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The present trial informs clinicians about switching conditions with the antidepressant agomelatine after the failure of a treatment with either paroxetine or venlafaxine.
The total number of discontinuation-emergent symptoms, according to the Discontinuation-Emergent Signs and Symptoms checklist, was compared in double-blind conditions after 3 switching options: immediate substitution or initiation of agomelatine (25 mg/day p.o.) with either a short- or long-tapering of the previous drug. Secondary objectives included tolerability and safety assessments and the early clinical benefit after the switch.
For all switching options, a withdrawal syndrome was observed 1 week after cessation of the selective serotonin reuptake inhibitor (SSRI)/serotonin–norepinephrine reuptake inhibitor (SNRI) treatment. Psychic symptoms were the most frequently reported, and somatic symptoms were comparatively few. Early discontinuation symptoms after cessation of SSRI/SNRI treatment did not prejudice the antidepressant benefits of agomelatine over 8 weeks.
Both abrupt and start–taper switching with agomelatine are options in everyday practice for those patients who have not responded to either paroxetine or venlafaxine. However, regardless of the switching strategy, the present double-blind study shows that early discontinuation symptoms that arise upon cessation of SSRI/SNRI can alter the patients’ perception of the clinical benefit of the new antidepressant. Both practitioners and patients must be warned about these early discontinuation symptoms to prevent the symptoms from being confounded with a lack of therapeutic benefit of the new treatment.
This chapter discusses the cumulative effect of oral parafunctions (OPFs) on the health of a patient's natural dentition, dental restorations, oral soft structures, and temporomandibular joints (TMJs). Nail biting and other OPFs are common in young children. Consequently, unmanaged parafunctional habits may contribute to the etiology of trauma in the stomatognathic systems of adolescents and adults. Prevention, early detection, and intervention are important clinical activities to diminish the influences of chronic OPFs on the teeth, muscles, and temporomandibular joints. The dentist can assist in detecting OPFs, protecting vulnerable oral and TMJ structures, and making appropriate referrals. Although occlusal splints can protect the oral structures from wear, they have little effect on parafunctional habits. Growing evidence suggests that psychological interventions to address factors contributing to the maintenance of these adverse habits can assist patients in overcoming them.