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Wålinder, Jan
Publications (9 of 9) Show all publications
Wålinder, J., Prochazka, J., Odén, A., Sjödin, I., Dahl, M., Ahlner, J. & Bengtsson, F. (2006). Mirtazapine naturalistic depression study (in Sweden) - MINDS(S): Clinical efficacy and safety. Human Psychopharmacology: Clinical and Experimental, 21(3), 151-158
Open this publication in new window or tab >>Mirtazapine naturalistic depression study (in Sweden) - MINDS(S): Clinical efficacy and safety
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2006 (English)In: Human Psychopharmacology: Clinical and Experimental, ISSN 0885-6222, E-ISSN 1099-1077, Vol. 21, no 3, p. 151-158Article in journal (Refereed) Published
Abstract [en]

Objective: To study how implementation of a naturalistic trial design for mirtazapine treatment in major depressive disorder for six (up to 12) months could be used and evaluated by means of clinical efficacy and safety. Method: An open-labelled, prospective, multicenter, non-comparative trial was conducted during a 2-year period in patients with major depression according to DSM-IV treated in psychiatric departments and primary care in Sweden. Minimal inclusion and exclusion criteria were used in order to diminish the potential patient selection bias. Maximum flexibility of the dosage of mirtazapine was allowed, and clinical assessments included MADRS, CGI, vital signs and spontaneous reporting of adverse events. Results: 192 patients were found eligible and enrolled in the study. A significant improvement in depressive symptoms according to MADRS and CGI was observed including particularly marked sleep improvement early in the treatment. Slight increases in body weight and BMI were observed. The investigational drug was well tolerated overall. Conclusion: The clinical efficacy and safety of mirtazapine found in this naturalistic setting is in line with previously reported data on mirtazapine in traditional controlled clinical trials. The results confirm that the naturalistic study design facilitated conduct of the trial. The authors suggest that this type of study design should also be applied to other antidepressant drugs that are frequently prescribed in the general population. Copyright © 2006 John Wiley & Sons, Ltd.

Keywords
mirtazapine, selection bias, naturalistic study design, major depression
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-33834 (URN)10.1002/hup.753 (DOI)19904 (Local ID)19904 (Archive number)19904 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
Reis, M., Olsson, G., Carlsson, B., Lundmark, J., Dahl, M.-L., Wålinder, J., . . . Bengtsson, F. (2002). Serum levels of citalopram and its main metabolites in adolescent patients treated in a naturalistic clinical setting. Journal of Clinical Psychopharmacology, 22(4), 406-413
Open this publication in new window or tab >>Serum levels of citalopram and its main metabolites in adolescent patients treated in a naturalistic clinical setting
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2002 (English)In: Journal of Clinical Psychopharmacology, ISSN 0271-0749, E-ISSN 1533-712X, Vol. 22, no 4, p. 406-413Article in journal (Refereed) Published
Abstract [en]

The prescribing of selective serotonin reuptake inhibitors for adolescents is extensive despite the fact that there are few pharmacokinetic (PK), effi]cacy, safety, or tolerability studies on this group. This study reports the PK findings from two trials in adolescents treated with citalopram (CIT) in naturalistic clinical settings: one retrospective and one prospective. The aim of our study was to describe serum concentrations of CIT, desmethylcitalopram (DCIT), and didesmethylcitalopram (DDCIT) (trough values in steady state) in adolescents in relation to daily dose and clinical information obtained from therapeutic drug monitoring request forms. Altogether, 44 patients younger than 21 years were scrutinized using this combined open-label approach. The main findings were that (1) there was a pronounced interindividual variability of serum CIT, DCIT, and DDCIT concentrations in all doses prescribed, in agreement with previous studies on adults; on correcting for dose, the coefficient of variance was about 50% for CIT, DCIT, and DDCIT; (2) the transformation of CIT to DCIT and of DCIT to DDCIT was similar within the dose range 20 to 60 mg/day; (3) there was a difference between the sexes on comparing the dose-corrected concentrations of CIT and DCIT, with girls presenting significantly higher values than boys; and (4) there was a strong dose-serum concentration relationship in three identified subgroups of adolescents: (a) nonsmokers (CIT, r 2 = 0.71; DCIT, r 2 = 0.81), (b) girls not taking oral contraceptives (CIT, r 2 = 0.75; DCIT, r 2 = 0.71,), and (c) girls in the last 14 days of the menstrual cycle (CIT, r 2 = 0.68; DCIT, r 2 = 0.64). In summary, the present study tentatively supports influences of sex, oral contraceptives, and smoking habits on the disposition of CIT in younger patients. Hence, future studies on CIT should assess these parameters.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26736 (URN)10.1097/00004714-200208000-00012 (DOI)11331 (Local ID)11331 (Archive number)11331 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
Carlsson, B., Olsson, G., Reis, M., Wålinder, J., Nordin, C., Lundmark, J., . . . Ahlner, J. (2001). Enantioselective Analysis of Citalopram and Metabolites in Adolescents. Therapeutic drug monitoring, 23(6), 658-664
Open this publication in new window or tab >>Enantioselective Analysis of Citalopram and Metabolites in Adolescents
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2001 (English)In: Therapeutic drug monitoring, ISSN 0163-4356, Vol. 23, no 6, p. 658-664Article in journal (Refereed) Published
Abstract [en]

Studies of the antidepressant effect and pharmacokinetics of citalopram have been performed in adults, but the effects on children and adolescents have only been studied to a minor extent despite its increasing use in these age groups. The aim of this study was to investigate a group of adolescents treated for depression, with respect to the steady-state plasma concentrations of the enantiomers of citalopram and its demethylated metabolites desmethylcitalopram and didesmethylcitalopram. Moreover, the authors studied the genotypes for the polymorphic cytochrome P450 enzymes CYP2D6 and CYP2C19 in relation to the different enantiomers. The S/R ratios of citalopram and desmethylcitalopram found in this study of 19 adolescents were similar to studies involving older patients. The concentrations of the R-(-)- and S-(+)-enantiomers of citalopram and desmethylcitalopram were also in agreement with values from earlier studies, the R-(-)-enantiomer (distomer) being the major enantiomer. The results indicate that the use of oral contraceptives may have some influence on the metabolism of citalopram. This might be because of an interaction of the contraceptive hormones with the CYP2C19 enzyme.

Keywords
Citalopram; Enantiomer; Genotypes; Adolescent
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13691 (URN)10.1097/00007691-200112000-00011 (DOI)
Available from: 2003-06-20 Created: 2003-06-20 Last updated: 2013-10-28
Lundmark, J., Bengtsson, F., Nordin, C., Reis, M. & Wålinder, J. (2000). Therapeutic drug monitoring of selective serotonin reuptake inhibitors influences clinical dosing strategies and reduces drug costs in depressed elderly patients. Acta Psychiatrica Scandinavica, 101(5), 354-359
Open this publication in new window or tab >>Therapeutic drug monitoring of selective serotonin reuptake inhibitors influences clinical dosing strategies and reduces drug costs in depressed elderly patients
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2000 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 101, no 5, p. 354-359Article in journal (Refereed) Published
Abstract [en]

Objective: This study was initiated in order to describe and evaluate the effects of a therapeutic drug monitoring (TDM) routine of selective serotonin reuptake inhibitors (SSRIs) on treatment strategies and drug costs in depressed elderly patients.

Method: Blood samples were drawn from elderly depressed patients and analysed for steady-state trough serum concentrations of citalopram (n=48), paroxetine (n=48) or sertraline (n=39). A global efficacy evaluation was made at baseline and after 6–9 months. Antidepressant drug costs before and after TDM were estimated.

Results: Eight samples were excluded due to technical problems or non-compliance. In 65 of the 127 (51.2%) remaining cases, the treatment strategy was changed according to the TDM outcome, in most a reduction of the prescribed dose. Bioanalytical TDM costs included the antidepressant drug costs after TDM were reduced by 10.2%.

Conclusion: The results support the utility of TDM in the search for the individual minimum effective SSRI dose in the elderly.

Keywords
antidepressants, serotonin uptake inhibitors, pharmacokinetics, pharmaceutical economics, depression
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27667 (URN)10.1034/j.1600-0447.2000.101005354.x (DOI)12405 (Local ID)12405 (Archive number)12405 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
Jonsson, D. & Wålinder, J. (1995). Cost-effectiveness of clozapine treatment in therapy-refractory schizophrenia. Acta Psychiatrica Scandinavica, 92(3), 199-201
Open this publication in new window or tab >>Cost-effectiveness of clozapine treatment in therapy-refractory schizophrenia
1995 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 92, no 3, p. 199-201Article in journal (Refereed) Published
Abstract [en]

The costs and effects of clozapine treatment of refractory schizophrenic patients have been discussed recently. This study shows that 18 months of clozapine treatment results in an improvement of symptoms and social functioning in approximately 70% of treatment-refractory schizophrenic patients, compared with treatment with conventional neuroleptics during a similar period of time. Treatment with clozapine reduces the cost of inpatient care but places increased demands on active rehabilitation resources in outpatient care. This leads to increased total costs in a short-term perspective, but clozapine treatment is cost-saving for annual maintenance therapy. These costs must be weighed against the positive effects on psychotic symptoms and social functioning.

Keywords
schizophrenia, clozapine, cost-effectiveness
National Category
Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-79065 (URN)10.1111/j.1600-0447.1995.tb09568.x (DOI)
Available from: 2012-06-28 Created: 2012-06-28 Last updated: 2018-01-12Bibliographically approved
Fall, P.-A., Ekman, R., Granérus, A.-K., Thorell, L.-H. & Wålinder, J. (1995). ECT in Parkinson's disease: Changes in motor symptoms, monoamine metabolites and neuropeptides. Journal of Neural Transmission. Parkinson's disease and dementia section., 10(2-3), 129-140
Open this publication in new window or tab >>ECT in Parkinson's disease: Changes in motor symptoms, monoamine metabolites and neuropeptides
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1995 (English)In: Journal of Neural Transmission. Parkinson's disease and dementia section., ISSN 0936-3076, Vol. 10, no 2-3, p. 129-140Article in journal (Refereed) Published
Abstract [en]

Electroconvulsive therapy (ECT) was given to 16 non-depressed, non-demented patients with advanced Parkinson's disease (PD). In all the patients an antiparkinsonian effect was seen, lasting for 18 months in one patient, 3-5 months in seven patients, and a few days to four weeks in eight patients. After ECT the levels of homovanillic acid and neuropeptide Y in cerebrospinal fluid (CSF) were significantly increased. The eight patients with long lasting motor improvement after ECT had significantly lower CSF-3-methoxy-4-hydroxyphenylglycol compared to the group with short lasting improvement. Five patients developed transitory mental confusion after ECT. In these patients, and in no others, a high albumin-ratio was found already before ECT was given - an indication of blood CSF barrier damage. Our results suggest that ECT is valuable in patients with drug refractory PD or PD with intolerance to antiparkinsonian drugs.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13532 (URN)
Available from: 1999-05-28 Created: 1999-05-28 Last updated: 2009-08-18
Lundmark, J., Wålinder, J., Alling, C., Manniche, P. M. & Dalgaard, L. (1994). The effect of paroxetine on cerebrospinal fluid concentrations of neurotransmitter metabolites in depressed patients. European Neuropsychopharmacology, 4(1), 1-6
Open this publication in new window or tab >>The effect of paroxetine on cerebrospinal fluid concentrations of neurotransmitter metabolites in depressed patients
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1994 (English)In: European Neuropsychopharmacology, ISSN 0924-977X, E-ISSN 1873-7862, Vol. 4, no 1, p. 1-6Article in journal (Refereed) Published
Abstract [en]

This paper describes the effect of the selective serotonin reuptake inhibiting drug (SSRI), paroxetine, on cerebrospinal fluid concentrations of neurotransmitter metabolites in depressed patients. 5-Hydroxyindoleacetic acid (5-HIAA), 3-methoxy-4-hydroxyphenylglycol (MHPG) and homovanillic acid (HVA) were measured at baseline and after 3 weeks of treatment with 30 mg paroxetine daily. In line with similar studies on other SSRIs, influence on both the serotonin and noradrenaline metabolite was found. The mechanism behind the action of paroxetine on both 5-HIAA and MHPG is assumed to be an expression of the linkage between the serotonergic and noradrenergic systems in the brain. A frequently reported correlation between 5-HIAA and HVA was also found. The analysis of paroxetine in CSF proves the transportation of the drug into the central nervous system.

Keywords
Cerebrospinal fluid, Serotonin, Selective serotonin reuptake inhibitors, Paroxetine, Major depression
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79926 (URN)10.1016/0924-977X(94)90308-5 (DOI)7515737 (PubMedID)
Available from: 2012-08-15 Created: 2012-08-15 Last updated: 2017-12-07Bibliographically approved
Jonsson, D. & Wålinder, J. (1994). The socioeconomic cost of treatment of therapy-refractory schizophrenic patients in Sweden. Nordic Journal of Psychiatry, 48(5), 311-313
Open this publication in new window or tab >>The socioeconomic cost of treatment of therapy-refractory schizophrenic patients in Sweden
1994 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 48, no 5, p. 311-313Article in journal (Refereed) Published
Abstract [en]

The aim of the study is to examine the socioeconomic costs of treatment of therapy-refractory schizophrenic patients. The patients usually have a great need for health care and remain in institutions for long periods of time. The method is retrospective, and the data refer to patients who received treatment at the Department of Psychiatry, University Hospital in Linköping, Sweden in 1990. The total annual health care cost for treatment of therapy-refractory schizophrenia is estimated to be SEK 4.8 million (USD 1 = SEK 7.7). Inpatient care amounts to 93% of the total cost, and the cost of outpatient care to 6%. The cost of drugs and laboratory services corresponds to 1 % of the total cost. The high cost of inpatient care and the low cost of outpatient care may indicate that a redistribution of resources from inpatient to outpatient care is necessary. A generalization of the results indicates that the total annual cost of treating all therapy-refractory schizophrenic patients in Sweden is approximately SEK 1.9 billion. The result highlights the need for discussions concerning alternative treatment methods but also focuses on the importance of using health economic evaluations within psychiatry.

National Category
Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-79060 (URN)10.3109/08039489409081366 (DOI)
Available from: 2012-06-28 Created: 2012-06-28 Last updated: 2018-01-12Bibliographically approved
Lundmark, J., Scheel Thomsen, I., Fjord-Larsen, T., Manniche, P. M., Mengel, H., Møller-Nielsen, E. M., . . . Wålinder, J. (1989). Paroxetine: pharmacokinetic and antidepressant effect in the elderly. Acta Psychiatrica Scandinavica, 80(S350), 76-80
Open this publication in new window or tab >>Paroxetine: pharmacokinetic and antidepressant effect in the elderly
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1989 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 80, no S350, p. 76-80Article in journal (Refereed) Published
Abstract [en]

To evaluate the pharmacokinetic properties, efficacy, and tolerability of paroxetine in elderly depressed patients, a clinical study was set up - initially at Aalborg Psychiatric Hospital in Denmark, and subsequently at the University Hospital in Linköping, Sweden. A total of 21 patients with a median age of 72 years were included in the study. After a single dose of 20 or 30mg of paroxetine followed by two drug-free days, treatment continued with 20 or 30mg daily for seven weeks. The majority of patients showed a continuous reduction in their HAMD scores, starting in the second week of treatment. Paroxetine was well tolerated at the doses given, and side-effects were mostly mild and transient. Steady-state, pre-dose plasma levels of paroxetine showed considerable variability, and the median steady-state concentration was higher in elderly patients compared with data from a previous study in young volunteers. Elimination half-lives also showed variability between these elderly patients, but tended to be longer after cessation of multiple dosing than after a single dose. They also tended to be longer than in the young volunteers. The results of this study do not advocate reduced doses of paroxetine in the elderly, but further studies are warranted.

Keywords
elderly patients, depression, 5-HT uptake inhibitors, paroxetine, efficacy, tolerability, pharmacokinetics
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79925 (URN)10.1111/j.1600-0447.1989.tb07177.x (DOI)
Available from: 2012-08-15 Created: 2012-08-15 Last updated: 2017-12-07Bibliographically approved
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