Due to the high prevalence of depression and its considerable negative consequences for the lives and health of sufferers, it is necessary to broaden our knowledge of the epidemiology, clinical picture and treatment of the disease among psychiatrists and doctors of other specialties, particularly general practitioners. The awareness of the importance of the issue has inspired the publication this year of the “Guidelines for family doctors concerning the management of depression in adults”, commissioned by the Supreme Medical Chamber. A task force under the guidance of prof. Jerzy Samochowiec included experts in the field of psychiatry (Wiesław Cubała, Dominika Dudek, Janusz Heitzman, Jolanta Kucharska-Mazur, Sławomir Murawiec and Joanna Rymaszewska), a family medicine specialist (Agnieszka Jankowska-Zduńczyk), a methodologist (Małgorzata Bała) and a representative of a patients’ organization (Joanna Chatizow). The guidelines were developed on the basis of the literature on the subject, global treatment standards and the specific character of healthcare organization in Poland as well as the availability of the recommended methods of diagnosis and treatment.
The commentary presents recommendations on pharmacological prevention of depression and treatment of geriatric depression.
The aim of preventive treatment of episodic and chronic migraine is the reduction of the frequency and severity of attacks and thereby the improvement of the patient’s quality of life. It is estimated that 38% of patients with migraine would benefit from preventive treatment, whereas in clinical practice only about 13% of them receive it. The intolerable side effects and low efficacy of pharmacological treatment are the main reasons for the discontinuation of treatment. It is suggested that calcitonin-gene-related-peptide (CGRP) plays a critical role in migraine patophysiology. Despite the fact that the effectiveness of CGRP antagonists in the treatment of migraine has been demonstrated in clinical trials, further research on CGRP antagonists has been suspended due to safety concerns regarding their toxic effects on the liver. In recent decades a new class of drugs has been developed, i.e. monoclonal antibodies against CGRP. To date, four monoclonal antibodies have demonstrated efficacy in phase two and three of clinical trials, significantly reducing the number of migraine days experienced by subjects per month versus the placebo. Moreover, they are effective more quickly than the currently available preventive treatments. Monoclonal antibodies have a favorable safety profile, which is similar to that of the placebo groups. No toxic effects on the liver or negative influences on hemodynamic or laboratory parameters have been reported and the discontinuation rates due to adverse events in patients treated with monoclonal antibodies were low. Despite these advantages, the long-term efficacy and safety of CGRP monoclonal antibodies remains unknown and more studies are needed.
The paper presents the first analytically documented Polish case of suicidal poisoning with lamotrigine – a modern antiepileptic and mood stabilizer the mechanism of action of which is not yet fully known, although its chemical structure is similar to that of phenytoin. The authors examine the data available from the forensic and medical files and toxicological examination of the material conducted at the Department of Forensic Medicine and Forensic Toxicology of the Medical University of Silesia in Katowice. Additionally, the paper discusses the possible mechanisms of action and the most important interactions between lamotrigine and other drugs. The case discussed confirms that lamotrigine can be used as a poison with which to commit suicide, particularly by mentally ill patients who have may have easy access to the drug. The LC-MS method allows for the identification and quantitative analysis of lamotrigine in the post mortem biological material.