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Depression and ischaemic heart disease: Treatment considerations
S238
PI Affective disorders and antidepressants
psychological differences are reflected in alterations of the underlying neurophysiological substrate. Methods: In a study of 16 polydrug Ecstasy users with a lifetime average consumption of 270 tablets and 17 Ecstasy-nsiive controls we compared mood, personality and regional cerebral blood flow (rCBF) profiles. The two populations differed in respect to use of other psychoactive drugs, Ecstasy-naive controls had somewhat less use of cannabis and LSD. Brain activity was measured as rCBF using [HisO]-PET. Mood was assessed by the Hamilton Depression Scale (HAM-D), the Altered States of Consciousness Questionnaire (OAV) and the Mood Rating Scale (EWL), while personality traits were self-rated using the Freiburg Personality Inventory (FPI). Statistical parametric mapping (SPM) and multivariate analysis of variance (MANOVA) was used for statistical data treatment. Results: The present data demonstrate that brain activation during performance of a visual vigilance task (a continuous performance task, CPT) did not differ between the two groups. However, significantly higher levels of HAM-D depressiveness and FPI nervousness were found in Ecstasy subjects as compared to the Ecstasy-ndive controls. Furthermore, Ecstasy users reported more OAV/EWL anxiety and somatic complaints during PET measurements than controls. Conclusion: Our data indicate. that, despite differences in mood and personality, polydrug Ecstasy users do not differ from Ecstasy-ndive controls in terms of local brain activity and CPT performance scores. Also no significant group differences in regional brain activation emerged when differences in the past drug-history were statistically controlled. This finding is in line with more recent data indicating that some but not all Ecstasy users show impairments in more complex cognitive functions (memory) rather than basic functions (vigilance, attention) as tested in this study. Heightened depressiveness and increased state anxiety in our Ecstasy group is consistent with results from other studies in Ecstasy users and may be related to serotonergic hypofimction due to repeated MDMA consumption. However, more research and particularly longitudinal studies are needed to address whether these psychological measures are attributable to alterations or damage of the serotonergic system, pre-existing differences in personality or experimental settings.
IP.1.091/
Incidence of depression in general practice and gynaecological practice in Belgium
K. van Heeringen’, H. Boon*. ‘Department of Psychiatv, University of Ghent; 2Department of Psychiahy. University of Mans. Belgium
Recent evidence suggests that general and gynaecological practitioners may be underestimating the incidence of depression among their patients. In two large Belgian studies, the incidence of depression was assessed initially from an interview with the patient, and subsequently from a 9-item questionnaire corresponding to the Goldberg Depression Scale. In the first study, 170 gynaecological practitioners (76% male; 34% aged over 50 years) questioned 2 174 women (mean age 37 years). According to the practitioners’ opinion, 12% of women had depressive symptoms; however, 35% of women had 22 positive answers on the Goldberg Depression Scale, and 19% had 24 positive answers. A minimum score of four positive answers on the Goldberg Depression Scale indicates a very high probability of depression being present. In the second study, 531 general practitioners (80% male; 16% aged over 50 years) interviewed 8225 patients (mean age 53 years, 60.5% female). Depressive symptoms were exhibited by 25% of patients according to the practitioner, whereas 43% had 22 positive answers on the Goldberg Depression Scale, and 3 1% had 24 positive answers. Results from these two studies indicate that many of the patients who are scoring at least four positive answers on the Goldberg Depression Scale arc not being identified as potentially depressive when being interviewed by the practitioners. Systematic screening with depression scales, such as the Goldberg Depression Scale, may therefore be advisable.
IP.1 .o%!l
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ischaemlc heart disease: treatment
M. Isaac. Psychopharmacology Evaluation Unit, University Hospital, London, UK The presence of depression after myocardial infarction (MI) is a common occurrence. Depressive symptoms have been reported to occur in 45% of patients (n = 283) within 10 days of MI; of these, 18% fulfilled DSM-IV criteria for major depression (Schleifer et al 1989). Furthermore, mortality rates 6 months after MI have been reported to be higher in depressed patients than non-depressed patients (15% versus 5%) (Frasure-Smith et al 1993). Depression was found to be a significant predictor, and an independent risk factor of mortality at 6 months after MI (Frasure-Smith et al 1993). Detection and effective treatment of depression in ischaemic heart disease patients is therefore important, although it remains to be confirmed whether antidepressant therapy can improve post-MI survival rates. The efficacy and safety of antidepressants in these patients needs to be investigated. A comparative, 6-week, double-blind, randomised study has recently evaluated efficacy and safety of the SSRI paroxetine and the TCA nortriptyline in the treatment of patients with ischaemic heart disease (included MI, coronary artery bypass graft surgery and coronary angioplasty) and comorbid unipolar major depression (Roose et al 1998). Efficacy was defined as a 50% reduction in HAM-D scores or a final HAM-D score of 18. Cardiovascular safety was assessed by measuring heart rate and rhythm, supine and standing systolic and diastolic blood pressures, electrocardiogram conduction intervals, and indexes of heart rate variability. Improvement in depressive symptoms (intent-to-treat analysis) occurred in 61% (25/41) of patients receiving paroxetine, compared with 55% (22/40) in the nortriptyline group. Nortriptyline patients experienced a sustained 11% increase in heart rate, and a reduction in heart rate variability, whereas paroxetine patients experienced no sustained or clinically significant effects on either heart rate, rhythm, or indexes of heart rate variability. Adverse cardiac events occurred in 2% (l/41) of paroxetine patients, and 18% (7/40) of nortriptyline patients. Despite similar efficacy between paroxetine and nortriptyline, the anti-cholinergic side effects associated with the TCA are particularly unwelcome in depressed patients with cardiovascular disease. Treatment of these patients with SSRIs would appear to be preferable. References [l] Frasure-Smith et al. JAMA 1993; 275: 1819-1825. [2] Roose et al. JAMA 1998; 279: 287-291. [3] Schleifer et al. Arch Intern Med 1989; 149: 1785-1789.
Ip.1.0931
Opposite effects of 3&methylenedioxy methamphetamine (MDMA) on sensorimotor in rats versus healthy humans
gating
EX. Vollenweider’, M.E. Liechti’, A. Gamma, M.A. GeyeP, D. Hell’. ‘Psychiatric University Hospital Ziirich, Research Department, Box 68, CH-8029 Ziirich, Switzerland ‘University of California San Diego, Department of Psychiam, La Jolla, California, 92093-0804, USA
Introduction: Prepulse inhibition of acoustic startle (PPI) refers to the reduction in the startle response when the startling stimulus is preceded by a weak prepulse stimulus. This phenomenon provides an operational measure of sensorimotor gating that has been found to be reduced in patients with schizophrenia and rats treated with serotonin agonists or serotonin releasers. For example, serotonin (5-HT) releasing agents such as 3,4-methylenedioxy-N-methylamphetamine (MDMA or “Ecstasy”) or N-ethyl-3,4-methylenedioxy-amphetamine (MDE or “Eve”) reduce PPI in rats or mice (Mansbach et al. 1989). In this study, we compared the effects of a serotonin releaser, MDMA, on prepulse inhibition in laboratory rats and healthy human volunteers. In particular, we investigated whether
PI Affective disorders and antidepressants
psychological differences are reflected in alterations of the underlying neurophysiological substrate. Methods: In a study of 16 polydrug Ecstasy users with a lifetime average consumption of 270 tablets and 17 Ecstasy-nsiive controls we compared mood, personality and regional cerebral blood flow (rCBF) profiles. The two populations differed in respect to use of other psychoactive drugs, Ecstasy-naive controls had somewhat less use of cannabis and LSD. Brain activity was measured as rCBF using [HisO]-PET. Mood was assessed by the Hamilton Depression Scale (HAM-D), the Altered States of Consciousness Questionnaire (OAV) and the Mood Rating Scale (EWL), while personality traits were self-rated using the Freiburg Personality Inventory (FPI). Statistical parametric mapping (SPM) and multivariate analysis of variance (MANOVA) was used for statistical data treatment. Results: The present data demonstrate that brain activation during performance of a visual vigilance task (a continuous performance task, CPT) did not differ between the two groups. However, significantly higher levels of HAM-D depressiveness and FPI nervousness were found in Ecstasy subjects as compared to the Ecstasy-ndive controls. Furthermore, Ecstasy users reported more OAV/EWL anxiety and somatic complaints during PET measurements than controls. Conclusion: Our data indicate. that, despite differences in mood and personality, polydrug Ecstasy users do not differ from Ecstasy-ndive controls in terms of local brain activity and CPT performance scores. Also no significant group differences in regional brain activation emerged when differences in the past drug-history were statistically controlled. This finding is in line with more recent data indicating that some but not all Ecstasy users show impairments in more complex cognitive functions (memory) rather than basic functions (vigilance, attention) as tested in this study. Heightened depressiveness and increased state anxiety in our Ecstasy group is consistent with results from other studies in Ecstasy users and may be related to serotonergic hypofimction due to repeated MDMA consumption. However, more research and particularly longitudinal studies are needed to address whether these psychological measures are attributable to alterations or damage of the serotonergic system, pre-existing differences in personality or experimental settings.
IP.1.091/
Incidence of depression in general practice and gynaecological practice in Belgium
K. van Heeringen’, H. Boon*. ‘Department of Psychiatv, University of Ghent; 2Department of Psychiahy. University of Mans. Belgium
Recent evidence suggests that general and gynaecological practitioners may be underestimating the incidence of depression among their patients. In two large Belgian studies, the incidence of depression was assessed initially from an interview with the patient, and subsequently from a 9-item questionnaire corresponding to the Goldberg Depression Scale. In the first study, 170 gynaecological practitioners (76% male; 34% aged over 50 years) questioned 2 174 women (mean age 37 years). According to the practitioners’ opinion, 12% of women had depressive symptoms; however, 35% of women had 22 positive answers on the Goldberg Depression Scale, and 19% had 24 positive answers. A minimum score of four positive answers on the Goldberg Depression Scale indicates a very high probability of depression being present. In the second study, 531 general practitioners (80% male; 16% aged over 50 years) interviewed 8225 patients (mean age 53 years, 60.5% female). Depressive symptoms were exhibited by 25% of patients according to the practitioner, whereas 43% had 22 positive answers on the Goldberg Depression Scale, and 3 1% had 24 positive answers. Results from these two studies indicate that many of the patients who are scoring at least four positive answers on the Goldberg Depression Scale arc not being identified as potentially depressive when being interviewed by the practitioners. Systematic screening with depression scales, such as the Goldberg Depression Scale, may therefore be advisable.
IP.1 .o%!l
k;;;:;is;;zl
ischaemlc heart disease: treatment
M. Isaac. Psychopharmacology Evaluation Unit, University Hospital, London, UK The presence of depression after myocardial infarction (MI) is a common occurrence. Depressive symptoms have been reported to occur in 45% of patients (n = 283) within 10 days of MI; of these, 18% fulfilled DSM-IV criteria for major depression (Schleifer et al 1989). Furthermore, mortality rates 6 months after MI have been reported to be higher in depressed patients than non-depressed patients (15% versus 5%) (Frasure-Smith et al 1993). Depression was found to be a significant predictor, and an independent risk factor of mortality at 6 months after MI (Frasure-Smith et al 1993). Detection and effective treatment of depression in ischaemic heart disease patients is therefore important, although it remains to be confirmed whether antidepressant therapy can improve post-MI survival rates. The efficacy and safety of antidepressants in these patients needs to be investigated. A comparative, 6-week, double-blind, randomised study has recently evaluated efficacy and safety of the SSRI paroxetine and the TCA nortriptyline in the treatment of patients with ischaemic heart disease (included MI, coronary artery bypass graft surgery and coronary angioplasty) and comorbid unipolar major depression (Roose et al 1998). Efficacy was defined as a 50% reduction in HAM-D scores or a final HAM-D score of 18. Cardiovascular safety was assessed by measuring heart rate and rhythm, supine and standing systolic and diastolic blood pressures, electrocardiogram conduction intervals, and indexes of heart rate variability. Improvement in depressive symptoms (intent-to-treat analysis) occurred in 61% (25/41) of patients receiving paroxetine, compared with 55% (22/40) in the nortriptyline group. Nortriptyline patients experienced a sustained 11% increase in heart rate, and a reduction in heart rate variability, whereas paroxetine patients experienced no sustained or clinically significant effects on either heart rate, rhythm, or indexes of heart rate variability. Adverse cardiac events occurred in 2% (l/41) of paroxetine patients, and 18% (7/40) of nortriptyline patients. Despite similar efficacy between paroxetine and nortriptyline, the anti-cholinergic side effects associated with the TCA are particularly unwelcome in depressed patients with cardiovascular disease. Treatment of these patients with SSRIs would appear to be preferable. References [l] Frasure-Smith et al. JAMA 1993; 275: 1819-1825. [2] Roose et al. JAMA 1998; 279: 287-291. [3] Schleifer et al. Arch Intern Med 1989; 149: 1785-1789.
Ip.1.0931
Opposite effects of 3&methylenedioxy methamphetamine (MDMA) on sensorimotor in rats versus healthy humans
gating
EX. Vollenweider’, M.E. Liechti’, A. Gamma, M.A. GeyeP, D. Hell’. ‘Psychiatric University Hospital Ziirich, Research Department, Box 68, CH-8029 Ziirich, Switzerland ‘University of California San Diego, Department of Psychiam, La Jolla, California, 92093-0804, USA
Introduction: Prepulse inhibition of acoustic startle (PPI) refers to the reduction in the startle response when the startling stimulus is preceded by a weak prepulse stimulus. This phenomenon provides an operational measure of sensorimotor gating that has been found to be reduced in patients with schizophrenia and rats treated with serotonin agonists or serotonin releasers. For example, serotonin (5-HT) releasing agents such as 3,4-methylenedioxy-N-methylamphetamine (MDMA or “Ecstasy”) or N-ethyl-3,4-methylenedioxy-amphetamine (MDE or “Eve”) reduce PPI in rats or mice (Mansbach et al. 1989). In this study, we compared the effects of a serotonin releaser, MDMA, on prepulse inhibition in laboratory rats and healthy human volunteers. In particular, we investigated whether