2016, volume 32, issue 1

Original article

The level of vitamin B12 as a factor of efficacy of ketamine infusion in bipolar depression

Magda K. Malewska, Agnieszka Permoda-Osip, Alicja Bartkowska-Śniatkowska, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2016, 32 (1), 9–15

Introduction. The aim of the study was to assess the efficacy of single ketamine infusion in patients with bipolar depression, receiving mood-stabilizing drugs, previously treated with antidepressant drugs, which was inefficient in the context of vitamin B12 level before the procedure application.

Methodology. Twenty eight patients suffering from bipolar depression were included in the study: 5 males and 23 females, aged 27–67 years (mean 46), receiving ≥1 mood-stabilizing drugs of the first or/and second generation. The infusion of ketamine 0.5 mg/kg was performed after ≥7 days of discontinuation of antidepressant drugs. The criterion for a clinical improvement was the ≥50% reduction on the 17-item Hamilton Depression Rating Scale on the 7th day after infusion as compared to the pre-infusion status. The patients were divided into three groups: 1) vitamin B12 level < 350 pg/ml (11 patients); 2) vitamin B12 level ≥350 pg/ml (10 patients); 3) vitamin B12 level < 350 pg/ml, injected with 1000 μg before the infusion.

Results. The mean level of improvement in these groups after 7 days of treatment equalled 28%, 55% and 71%, respectively. Compared with the group 1, the improvement was significantly higher in group 2 (p = 0.011) and 3 (p = 0.003). A significant correlation was found between baseline vitamin B12 level (taking into account the supplementation in 7 patients) and clinical efficacy (r = 0.51; p = 0.006).

Conclusions. The results obtained suggest that high vitamin B12 level prior to ketamine infusion is associated with a better clinical efficacy. In patients with low vitamin B12 level, a supplementation with this vitamin may be recommended for achieving optimal effects.

Review article

The relationship between statin use and depression

Maria Rutkowska, Wojciech Słupski
Farmakoterapia w Psychiatrii i Neurologii 2016, 32 (1), 17–26

For almost 30 years, statins have been widely used in primary and secondary prevention of cardiovascular diseases. In addition to the lipid lowering effect, they also exhibit anti-inflammatory, antioxidant and neurotrophic activities, which may be important in the treatment and prevention of depression. Reports on the relationship between the use of statins and depression are contradictory. Many clinical trials have showed no effect of statins on mood and some of them have revealed the antidepressant effect of these drugs, especially in patients with cardiovascular diseases. The increased risk of depression was rarely observed in patients taking statins.

Original article

Wpływ terapii elektrowstrząsowej w depresji lekoopornej na stężenie czynnika neurotrofowego pochodzenia mózgowego (BDNF) / The effect of electroconvulsive therapy in drug-resistant depression on serum level of the brain-derived neurotrophic factor (BDNF)

Krystian J. Wiśniewski, Miłosz Krzywotulski, Maria Skibińska, Alicja Bartkowska-Śniatkowska, Maria Chłopocka-Woźniak, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2016, 32 (1), 27–32

Objectives. Electroconvulsive therapy (ECT) causes an increased neurogenesis and the brain-derived neurotrophic factor (BDNF) is important for neuronal survival. Many studies have shown, that, in depression, BDNF level is decreased, and that ECT can cause its increase. To investigate whether such a relationship occurs in drug-resistant depression (DRD), the purpose of this study was an assessment of the effect of ECT on serum BDNF level in patients with DRD.

Material and methods. The study was performed on 58 patients with DRD, 25 male, 33 female, aged 56 ±13 (mean ± SD), treated with ECT in 2013–2014. In 35 patients, all ECT sessions were performed with thiopental anesthesia (dosed 2–5 mg/kg). In 11 patients, ketamine was used as an anesthetic for 2nd and 3rd session (dosed 1.0–1.5 mg/kg), and in 12 patients, for sessions 2nd, 4th, 6th, 8th, and 10th (dosed 1.0–1.5 mg/kg). Serum BDNF levels were determined in the morning, before 1st session and after 7, 14 and 21 days of the ECT treatment.

Results. The levels of BDNF did not show significant differences in the course of ECT. This pertained to the whole group, male and female groups, recurrent depression and bipolar disorder groups, aged less than and above 55 years, with less than and above 30 points in the Hamilton Depression Rating Scale, and undergone thiopental anesthesia only or two modes of thiopental interchanged with ketamine.

Conclusions. Obtained results indicate, that, in patients with DRD, which had received antidepressant and mood-stabilizing treatment, despite improvement in psychiatric status in the course of ECT, no significant changes in BDNF level were observed.

Review article

Rola sirtuin w wybranych zaburzeniach psychicznych / The role of sirtuins in selected mental disorders

Maria Filip, Maciej Kuśmierek, Kinga Bobińska, Piotr Gałecki
Farmakoterapia w Psychiatrii i Neurologii 2016, 32 (1), 33–39

Objective. Sirtuins – proteins found in all living organisms – are involved in many cellular processes such as aging, transcription, apoptosis, inflammation, silencing of gene transcription, DNA repair. The role of sirtuins as part of the pathogenesis of some mental disorders has been discussed. Unfortunately, there are only a few papers showing correlation between the mechanisms of action of sirtuins and the onset of mental illness. The aim of the study was to show the role of sirtuins in the pathogenesis of some psychiatric disorders.

Literature review. For several years, research studies have been conducted on the effects of sirtuins and the occurrence of schizophrenia, bipolar and depressive disorders. Some studies provide evidence that the allelic variants of SIRT1 contribute to an increased risk of schizophrenia, at least in some Asian populations. Recently, SIRT1 has been recognized as an important molecule that plays a role in the mechanisms of circadian rhythms. Abnormalities of the circadian cycle can be related to the pathophysiology of major depressive disorder (MDD), suggesting an important role of SIRT1. It has been shown that SIRT2 protein is involved in the pathophysiology of depression caused by the chronic unpredictable stress (CUS). Inhibition of SIRT2 protein expression in the hippocampus has the effect on depression disorders. These studies have been conducted on animal models.

Conclusions. There are bound to exist various previ­ously unknown relationships between sirtuins and the prevalence of mental disorders. There is a chance a better understanding of these mechanisms will enable the development of new forms of therapy for these diseases.

Review article

Doksylamina w leczeniu zaburzeń snu i lęku / Doxylamine in the treatment of sleep disturbances and anxiety

Marek Krzystanek, Anna Białek, Artur Pałasz, Rafał Skowronek
Farmakoterapia w Psychiatrii i Neurologii 2016, 32 (1), 41–47

Doksylamine is the inquiring proposal, facing the limited number of the safe and effective sedative and sleeping drugs. Doxylamine belongs to the first-generation H1-antihistamine group. It shows sedative, sleep-inducing, antiemetic and anti-allergic effect.

The aim of the article was to compare doxylamine with other sleeping pills and tranquilizers. The detailed research was performed to investigate effectiveness and tolerance of doxylamine in the treatment of insomnia and anxiety. The potency of the sedative effect of doxylamine, flunitrazepam and fenobarbital are comparable, but doxylamine does not cause addiction. Numerous studies prove the effectiveness and safety of doxylamine in the short-term treatment of insomnia. The safety of doxylamine in pregnancy was also proven. The therapeutic index of doxylamine is wide, and its potential side effects are usually mild and transient. Most common adverse effects are daytime sleepiness and dry mouth.

The collected data indicate the doxylamine as an alternative to sleep-inducers and tranquilizers.