Archives

Therapeutic monitoring of depression is a method aiming at the optimalization of pharmacotherapy, serving to enlarge the efficacy and safety of pharmacotherapy in an individual case of illness. The application of modern monitoring techniques, such as: precise clinical assessment, determination of tricyclic antidepressant (TCA) concentration in blood or assessment of phenotype of hydroxylation enable the optimalization of therapy focused on a specific patient. On the example of therapy applied to 32 patients treated with TCA in major depression, a trial was taken up to analyse the obtained results, considering the eventual prognostic factors.

The purpose of this study was to evaluate the efficacy of potentiation of antidepressants with lithium or carbamazepine in the treatment-resistant depression, and to assess the influence of these agents on endocrine parameters and adenosine triphosphatase activity. Variables associated with good outcome were also ana1ysed. Fifty nine patients with treatment-resistant depression were randomly allocated to addition of either lithium or carbamazepine to ongoing treatment. Efficacy of both strategies was similar in the group of treatment-resistant patients. In the lithium group, decrease in cortisol level in responders and increase in nonresponders were observed. These observations may suggest regulatory influence of lithium on the hypothalamus-pituitary-adrenal (HPA) axis activity in patients with good results of lithium potentiation. CBZ responders had significantly lower baseline severity of depression than CBZ nonresponders. Clinical improvement correlated significantly with increase in adenosine triphosphatase activity in that group.

One hundred and forty psychiatrists took part in the multicenter c1inical study of efficacy and tolerability of tianeptine, carried out in Poland in 1996-1998. The study was performed on 566 patients (160 male and 406 female) with depression in the course of affective illness, not treatment-resistant (major depressive disorder, single episode – 205 patients, major depressive dis order, recurrent – 345 patients, bipolar disorder – 16 patients; diagnoses according to DSM-IV). The mean baseline intensity of depression as measured on 17-item Hamilton Depression Rating Scale (HAMD) was 25.8 points. Six-week out-patient treatment with tianeptine brought about a significant improvement (50% or more reduction on HAMD) in 2/3 of patients and more than 40% of patients achieved a clinical remission (8 points or less in HAMD). The mean final score of depression in HAMD in 508 patients who completed the study was 10.5 points. Among patients who completed the study, a significant improvement was more frequently observed in women compared to men (73%, vs 63%; p < 0.05) and in patients with first depressive episode compared with recurrent episode (76% vs 67%; p < 0.05). The criteria of improvement were more frequently met by patients with moderate or severe depression compared to mild depression, both in those included in the study (68% vs 56.5%; p < 0.01) and in patients who completed the study (75% vs 64.7%; p< 0.01). The efficacy of tianeptine was similar in patients concomitantly treated for somatic illnesses as in whole group. The treatment was not completed in 58 patients (10.2%), more frequently in women (12.5%) than in men (5%) (p < 0.01). In 11 patients (1.9%) the interruption of therapy was due to serious adverse events and side effects. The percentage of patients experiencing any side effects was decreasing in the course of therapy from 18% to 9%. Treatment with tianeptine did not result in any significant laboratory abnormalities nor in changes of vital parameters. Subjective assessment of the tolerability of the drug and of the satisfaction with treatment was good and was similar in older patients and in patients with somatic illnesses as in the whole group. Authors conc1ude that in the outpatient treatment of depression in the course of affective disorders, tianeptine is an effective antidepressant drug, with excellent tolerability demonstrated also by patients in older age and patients with concomitant somatic illnesses.

Our study aims to assess the weight changes during the treatment of depressive patients with SSRI’s. We studied 150 depressive patients during 6-8 weeks of treatment. It was no significant weight changes during treatment with fluoxetine, fluvoxamine, paroxetine and sertraline. Only several depressive patients with obesity and overweight showed a significant weight loss during the SSRI’s treatment. This problem needs further investigation.

Fourteen patients with major depression (according to the DSM-IV criteria) who were treated with paroxetine (20-50 mg) took part in the trial. We evaluated their mental status and took their digital EEG before treatment, after 14, 28 and 42 days of treatment. Frequency analysis of 120 second long periods by the use of FFT was performed. There was neither relationship between dosage of paroxetine and changes in EEG nor between score of Hamilton Depression Rating Scale and EEG changes during the performance of the trial. However we found that after 6 weeks of treatment β1 and β2 activity rose with the statistical significance. We also noticed that rising of β2 activity in the fourth week of treatment may predict a good final effect of the paroxetine therapy.

The aim of our work was the estimation of therapeutic efficacy, as wen as tolerability of two new generation antidepressants with various mechanisms of pharmacological action in elderly patients with depression.
Sixty patients over 60 who met diagnostic criteria for depression in the course or unipolar or bipolar affective illness according DSM-IV criteria, hospitalised at Department of Adult Psychiatry were inc1uded in the study. Forty four patients had also various somatic illnesses (e.g. hypertension, diabetes), requiring separate treatment.
30 patients were treated with fluvoxamine, a selective serotonin reuptake inhibitor in dose 150-300 mg daily and 30 patients received tianeptine, drug which enhances serotonin reuptake and regulates hypothalamic-pituitary-adrenal axis, in dose 37.5 mg daily, for 6 weeks. The evaluation of c1inical state was made using the Hamilton Depression Rating Seale (HAMD) and Clinical Global Impression (CGI) scale before treatment and after 3 and 6 weeks of therapy. The assessment of somatic status and laboratory tests were done on the same days.
The mean pretreatment HAMD score was similar for both groups, on the average 24 points. After 6 weeks of therapy a marked improvement (50% reduction of HAMD score) was observed in 20 patients (70%) in the fluvoxamine group and in 15 persons (50%) who received tianeptine. Both drugs were wen tolerated by patients. 9 patients who were treated with fluvoxamine reported transient nausea, somnolence and headaches. In the tianeptine group, only 4 patients had similar symptoms 3 weeks of therapy. In both groups any abnorma1ities in laboratory tests and circulatory system or the worsening of concomitant somatic conditions were not noted.
Our study confirmed reports of other authors concerning the effectiveness and safety of fluvoxamine and tianeptine in elderly patients with depression.

The aim of this research was to assess the efficacy of treatment with antidepressants on patients diagnosed as suffered from alcoholic dependency syndrome and depression. All the people tested fulfilled requirements of ICD-l0 criteria of alcoholic dependency and relapsible depressive disturbances. During the treatment of depressive disturbances the following drugs had been used: fluoxetine, myanserine, clomipramine. The efficacy of treatment was measured by HDRS on 7th, 14th, 28th and 42nd day of cure. Distinct mental condition improvement including recovery from depression in 40% of cases had been gained.