- Email: [email protected]
P-32 The safeness of labetalol in electroconvulsive therapy
Poster
Sl-21
presentations
high probability of recurrence (at least two episodes of major depression being no more than 18 months earlier). We recruited 64 unipolar subjects (10 men and 54 women) after recovery from the index depressive episode. Recovery was defined by the presence of euthymia for at least two consecutive weeks according DSM-III-R criteria, in absence of functional impairment and the Hamilton Rating Scale for Depression score < 8. After recovery, patients were randomly assigned to one of the two long-term treatment groups: fluvoxamine (N = 32) or lithium (N = 32). During the four-year follow-up study two patients developed a manic episode (1 in each group) and were excluded. No patient dropped out for unpleasant side effects or did not continue the drug assumption. Plasma levels of fluvaxamine and lithium were monthly evaluated and ranged about 0.7 mEq/l and about 100 rig/ml, respectively. The Savage Cox test was used to compare survival curves and the Cox proportional hazard model was employed to calculate the hazard of recurrence taking into account all clinical variables of interest. We found that the unipolar subjects with high probability of recurrence in fluvoxamine treatment had an outcome with a lower frequency of new recurrences when compared to those in lithium prophylactic treatment. In fact, during the follow-up period, 13 subjects had a single new depressive episode: 5 on fluvoxamine (16.1%) and 8 on lithium therapy (25.8%). There was a significant difference in survival rates between the two medication groups (2 value = 2.02; p = 0.04). The age of onset significantly affected the risk of recurrence: recurred patients displayed a significant earlier onset than non recurred patients (35.1?12.3 vs 41.7z10.9; z value = 1.95; p = 0.05). The pre-treatment recurrence index was also significantly higher among recurred patients (7.724.6 vs 4.523.5; z value = 2.44; p = 0.01). In conclusion the results herein presented indicate that the SSRI fluvoxamine can be considered an effective compound in the maintenance therapy of unipolar subjects with high probability of recurrence.
Reference 1. Belsher, Ci. and Costello, C.G. (1966) Relapse after recowy from unipolar depression: a critical review, Psychological Bulletin 104, 64-96. 2. Montgomery, S.A. (1994) Long-term treatment of depression, British Journal of Psychiatry 165, 31.36.
P 32 (_
~~~~~rsz$ness
P.N. Dannon, Sheba Medical lsrael Keywords: cations.
P. Ross, Cenfer,
Electroconvulsive
of labetalol
in electroconvulsive
S. Hirscmann, I. lancu. L. Grunhaus. Chaim ECT Unit, Psychiafry Division, Tel Hashomer,
therapy
(ECT),
labetalol,
asystole,
cardiovascular
compli-
Labetalol, a combined alpha and beta adrenergic blocker is often used to attenuate the transient increases in heart rate and blood pressure that accompany electroconvulsive therapy (ECT) (Stoudemire et al. 1990, Figiel et al. 1993). It has been suggested that labetalol due to its potential severe bradykinetic effects, should not be administered during ECT without the protection provided by anticholinergic medications (Liebowitz et al. 1993, Kaufman 1994). We present our experience with thirty-two patients from all age groups who received labetalol without anticholinergic treatment during ECT. None of the patients demonstrated adverse bradykinetic effects. We conclude that administration of labetalol during ECT does not routinely require premeditation with anticholinergic drugs.
Reference Fiegel G.S., De Leo B., Zorumski CF., Baker K., Goewett A., Jarvis M., Smith D.S., Mattingly G., Auwitch J. (1993) Combined use of labetalol and nifedipine in controlling the cardiovascular response from ECT, J Geriatr Psychiatry Neurology 6, 65-92. Liebowitz N.R.. El-Mallakh R.S. (1993) Cardiac arrest during ECT: A cholinergic phenomenon?. J Clin Psvchiatrv 54. 279-260. Kaufman K.R. (1994) Asyst& witk electroconvulsive therapy, J Internal Medicine 235, 275.277. Stoudemire A., Knos G., Gladson M.. Markwalter H., Sung YF., Morris R., Cooper R. (1990) Labet’dlol in the control of cardiovascular responses to ECT in high-risk depressed medical patients, J Clin Psychiatry 51, 506.512.
p 33 I-1
Can antidepressants prevent institutional care? Citalopram in the treatment of elderly depressed patients with and without dementia disorders
T. Koskinen’ , H. Lehto’. Finland, 20y. H. Lundbeck Keywords: Citalopram
Depression;
’ Psychiatric Clinic, University ab. Turku, Finland
Dementia;
Elderly;
Institutional
care;
of Kuopio, Antidepressant
drugs;
Depression is the most frequent mental disorder in the elderly. As a cause of cognitive impairment, it is often overlooked in the late life. Dementia is another frequent disorder in the elderly and Alzheimer’s disease is the most common cause of dementia. Depressive illness in the elderly may also masquerade as dementia. It has been suggested that depression may affect the cognitive functioning of patients with AS. However, the magnitude of the impact should be related to the severity of the depression. So, before a final diagnosis of irreversible dementia is made, a trial of antidepressant drugs should be given. Both depression and dementia can lead to a long term institutional care. Two placebo-controlled clinical investigations have demonstrated citalopram’s efficacy in the treatment of elderly depressed patients with and without dementia disorders. However, these two comprehensive trials were of relatively short duration and could not give any exact data of long-term effects. In our present study, we have wanted to explore whether citalopram can prevent institutional psychogeriatric ward. A total of 183 patients 65 years of age and older suffering from clinical depression and dementia disorders formed the basis of this study. Depressive inpatients as well outpatients with or without mil or moderate dementia (excluding vascular dementia) and patients with somatic disorders not described in the exclusion criteria were included to the study. They were referred by their local GPs. and who fulfilled the DSM-III-R criteria of depression were followed up for six months. The patients had to have still potential to improve or maintain their ability to live at home with possible social support, counseling, psychotherapy, nursing home services and hospital settings. All patients received citalopram from IO to 30 mg. No antidepressant other than the test drug were allowed, but patients in stabilized treatment with a neuroleptic, a benzodiazepine or a drug for a somatic disorder were included without withdrawal of the concomitant medication. Of included 150 women and 33 men (altogether 183) 125 would be assessed after the follow up. Mean age at the beginning of the follow up was 7727 years. Efficacy on depression was good. 78% of the patients rated on Clinical Global Impression Scale had scores indicating improvement at end point, and only 2% deterioration. A total of 150 patients also had signs of dementia according to Clinical Dementia Rating Scale. The CDR-severity of dementia also showed an improvement. On Gottfries-Brane-Steen Dementia Rating Scale (6 symptoms common in dementia) the mean total score at end point was less than a half from that at baseline. In all subscales, the decrease was highly significant. Anxiety, depression and restlessness showed the greatest improvement. General functioning was improved in 59% of the patients, and only 11% showed worsening, 25% of the patients needed less social support, counseling and nursing home services, and only 13% needed them more. The latter also had their somatic condition impaired. In our study, the improvement in cognitive functioning might be explained as follows: if the cognitive disturbances were secondary to depression, representing what is commonly called pseudcdementia, relieving depression also relieved the cognitive disturbances. However, there may be another explanation; there is some evidence that cerebral cholinergic function is modulated via serotonin. The most frequent individual side effects reported were nausea (4%) stomach pain (2%) and restlessness, fatigue and dizziness (1% of each). It is noteworthy that there were no cardiovascular complications of citalopram treatment, although many patients had various preexisting ECG abnormalities In our study, long term treatment (8 months) with citalopram improved depressive and dementia symptoms in the elderly. The overall results support our hypothesis that citalopram prevents the need for institutional care. Finding may be of great value, for both the patients, their relatives and the whole society.
References Nyth, A.L. and Gottfrtes, C.G. (1990) The clinical emotional disturbances in dementia disorders, Psychiatry 157, 694-901.
efficacy of citalopram in treatment of A Nordic multicenter study, Brit J
Sl-21
presentations
high probability of recurrence (at least two episodes of major depression being no more than 18 months earlier). We recruited 64 unipolar subjects (10 men and 54 women) after recovery from the index depressive episode. Recovery was defined by the presence of euthymia for at least two consecutive weeks according DSM-III-R criteria, in absence of functional impairment and the Hamilton Rating Scale for Depression score < 8. After recovery, patients were randomly assigned to one of the two long-term treatment groups: fluvoxamine (N = 32) or lithium (N = 32). During the four-year follow-up study two patients developed a manic episode (1 in each group) and were excluded. No patient dropped out for unpleasant side effects or did not continue the drug assumption. Plasma levels of fluvaxamine and lithium were monthly evaluated and ranged about 0.7 mEq/l and about 100 rig/ml, respectively. The Savage Cox test was used to compare survival curves and the Cox proportional hazard model was employed to calculate the hazard of recurrence taking into account all clinical variables of interest. We found that the unipolar subjects with high probability of recurrence in fluvoxamine treatment had an outcome with a lower frequency of new recurrences when compared to those in lithium prophylactic treatment. In fact, during the follow-up period, 13 subjects had a single new depressive episode: 5 on fluvoxamine (16.1%) and 8 on lithium therapy (25.8%). There was a significant difference in survival rates between the two medication groups (2 value = 2.02; p = 0.04). The age of onset significantly affected the risk of recurrence: recurred patients displayed a significant earlier onset than non recurred patients (35.1?12.3 vs 41.7z10.9; z value = 1.95; p = 0.05). The pre-treatment recurrence index was also significantly higher among recurred patients (7.724.6 vs 4.523.5; z value = 2.44; p = 0.01). In conclusion the results herein presented indicate that the SSRI fluvoxamine can be considered an effective compound in the maintenance therapy of unipolar subjects with high probability of recurrence.
Reference 1. Belsher, Ci. and Costello, C.G. (1966) Relapse after recowy from unipolar depression: a critical review, Psychological Bulletin 104, 64-96. 2. Montgomery, S.A. (1994) Long-term treatment of depression, British Journal of Psychiatry 165, 31.36.
P 32 (_
~~~~~rsz$ness
P.N. Dannon, Sheba Medical lsrael Keywords: cations.
P. Ross, Cenfer,
Electroconvulsive
of labetalol
in electroconvulsive
S. Hirscmann, I. lancu. L. Grunhaus. Chaim ECT Unit, Psychiafry Division, Tel Hashomer,
therapy
(ECT),
labetalol,
asystole,
cardiovascular
compli-
Labetalol, a combined alpha and beta adrenergic blocker is often used to attenuate the transient increases in heart rate and blood pressure that accompany electroconvulsive therapy (ECT) (Stoudemire et al. 1990, Figiel et al. 1993). It has been suggested that labetalol due to its potential severe bradykinetic effects, should not be administered during ECT without the protection provided by anticholinergic medications (Liebowitz et al. 1993, Kaufman 1994). We present our experience with thirty-two patients from all age groups who received labetalol without anticholinergic treatment during ECT. None of the patients demonstrated adverse bradykinetic effects. We conclude that administration of labetalol during ECT does not routinely require premeditation with anticholinergic drugs.
Reference Fiegel G.S., De Leo B., Zorumski CF., Baker K., Goewett A., Jarvis M., Smith D.S., Mattingly G., Auwitch J. (1993) Combined use of labetalol and nifedipine in controlling the cardiovascular response from ECT, J Geriatr Psychiatry Neurology 6, 65-92. Liebowitz N.R.. El-Mallakh R.S. (1993) Cardiac arrest during ECT: A cholinergic phenomenon?. J Clin Psvchiatrv 54. 279-260. Kaufman K.R. (1994) Asyst& witk electroconvulsive therapy, J Internal Medicine 235, 275.277. Stoudemire A., Knos G., Gladson M.. Markwalter H., Sung YF., Morris R., Cooper R. (1990) Labet’dlol in the control of cardiovascular responses to ECT in high-risk depressed medical patients, J Clin Psychiatry 51, 506.512.
p 33 I-1
Can antidepressants prevent institutional care? Citalopram in the treatment of elderly depressed patients with and without dementia disorders
T. Koskinen’ , H. Lehto’. Finland, 20y. H. Lundbeck Keywords: Citalopram
Depression;
’ Psychiatric Clinic, University ab. Turku, Finland
Dementia;
Elderly;
Institutional
care;
of Kuopio, Antidepressant
drugs;
Depression is the most frequent mental disorder in the elderly. As a cause of cognitive impairment, it is often overlooked in the late life. Dementia is another frequent disorder in the elderly and Alzheimer’s disease is the most common cause of dementia. Depressive illness in the elderly may also masquerade as dementia. It has been suggested that depression may affect the cognitive functioning of patients with AS. However, the magnitude of the impact should be related to the severity of the depression. So, before a final diagnosis of irreversible dementia is made, a trial of antidepressant drugs should be given. Both depression and dementia can lead to a long term institutional care. Two placebo-controlled clinical investigations have demonstrated citalopram’s efficacy in the treatment of elderly depressed patients with and without dementia disorders. However, these two comprehensive trials were of relatively short duration and could not give any exact data of long-term effects. In our present study, we have wanted to explore whether citalopram can prevent institutional psychogeriatric ward. A total of 183 patients 65 years of age and older suffering from clinical depression and dementia disorders formed the basis of this study. Depressive inpatients as well outpatients with or without mil or moderate dementia (excluding vascular dementia) and patients with somatic disorders not described in the exclusion criteria were included to the study. They were referred by their local GPs. and who fulfilled the DSM-III-R criteria of depression were followed up for six months. The patients had to have still potential to improve or maintain their ability to live at home with possible social support, counseling, psychotherapy, nursing home services and hospital settings. All patients received citalopram from IO to 30 mg. No antidepressant other than the test drug were allowed, but patients in stabilized treatment with a neuroleptic, a benzodiazepine or a drug for a somatic disorder were included without withdrawal of the concomitant medication. Of included 150 women and 33 men (altogether 183) 125 would be assessed after the follow up. Mean age at the beginning of the follow up was 7727 years. Efficacy on depression was good. 78% of the patients rated on Clinical Global Impression Scale had scores indicating improvement at end point, and only 2% deterioration. A total of 150 patients also had signs of dementia according to Clinical Dementia Rating Scale. The CDR-severity of dementia also showed an improvement. On Gottfries-Brane-Steen Dementia Rating Scale (6 symptoms common in dementia) the mean total score at end point was less than a half from that at baseline. In all subscales, the decrease was highly significant. Anxiety, depression and restlessness showed the greatest improvement. General functioning was improved in 59% of the patients, and only 11% showed worsening, 25% of the patients needed less social support, counseling and nursing home services, and only 13% needed them more. The latter also had their somatic condition impaired. In our study, the improvement in cognitive functioning might be explained as follows: if the cognitive disturbances were secondary to depression, representing what is commonly called pseudcdementia, relieving depression also relieved the cognitive disturbances. However, there may be another explanation; there is some evidence that cerebral cholinergic function is modulated via serotonin. The most frequent individual side effects reported were nausea (4%) stomach pain (2%) and restlessness, fatigue and dizziness (1% of each). It is noteworthy that there were no cardiovascular complications of citalopram treatment, although many patients had various preexisting ECG abnormalities In our study, long term treatment (8 months) with citalopram improved depressive and dementia symptoms in the elderly. The overall results support our hypothesis that citalopram prevents the need for institutional care. Finding may be of great value, for both the patients, their relatives and the whole society.
References Nyth, A.L. and Gottfrtes, C.G. (1990) The clinical emotional disturbances in dementia disorders, Psychiatry 157, 694-901.
efficacy of citalopram in treatment of A Nordic multicenter study, Brit J