Factors associated with the appearance of gastrointestinal symptoms in patients with diabetes Even though gastrointestinal symptoms are traditionally associated with patients living with diabetes, the reported prevalence in different population groups varies.15 Distinct factors, in addition to the drugs themselves for managing the disease, can cause gastrointestinal manifestations, making the approach to the patients with diabetes and gastrointestinal symptoms a challenge
the expected effect size is small and the onset is slow - Avoid antidepressants in bipolar depression presenting with subtle increased psychomotor tempo, pressured speech and racing thoughts due to the increased risk of switch and potentially rapid cycling - Consider ETC as a viable option for the treatment of bipolar depression resistant to pharmacological treatment - Never treat with antidepressants without a mood stabiliser - If an antidepressant is added, use mainly SSRIs due to their low switch rate - If an antidepressant is used in maintenance treatment, the occurrence of manic/mixed symptoms should be monitored carefully The above recommendation is consistent with current Danish guidelines for the pharmacological treatment of bipolar disorder [42], which recommend lithium, quetiapine and lamotrigine as first-line agents for bipolar I disorder, current depressive episode, in at least 70% of patients, and for bipolar II disorder, current depressive episode, in at least 60%
Several peripheral and central mechanisms are believed to be involved, including altered gut hormone secretion, decrease in energy expenditure following weight loss, and psychological processes associated with the food reward system
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