2006, volume 22, issue 3-4

Original article

Serum zinc as a peripheral marker of depression

Marcin Siwek, Dominika Dudek, Andrzej Zięba, Gabriel Nowak
Farmakoterapia w Psychiatrii i Neurologii, 2006, 3–4, 141–149

Background: a growing body of evidence (including clinical investigations) suggests that the alterations of blood zinc level could be a potential marker of depression.
Aim of the study: to assess if the serum zinc is a state or trait marker of depression and drug resistance.
Methods: a group of thirty, 18–55-year old, unipolar depressed patients fulfilling the ICD-10 criteria for a moderate or severe depressive episode without psychotic symptoms was recruited. After a one week washout period patients were treated with imipramine (100–200 mg daily) for 12 weeks. Serum zinc level and patient’s psychological status were assessed four times: the day before the washout and 2, 6, and 12 weeks after the commencement of the treatment. Patient’s serum zinc was compared to a group of 25 healthy volunteers.
Results: Serum zinc level was significantly lower in acute depressed patients than in healthy volunteers but there was no significant correlation between serum zinc and severity of depression measured by BDI or HADRS. At the end of the study, there were significant differences in zinc values between therapy responders and non-responders and between remitters and non-remitters. Serum zinc in treatment responders and in remitters significantly rose and reached the level comparable to the healthy control group.
Conclusions: Serum zinc is a state marker of depression. There are no relationships between serum zinc and severity of depression.

Original article

Effectiveness and safety of olanzapine in subjects with schizophrenia treated in routine practice: the results of the open-label, non-interventional, multicentre, prospective study

Tomasz Sobów, Agata Roszkowska
Farmakoterapia w Psychiatrii i Neurologii, 2006, 3–4, 151–157

Aim of the study: to evaluate effectiveness and safety of generic olanzapine (Zolafren®) under the conditions of routine clinical practice in Poland.
Material and methods: an open-label, prospective, multicentre and non-interventional study. Primary effectiveness parameter was a change in PANSS scale, while primary safety and tolerance parameters were drop-outs due to side effects, a change in Simpson-Angus scale and weight gain. From the initially completed 6019 case reports forms, data on 5144 subjects with schizophrenia aged 18–65 were included in the final analysis.
Results: drop-out rate due to side effects was 1.2%, considerably lower than in randomized controlled trials. Marginal, though statistically significant reduction in Simpson-Angus scale was observed, the finding that might be interpreted as no influence on extrapyramidal symptoms. Mean weight gain was 2 kg, being higher in patients younger than 30 (particularly women) and lower in those older than 55. Mean reduction in total PANSS scale was 30 points after 6–8 weeks, supporting strongly clinical effectiveness of the drug.
Conclusions: generic olanzapine (Zolafren®) proved to be safe and effective in patients treated routinely as evaluated by prospective, open-label study. Age and, to lesser extend, gender, might be important factors modifying safety and tolerance, particularly weight gain and possible metabolic complications.

Review article

Endocrine and metabolic side-effects of lithium

Dominik Strzelecki
Farmakoterapia w Psychiatrii i Neurologii, 2006, 3–4, 159–166

During lithium treatment appear several significant hormonal changes, which can cause worsening of mental and physical state. Most frequent disorders concern thyroid gland – often diagnosed hypothyreosis, sporadically hyperthyreosis. Other serious adverse effects of lithium treatment are hyperparathyreosis and metabolic disturbances: diabetes mellitus, diabetes insipidus and weight gain. Review article describes typical hormonal and metabolic dysfunctions, their prevalence, risk factors, possible mechanisms, monitoring and treatment.

Review article

Fluvoxamine – selective inhibitor of serotonin reuptake of the longest duration of use

Jan Jaracz, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii, 2006, 3–4, 167–175

Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) of the longest duration of use. It was first registered in Europe for treatment of depression in 1983 preceding registration of fluoxetine in the United States by 4 years. A number of randomized clinical studies confirmed the efficacy of fluvoxamine in treatment of depression including severe depressive episodes as well as in prophylactic treatment of unipolar affective disorder. Fluvoxamine is also effective in obsessive-compulsive disorder, social phobia and panic disorder. Its usefulness in treatment of obsessive-compulsive spectrum disorders and as an adjunct medication in schizophrenia needs confirmation in further studies. Fluvoxamine is generally well tolerated but may cause side effects similar to other SSRI’s. Some like sexual dysfunction are less common. Main pharmacokinetic interactions (among other with clozapine) are related to the fact, that fluvoxamine is a potent inhibitor of cytochrome P450 CYP1A2.

Review article

Memantine – a glutamatergic strategy in the treatment of Alzheimer’s disease

Marcin Flirski, Tomasz Sobów
Farmakoterapia w Psychiatrii i Neurologii, 2006, 3–4, 177–186

Until recently, cholinesterase inhibitors have been the only available option in the treatment of Alzheimer’s disease (AD). This review is devoted to the role of glutamatergic system in the pathogenesis and therapy of AD, with a focus on a new drug – an NMDA receptor antagonist, memantine – and its place in the therapeutic strategy of AD. In this paper we give an overview of memantine’s mechanism of action in a broader context of glutamatergic dysfunction in AD, and review data on the influence of memantine on cognitive functions, behavioural disturbances and functional status of AD patients. The aspect of tolerance and safety of memantine use in the elderly is also included.

Case report

Efficacy of citalopram in more than maximal dose in drug-resistant depression. The treatment outcome after switching into the escitalopram. Case report

Łukasz Święcicki
Farmakoterapia w Psychiatrii i Neurologii, 2006, 3–4, 187–190

A case report of 30 years white man with chronic, drug-resistant depression, was presented. The condition resolved during treatment with citalopram, 100 mg/day (against medical advise). There was no side effects. Results of debryzochine test show activity of CYP2D6 to be in normal range. After switching into the escitalopram, after two years of citalopram treatment, it would be possible to change the dosing to 10 mg per day, without adversive effects on to the psychiatric status.