Introduction: Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic load is identified by the use of biomarkers and clinical criteria. Objective: To summarize the current knowledge on allostatic load and overload and its clinical implications based on a systematic review of the literature. Methods: PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to December 2019. A manual search of the literature was also performed, and reference lists of the retrieved articles were examined.We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical adult populations. Results: A total of 267 original investigations were included. They encompassed general population studies, as well as clinical studies on consequences of allostatic load/overload on both physical and mental health across a variety of settings. Conclusions: The findings indicate that allostatic load and overload are associated with poorer health outcomes. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. An integrated approach that includes both biological markers and clinimetric criteria is recommended.

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Allostatic Load and Its Impact on Health: A Systematic Review

A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based?

Studies on psychotropic medications decrease, discontinuation, or switch have uncovered withdrawal syndromes. The present overview aimed at analyzing the literature to illustrate withdrawal after decrease, discontinuation, or switch of psychotropic medications based on the drug class (i.e., benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonists, antidepressants, ketamine, antipsychotics, lithium, mood stabilizers) according to the diagnostic criteria of Chouinard and Chouinard [Psychother Psychosom. 2015;84(2):63-71], which encompass new withdrawal symptoms, rebound symptoms, and persistent post-withdrawal disorders. All these drugs may induce withdrawal syndromes and rebound upon discontinuation, even with slow tapering. However, only selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, and antipsychotics were consistently also associated with persistent post-withdrawal disorders and potential high severity of symptoms, including alterations of clinical course, whereas the distress associated with benzodiazepines discontinuation appears to be short-lived. As a result, the common belief that benzodiazepines should be substituted by medications that cause less dependence such as antidepressants and antipsychotics runs counter the available literature. Ketamine, and probably its derivatives, may be classified as at high risk for dependence and addiction. Because of the lag phase that has taken place between the introduction of a drug into the market and the description of withdrawal symptoms, caution is needed with the use of newer antidepressants and antipsychotics. Within medication classes, alprazolam, lorazepam, triazolam, paroxetine, venlafaxine, fluphenazine, perphenazine, clozapine, and quetiapine are more likely to induce withdrawal. The likelihood of withdrawal manifestations that may be severe and persistent should thus be taken into account in clinical practice and also in children and adolescents.

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Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications

In light of the current coronavirus disease 2019 (COVID-19) pandemic and potential future infectious disease outbreaks, a comprehensive understanding of the negative effects of epidemics and pandemics on healthcare workers' mental health could inform appropriate support interventions Thus, we aimed to synthesize and quantify the psychological and psychosomatic symptoms among frontline medical staff We searched four databases up to March 19, 2020 and additional literature, with daily search alerts set up until October 26, 2020 Studies reporting psychological and/or psychosomatic symptoms of healthcare workers caring for patients with severe acute respiratory syndrome, H1N1, Ebola, Middle East respiratory syndrome, or COVID-19 were eligible for inclusion Two reviewers independently conducted the search, study selection, quality appraisal, data extraction, and synthesis and involved a third reviewer in case of disagreement We used random effects modeling to estimate the overall prevalence rates of psychological/psychosomatic symptoms and the I2 statistic We included 86 studies, reporting data from 75,991 participants Frontline staff showed a wide range of symptoms, including concern about transmitting the virus to the family (6039%, 95% CI 4253-7696), perceived stress (5677%, 95% CI 3421-7795), concerns about own health (4597%, 95% CI 3108-6123), sleeping difficulties (3988%, 95% CI 2770-5272), burnout (3181%, 95% CI 1332-5389), symptoms of depression (2572%, 95% CI 1834-3386), symptoms of anxiety (2536%, 95% CI 1790-3364), symptoms of posttraumatic stress disorder (2451%, 95% CI 1816-3146), mental health issues (2311%, 95% CI 1598-3110), and symptoms of somatization (1468%, 95% CI 1067-1918) We found consistent evidence for the pervasive and profound impact of large-scale outbreaks on the mental health of frontline healthcare workers As the CO-VID-19 crisis continues to unfold, guaranteeing easy access to support structures for the entire healthcare workforce is vitally important

What We Have Learned from Two Decades of Epidemics and Pandemics: A Systematic Review and Meta-Analysis of the Psychological Burden of Frontline Healthcare Workers.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20698

The pursuit of euthymia.

Background: Serotonin-noradrenaline reuptake inhibitors (SNRI) are widely used in medical practice Their discontinuation has been associated with a wide range of symptoms The aim of this paper is to identify the occurrence, frequency, and features of withdrawal symptoms after SNRI discontinuation Methods: PRISMA guidelines were followed to conduct a systematic review Electronic databases included PubMed, the Cochrane Library, Web of Science, and MEDLINE from the inception of each database to June 2017 Titles, abstracts, and topics were searched using a combination of the following terms: “duloxetine” OR “venlafaxine” OR “desvenlafaxine” OR “milnacipran” OR “levomilnacipran” OR “SNRI” OR “second generation antidepressant” OR “serotonin norepinephrine reuptake inhibitor” AND “discontinuation” OR “withdrawal” OR “rebound” Only published trials in the English language were included Results: Sixty-one reports met the criteria for inclusion There were 22 double-blind randomized controlled trials, 6 studies where patients were treated in an open fashion and then randomized to a double-blind controlled phase, 8 open trials, 1 prospective naturalistic study, 1 retrospective study, and 23 case reports Withdrawal symptoms occurred after discontinuation of any type of SNRI The prevalence of withdrawal symptoms varied across reports and appeared to be higher with venlafaxine Symptoms typically ensued within a few days from discontinuation and lasted a few weeks, also with gradual tapering Late onset and/or a longer persistence of disturbances occurred as well Conclusions: Clinicians need to add SNRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with other types of psychotropic drugs The results of this study challenge the use of SNRI as first-line treatment for mood and anxiety disorders

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Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review.

Allostatic overload in patients with essential hypertension.

The building of life stress, well expressed by the concept of allostatic load, plays an important part in all phases of endocrine illness. Allostatic load refers to the cumulative burden of both stressful life events and chronic stress. When environmental challenges exceed the individual ability to cope, allostatic overload ensues. Assessment of allostatic load/overload by clinical measurements including indices and rating scales, in addition to biomarkers, offers a characterization of the person’s psychosocial environment that is missing from current formulations. Consideration of allostatic load in endocrinology may shed light on a number of clinical issues: interpretation of abnormal hormone values that lack explanations; coping with the various phases of illness; maladaptive illness behavior; response to treatment; presence of residual symptoms; health-damaging lifestyle habits. Addressing allostatic load calls for innovative models of endocrine outpatients with multidisciplinary organization of care, extended time for the interview, focus on rehabilitation. We provide an overview on the mechanisms of allostatic load, how it can be assessed, its potential role in endocrine disturbances, and how its consideration may lead to a needed innovation in patient care.

Marcella Lucente

Papers

Allostatic Load and Its Impact on Health: A Systematic Review

Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review.

Allostatic overload in patients with essential hypertension.

Allostatic Load and Endocrine Disorders