2017, volume 33, issue 2

Original article

Assessment of the effectiveness of electroconvulsive therapy in treatment-resistant depression

Miłosz R. Krzywotulski, Anna Bodnar-Czapiewska, Maria Skibińska, Anna Lewandowska, Maria Chłopocka-Woźniak, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (2), 89–109

Objectives. The aim of this study was to evaluate the effectiveness of ECT in treatment-resistant depression and to analyze the clinical, psychological and biochemical factors connected with that efficacy.

Material and methods. The study involved 80 patients treated in a psychiatric ward, with diagnosis of treatment-resistant depression, including 60 women and 20 men, aged 21–82 (mean 54) years, who underwent 6–16 (average 10) ECT treatments. There were 55 patients with bipolar affective disorder, 18 persons with unipolar affective disorder and 7 patients with depressive episode in the study. Clinical evaluation was performed using a 17-item Hamilton Depression Rating Scale.

Results. The average intensity of depression before treatment was 32 (SD = 6) points in this scale. A clinical improvement was defined as a reduction of intensity of depression of at least 50% in HDRS compared to baseline was attained in 56 (70%) patients. Remission, defined as a reduction in the severity of depression to a level of 7 points or less in HDRS score, was achieved in 25 (31%) patients. There was no significant relationship between efficacy (improvement and remission) and gender, age, diagnosis, duration of illness, duration of current episode, psychotic symptoms and prior lithium or venlafaxine treatment. There was worsening of some cognitive functions, including working and semantic memory, observed immediately after the treatment. ECT was more effective in patients with lower baseline BDNF levels and better results of some cognitive tests at the baseline.

Conclusions. These results confirm data from literature indicating that ECT therapy is effective for treatment-resistant depression.

Review article

May side effects be a reason for withdrawing bupropion and varenicline from the market?

Natalia Obsada, Jadwiga T. Zalewska-Kaszubska
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (2), 111–120

Varenicline and bupropion are non-nicotinic drugs approved for treatment of tobacco dependence, but there are post-marketing case reports of suicidality associated with the usage of these drugs. For this reason, Food and Drug Administration and European Medicines Agency decided to add "Boxed Warnings" to product labelling to alert healthcare professionals and patients about possible psychiatric symptoms. Lately, rimonabant, a CB1 receptor antagonist, has been withdrawn from the market because of an increased risk of depression and suicidality. However, concerns about the safety of varenicline and bupropion are mostly based on case reports and currently benefits of smoking cessation are thought to be greater than the risk of psychiatric adverse effects associated with varenicline and bupropion therapy.

Review article

Hypersexuality in patients with Parkinson disease treated with rasagiline

Marcin Kopka
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (2), 121–128

Impulse control disorders are characterised by the failure to resist an impulse or temptation to perform an act that is harmful to the person or to others. One of them is hypersexuality. It is estimated that the incidence of hypersexuality in Parkinson's disease is between 2 and 4%. It is often associated with treatment with dopamine agonist of L-DOPA. In the last four years, first five cases were described published, in which hypersexuality was suggested to be associated with treatment with rasagiline. Rasagiline is an irreversible, selective monoamine oxidase type B inhibitor. It is used in early and advanced Parkinson's disease. Its efficacy was demonstrated in many randomised controlled studies. According to a recommendation of European Federation of Neurological Societies (EFNS), it was assigned an "A" level for symptomatic treatment of Parkinson's disease. Generally, the treatment with rasagiline is well tolerated. Incidence of adverse effects with rasagiline is similar to the treatment with placebo. Symptoms of hypersexuality appeared shortly after adding rasagiline and disappeared shortly after discontinuation of this drug. The above-mentioned time sequence suggests relationship with the treatment. Future studies are needed to confirm the relationship between treatment with rasagiline and hypersexuality.

Original article

Chemoattractants, very small embryonic-like stem cells (VSELs) and pluripotency stem cell markers in bipolar affective disorder

Ewa Ferensztajn-Rochowiak, Barbara Dołęgowska, Marta Budkowska, Michał Michalak, Paweł Mierzejewski, Mariusz Z. Ratajczak, Janusz K. Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (2), 129–141

Objectives. The aim of the present study was the assessment of the levels of sphingosine-1-phosphate (S1P), stromal cell-derived factor 1 (SDF–1) and complement cascade components C3a, C5a, C5b–9 in peripheral blood of patients with bipolar disorder (BD) treated with lithium and without lithium treatment and its relations with very small embryonic-like stem cells (VSELs) and pluripotency markers Oct-4, Sox2, Nanog.

Material and methods. The study comprised 30 patients with bipolar disorder and 15 healthy controls, sex and age matched. Within bipolar group, 15 patients were treated continuously with lithium carbonate for 8–40 years (mean 16 years) and other 15 subjects who hadn't ever received lithium, with illness duration of minimum 10 years. S1P measurement was performed using reversed phase high-performance liquid chromatography. SDF-1 and C5a, C5a, C5b–9 was evaluated using ELISA kits. The assessment of VSELs was performed using flow cytometric analysis and evaluation of pluripotency markers (Oct-4, Sox2, Nanog) was performed using the Real-time quantitative reverse transcription PCR (RQ-PCR) procedure.

Results. There were no differences between groups ac- cording to S1P, SDF-1, C3a, C5a and C5b–9 levels. In the BD group never treated with lithium, negative correlation was observed between complement component C5a and the number of CD34+VSELs, the number of CD133+ VSELs and % of CD133+VSELs, as well as with pluripotency markers Oct-4, Sox2 and Nanog. In patients treated continuously with lithium and the control group, no correlation was noticed between C5a and CD133+ VSELs and pluripotency markers.

Conclusions. The obtained results show significant relation between complement component C5a and VSELs and pluripotency markers in BD group never treated with lithium.

Letter to the Editor

Critical remarks to Agnieszka Piróg-Balcerzak’s, Bogusław Habrat’s, Paweł Mierzejewski’s. Niewłaściwe używanie i nadużywanie kwetiapiny. Psychiatria Polska 2015; 49 (1): 81–93

Marek Zielinski, Piotr Sobol-Kołodziejczyk
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (2), 143–147

Summary of the article of Agnieszka Piróg-Balcerzak, Bogusław Habrat, Paweł Mierzejewski. Niewłaściwe używanie i nadużywanie kwetiapiny [Misuse and abuse of quetiapine]. Psychiatria Polska 2015; 49 (1): 81–93: Quetiapine (quetiapinum) is an atypical antipsychotic commonly used in psychiatry, often for symptomatic treatment of a number of mental disorders. One of the reasons for using it is the alleviation of clinical symptoms caused by the use of various psychoactive substances. The article shows and discusses reports on misuse of quetiapine, its abuse, and even psychiatric addiction as symptoms similar to those of what is known as the discontinuation syndrome, often related to withdrawal syndrome occurring with addictions. Most of the cited reports concern men – in particular those with a history of addiction to other psychoactive substances, with personality disorders or those who are in conflict with the law. Therefore, clinicians should be alert when they prescribe quetiapine to such patients. The article discusses potential mechanisms responsible for quetiapine abuse, which is most probably related to sedative and anxiolytic activity, that results in stimulation. Thus, the similarity to the H1 receptor and antihistamine agents results in satisfying action (cf. p. 81).