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Therapeutic effect of rianeptine on elderly depression and hippocampal volume change
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
nonpsychotic MDD after an unsatisfactory outcome with citalopram were evaluated to determine attrition rates and identify whether any pretreatment sociodemographic or clinical characteristics predict attrition. The study was conducted using data from the multisite Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Results: Twenty percent of participants in the medication augmentation group and 27% in the medication switch group dropped out before the end of the 12week trial. Remission rates in both groups were substantially lower for dropouts (7% vs. 43% in medication augmentation; 12% vs. 31% in medication switch). For medication augmentation, African–American and other non-Caucasian races, Hispanic ethnicity, younger age, a family history of drug abuse, concurrent drug abuse, sociodemographic disadvantage, less symptom improvement with first step citalopram treatment, and greater symptom severity when beginning augmentation were associated with attrition. With medication switch, African–American and other non-Caucasian races, younger age, melancholic features, and lower exit doses of but more severe side effects with citalopram treatment were associated with attrition. Conclusion: Minority status, younger age, and greater difficulty with the first treatment step are risk factors for attrition at the second step. Focus on patients with these and other attrition risk factors for medication augmentation or switch strategies may enhance retention and improve outcomes. Keywords: Attrition, Dropout, Major depressive disorder doi:10.1016/j.jad.2007.12.065
S83
ache (chronic migraine, chronic tension-type headache or both), 18–55 years, were recruited from April 2006 to March 2007, if they scored N21 on the MontgomeryÄsberg Depression Scale (MADRS) and had no other significant clinical condition. Subjects received duloxetine 60 mg/day for 8 weeks. MADRS scores and a visual analog pain scale (VAS) were the co-primary outcome measures. WHO quality of life scale (WHOQoL BREF) scores and headache days/week were secondary outcome measures. Results: MADRS scores significantly decreased from baseline to endpoint (29.5 ± 5.2 to 8.9 ± 8.7, p b 0.001), and VAS scores decreased from 5.8 ± 1.9 to 1.9 ± 2.5 ( p b 0.001). Combined intent-to-treat response rate (N50% reduction on MADRS and N 40% on VAS) was 66.7% (20/30). Significant improvements on both headache and depression were evident after the first week. WHOQoL scores increased 18.8 ± 21.9 ( p b 0.001) and number of headache days/week decreased from 5.2 ± 2.0 to 2.9 ± 2.5 days (p b 0.001). Two subjects discontinued for side effects and three for nonadherence. Conclusion: In this preliminary open trial, duloxetine 60 mg/day was effective, fast acting and well tolerated for the treatment of comorbid major depression and chronic headache. Keywords: Major depression, Chronic headache, Duloxetine, Antidepressant doi:10.1016/j.jad.2007.12.066
[P1.34] Therapeutic effect of rianeptine on elderly depression and hippocampal volume change M.Y. Chung*, S.S. Kim, T.Y. Kim
[P1.33] An open trial of duloxetine for patients with major depression and chronic primary headache F.M. Volpe* Hospital SOCOR, Brazil Background: Although major depression and chronic headache are strongly associated, there is insufficient evidence on the use of antidepressants for this specific comorbidity. This trial aimed to investigate the efficiency and tolerability of duloxetine for this indication. Methods: Thirty outpatients of our clinic, with DSM-IV major depression and concurrent primary chronic head-
Seoul Veterans Hospital, Republic of Korea Objective: This research was performed to study the effect of tianeptine, a novel antidepressant, on elderly depressed patients, to compare the hippocampus size between a normal control group and elderly depressed group, and to measure the change of hippocampal volume according to the treatment effect of tianeptine. The relationship between hippocampus size and severity of depression at baseline was studied. Methods: A group of elderly depressed patients and normal control subjects over 62 years old were recruited, 15 elderly depressed patients, all male, and average age of 70 (62–80 years old) and 15 normal
S84
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
control subjects were recruited along with age and education duration matched. To measure the effect of antidepressant, Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HDRS) and Clinical Global Impression (CGI) Scale were applied at baseline, 4th and 8th weeks. MRI was used to compare the volume of hippocampus between patients and control group and to measure the hippocampal volume of the patients at baseline and after 8-week treatment. Results: For the elderly depressed patients group, tianeptine significantly reduced MADRS, HDRS, and CGI. There was no significant difference of hippocampal volume between the elderly depressed patients and normal control group, at baselne and 8-week treatment. Conclusion: This study showed that tianeptine is a safe, effective and well-tolerated antidepressant for elderly depression. However, a change of hippocampal volume was not observed over the course of an 8-week, shortterm therapy. Keywords: Elderly depression, Hippocampus, Tianeptine doi:10.1016/j.jad.2007.12.067
ended in the end of 2003 or death. Data of prescriptions were used to construct contiguous treatment periods of follow-up time. Life-table analysis with Poisson regression was used to estimate rate ratios of antidepressant use in respect to all-causes mortality and to deaths from suicide or ischemic heart disease (IHD) in particular. Results: Current AD use was associated with substantially lowered all-cause mortality (RR 0.29, 95% CI 0.28, 0.29) and IHD mortality (RR 0.36, 95% CI 0.35, 0.37) compared with no current AD. Concerning the temporal evolution of suicide risk, suicide mortality was increased during the first month after initiation of AD treatment (RR 6.16, 95% CI 5.49, 6.90), but the risk of suicide was even higher (RR 8.65, 95% CI 7.80, 9.59) during the first month after discontinuation of AD treatment when compared with no AD use for over 360 days. Discussion: Current AD treatment is associated with substantially decreased IHD and overall mortality among those patients who have ever used AD. In order to prevent suicides, patients should be monitored at least as intensively during the first month after the discontinuation of AD treatment as after initiation of treatment. Keywords: Antidepressant, Mortality, Suicide, Epidemiology doi:10.1016/j.jad.2007.12.068
[P1.35] Antidepressant use and mortality in Finland: A register-linkage study from a nationwide cohort J. Haukkaa, M. Arffmanb, T. Partonena, S. Sihvob, J. Tiihonen*,c, J. Lönnqvista,d
[P1.36] Treating bipolar affective disorders in a developing country: The experience in North Eastern Nigeria
a
National Public Health Institute, Finland National Research and Development Centre for Welfare and Health, Finland c University of Kuopio, Finland d University of Helsinki and Helsinki University Central Hospital, Finland b
Introduction: It is generally acknowledged that depressed patients should be monitored intensively during the first weeks after initiation of antidepressant (AD) treatment because of transiently increased risk of suicide. However, the temporal evolution of mortality and suicide risk after discontinuation of AD treatment has remained unknown. Methods: Study population consisted of all individuals residing in Finland from 1994 to 2003 who had purchased at least one prescription of an antidepressant. Data sources were the National Prescription Register Causes of Death Register, Census Data of Statistics Finland and National Care Register. Follow-up started at the first purchase and
M.S. Jidda* Federal Neuropsychiatric Hospital Maiduguri, Nigeria Background: The efficacy and cost effectiveness of mood stabilizers in bipolar affective disorders have been established, and in the western world constitutes a key modality of management of these disorders. Addition of mood stabilizers to a treatment regimen increases cost 8 folds. However, in Africa how affordable an intervention is makes all the difference, as it depends not only on compliance but even initiation of treatment. The prescription of mood stabilizers in our environment is complicated by economic considerations. Local evidence is required to justify the enormous increase which follows the addition of mood stabilizers to treatment regimen in one of the most impoverished regions of Africa.
nonpsychotic MDD after an unsatisfactory outcome with citalopram were evaluated to determine attrition rates and identify whether any pretreatment sociodemographic or clinical characteristics predict attrition. The study was conducted using data from the multisite Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Results: Twenty percent of participants in the medication augmentation group and 27% in the medication switch group dropped out before the end of the 12week trial. Remission rates in both groups were substantially lower for dropouts (7% vs. 43% in medication augmentation; 12% vs. 31% in medication switch). For medication augmentation, African–American and other non-Caucasian races, Hispanic ethnicity, younger age, a family history of drug abuse, concurrent drug abuse, sociodemographic disadvantage, less symptom improvement with first step citalopram treatment, and greater symptom severity when beginning augmentation were associated with attrition. With medication switch, African–American and other non-Caucasian races, younger age, melancholic features, and lower exit doses of but more severe side effects with citalopram treatment were associated with attrition. Conclusion: Minority status, younger age, and greater difficulty with the first treatment step are risk factors for attrition at the second step. Focus on patients with these and other attrition risk factors for medication augmentation or switch strategies may enhance retention and improve outcomes. Keywords: Attrition, Dropout, Major depressive disorder doi:10.1016/j.jad.2007.12.065
S83
ache (chronic migraine, chronic tension-type headache or both), 18–55 years, were recruited from April 2006 to March 2007, if they scored N21 on the MontgomeryÄsberg Depression Scale (MADRS) and had no other significant clinical condition. Subjects received duloxetine 60 mg/day for 8 weeks. MADRS scores and a visual analog pain scale (VAS) were the co-primary outcome measures. WHO quality of life scale (WHOQoL BREF) scores and headache days/week were secondary outcome measures. Results: MADRS scores significantly decreased from baseline to endpoint (29.5 ± 5.2 to 8.9 ± 8.7, p b 0.001), and VAS scores decreased from 5.8 ± 1.9 to 1.9 ± 2.5 ( p b 0.001). Combined intent-to-treat response rate (N50% reduction on MADRS and N 40% on VAS) was 66.7% (20/30). Significant improvements on both headache and depression were evident after the first week. WHOQoL scores increased 18.8 ± 21.9 ( p b 0.001) and number of headache days/week decreased from 5.2 ± 2.0 to 2.9 ± 2.5 days (p b 0.001). Two subjects discontinued for side effects and three for nonadherence. Conclusion: In this preliminary open trial, duloxetine 60 mg/day was effective, fast acting and well tolerated for the treatment of comorbid major depression and chronic headache. Keywords: Major depression, Chronic headache, Duloxetine, Antidepressant doi:10.1016/j.jad.2007.12.066
[P1.34] Therapeutic effect of rianeptine on elderly depression and hippocampal volume change M.Y. Chung*, S.S. Kim, T.Y. Kim
[P1.33] An open trial of duloxetine for patients with major depression and chronic primary headache F.M. Volpe* Hospital SOCOR, Brazil Background: Although major depression and chronic headache are strongly associated, there is insufficient evidence on the use of antidepressants for this specific comorbidity. This trial aimed to investigate the efficiency and tolerability of duloxetine for this indication. Methods: Thirty outpatients of our clinic, with DSM-IV major depression and concurrent primary chronic head-
Seoul Veterans Hospital, Republic of Korea Objective: This research was performed to study the effect of tianeptine, a novel antidepressant, on elderly depressed patients, to compare the hippocampus size between a normal control group and elderly depressed group, and to measure the change of hippocampal volume according to the treatment effect of tianeptine. The relationship between hippocampus size and severity of depression at baseline was studied. Methods: A group of elderly depressed patients and normal control subjects over 62 years old were recruited, 15 elderly depressed patients, all male, and average age of 70 (62–80 years old) and 15 normal
S84
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
control subjects were recruited along with age and education duration matched. To measure the effect of antidepressant, Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HDRS) and Clinical Global Impression (CGI) Scale were applied at baseline, 4th and 8th weeks. MRI was used to compare the volume of hippocampus between patients and control group and to measure the hippocampal volume of the patients at baseline and after 8-week treatment. Results: For the elderly depressed patients group, tianeptine significantly reduced MADRS, HDRS, and CGI. There was no significant difference of hippocampal volume between the elderly depressed patients and normal control group, at baselne and 8-week treatment. Conclusion: This study showed that tianeptine is a safe, effective and well-tolerated antidepressant for elderly depression. However, a change of hippocampal volume was not observed over the course of an 8-week, shortterm therapy. Keywords: Elderly depression, Hippocampus, Tianeptine doi:10.1016/j.jad.2007.12.067
ended in the end of 2003 or death. Data of prescriptions were used to construct contiguous treatment periods of follow-up time. Life-table analysis with Poisson regression was used to estimate rate ratios of antidepressant use in respect to all-causes mortality and to deaths from suicide or ischemic heart disease (IHD) in particular. Results: Current AD use was associated with substantially lowered all-cause mortality (RR 0.29, 95% CI 0.28, 0.29) and IHD mortality (RR 0.36, 95% CI 0.35, 0.37) compared with no current AD. Concerning the temporal evolution of suicide risk, suicide mortality was increased during the first month after initiation of AD treatment (RR 6.16, 95% CI 5.49, 6.90), but the risk of suicide was even higher (RR 8.65, 95% CI 7.80, 9.59) during the first month after discontinuation of AD treatment when compared with no AD use for over 360 days. Discussion: Current AD treatment is associated with substantially decreased IHD and overall mortality among those patients who have ever used AD. In order to prevent suicides, patients should be monitored at least as intensively during the first month after the discontinuation of AD treatment as after initiation of treatment. Keywords: Antidepressant, Mortality, Suicide, Epidemiology doi:10.1016/j.jad.2007.12.068
[P1.35] Antidepressant use and mortality in Finland: A register-linkage study from a nationwide cohort J. Haukkaa, M. Arffmanb, T. Partonena, S. Sihvob, J. Tiihonen*,c, J. Lönnqvista,d
[P1.36] Treating bipolar affective disorders in a developing country: The experience in North Eastern Nigeria
a
National Public Health Institute, Finland National Research and Development Centre for Welfare and Health, Finland c University of Kuopio, Finland d University of Helsinki and Helsinki University Central Hospital, Finland b
Introduction: It is generally acknowledged that depressed patients should be monitored intensively during the first weeks after initiation of antidepressant (AD) treatment because of transiently increased risk of suicide. However, the temporal evolution of mortality and suicide risk after discontinuation of AD treatment has remained unknown. Methods: Study population consisted of all individuals residing in Finland from 1994 to 2003 who had purchased at least one prescription of an antidepressant. Data sources were the National Prescription Register Causes of Death Register, Census Data of Statistics Finland and National Care Register. Follow-up started at the first purchase and
M.S. Jidda* Federal Neuropsychiatric Hospital Maiduguri, Nigeria Background: The efficacy and cost effectiveness of mood stabilizers in bipolar affective disorders have been established, and in the western world constitutes a key modality of management of these disorders. Addition of mood stabilizers to a treatment regimen increases cost 8 folds. However, in Africa how affordable an intervention is makes all the difference, as it depends not only on compliance but even initiation of treatment. The prescription of mood stabilizers in our environment is complicated by economic considerations. Local evidence is required to justify the enormous increase which follows the addition of mood stabilizers to treatment regimen in one of the most impoverished regions of Africa.