- Email: [email protected]
P.2.c.021 Antidepressant switch efficacy in selective serotonin reuptake inhibitors resistant major depressive disorder
S324
P.2.c Affective disorders and antidepressants – Antidepressants (clinical)
Results: The HAMD-17 mean scores decreased significantly in both groups, the group B presented better improvements in HAMA and CGI-I from the first 14 days (>50%). Group B used fewer lorazepam and improved rapidly the items “insomnia” (>32%), “somatic concerns” (>46%) and vasomotor symptoms (>82%). We also investigated the quality of life (QoL) at the baseline and after 3 month of treatment. The results of Group B emphasized a significant improvement of family and social relationships, sexual activity and professional achievements. Conclusions: (1) In the treatment of menopausal depression, augmentation with estrogens substitution could increase the efficacy of the antidepressant. (2) The augmentation with estrogen therapy improves also anxiety, insomnia and vasomotor symptoms, without other co-medication. (3) The multi-link mechanism of neuroendocrin changes (serotonin-estrogens) due to menopause deserves more specific researches. References [1] Richards M, Rubinow DR, Daly RC, Schmidt PJ, 2006, Premenstrual symptoms and perimenopausal depression, Am J Psychiatry, Jan, 163, 1, 133. [2] Rybaczyk LA, Bashaw MJ, Pathak DR, Moody SM, Gilders RM, Holzschu DL, 2005, An overlooked connection: Serotonergic mediation of estrogen-related physiology and pathology, BMC Women’s Health, Dec 20, 5, 12. [3] Schmidt PJ, 2005, Depression, the perimenopause, and estrogen therapy, Ann N Y Acad Sci, Jun, 1052, 27−40.
P.2.c.021 Antidepressant switch efficacy in selective serotonin reuptake inhibitors resistant major depressive disorder O. Vasiliu ° , D. Vasile, M. Miclos, P. Ivanov. Military Central Hospital, Department of Psychiatry, Bucharest, Romania Background: Patients treated with a selective serotonin reuptake inhibitor (SSRI) who obtained no response or only a partial response after 4 to 6 weeks are switched on another SSRI for a trial period or directly on a dual antidepressant. If the second choice is preferred, mirtazapine (an alpha 2 presynaptic antagonist) or venlafaxine (serotonin and norepinephrine reuptake inhibitor) could be used. Objectives: We focused our study on the responsivity rates of SSRI resistant patients which has been monitored from depressive symptomatology, clinical global status, neccesity to use complementary medication and self perceived improvement in clinical status perspectives. Methods: A group of 20 patients, 12 male and 8 female, mean age 32.5, diagnosed with Major Depressive Episode (according to the DSM-IV TR criteria) were admitted in our clinic for a therapeutic switch after a previous SSRI treatment of at least 4 weeks. Inclusion criteria: a Hamilton Scale for Depression (HAMD) score over 20, Clinical Global Impression (CGI) over 3. Exclusion criteria: treatment with either mirtazapine or venlafaxine during previous major depressive episodes, history of severe organic impairments or substance related disorders. We formed two equally groups, one received mirtazapine medium daily dose of 45 mg, the other received venlafaxine 150 mg daily medium dose. The administration of benzodiazepines or moodstabilisers was allowed for brief periods if clinical status imposed. We evaluated weekly for 4 weeks and monthly afterthat (for another 5 months) these patients using HAMD, Zung Depression Scale (ZDS), CGI, Visual Analogic Scale (VAS) and Global Assessment of Functioning (GAF). Initial scores were: HAMD 24.5, ZDS 60, CGI 4.5, VAS 8 (out of 10), GAF 65.
Results: Patients recorded a global decrease in HAMD score of 14.5 reaching the minimum of 10 points after the 6 months of the study. The ZDS score decreased also, from 60 to 25. The self perceived gravity of the disorder was diminished on the VAS to 2 at the end of the study. The general status improved as the CGI-I score (decreased to 1.5) and GAF (increased to 85) showed. There were obtained no statistical significant data to differentiate the two drugs efficacy reflected on HAMD, ZDS, CGI or GAF at the end of the study. Nevertheless, patients treated with mirtazapine had a faster onset of improvement as soon as the first two weeks, while the venlafaxine group needed an extra week to reach the same level of improvement. There were only short periods when complementary medication was administered, but the group receiving venlafaxine needed more than mirtazapine treated group this kind of association (8 patients, compared to 5) and for a longer period (20.5 days compared to only 12.3). Conclusions: Mirtazapine and venlafaxine represent usefull approaches to the SSRI resistant major depressive disorder. Mirtazapine seems to have a faster onset of action, needs less complementary medication but has a similar efficacy with venlafaxine on long term. References [1] Benkert O., Szegedi A., Kohnen R., 2000, Mirtazapine compared with paroxetine in major depression, Journal of Clinical Psychiatry, 61, 656. [2] Carpenter L.L., Yasmin S., Price L.H., 2000, A double blind, placebo controlled study of antidepressant augmentation with mirtazapine, Biological Psychiatry, 51, 83. [3] Smith D., Dempster C., Glanville J., et al., 2002, Efficacy and tolerability of venlafaxine compared with selective serotonin reuptake inhibitors and other antidepressants: A meta-analysis, British Journal of Psychiatry, 180, 396–404.
P.2.c.022 Mirtazapine versus tricyclic antidepressants for the treatment of depression, anxiety and distressing symptoms of cancer E.S. Cankurtaran1 ° , A.H. Soygur1 , E. Ozalp2 , L. Turhan2 . 1 Ankara Oncology Training and Research Hospital, Psychiatry Clinic, Ankara, Turkey; 2 Ankara Oncology Research and Training Hospital, Psychiatry Clinic, Ankara, Turkey Purpose: Cancer patients face not only with distressing symptoms such as appetite loss, nausea, vomitting, weight loss, sleep disturbances and pain but also psychiatric comorbidities such as adjustment disorder, depression could accompany frequently the disease process [1]. Mirtazapine is a potent antagonist at postsynaptic 5HT2, 5HT3 serotonin receptors and H1 receptor which may have potential as an adjuvant analgesic and antiemetic [2]. There is only one open-label, crossover trial evaluating the effect of mirtazapine on the distressing symptoms of cancer [3]. The effectiveness of different agents on distressing symptoms of cancer are still subject for discussion. This study aims to compare the effectiveness of mirtazapine and tricyclic antidepressants on not only distressing but also depressive and anxiety symptoms of cancer patients. Methods: Fifty-seven patients with cancer attending to Ankara Oncology Research and Training Hospital who were diagnosed with any of those; major depressive disorder, anxiety disorder or adjustment disorder by the Structured Clinical Interview for DSM-IV, were included in the study. Twenty cancer patients on mirtazapine (15−30 mg daily), seventeen patients on tricyclics (imipramine or amytriptilline; 25−75 mg daily) and twenty patients in the control group without medication were interviewed in three week intervals, totally three times in six weeks, while they
P.2.c Affective disorders and antidepressants – Antidepressants (clinical)
Results: The HAMD-17 mean scores decreased significantly in both groups, the group B presented better improvements in HAMA and CGI-I from the first 14 days (>50%). Group B used fewer lorazepam and improved rapidly the items “insomnia” (>32%), “somatic concerns” (>46%) and vasomotor symptoms (>82%). We also investigated the quality of life (QoL) at the baseline and after 3 month of treatment. The results of Group B emphasized a significant improvement of family and social relationships, sexual activity and professional achievements. Conclusions: (1) In the treatment of menopausal depression, augmentation with estrogens substitution could increase the efficacy of the antidepressant. (2) The augmentation with estrogen therapy improves also anxiety, insomnia and vasomotor symptoms, without other co-medication. (3) The multi-link mechanism of neuroendocrin changes (serotonin-estrogens) due to menopause deserves more specific researches. References [1] Richards M, Rubinow DR, Daly RC, Schmidt PJ, 2006, Premenstrual symptoms and perimenopausal depression, Am J Psychiatry, Jan, 163, 1, 133. [2] Rybaczyk LA, Bashaw MJ, Pathak DR, Moody SM, Gilders RM, Holzschu DL, 2005, An overlooked connection: Serotonergic mediation of estrogen-related physiology and pathology, BMC Women’s Health, Dec 20, 5, 12. [3] Schmidt PJ, 2005, Depression, the perimenopause, and estrogen therapy, Ann N Y Acad Sci, Jun, 1052, 27−40.
P.2.c.021 Antidepressant switch efficacy in selective serotonin reuptake inhibitors resistant major depressive disorder O. Vasiliu ° , D. Vasile, M. Miclos, P. Ivanov. Military Central Hospital, Department of Psychiatry, Bucharest, Romania Background: Patients treated with a selective serotonin reuptake inhibitor (SSRI) who obtained no response or only a partial response after 4 to 6 weeks are switched on another SSRI for a trial period or directly on a dual antidepressant. If the second choice is preferred, mirtazapine (an alpha 2 presynaptic antagonist) or venlafaxine (serotonin and norepinephrine reuptake inhibitor) could be used. Objectives: We focused our study on the responsivity rates of SSRI resistant patients which has been monitored from depressive symptomatology, clinical global status, neccesity to use complementary medication and self perceived improvement in clinical status perspectives. Methods: A group of 20 patients, 12 male and 8 female, mean age 32.5, diagnosed with Major Depressive Episode (according to the DSM-IV TR criteria) were admitted in our clinic for a therapeutic switch after a previous SSRI treatment of at least 4 weeks. Inclusion criteria: a Hamilton Scale for Depression (HAMD) score over 20, Clinical Global Impression (CGI) over 3. Exclusion criteria: treatment with either mirtazapine or venlafaxine during previous major depressive episodes, history of severe organic impairments or substance related disorders. We formed two equally groups, one received mirtazapine medium daily dose of 45 mg, the other received venlafaxine 150 mg daily medium dose. The administration of benzodiazepines or moodstabilisers was allowed for brief periods if clinical status imposed. We evaluated weekly for 4 weeks and monthly afterthat (for another 5 months) these patients using HAMD, Zung Depression Scale (ZDS), CGI, Visual Analogic Scale (VAS) and Global Assessment of Functioning (GAF). Initial scores were: HAMD 24.5, ZDS 60, CGI 4.5, VAS 8 (out of 10), GAF 65.
Results: Patients recorded a global decrease in HAMD score of 14.5 reaching the minimum of 10 points after the 6 months of the study. The ZDS score decreased also, from 60 to 25. The self perceived gravity of the disorder was diminished on the VAS to 2 at the end of the study. The general status improved as the CGI-I score (decreased to 1.5) and GAF (increased to 85) showed. There were obtained no statistical significant data to differentiate the two drugs efficacy reflected on HAMD, ZDS, CGI or GAF at the end of the study. Nevertheless, patients treated with mirtazapine had a faster onset of improvement as soon as the first two weeks, while the venlafaxine group needed an extra week to reach the same level of improvement. There were only short periods when complementary medication was administered, but the group receiving venlafaxine needed more than mirtazapine treated group this kind of association (8 patients, compared to 5) and for a longer period (20.5 days compared to only 12.3). Conclusions: Mirtazapine and venlafaxine represent usefull approaches to the SSRI resistant major depressive disorder. Mirtazapine seems to have a faster onset of action, needs less complementary medication but has a similar efficacy with venlafaxine on long term. References [1] Benkert O., Szegedi A., Kohnen R., 2000, Mirtazapine compared with paroxetine in major depression, Journal of Clinical Psychiatry, 61, 656. [2] Carpenter L.L., Yasmin S., Price L.H., 2000, A double blind, placebo controlled study of antidepressant augmentation with mirtazapine, Biological Psychiatry, 51, 83. [3] Smith D., Dempster C., Glanville J., et al., 2002, Efficacy and tolerability of venlafaxine compared with selective serotonin reuptake inhibitors and other antidepressants: A meta-analysis, British Journal of Psychiatry, 180, 396–404.
P.2.c.022 Mirtazapine versus tricyclic antidepressants for the treatment of depression, anxiety and distressing symptoms of cancer E.S. Cankurtaran1 ° , A.H. Soygur1 , E. Ozalp2 , L. Turhan2 . 1 Ankara Oncology Training and Research Hospital, Psychiatry Clinic, Ankara, Turkey; 2 Ankara Oncology Research and Training Hospital, Psychiatry Clinic, Ankara, Turkey Purpose: Cancer patients face not only with distressing symptoms such as appetite loss, nausea, vomitting, weight loss, sleep disturbances and pain but also psychiatric comorbidities such as adjustment disorder, depression could accompany frequently the disease process [1]. Mirtazapine is a potent antagonist at postsynaptic 5HT2, 5HT3 serotonin receptors and H1 receptor which may have potential as an adjuvant analgesic and antiemetic [2]. There is only one open-label, crossover trial evaluating the effect of mirtazapine on the distressing symptoms of cancer [3]. The effectiveness of different agents on distressing symptoms of cancer are still subject for discussion. This study aims to compare the effectiveness of mirtazapine and tricyclic antidepressants on not only distressing but also depressive and anxiety symptoms of cancer patients. Methods: Fifty-seven patients with cancer attending to Ankara Oncology Research and Training Hospital who were diagnosed with any of those; major depressive disorder, anxiety disorder or adjustment disorder by the Structured Clinical Interview for DSM-IV, were included in the study. Twenty cancer patients on mirtazapine (15−30 mg daily), seventeen patients on tricyclics (imipramine or amytriptilline; 25−75 mg daily) and twenty patients in the control group without medication were interviewed in three week intervals, totally three times in six weeks, while they