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The efficacy of sertraline in elderly patients suffering from major depression
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190-381
1997;42:1S-297S
Mirtazaplne In recurrent brief depression (RBD)
M. Stamenkovic. L. Pezawas, H.N. Aschauer, M. de Zwaan, S. Kasper. Department of General Psychiatry, University Hospital of Psychiatry, Vienna. Austria RBD has a high prevalence in the general population (10%). At present, data on the treatment of RBD are sparse. Results on a few treatment studies with SSRls do not demonstrate their efficacy in this disorder. Mirtazap• ine Is a noradrenergic and specific selective serotoninergic antidepressant (NaSSA). Methods: We present a case report of two patients suffering from RBD treated successfully with mirtazapine (30 mg per day) during a period of four months. Both patients kept a diary in order to document eighteen psychopathological symptoms of major depression according to DSM-IV. which they marked as mild (= 1), moderate (= 2) or severe (= 3) respectively. Results: The first patient (35 years female) had once or twice a month severely depressive episodes lasting for one week since 15 years. During the brief episodes she had suicidal ideas with symptomatic alcohol abuse. The mean daily diary score (DDS) of depressive symptoms before medication was 25 and decreased in the following months of treatment. In the fourth month no depressive episode occurred. The mean duration of depressive episodes (8 days) decreased also (4 days). Hamilton Depression Rating scale (HDRS) score at the last depressive episode before treatment with mirtazapine was 28 and after 4 months of treatment zero. The other female patient (36 years) had severe brief depressive episodes lasting 1 to 3 days occurring almost every week since five years. DDS dropped from 35 to 11. The rate of occurrence of depressive episodes decreased from once a week to once a month. HAMD score changed from 25 before treatment to 9 In the fourth month of treatment. We showed an improvement In RBD In two patients treated with mlrtazap• Ine 30 mg daily. Because of Its efficacy we assume. that central noradrenergic system might playa major role in RBD.
190-391
Poster session IV
BIOL. PSYCHIATRY
Long-term f1uvoxamlne In panic disorder
Rudolph Hoehn-Saric. Johns Hopkins Medical Institution, Baltimore, Maryland, US Objectives: Fluvoxamlne, an SSRI has proved to be efficacious in short-term trials in panic disorder, but as panic is often a chronic illness. a long-term study was needed to assess its continued efficacy. Methods: An open extension study of two Identical double-blind, placebo controlled trials was conducted In 73 patients with DSM-IIIR panic disorder. Patients received 50-450 mglday of f1uvoxamine for up to 12 months. The Clinical Anxiety Scale (CAS) total score (6 Items) was used to measure generalised anXiety. An estimate of panic attack frequency and severity was obtained from CAS Item 7. The Clinical Global Impression (CGI) scale was used to determine global Improvement and severity of illness. Safety and tolerability of f1uvoxamine were assessed at each scheduled visit by recording vital signs. Results: In the 31 patients previously treated with placebo, f1uvoxamlne decreased the frequency of panic attacks, In the 42 patients previously treated with f1uvoxamine. therapeutics gains were maintained. Some previ• ous non-responders to f1uvoxamlne also Improved with continued treatment. The incidence of adverse effects tended to be higher in those patients receiving f1uvoxamlne for the first time. but most adverse effects were minor and treatment was not discontinued. Conclusions: Fluvoxamlne Is a useful and safe drug for long-term man• agement of panic disorder with sustained efficacy and confirmed long term tolerability.
190-40 1 Arnlsulprlde vs amitriptyline In the medium-term treatment of dysthymia: A safety study L. Ravizza for the Amilong Investigators. Psychiatric Clinic, University of Torino via Cherasco, 11 Torino, Italy A double-blind. randomized. parallel group study to compare safety and efficacy of a six-month treatment with either amisulpride 50 mglday or amitriptyline 25-75 mglday was carried out In 26 Italian Psychiatric centres. Two hundred fifty dysthymic patients (165 amisulpride, 85 amitriptyline) were Included in the intention-te-treat analysis. The two groups were well balanced for age (X ± SO: 46.5 ± 12.7 yr; amisulpride. 48.1 ± 12.4 yr amitriptyline). sex (female/male ratio in both groups: 1.8) and baseline symptom severity. A total of 139 patients (93 amlsulpride, 46 amitriptyline) completed the study
with no statistical differences In reasons for premature termination between groups. Proportion of patients with at least one treatment emergent adverse event was higher with amitriptyline (72.9%) than with amisuipride (64.2%, NS). In the amitriptyline group a statistically significantly higher Incidence of eNS and autonomic nervous system disorders was observed (41.2% and 44.7%, respectively vs 23.6% and 15.8% for amisulpride). Endocrine disorders were more frequent with amlsulpride (17.6% vs 7.1%) and mostly confined to females of fertile age. . Results on the symptom rating scales indicate that both drugs were equally effective: 60% and 62"10 of patients under amisulpride and amitriptyline respectively, having achieved a 50% reduction of the MADRS at M6. In conclusion. results of the present study. in a large caselist, support the safe use of amisulpride in the medium-term treatment of dysthymia.
190-41
I The efficacy of sertraline In elderly patients SUffering from major depression
K. Wilson 1• C. Berti 2 , A. Whitehead 2. 1 Royal Uverpool University Hospital, Uverpool. UK, 2 Medical Department, Pfizer Umited. Sandwich, Kent, UK We report Initial findings from a large study evaluating sertrallne In the prevention of relapse of depression In elderiy patients. 254 patients (mean age: n.6 :I: 6.9 years) with major depression (DSM-III-R) were treated with sertrallne (50-200 mglday). After Phase I. acute treatment (8 weeks titration) and Phase II (8 weeks maintenance). n% of the responders received 50 mglday and 19% received 100 mglday. The remaining 4% of subjects required doses of 150 mg or 200 mglday to benefit. Patients significantly (p > 0.(01) ImproVed on both HAM-D (62% reduction from baseline) and MADRS (62% reduction). Responders (three consecutive HAM-D assessments of =:;10) were randomised to continue on SBrtraline or placebo for a further two years (Phases III and IV). The preliminary analysis of Phases I and II suggests that sertraline 50 mglday Is a suitable regimen to produce significant Improvement in depressed elderiy patients. The improvement In sleep paralleled the overall Improvement In HAM-D scores. Anxiety scores followed a similar pattern but at a slightly slower rate of Improvement. The investigators concluded that sertraline Is effective and well tolerated In the acute treatment and maintenance therapy of major depression in an elderiy population.
190-421
Remission rates during short-term treatment with mlrtazapine
P. Bech. M. Zivkov. Fredriksborg General Hospital, Hil/erBd, Denmark, NV Organon, Oss. The Netheriands Aim: To analyze the remission rates (percentages of patients with 17-HAMD score =:;7), the most stringent outcome criterion of antidepressant treat• ment, In the double-blind. randomized. short-term. actlve-control studies of mlrtazapine. Method: Percentages of patients who completed the full study period were calculated for all amilriptyline-controlled studies (n = 7), as well as for other actlve-controlled studies (clomipramine. n = 1; doxepin, n. 1; and trazodone. n 1). Amitriptyline-controlled studies were further divided Into subset where mirtazapine was used In dosages between 5 and 35 mglday (n • 4) and subset with dosages 20-60 mglday (n = 3). In the other active-controlled studies mlrtazaplne was used in doses between 20 and 80 mglday. Results: Remission rates for mirtazaplne were between 33 and 50% In the studies using the lower doses of mlrtazapine. In the studies using the higher doses. remitter rates obtained during the mlrtazaplne treatment were between 46 and 58%. .Conclusion: In general, remission rates obtained with mirtazaplne are high (3H8%), and In the majority of the studies higher than those obtained with the active comparator. High Initial doses of mirtazaplne appear to be related to Increased remission rates.
=
190-381
1997;42:1S-297S
Mirtazaplne In recurrent brief depression (RBD)
M. Stamenkovic. L. Pezawas, H.N. Aschauer, M. de Zwaan, S. Kasper. Department of General Psychiatry, University Hospital of Psychiatry, Vienna. Austria RBD has a high prevalence in the general population (10%). At present, data on the treatment of RBD are sparse. Results on a few treatment studies with SSRls do not demonstrate their efficacy in this disorder. Mirtazap• ine Is a noradrenergic and specific selective serotoninergic antidepressant (NaSSA). Methods: We present a case report of two patients suffering from RBD treated successfully with mirtazapine (30 mg per day) during a period of four months. Both patients kept a diary in order to document eighteen psychopathological symptoms of major depression according to DSM-IV. which they marked as mild (= 1), moderate (= 2) or severe (= 3) respectively. Results: The first patient (35 years female) had once or twice a month severely depressive episodes lasting for one week since 15 years. During the brief episodes she had suicidal ideas with symptomatic alcohol abuse. The mean daily diary score (DDS) of depressive symptoms before medication was 25 and decreased in the following months of treatment. In the fourth month no depressive episode occurred. The mean duration of depressive episodes (8 days) decreased also (4 days). Hamilton Depression Rating scale (HDRS) score at the last depressive episode before treatment with mirtazapine was 28 and after 4 months of treatment zero. The other female patient (36 years) had severe brief depressive episodes lasting 1 to 3 days occurring almost every week since five years. DDS dropped from 35 to 11. The rate of occurrence of depressive episodes decreased from once a week to once a month. HAMD score changed from 25 before treatment to 9 In the fourth month of treatment. We showed an improvement In RBD In two patients treated with mlrtazap• Ine 30 mg daily. Because of Its efficacy we assume. that central noradrenergic system might playa major role in RBD.
190-391
Poster session IV
BIOL. PSYCHIATRY
Long-term f1uvoxamlne In panic disorder
Rudolph Hoehn-Saric. Johns Hopkins Medical Institution, Baltimore, Maryland, US Objectives: Fluvoxamlne, an SSRI has proved to be efficacious in short-term trials in panic disorder, but as panic is often a chronic illness. a long-term study was needed to assess its continued efficacy. Methods: An open extension study of two Identical double-blind, placebo controlled trials was conducted In 73 patients with DSM-IIIR panic disorder. Patients received 50-450 mglday of f1uvoxamine for up to 12 months. The Clinical Anxiety Scale (CAS) total score (6 Items) was used to measure generalised anXiety. An estimate of panic attack frequency and severity was obtained from CAS Item 7. The Clinical Global Impression (CGI) scale was used to determine global Improvement and severity of illness. Safety and tolerability of f1uvoxamine were assessed at each scheduled visit by recording vital signs. Results: In the 31 patients previously treated with placebo, f1uvoxamlne decreased the frequency of panic attacks, In the 42 patients previously treated with f1uvoxamine. therapeutics gains were maintained. Some previ• ous non-responders to f1uvoxamlne also Improved with continued treatment. The incidence of adverse effects tended to be higher in those patients receiving f1uvoxamlne for the first time. but most adverse effects were minor and treatment was not discontinued. Conclusions: Fluvoxamlne Is a useful and safe drug for long-term man• agement of panic disorder with sustained efficacy and confirmed long term tolerability.
190-40 1 Arnlsulprlde vs amitriptyline In the medium-term treatment of dysthymia: A safety study L. Ravizza for the Amilong Investigators. Psychiatric Clinic, University of Torino via Cherasco, 11 Torino, Italy A double-blind. randomized. parallel group study to compare safety and efficacy of a six-month treatment with either amisulpride 50 mglday or amitriptyline 25-75 mglday was carried out In 26 Italian Psychiatric centres. Two hundred fifty dysthymic patients (165 amisulpride, 85 amitriptyline) were Included in the intention-te-treat analysis. The two groups were well balanced for age (X ± SO: 46.5 ± 12.7 yr; amisulpride. 48.1 ± 12.4 yr amitriptyline). sex (female/male ratio in both groups: 1.8) and baseline symptom severity. A total of 139 patients (93 amlsulpride, 46 amitriptyline) completed the study
with no statistical differences In reasons for premature termination between groups. Proportion of patients with at least one treatment emergent adverse event was higher with amitriptyline (72.9%) than with amisuipride (64.2%, NS). In the amitriptyline group a statistically significantly higher Incidence of eNS and autonomic nervous system disorders was observed (41.2% and 44.7%, respectively vs 23.6% and 15.8% for amisulpride). Endocrine disorders were more frequent with amlsulpride (17.6% vs 7.1%) and mostly confined to females of fertile age. . Results on the symptom rating scales indicate that both drugs were equally effective: 60% and 62"10 of patients under amisulpride and amitriptyline respectively, having achieved a 50% reduction of the MADRS at M6. In conclusion. results of the present study. in a large caselist, support the safe use of amisulpride in the medium-term treatment of dysthymia.
190-41
I The efficacy of sertraline In elderly patients SUffering from major depression
K. Wilson 1• C. Berti 2 , A. Whitehead 2. 1 Royal Uverpool University Hospital, Uverpool. UK, 2 Medical Department, Pfizer Umited. Sandwich, Kent, UK We report Initial findings from a large study evaluating sertrallne In the prevention of relapse of depression In elderiy patients. 254 patients (mean age: n.6 :I: 6.9 years) with major depression (DSM-III-R) were treated with sertrallne (50-200 mglday). After Phase I. acute treatment (8 weeks titration) and Phase II (8 weeks maintenance). n% of the responders received 50 mglday and 19% received 100 mglday. The remaining 4% of subjects required doses of 150 mg or 200 mglday to benefit. Patients significantly (p > 0.(01) ImproVed on both HAM-D (62% reduction from baseline) and MADRS (62% reduction). Responders (three consecutive HAM-D assessments of =:;10) were randomised to continue on SBrtraline or placebo for a further two years (Phases III and IV). The preliminary analysis of Phases I and II suggests that sertraline 50 mglday Is a suitable regimen to produce significant Improvement in depressed elderiy patients. The improvement In sleep paralleled the overall Improvement In HAM-D scores. Anxiety scores followed a similar pattern but at a slightly slower rate of Improvement. The investigators concluded that sertraline Is effective and well tolerated In the acute treatment and maintenance therapy of major depression in an elderiy population.
190-421
Remission rates during short-term treatment with mlrtazapine
P. Bech. M. Zivkov. Fredriksborg General Hospital, Hil/erBd, Denmark, NV Organon, Oss. The Netheriands Aim: To analyze the remission rates (percentages of patients with 17-HAMD score =:;7), the most stringent outcome criterion of antidepressant treat• ment, In the double-blind. randomized. short-term. actlve-control studies of mlrtazapine. Method: Percentages of patients who completed the full study period were calculated for all amilriptyline-controlled studies (n = 7), as well as for other actlve-controlled studies (clomipramine. n = 1; doxepin, n. 1; and trazodone. n 1). Amitriptyline-controlled studies were further divided Into subset where mirtazapine was used In dosages between 5 and 35 mglday (n • 4) and subset with dosages 20-60 mglday (n = 3). In the other active-controlled studies mlrtazaplne was used in doses between 20 and 80 mglday. Results: Remission rates for mirtazaplne were between 33 and 50% In the studies using the lower doses of mlrtazapine. In the studies using the higher doses. remitter rates obtained during the mlrtazaplne treatment were between 46 and 58%. .Conclusion: In general, remission rates obtained with mirtazaplne are high (3H8%), and In the majority of the studies higher than those obtained with the active comparator. High Initial doses of mirtazaplne appear to be related to Increased remission rates.
=