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P.1.229 Paroxetine improves somatic pain associated with physical illness in patients with and without comorbid depressive or anxiety disorders
PI.
S272
m
P 1 228
G. K. Y. of
Old
vs.
new
antidepressants
Affective
following
disorders
ECT
Papadimitriou’ , I.M. Zervas2, M.I. Audreadaki2, K. Psarros2, Koutoaugelos2, C. Dimitrakopoulos2, N. Vaidakis2, Papakostas2. ‘Athens University Medical School, Department Psychiatry, Athens, Greece; 2Greece
The issue of which type of autidepressaut treatment to use for prophylaxis against relapse in major depression followiug succesful ECT is still open as data regardiug comparative effectiveness of various treatments is limited. In this retrospective study we report ou autidepressaut prophylaxis in 43 affectively ill iupatieuts who were treated with ECT in our Departmeut. Prophylactic treatments administered to these patients were classified as: a) Tricyclic or heterocyclic autidepressauts (TCA) b) Serotouiu or novel serotouhliuoradreualiue blockers (SRI) c ) combined TCAiSRI maiutesauce. Teu patients had uot received auy autidepressaut treatment either because they were uot compliant or because they were treated ouly with beuzodiazepiues; these were evaluated separately as a no-prophylaxis group. Outcome was evaluated for relapse at six mouths aud oue year followiug the ECT course. Patients who had combined treatment had indicators of more severe ilhless in their clinical history. The statistical analysis showed uo significant differences betweeu groups. However, we found that 1 -year relapse rate teuds to be lower with autidepressaut prophylaxis thau without (27% versus 50%). In our sample there was uo difference betweeu SRI’ s aud TCA’ s in preveutiug relapses followiug ECT. According to our fiudiugs, in this retrospective study autidepressaut treatmeut is better thau uo treatment for preveutiou of relapse after successful ECT, but there is uo difference betweeu old aud uew medication in the long-term mauagemeut of affective disorder. References [l]
Lauritzen L, Odgaard K, Clemnesen L, et al. Relapse prevention by means of paroxetine in ECT-treated patients with major depression: a comparison with imipramine and placebo in medium-term continuation therapy. Acta Psych& Stand 1996; 94:24 l-25 1.
and antidepressants bowel syndrome (IBS, 11=20), r h eumatoid arthritis (RA, F 191), diabetic ueuropathy @N, F 29), aud non-cardiac chest paiu were assessed (11=59) to determine the efficacy of paroxetiue in treating pain Patients with RA had comorbid depression aud half the patients with IBS had a comorbid anxiety disorder. Patients with DN aud non-cardiac chest paiu did uot have comorbid depression or au anxiety disorder. Pam was assessed using physician-rated (CGI-improvement aud severity; ueuropathy observer scale, NO&paiu item) aud patient-rated scales (patient global paiu rating (PGI) scale, visual aualogue scales @‘AS) aud the McGill paiu questiomiaire). Results: In the open-label IBS study of paroxetiue (204Omg), 80% (~Sil0) of patients with a comorbid anxiety disorder experieuced a 50% or greater decrease in IBS-associated abdominal paiu aud 70% had improvements in paiu severity (PGI) compared with 60% (11~6110) aud 40%, respectively of patients without comorbid anxiety. These differences did uot achieve statistical significance. However, the numbers were small. Paroxetiue (20& 40mg) also reduced the proportiou of RA patients experieuciug moderate paiu (67% at baseline to 47%). This reduction was similar to that observed with amitriptyliue (75515Omg; 64% at baseline to 45%). In patients with DN, improvements in paiu rated ou the NOS were significantly superior for paroxetiue (20& 70mg) (medial1 eudpoiut score 0.52) compared with placebo (medial1 eudpoiut score 1.42, piO.05, Wilcoxon’ s test). Similarly, paroxetiue (20&5Omg) also demo&rated a significantly greater (piO.05, t -test) CGI improvement rating of paiu compared with p 1acebo in patients with non-cardiac chest pain The improvement from basehue ou the McGill VAS also showed a treud in favour of paroxetiiie. Conclusions: These data suggest that paroxetiue improves symptoms of paiu associated with these physical illnesses. In addition, the fiudiugs are unlikely to be due to a pseudospecific effect ou mood or anxiety since in two of the studies moue of the subjects met criteria for major depression or au anxiety disorder. References [l]
mP 1 229
D. Duff’, Kingdom; US.A.
Paroxetine improves somatic pain associated with physical illness in patients with and without comorbid depressive or anxiety disorders E. Dube2. ’ GlaxoSmithKline, CDMA, 2GlaxoSmithKline, US Pharmaceuticals,
Harlow, United Philadelphia,
Background aud Objectives: Persisteut or chrouic paiu is commouly comorbid with depression aud the anxiety disorders aud individuals with pain-related disorders are at au iucreased risk of developiug these psychological disorders. The relationship betweeu paiu aud depression is complex aud uot fully uuderstood, however, there are data to suggest that serotouiu aud uorepiuephriue may modulate paiu as well as mood. A recent study found that paroxetiue 20mg (qd) elicited the same level of paiu relief as the SNRI duloxetiue 120mg (bd). However, paroxetiue exhibited a more favourable tolerability profile 1. In the present analyses the effects of paroxetiue ou paiu associated with physical illness, in patients with aud without comorbid depressive or anxiety disorders, were reviewed. Methods:Data from oue opeulabel aud three double-blind, raudomised, placeboor activecontrolled studies (6612 weeks duration) in patients with irritable
mPI
Detke, M.J et al., 2002. Duloxetine versus placebo and paroxetine in the acute and maintenance treatment of major depression. Poster presented at the 4 1st annual meeting of the ACNP. December 9, San Juan, Puerta Rica.
230
D. Duff’ Kingdom; Kingdom
Paroxetine symptoms
improves associated
general somatic with depression
, .I. Christie2. ’ GlaxoSmithKline, 2GlaxoSmithKline, Biometrics
CDMA, (BDA),
Harlow, Harlow,
United United
Background aud Objectives: Patients with depression commonly present to primary care physicians complaiuiug of somatic symptoms. Painful or uncomfortable physical symptoms are the most common reasons individuals seek help. Paroxetiue, is oue of the most well studied SSRIs (clinical trial database >lS,OOO patients) aud is the ouly autidepressaut indicated for the treatment of depression aud the full spectrum of major anxiety disorders (including panic disorder, OCD, social anxiety disorder, GAD aud PTSD)l. The aims of the present analyses were to assess the effectiveness of paroxetiue (20&50mg/day) in the treatment of general somatic symptoms (including pain) associated with depression Methods: Pooled data from 30 short-term (4412 weeks duration), double-blind, placebo-controlled paroxetiue studies in
S272
m
P 1 228
G. K. Y. of
Old
vs.
new
antidepressants
Affective
following
disorders
ECT
Papadimitriou’ , I.M. Zervas2, M.I. Audreadaki2, K. Psarros2, Koutoaugelos2, C. Dimitrakopoulos2, N. Vaidakis2, Papakostas2. ‘Athens University Medical School, Department Psychiatry, Athens, Greece; 2Greece
The issue of which type of autidepressaut treatment to use for prophylaxis against relapse in major depression followiug succesful ECT is still open as data regardiug comparative effectiveness of various treatments is limited. In this retrospective study we report ou autidepressaut prophylaxis in 43 affectively ill iupatieuts who were treated with ECT in our Departmeut. Prophylactic treatments administered to these patients were classified as: a) Tricyclic or heterocyclic autidepressauts (TCA) b) Serotouiu or novel serotouhliuoradreualiue blockers (SRI) c ) combined TCAiSRI maiutesauce. Teu patients had uot received auy autidepressaut treatment either because they were uot compliant or because they were treated ouly with beuzodiazepiues; these were evaluated separately as a no-prophylaxis group. Outcome was evaluated for relapse at six mouths aud oue year followiug the ECT course. Patients who had combined treatment had indicators of more severe ilhless in their clinical history. The statistical analysis showed uo significant differences betweeu groups. However, we found that 1 -year relapse rate teuds to be lower with autidepressaut prophylaxis thau without (27% versus 50%). In our sample there was uo difference betweeu SRI’ s aud TCA’ s in preveutiug relapses followiug ECT. According to our fiudiugs, in this retrospective study autidepressaut treatmeut is better thau uo treatment for preveutiou of relapse after successful ECT, but there is uo difference betweeu old aud uew medication in the long-term mauagemeut of affective disorder. References [l]
Lauritzen L, Odgaard K, Clemnesen L, et al. Relapse prevention by means of paroxetine in ECT-treated patients with major depression: a comparison with imipramine and placebo in medium-term continuation therapy. Acta Psych& Stand 1996; 94:24 l-25 1.
and antidepressants bowel syndrome (IBS, 11=20), r h eumatoid arthritis (RA, F 191), diabetic ueuropathy @N, F 29), aud non-cardiac chest paiu were assessed (11=59) to determine the efficacy of paroxetiue in treating pain Patients with RA had comorbid depression aud half the patients with IBS had a comorbid anxiety disorder. Patients with DN aud non-cardiac chest paiu did uot have comorbid depression or au anxiety disorder. Pam was assessed using physician-rated (CGI-improvement aud severity; ueuropathy observer scale, NO&paiu item) aud patient-rated scales (patient global paiu rating (PGI) scale, visual aualogue scales @‘AS) aud the McGill paiu questiomiaire). Results: In the open-label IBS study of paroxetiue (204Omg), 80% (~Sil0) of patients with a comorbid anxiety disorder experieuced a 50% or greater decrease in IBS-associated abdominal paiu aud 70% had improvements in paiu severity (PGI) compared with 60% (11~6110) aud 40%, respectively of patients without comorbid anxiety. These differences did uot achieve statistical significance. However, the numbers were small. Paroxetiue (20& 40mg) also reduced the proportiou of RA patients experieuciug moderate paiu (67% at baseline to 47%). This reduction was similar to that observed with amitriptyliue (75515Omg; 64% at baseline to 45%). In patients with DN, improvements in paiu rated ou the NOS were significantly superior for paroxetiue (20& 70mg) (medial1 eudpoiut score 0.52) compared with placebo (medial1 eudpoiut score 1.42, piO.05, Wilcoxon’ s test). Similarly, paroxetiue (20&5Omg) also demo&rated a significantly greater (piO.05, t -test) CGI improvement rating of paiu compared with p 1acebo in patients with non-cardiac chest pain The improvement from basehue ou the McGill VAS also showed a treud in favour of paroxetiiie. Conclusions: These data suggest that paroxetiue improves symptoms of paiu associated with these physical illnesses. In addition, the fiudiugs are unlikely to be due to a pseudospecific effect ou mood or anxiety since in two of the studies moue of the subjects met criteria for major depression or au anxiety disorder. References [l]
mP 1 229
D. Duff’, Kingdom; US.A.
Paroxetine improves somatic pain associated with physical illness in patients with and without comorbid depressive or anxiety disorders E. Dube2. ’ GlaxoSmithKline, CDMA, 2GlaxoSmithKline, US Pharmaceuticals,
Harlow, United Philadelphia,
Background aud Objectives: Persisteut or chrouic paiu is commouly comorbid with depression aud the anxiety disorders aud individuals with pain-related disorders are at au iucreased risk of developiug these psychological disorders. The relationship betweeu paiu aud depression is complex aud uot fully uuderstood, however, there are data to suggest that serotouiu aud uorepiuephriue may modulate paiu as well as mood. A recent study found that paroxetiue 20mg (qd) elicited the same level of paiu relief as the SNRI duloxetiue 120mg (bd). However, paroxetiue exhibited a more favourable tolerability profile 1. In the present analyses the effects of paroxetiue ou paiu associated with physical illness, in patients with aud without comorbid depressive or anxiety disorders, were reviewed. Methods:Data from oue opeulabel aud three double-blind, raudomised, placeboor activecontrolled studies (6612 weeks duration) in patients with irritable
mPI
Detke, M.J et al., 2002. Duloxetine versus placebo and paroxetine in the acute and maintenance treatment of major depression. Poster presented at the 4 1st annual meeting of the ACNP. December 9, San Juan, Puerta Rica.
230
D. Duff’ Kingdom; Kingdom
Paroxetine symptoms
improves associated
general somatic with depression
, .I. Christie2. ’ GlaxoSmithKline, 2GlaxoSmithKline, Biometrics
CDMA, (BDA),
Harlow, Harlow,
United United
Background aud Objectives: Patients with depression commonly present to primary care physicians complaiuiug of somatic symptoms. Painful or uncomfortable physical symptoms are the most common reasons individuals seek help. Paroxetiue, is oue of the most well studied SSRIs (clinical trial database >lS,OOO patients) aud is the ouly autidepressaut indicated for the treatment of depression aud the full spectrum of major anxiety disorders (including panic disorder, OCD, social anxiety disorder, GAD aud PTSD)l. The aims of the present analyses were to assess the effectiveness of paroxetiue (20&50mg/day) in the treatment of general somatic symptoms (including pain) associated with depression Methods: Pooled data from 30 short-term (4412 weeks duration), double-blind, placebo-controlled paroxetiue studies in