P-28 Comparison of moclobemide and sertraline in the treatment of atypical depression: A preliminary study

Sl-19

Poster presentations seen at the second, third, fifth, seventh, ninth and thirteenth weeks. HAM-D, Quality of Life, Clinical Global Impression and Visual Analogous Scales were given. Mean value of HAM-D scores decreased from 25.629 to 5.554 at the end of 13 weeks (p < 0.001); Severity of the illness according to Global Impression was 4.788 at the beginning of the study which dropped to 1.588 at the end (p
References Reimherr,

F.W., Byerley.

W.F., Ward,

F. et al. (1986)

Sertraline,

a selective

inhibitor

of

Serotonin uptake, for the treatment of outpatients with major depressive disorder, Psychopharmacology Bulletin 24, 200-205. Reimherr, F.W., Chouinard, G.. Cohn, C.K. et al. (1990) Antidepressant efficacy of serlraline: a double blind, parison study in outpatients Supp 6. 16-27.

(p-261

placebo and amitriptyline-controlled, multicenter comwith major depression, Journal of Clinical Psychiatry 51

The efficacy and safety of sertraline depression

$. Giilseren, 6. Aydemil, L. Kiiey, S. Ktiltiir. Atattirk State Hospifal, /zmir, Turkey Keywords:

Sertraline;

Major depression:

Efficacy;

Department

in major of Psychiatry,

Safety

In this study, we aimed to assess the efficacy, safety and adverse reactions of sertraline in a group of in-patients with major depression (MD). Thirtyfour patients diagnosed by SCID (Structured Clinical Interview for DSM-IIIR) as having MD (single or recurrent episode) attended the study. Symptomatology was assessed by HRSD (Hamilton Rating Scale for Depression) and HARS (Hamilton Anxiety Rating Scale), severity and global improvement by CGI (Clinical Global Impression) and adverse reactions by an Appropriate Adverse Reaction form. These assessments were done at the first admittance and were repeated at the 2nd, 3rd, 5th, 7th, 9th and lastly at the 13th weeks. Serlraline was started 50 mg daily and the dose was elevated by 50 mg day considering the clinical improvement. The mean age of the patients was 47.1 ?l 1.7 and 44% were male and 58% female. Fifty-six percent of the patients were diagnosed as MD, recurrent episode and 44% as MD, single episode. The total score of HRSD was 25.9k4.7 at the first admittance. The decrease in the severity of the disease measured by HRSD and CGI both became significant at the second week, and global improvement at the 7th week. Clinical improvement in the severity of anxiety symptoms in these patients measured by HARS was also significant. The mean dose of sertraline was 75 mg/day at the 5th week, 95 mg/day at the 13th week. The most frequent adverse reactions were nausea and diarrhea and they disappeared in a few days without any intervention. One patient dropped out because of adverse reaction. These results support the efficacy and safety of sertraline for the treatment of MD.

IP-27

Moclobemide and settraline in the treatment of melancholic depression: a comparative study

M.H. TiirkCapar”, S.D. Cirsel’, E.N.D. A. Akdemir’, M.H. Qzbay’. ‘Department

Training Hospital, Turkey Keywords:

There Table

Melancholic

is a common

Menevig

E.0.

KIII~‘.

A. Sirin*,

of Psychiatry Social Security s. No.: 83115 A. Ayrancr-Ankara 06690,

depression;

belief

iscan,

treatment

that

response;

melancholic

serlraline;

depressives

moclobemide

are

particularly

responsive to drug treatment. The objectives of this study were first to compare the drug responses (moclobemide versus sertraline) in melancholic major depressive patients. Secondly we aimed to compare the responses of melancholic and non melancholic patients to drug treatment. The study included 63 patients, with diagnosis of major depression according to DSM-III-R criteria, of whom 32 were melancholic type. The Hamilton Depression Rating Scale (HDRS) and Clinical Global Impression (CGI) Scale were used to assess the severity of depression and response to treatment. In this single blind, comparative randomized study, 29 patients received moclobemide while 34 of them were receiving sertraline for 13 weeks. The mean baseline scores on HDRS for moclobemide and serlraline groups were 21.9( k7.2) and 23.5(?7.3) respectively. A 50% decrease on HDRS scores was defined as treatment response in this study. At the end of 13 weeks, mean decrease on HDRS scores was 14.78 for the whole group. The results of intent to treat analysis revealed that the response rates were 69% and 59.59 +Z for melancholic and non melancholic patients respectively, but the difference was statistically insignificant. The response rate of moclobemide in non melancholic group was 73.3% and that of sertraline was 41.7%. The melancholic group showed a response rate of 82.4% and 50% to sertraline and moclobemide respectively (Table 1). Moclobemide was tolerated better than sertraline with regards to side effects. A significant antidepressant effect was observed in both groups. Although statistically insignificant, there appeared a difference between melancholic and non melancholic groups as the former benefited more from antidepressant treatment. Our results imply that moclobemide is more effective in non melancholic group in contrast to sertraline that proved better in melancholic group, but the differences are not statistically significant due to small numbers of subjects. As far as we know there are no data supporling our results with sertraline; thus suggesting that melancholic patients may have better response to sertraline in contrast to non melancholic group. On the other hand, our findings are consistent with the published data suggesting that non melancholic depressives have a better response with moclobemide (Woggon, 1993).

Reference Woggon 6. (1993) The role of moclobemide in endogenous depression: recent data. International Clinical Psychopharmacology 7, 137-139.

P-28 Comparison

El

treatment study

Keywords:

Atypical

MeneviS depression;

type

Melancholic Non melancholic

Mcclobemide Responders 6 (50.0%) 11 (73.3%)

Seltraline Nonresponders

Responders

6 (50%) 4 (26.7%)

14 (62.4%) 5 (41.7%)

igcan’,

A. AkdemiT,

A. Sirin”,

of Psychiatry, Social Security s. No: 83115 A. Ayranci-Anakara 06690,

treatment

response;

sertraline;

moclobemide

There is a general consensus that classical MAO inhibitors are more effective than tricyclic antidepressants (TCA) in the treatment of atypical depression (Schatzberg and Nemeroff, 1995). Moclobemide that is a member of reversible inhibitors of monoamino oxidase (RIMA) shows the same efficacy in major depression as TCAs. Whether moclobemide is as efficacious classical MAO inhibitors in the treatment of atypical depression needs further evaluation. On the other hand, some authors suggest that SSRls can be used as a second treatment choice for atypical depression. The aim of our study was to explore an compare the efficacy of moclobemide and sertraline in the treatment of atypical depression. The effectiveness of moclobemide and sertraline in the treatment of atypical depressive patients was compared in a 13 week single blind randomized trial. The Hamilton Depression Rating Scale (HDRS) and Clinical Global Impression (CGI) Scale were used to assess the severii of depression and response to treatment. Twelve patients that were diagnosed as atypical major depression

1

Depression

of

of moclobemide and settraline in the of atypical depression: A preliminary

S.D. ijrsel’, M.H,: Ttirkppar’, E.N.D. E. Gdka’, M.H. Ozbay’. ‘Department

Training Hospital, Turkey

a survey

Non-

responders

Significance (p < 0.05)

3 (17.6%) 7 (56.3%)

0.07 0.1

Poster

Sl-20 Table 1 Drugs Moclobemide Settraline

Responders 4(57.1%) 1 (25%)

Non-Responders

Total

3 (42.9%) 3 (75%)

7 4

presentations

was observed in the fluoxetine treated group in two patients, and one patient developed extrapyramidal symptoms and the therapy was discontinued. No changes in the routine tests applied were observed. According to these results, both antidepressants seem to be effective and well tolerated in the treatment of elderly depressed patients, but moclobemide exerts earlier onset of action compared to fluoxetine.

References according to DSM-IV atypical depression criteria, assigned to study. Only one patient who didn’t come to any follow-up controls was excluded from the study. Seven patients received moclobemide and 4 patients received sertraline. The mean baseline scores on HDRS for moclobemide and sertraline groups were 22.0 (k4.9) and 21.7( 54. 5) respectively. A 50%, decrease on HDRS scores as treatment response in this study. The result of intent to treat analysis revealed that the response rates were 57.1% and 25.0% for moclobemide and sertraline groups respectively, but the difference was statistically insignificant (p: 036) (Table 1). Our results imply that moclobemide is as efficient as classical MAO inhibitors in the treatment of atypical depression. Recently, a double-blind study from Finland that compared the efficacy of fluoxetine and moclobemide in the treatment of atypical depression concluded that atypical depressive patients respond more favorably to moclobemide than to fluoxetine (Lonnqvist et al. 1994). Our results support this conclusion; but due to small number of patients, more controlled studies are needed for affimting that moclobemide is more efficient than SSRI in the treatment of atypical depression. References Lonnqvist, J, Sihvo S, Syvalahti E, Ktviruusu 0 (1994) Moclobemide and fluoxetine in atypical depression: a double-blind trial. Journal of Affective Disorders. 32, 169-77. Schatzberg AF. Nemeroff CB. (eds) (1995) Textbook of Psychopharmacology. Amedcan Psychiatric Press, Inc. Washington, DC: 563.

(p-291

Fluoxetine depressed

Cl. Sugarski-Kirola, Psychiatry, Clinical Yugoslavia Keywords:

Depression:

versus patients

moclobemide

Dj Zivkovic, 2. Stankovic, Cenfer of Serbia Pasterova

fluoxetine;

mcclobemide;

in elderly A. Damjanovic. 2, Belgrade

Insfifufe I 1000,

for

elderly

Depressive disorder is common among elderly patients. In spite of the variety of antidepressants available in the market, their choice is limited because of coexisting medical diseases found in elderly patients as well as physiological age-related changes. Fluoxetine and moclobemide, two distinct types of antidepressants are said to be effective, and lack the usual side-effects of classical antidepressants. The aim of this study was: 1. to determine the efficacy of both drugs through reduction of depressive symptomatology 2. to compare the onset of antidepressant action 3. to examine the tolerability and the possible side-effects. In this study 42 female inpatients with a DSM Ill R diagnosis of major depression were consecutively assigned to the treatment with either fluoxetine 20-40 mg/day or moclobemide 300-600 mg/day. Apart from medazepam no other concomitant therapy was applied. 38 patients completed the six week treatment. The mean age of patients was 62.5. There was no significant difference in demographic or depression-severity measures at the beginning of the treatment among the patients. HAMD17 and CGI were applied at baseline, after 3-7 days washout period and weekly for 6 weeks. Reduction of > = 50% of total HAMD17 score or a decrease to < = 12 from the initial HAMD17 score was considered as a positive treatment response. Vital signs (pulse, blood pressure, etc. ) were taken daily and ECG and laboratory tests once a week. Student test (p < 0.05) was applied for the statistical evaluation of the results, The efficacy of the treatment at the end, seen as previously defined responder rate was similar for both groups, 74% for moclobemide and 69% for fluoxetine, demonstrating significant antidepressant effect of both drugs. After two weeks of treatment 42% of the moclobemide treated patients reached the HAMD responder criterion, against 19% of the fluoxetine treated group. Moclobemide therefore, exerted significantly faster onset of action (p< 0.05) in comparison to fluoxetine. The tolerability of moclobemide was good, except for one patient who dropped out of the treatment because of gastrointestinal disturbances. The increase of anxiety

1. Fitton A., Faulds D.. Goa KL (1992): Moclobemide: a review of its pharmacological properties and therapeutic use in depressive illness. Drugs 43: 561.596. 2. Montgomery SA (1969a): The efficacy of fluoxetine as an antidepressant in the short term and long term. Int. Clin Psychopharmacol. 4 (suppl.1): 113-119.

I

P-30

Clopixol hospital

Acuphasem setting

in the treatment

of mania

in a

S. Stefanova, L. Hranovb, N. Yanakiev”, E. Dimitrovad. ‘State‘s Psycniatric Hospital, Tzafev Bred, Bulgaria; bDepartment of Psychiatry. Medical University, Sofia, Bulgaria; ‘District Hospital, Psychiafric Ward, Blagoevgrad, Bulgaria; d Mental Health Center, Turgovishte, Bulgaria. An open 6-day trial of Clopixol Acuphaseo was carried through on 9 patients with an acute manic episode (5 males and 4 females aged 26-64 years; mean age 46.67) in a hospital setting to establish the practical usefulness of the drug for this condition. The mean single dose was 80.0 mg (11 applications of 50 mg each, 6 of 100 mg and 3 of 156 mg). The mean number of injections was 2.22 (one patient received 1 injection, 5 patients received 2 and 3 patients received 3 injections each). The mean interval between applications was 54.5 hours (24 hours in 4 cases, 46 hours in 1 case, 72 hours in 5 cases and 96 hours in 1 case). The mean total dose applied was 177.78 mg (one patient received a total dose of 100 mg, 4 patients received 150 mg, 3 patients received 200 mg each and one received 300 mg for the whole course of treatment). Mean CGI score at the beginning of therapy was 5.11 and dropped by 32.4% at the end of the observation period. 7 patients were considered to be “much” or “very much” improved and 2 patients were rated as “minimally improved” or with “no change” at the end of the 6-day period, so that 3 patients were full responders to treatment (2 or more points on CGI), 5 were partial responders and 1 did not respond to Clopixol Acuphase. Tolerability was good and none of the patients dropped out of the study protocol. The most common (and in fact sought after) “side” effect was somnolence. Extrapyramidal symptoms were mild and relatively rare. With regard to single dose and interval between injections manic patients remained in between the parallel groups of 10 schizoaffective (limited number of high-dose applications in long intervals) and 26 schizophrenic patients (higher number of smaller-dose applications in short intervals). Manic patients respond least to treatment with Clopixol Acuphase@ compared to the other two groups of psychotic patients but the overall therapeutic effect is satisfactory from a practical perspective. Clopixol Acuphase” proved to be a valuable clinical tool in the management of mania in a hospital setting.

[p-311Four-year

unipolar recurrence

outcomes for maintenance subjects with high probability

therapies of

R. Zanardi, L. Franchini, M. Gasperini, J. Perez, E. Smeraldi. Scientifico H. San Raffaele, Department of Neuropsychiatric School of Medicine, University of Milan, ltaly Keywords:

Depression;

Maintenance

therapy;

in

lstifufo Sciences,

Fluvoxamine

A maintenance therapy is strongly suggested since a significant proportion of individuals with Major Depressive Disorder have a course of illness characterized by recurrence. In fat, it has been suggested that after the recovery from a major depressive episode there is a 50% of probability that the subjects experienced a new episode within two years (1). Several selective serotonin reuptake inhibitors (SSRls) have been shown to be effective in preventing relapses and/or recurrent episodes of depression (2). We have compared the efficacy of the SSRI fluvoxamine and lithium during a four-year follow-up study in a population of unipolar subjects with