P.2.a.013 Effect of escitalopram on depressive symptoms in patients with coronary artery stents

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P.2.a. Affective disorders and antidepressants − Affective disorders (clinical)

both bipolar II1/2 and IV. In this study, totally 39 patients were classified into soft bipolar spectrum. Unipolar patients had significantly better SASS scores than soft bipolar spectrum patients. Conclusions: The present findings suggest that soft bipolar spectrum may lead to poor social adaptation. References [1] De Fruyt, J., Demyttenaere, K., 2007. Bipolar (spectrum) disorder and mood stabilization: standing at the crossroads? Psychother. Psychosom. 76, 77−88. [2] Akiskal H.S, Pinto O., 1999. The evolving bipolar spectrum. Prototypes I, II, III and IV. Psychiatr. Clin. North Am. 22, 517–534.

P.2.a.012 Do we treat different patients with different antidepressant? Clinical and economic assessments in Spanish setting M. Blanca-Tamayo1 ° , A. Sicras-Mainar2 , B. Pascual-Arce3 , L. Garc´ıa-S´anchez3 , M.C. P´erez-Navarro3 , R. Navarro-Artieda4 , N. Muro-Perea3 . 1 Hospital Municipal de Badalona, Department of Psychiatry, Barcelona, Spain; 2 Hospital Municipal de Badalona, Department of Planning, Barcelona, Spain; 3 Hospital Municipal de Badalona, Department of Pharmacy, Barcelona, Spain; 4 Hospital Germans Trias i Pujol, Department of Documentation, Barcelona, Spain Purpose of study: To Determinate economic and clinical appraisal of escitalopram (ESC), citalopram (CIT) and venlafaxine (VEN) use in patients with a new major depressive episode in a Spanish population setting. Patients and Methods: An observational, prospective, multicenter study, using patient records from 6 primary health care centers and population data bases, was performed. The inclusion criteria were: age > 20 years, a depressive episode between January 2003 and March 2007, with antidepressant prescription >60 days after the first prescription and a follow-up of at least 18 months (study: 12months; continuation: 6 months). Three subgroups were considered: patients under ESC, CIT or VEN treatment. Main measures: sociodemographic data, remission, comorbidities (arterial hypertension, diabetes mellitus, dyslipidemia, obesity, smoking, alcoholism, ischemic heart disease, cerebrovascular accident, heart/liver/kidney failure, bronchial asthma, COPD and malignancies), Resource Utilization Bands (RUB), healthcare costs (direct) and lost of productivity (indirect). The working algorithm of Grouper ACG_ version 9.0 (http://www.acg.jhph.edu), is comprised by a series of consecutive steps until the attainment of the 106 mutually exclusive ACG for each attended patient. In order to create an ACG, we need the age, the gender and the presenting problems or diagnoses codified according to the ICD9-CM. Logistic regression and ANCOVA’s analysis (Bonferroni correction) were used. Results: 965 subjects were included: ESC=131; CIT=491; VEN = 343. Patients under ESC treatment were younger (ESC: 49.7 ±15.5; CIT: 59.1±16.9; VEN: 55.5± 15.0), with upper proportion male (ESC: 32.1%, CIT: 22.2%, VEN: 22.7%) and less general morbidity (number of episodes: ESC 6.3±4.0; CIT 7.9± 4.3; VEN 7.1±4.2; p < 0.02). ESC treated patients were associated with highest remission rates (58.0%) vs. CIT (38.3%) or VEN (32.4%) (p < 0.001). The oldest patients were treated with citalopram (p < 0.001). There were some differences in comorbidity profile among the three treatment groups (see table 1).

ESC treatment patients showed differences in general morbidity −RUB− (ECS: 2.7; CIT: 2.8; VEN: 2.7 (p = 0.002)) and in Charlson index (ESC: 0.4, CIT: 0.7, VEN: 0.4 (p = 0.003). There weren’t differences between ESC and CIT groups in “psychotropic drug unitary cost” (294.7€ vs. 265.2€; p=NS), but VEN group had a higher unitary cost (643.0€; p = 0.003). The adjusted cost model (sanitary and no sanitary) showed that ESC group had lower total cost than the other treatment groups (ESC: 2,276.2€, CIT: 3,093.8€, VEN: 3,801.2€ (p = 0.04)). Table 1: Demographic data, comorbidities and Adjusted cost model among treatment groups Escitalopram N = 131 Patients in remission 58.0% Characteristics demographics Age (years) 49.7±15.5 >74 years 11.3% Gender (female) 67.9% Comorbidities Hypertension arterial 25.2% Smokers 32.2% Thyroid diseases 4.3% Fibromyalgia 6.2% Osteoporosis 7.8% Adjusted cost model Healthcare total costs 970.7 (721.4−1219.9) Primary care cost 583.4 (504.4−662.3) Total cost (healthcare 2,276.2 and lost productivity) (1,187.8−3,364.6)

Citalopram N = 491

Venlafaxine N = 343

p

38.3%

32.4%

<0.001

59.1±16.9 23.9% 77.8%

55.5±15.0 14.9% 77.3%

<0.001 <0.001 0.049

40.0% 18.6% 9.8% 8.0% 18.4%

33.0% 21.3% 5.7% 12.3% 20.,2%

0.006 0.006 0.038 0.045 0.005

1,055.0 (911.3−1,198.6) 610.7 (565.2−656.1) 3,093.8 (2,466.6−3,721.3)

1,491.9 (1,322.4−1,661.4) 976.5 (922.8−1,030.1) 3,801.2 (3,061.1−4,541.3)

<0.001 <0.001 0.045

Conclusions: In Primary care setting, the escitalopram group achieved highest remission rates with lower sanitary cost, although escitalopram doesn’t exist as generic drug. We should also consider that escitalopram group patients were younger and had less general morbidity. P.2.a.013 Effect of escitalopram on depressive symptoms in patients with coronary artery stents L.N. Yur’yeva1 ° , A.I. Mamchur1 , A.A. Dukelskiy1 . 1 Medical Institute, Postgraduate faculty of psychiatry, Dniepropetrovsk, Ukraine We have surveyed 70 men aged between 48 and 77 years with documented ischemic heart disease (myocardium heart attack in the anamnesis, coronaroangiography) who had undergone endovascular intervention with implantation of stents in coronary vessels. Clinical-psychopathological assessment was performed three to five weeks after stenting, using the Hamilton depression scale (17 items), the Beck depression scale and the anxiety scale of Shihana; thirty-seven percent of the subjects had clinical signs of a depressive episode on ICD-10. We investigated the subjects’ quality of life using indexes such as: physical well-being (sensation of vigour, absence of pain and physical problems), psychological/emotional well-being (good state of health, satisfactory feeling), self-support and independence of actions (performance of daily vital problems, acceptance of own decisions), working capacity (possibility to work, or perform school or house duties), interpersonal interactions (possibility to answer and support good relations with family members, with friends, in a group), social-emotional support (presence of trusted people who can offer help and emotional support), personal realisation (feeling of balance, finding satisfaction in sex, arts, etc.), spiritual realisation (belief sensation, material life). Using

P.2.a. Affective disorders and antidepressants − Affective disorders (clinical) Mezzich’s integrative quality of life (QoL) indicator, QoL was estimated separately by the patients, their relatives and the doctors. A dose of 10 mg/day escitalopram in men aged 48−77 years with coronary stents for ischemic heart disease and suffering from comorbid depression, significantly improved physical and psychological well-being, public and office support and the general perception of life. For 27 percent of IHD patients with comorbid depression in the postoperative period the antidepressants were included in a complex of somatotropic therapies of escitalopram 10 mg/day given at breakfast during 6 weeks, without dose titration. The 6-week escitalopram therapy proved effective for twenty-four surveyed patients, as shown by a 50% reduction of depressive symptoms with subsequent exit in remission. Escitalopram can be made the first choice treatment for patients of a somatic specialisation with comorbid depression, thanks to its high efficiency, convenience and simplicity of application, combined with a good post-therapeutic condition of the patient. Our data confirm the expedience of including, in the treatment of patients with coronary artery stents and comorbid depression refractory to modern antidepressants − inhibitors of return capture of serotonine, such as escitalopram, which was highly effective in curing depression and alarm, combined with good post-therapeutic well-being and absence of cardiotoxicity. P.2.a.014 5-HTTLPR SS depressed women: higher baseline thyroid-stimulating hormone and lower antidepressant response F. Gressier1 ° , S. Trabado2 , C. Verstuyft3 , P. Hardy1 , B. F`eve4 , 1 INSERM U669 Paris L. Becquemont3 , E. Corruble1 . Sud University, Department of Psychiatry, Le Kremlin Bicˆetre, France; 2 INSERM U693 Paris Sud University, Laboratory of Molecular Genetics Pharmacogenetics and Hormonology, Le Kremlin Bicˆetre, France; 3 Paris Sud University, Department of Pharmacology, Le Kremlin Bicˆetre, France; 4 INSERM U693 Paris Sud University, Department of Endocrinology, Le Kremlin Bicˆetre, France Purpose: Basal serum thyroid-stimulating hormone (TSH) levels may predict antidepressant efficacy in patients with major depressive episodes (MDE), subtle thyroid axis modifications being associated with lower antidepressant response. However, this literature shows inconsistent results, suggesting complex interactions between baseline serum TSH and antidepressant response [1]. Indeed, serum TSH levels have been associated not only with antidepressant response, but also with gender in the general population and in depressed patients. Moreover, the effects of TSH may be modulated by the local secretion of serotonin (5-HT), the 5-HT transporter being expressed by thyroid follicular cells. The 5-HTTLPR genotype, which is a determinant of the 5-HT activity, may also predict antidepressant efficacy in depressed patients. We evidenced a lower antidepressant efficacy in depressed women with the SS genotype as compared to women with the LS/LL genotype, but not in men [2]. So, we hypothesized that TSH levels may differ between the 5-HTTLPR genotypes in women, and may mediate antidepressant response depending on 5-HTTLPR genotypes and gender. Methods: 74 women and a control group of 28 men, hospitalized for a MDE, requiring a new antidepressant treatment were included in this 4-week prospective monocentric and naturalistic open study. All had a minimum score of 18 on the 17-item Hamilton Depression Rating Scale (HAMD-17). They were assessed

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for 5-HTTLPR genotypes and baseline TSH serum levels. The primary end point of the analysis was the percentage of responders (50% or more improvement from baseline) on HAMD. Results: Genotype distribution ratio of SS and LL/LS was 12/62 in women and 7/21 in men. Socio-demographics, course of illness and antidepressants prescribed did not differ significantly regarding genotype distribution. Mean basal TSH (SD) was 1.73±0.97mIU/L. A significant interaction between genotype and gender was observed (p = 0.009) for basal TSH. In bivariate analyses, women with the SS genotype had higher TSH levels (2.64±1.03) than LL/LS women (1.62±0.94) (p = 0.002) and women with the SS genotype had a lower antidepressant response (50.0%) than LL/LS women (79.0%) (p = 0.03). No significant difference was shown in men. In multivariate analyses, antidepressant response in depressed women was explained by baseline TSH (OR=3.41, 95% CI[1.28–9.08], p = 0.01) and 5-HTTLPR genotype (OR=0.05, 95% CI[0.01–0.38], p = 0.005), but not by other variables. Discussion: Our result concerning the relationship between baseline TSH values and 5-HTTLPR genotypes in women is in line with the known association of the thyroid function and the 5-HT system shown in depressed patients [3], since the 5-HTTLPR SS genotype is associated with a reduced central 5-HT activity. Moreover, our findings suggest that, in depressed women, baseline TSH plasma concentrations within a physiological range could represent a relevant peripheral surrogate marker of 5-HT signalling activity of the central nervous system. The underlying mechanism remains to be determined, gender differences in estrogens and/or higher sensitivity of TSH to prothyroliberin (TRH) stimulation being possible pathways. Conclusions: If this result could be confirmed, thyroid hormone supplementation could be an adequate therapeutic strategy to enhance antidepressant response in depressed women with the 5-HTTLPR SS genotype. References [1] Corruble, E., Goldberger, C., Spann, M., Relationship between TSH levels in the normal range and short-term duloxetine efficacy. J Affect Disord [Epub ahead of print]; doi: 10.1016/j.jad.2009.09.012. [2] Gressier, F., Bouaziz, E., Verstuyft, C., Hardy, P., Becquemont, L., Corruble, E., 2009 5-HTTLPR modulates antidepressant efficacy in depressed women. Psychiatr Genet 19, 195–200. [3] Kirkegaard, C., Faber, J., 1998 The role of thyroid hormones in depression. Eur J Endocrinol 138, 1−9.

P.2.a.015 Transcranial direct current stimulation in patients with treatment-resistant major depressive episode B. Dell’Osso1 ° , S. Zanoni1 , F. Castellano1 , C. Dobrea1 , B. Benatti1 , C. Arici1 , R. Ferrucci2 , M. Vergari2 , A. Priori2 , A.C. Altamura1 . 1 Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Psychiatry Department, Milan, Italy; 2 Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurological Sciences Department, Milan, Italy Background: Treatment-resistant Depression is defined as the failure to respond to two consecutive trials of antidepressants belonging to different pharmacological classes for appropriate periods and dosages in compliant subjects [1]. In this condition, both pharmacological and neuromodulation add-on strategies can be used [2].