is often misdiagnosed (or under diagnosed) due to the fact that this medical condition is being masked by the patients' high level of intellectual achievement. As the ADHD in adult persists, it may end-up with impairment in the personal-social-occupational function in which the management becomes a great challenge. The treatment of ADHD can be optimized by using various drugs targets agents like norepinephrine-dopamine reuptake inhibitor (NDRI), with or without psycho stimulants like methylphenidate, which is marketed as Ritalin. Bupropion, an NDRI has a novel effect on ADHD as the molecule exerts its effects by modulating the reward-pleasure mesolimbic dopaminergic system and at the same time regulates the elevating mood dimension of the noradrenergic neurotransmission. The role of Bupropion in the neural and psychopharmacological perspective treatment of ADHD was deliberated. The present review highlights the novel effects of Bupropion in ADHD treatment, together with the help of other successful bio-psycho-social measures. This may be of immense benefit to the psychiatrists for treating their patients.
Sexual dysfunction is a common condition in the opioid substitution therapy (OST) population. We aimed to determine the efficacy and safety of treatment for sexual dysfunction in the OST population. We searched for interventional studies from Medline, PubMed, and Scopus. Three independent authors conducted a risk-of-bias assessment (RoB 2). A total of seven studies (five randomized-controlled trials, two quasi-experimental), including 473 patients with sexual dysfunction, were identified. Among these, three bupropion (n=207), one trazodone (n=75), two rosa Damascena (n=100), and one ginseng (n=91) studies had reported significantly improve various sexual functioning domains in both genders. In a meta-analysis, bupropion significantly increased male sexual function with standardized mean difference of 0.53; 95% confidence interval of 0.19-0.88; P < 0.01; I2=0. The adverse effects were minor for all agents, and no significant difference between treatment and placebo groups in randomized-controlled trials. These agents have a promising future as therapy for sexual dysfunction in the OST population. However, given the limited sample size and number of studies, further studies should be conducted to confirm the use of these agents.
Objective: This systematic review is aimed to quantitatively summarise the
prevalence of sexual dysfunction among non-SSRI second generation
antidepressants namely agomelatine, bupropion, duloxetine, venlafaxine, and
mirtazapine.
Methods: Relevant studies published from inception till
December 2012 were identified by searching PubMed, OVID and Embase.
We included all literatures encompassing randomized controlled, cohort,
case-controlled and cross-sectional studies, which contained quantitative data
for prevalence on all aspects of sexual dysfunction in depressive patients who
were older than 18 years of age. Heterogeneity, publication bias and odds
ratio were assessed thoroughly.
Results: In the non-SSRI second generation
antidepressant group which consisted of 17,316 subjects, various studies
showed the range of sexual dysfunction prevalence between 0% and 67%.
Sexual dysfunction in patients who took non-SSRI second generation
antidepressants constituted a meta-analytical pooled prevalence of 15%, and
36% in those who took SSRIs. The combined relative risk of sexual
dysfunction in the non-SSRI second generation antidepressant group when
compared with SSRI was 0.57.
Conclusions: The pooled prevalence of sexual
dysfunction in non-SSRI second generation antidepressant is lower than in
SSRI antidepressants.