Objectives. The efficacy of pharmacotherapy augmentation by total sleep deprivation (TSD) with sleep phase advance (SPA) was evaluated in patients with treatment-resistant depression (TRD). The study examined the relationship between chronotype, affective temperaments and clinical improvement resulting from the treatment.
Material and methods. The study group comprised of 30 persons with treatment-resistant unipolar (n = 15) or bipolar (n = 15) depression aged 52 ± 12 years (17 women and 13 men). TSD and three consecutive nights with SPA were used during pharmacotherapy. Severity of depression was determined using the Hamilton Depression Rating Scale (HDRS). All patients were assessed using the Composite Scale of Morningness (CSM) and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A).
Results. Clinical response, defined as a reduction in the severity of depression by ≥ 50% in HDRS compared to the baseline score, lasting until the end of the study (14 days), was obtained in 16 out of 30 patients with TRD. There was found no significant correlation between clinical improvement, chronotype and affective temperaments.
Conclusions. TSD with SPA proved to be an effective method of pharmacotherapy augmentation in over half of the patients with TRD. The relationship between chronotype, affective temperaments and the clinical response to chronotherapy of depression requires further research.
Aim. Circadian Rhythm Sleep-Wake Disorders (CRSWD) are a common group of sleep disorders. The aim of this article is to present the principles for treatment of CRSWD with melatonin.
Methods. Review of data from randomised, placebo-controlled clinical trials.
Results. The main indication for the use of melatonin is a treatment of Delayed Sleep-Wake Phase Disorder (DSWPD). Melatonin is also recommended for the treatment of Irregular Sleep-Wake Rhythm Disorder and Non-24-Hour Sleep-Wake Rhythm Disorder. However, in the treatment of Advanced Sleep-Wake Phase Disorder melatonin plays a secondary role. The therapeutic effect of melatonin primarily depends on the appropriate time of its administration. In DSWPD it should be administered even 6–8 hours before the scheduled sleep time. The available data does not indicate that the melatonin’s therapeutic effect is strongly correlated with the used dose and the recommended doses fall within a wide range of 0.5 to 10 mg. However, usually higher doses, e.g. 5 mg, are beneficial in the first 3–6 weeks of treatment. In neuropsychiatric disorders in children, dosage even up to 10 mg is recommended. Melatonin is also an effective form for relieving symptoms of exogenous CRSWD: shift work disorder and jet lag disorder. Prolonged-release formulation of melatonin in a 2 mg dose is registered for the treatment of insomnia patients aged 55 years and older.
Conclusions. Treatment of CRSWD is based primarily on chronotherapeutic interventions. They include phototherapy, light avoidance, melatonin treatment and behavioural interventions that influence, among other things, the rhythm of meals, physical and social activity.
Pharmacovigilance is an important aspect of depression treatment, considering that 40–90% of patients experience side effects of antidepressant use. This paper discusses the issues of optimising the use of venlafaxine, including its pharmacodynamic and pharmacokinetic properties, indications, adverse effects and risk factors for their occurrence, such as co-morbidities or genetic polymorphisms and interactions with other drugs.
The article presents the report of the 6th School of Child and Adolescent Neuropsychopharmacology which took place in Venice (8th–13th April 2018). The authors discuss the structure and content of the course and also summarise a number of topics discussed during the course.
This article is a report from a workshop on clinical research methods organised by the European College of Neuropsychopharmacology (ECNP), which took place between 7 and 9 November 2018 in Barcelona. The programme of the workshops and an outline of the content of the speeches were presented here. The author made an effort to synthetically present issues concerning methods used in clinical research design, analysis of published results and creation of scientific publications, which were discussed during the workshop.