- Email: [email protected]
P.2.018 Use of olanzapine in the treatment of bipolar mania, a naturalistic setting
P2 Affective disorders and antidepressants
$398
conclude that while d-amphetamine does produce subjective and physiological effects congruent with those observed in bipolar mania, it does not appear to induce changes in brain PI-cycle neurochemistry.
References [1] Silverstone, P.H., McGrath, B.M., Kim, H., 2005. Bipolar Disorder and Myo-Inositol: A Review of the Magnetic Resonance Spectroscopy (MRS) Findings. Bipolar Disorders 7(1), 1 10. [2] Berridge, M.J., hwine, R.E, 1989. Inositol phosphates and cell signaling. Nature 341, 197 205. [3] Jacobs, D., Silverstone, T., 1986. Dextroamphetamine-induced arousal in human subjects as a model for mania. Psychol Med 16, 323 329.
•
Galactorrhea and selective serotonin reuptake inhibitors
A. Wessels-van Middendorp 1 *, L. Timmerman 2. ]Adhesie
GGZ Midden Overijssel, Clinical psychiatty, Deventet; The Netherlands; 2Twenteborg Ziekenhuis, Clinical psychiatty, The Netherlands I n t r o d u c t i o n : In this report the relationship between selective
serotonin reuptake inhibitors (SSRIs) and galactorrhea is described. The SSRI- dependent side effects are mostly characterised by serotonin potentiation. Both SSRIs and tricyclic antidepressants can also cause extrapyramidal side effects. The occurrence of movement disorders such as akathisia, dystonia and Parkinsonism after use of SSRIs was described. Furthermore, descriptions of deterioration of Parkinson's disease after use of fluoxetine, fluvoxamine or paroxetine, can be found in literature. Medication with serotonergic effects can cause a prolactin level elevation through an indirect mechanism. Two mechanisms are considered to explain the prolactin release induced by the serotonergic system: the presynaptic inhibition of dopamine discharge by the serotonergic receptors or the direct stimulation of the hypothalamic postsynaptic serotonergic receptors [1]. Case: We present a 33 year old Turkish woman with a depressive disorder. Because of hyperthyroidism, she received a PTU (propylthiouracyl) treatment and a radioactive iodine treatment, after which she developed hypothyroidism. She reported galactorrhea complaints (bilateral), alongside amenorrhea and headache. Laboratory research showed an elevation of serum prolactin. Because of the galactorrhea, the citalopram treatment was suspended. In this period the thyroid medication was adjusted too. After this, the galactorrhea complaints ceased. D i s c u s s i o n : In certain phases of life galactorrhea is a frequently occurring and harmless phenomenon. Sometimes however, a serious illness is the cause. Furthermore, many different medications can cause galactorrhea. Galactorrhea is caused by the prolactin level, which is regulated by different inhibiting and stimulating factors. Dopamine is the most important prolactin inhibiting factor (PIF) and thyrotropin-releasing hormone (TRH) and oxytocin are well-known prolactin releasing factors (PRF). Many other neurotransmitters and hormones have an effect on dopamine secretion through the tuberoinfundibular dopaminergic system and thereby directly influence prolactin secretion [2]. Literature data concerning galactorrhae under SSRIs are scarce. This case report describes the relation between the occurrence of galactorrhea and the use of SSRIs (citalopram). The internal medicine specialist did not take into account that galactorrhea can be a side effect of citalopram use and supposed hypothyroidism to be the cause of the galactorrhea. In the presented case, there is a striking relationship
between tapering off citalopram, and the reduction of galactorrhea related complaints. C o n c l u s i o n : Psychiatrists often see galactorrhea as an antipsychotics mediated side-effect. However, SSRIs can also cause galactorrhea. Although galactorrhea often is an innocent phenomenon, which can be provoked by the use of medication, the cause of galactorrhea must always be thoroughly investigated. When patients using SSRIs develop galactorrhea and hyperprolactinemia, it's a serious option to stop the medication. With thanks to: Mw Monster- Simons, LAREB.
References [1] Damsa, C.M.D., et al., 2004. Dopamine- dependent side effects of selective serotonin reuptake inhibitors: A clinical review. J Clin PsychiatL2¢, 65: 1064--1068. [2] Assies, J., 1990. Galactorroe. Ned Tijdschr Geneeskd, 134: 184(~1843.
~ U s e
of olanzapine in the treatment of bipolar mania, a naturalistic setting
D. Lecompte 1 *, J. Hulselmans 2, W. Pitchot 3, S. Wyckaert 4, S. Reiter 5, K. De Bruyckere 5. ]Brugmann University Hospital
Brussels, Dep. of Psychiatty, Brussel, Belgium; 2AZ Stuyvenberg Antwerp, Dep. of Psychiatty, Belgium; 3CHU Li@e, Dep. of Psychiatty, Belgium; eUPC St. Jozef Kortenberg, Dep. of Psychiatty, Belgium; 5Eli Lilly, Medical Dep., Belgium I n t r o d u c t i o n : Olanzapine is the first atypical antipsychotic approved for the treatment of mania and for prevention of bipolar relapse. The aim of this study is to describe the clinical characteristics, possible prognostic factors and outcome of manic or hypomanic patients treated with olanzapine in a naturalistic setting, and to compare the physician's evaluation with the patient's self-evaluation. M e t h o d s : This was a multicenter, Belgian study, using an anonymous data collection form and patient questionnaire. All demographic and clinical data were collected at hospital discharge in patients who received a treatment with olanzapine for at least 2 weeks or in ambulatory patients after 4 weeks of treatment with olanzapine. In this publication we will present the clinical profile of the patients and their outcome, evaluated by the physician, using the Clinical Global Impression-Improvement (CGI-I) rating scale. Results: Three hundred eighteen patients (55% female) received a treatment with olanzapine for an acute manic or hypomanic episode. Most (56%) of the patients had an age between 35 and 55 years, and 19% were first episode patients. The mean age of the patients at first symptoms of bipolar disorder was 29.4 years; the mean age at first treatment for mood symptoms was 32.0 years, and the mean age at diagnosis of bipolar disorder was 33.4 years. Diagnostic subtypes of mania were defined by the physician: 20% hypomania, 29% euphoric mania, 29% dysphoric mania and 22% mixed mania. Almost one third of the patients (31%) initiated a treatment with olanzapine in monotherapy (mean dose: 16.6 mg/d); 69% received olanzapine in combination therapy (mean dose: 15.1mg/d). Two thirds of the patients (65%) had received a previous treatment for current episode, of which 46% was a mood stabilizer, 20% an antipsychotic, 34% a combination. The use of olanzapine in mono- or combination therapy was not different following the mania subtypes. Most (87%) patients received some kind of psycho-education. There was a high satisfaction (78%) with the treatment results among physicians, 19% was partly satisfied and 3% was not satisfied. The mean CGI-I
P2 Affective disorders and antidepressants score (1 7), was 2.1 (SD: 0.8), and was independent of gender, age category, first or multiple episode, use of psycho-education, use of olanzapine in mono- or combination therapy (there was a trend in favor of combination therapy, p 0.076), and time elapsed between first symptoms and diagnosis. There was a relationship between the CGI-I score and the diagnostic subtype of mania (p 0.002). Euphoric mania yielded the most favorable outcome compared to the other mania subtypes (mean CGI-I: 1.9; SD: 0.7). Conclusions: Our results suggest that olanzapine is used equally in all types of mania, mainly in combination therapy. There was a high satisfaction with the treatment result by the physician. The diagnostic subtype of mania was the only prognostic factor for outcome on the basis of the CGI-I, with euphoric mania patients having the most favorable outcome.
•
Tryptophan depletion and kynurenine pathway in depression: the evidence of imbalance neuroprotection-neurodegeneration
A.M. Myint 1 *, R. Verkerk 2, Y.K. Kim 3, S. Scharpe 2, H. Steinbusch 1, B. Leonard 1 . ] University of Maastricht,
PsychiaOy and Neuropsychology, Maastricht, The Netherlands; 2University of Antwerp, Clinical Biochemistty, Belgium," 3Korea University, Psychiatty, Republic of Korea Purpose: Tryptophan is the precursor of serotonin, a brain amine which is important in mood changes and neuronal growth. It is well documented that the tryptophan depletion that leads to low brain serotonin level can induce short-term depressed mood in serotonergically vulnerable subjects. However, the neuroprotection-neurodegeneration imbalance beyond tryptophan depletion has been proposed as neurodegeneration hypothesis of chronic endogenous depression (Myint and Kim, 2003). This study was carried out to test the above hypothesis. Subjects and Methods: A total of 58 depressed patients who were drug naive at the time of admission to the psychiatric department of the general hospital were recruited. A total of 189 normal healthy persons who came to the same general hospital for regular check-up during the same period of time were recruited as controls. On admission or on the first visit and again at discharge, 10 ml of overnight-fasting early morning blood samples were collected in heparinised tubes and plasma samples were collected and stored at 70°C for analyses at a later date. Samples were analysed for (1) tryptophan (mmol/1), (2) competing aminoacids: tyrosine, valine, phenylalanin, isoleucine, leucine, taurine, a-amino-n-butyric acid, and methionine (mmol/1), (3) kynurenine (mmol/1), and (4) kyrenic acid (nmol/1), using High Performance Liquid Chromatography using UV detector and the fluorescent detectors. The tryptophan index (TRPi) which represents the tryptophan availability in the blood (100*tryptophan value/sum of competing amino acids values), tryptophan breakdown index (KYN/TRP) which represents the tryptophan breakdown (kynurenine value/tryptophan value) and neuroprotective ratio (KAKYN) (kynurenic acid valueNynurenine value) were calculated. Statistical analysis was done using SPSS version 11.0. Results: On admission, the tryptophan index in the patients were significantly lower (p <0.05) than the normal controls (9.99±0.26 vs 10.88±0.14), the tryptophan breakdown index in the patients were significantly lower (p < 0.04) than the normal controls (0.03±0.002 vs 0.05±0.02) the plasma kynurenic acid concentrations in the patients were significantly and strongly
$399
lower (p<0.0001) than the normal controls (24.29±1.18 vs 35.96±1.37), and the neuroprotective ratio in the patients were significantly and strongly lower (p <0.0001) than the normal controls (14.08±0.64 vs 19.36±0.61). The univariate analysis showed that the kynurenic acid and neuroprotective ratio were not influenced by age or gender. At the time of discharge, despite recovery following antidepressant treatment, the neuroprotective ratio remained unchanged. Conclusion: There is sustained decreased in neuroprotective pathway of tryptophan catabolism, which may lead to neurodegeneration may play a significant role in pathophysiology of major depression.
References [1] AM Myint, YK Kim (2003). Cytokine-serotonin interaction through IDO: a neurodegeneration hypothesis of depression. Medical Hypothesis; 6195 60:51%525.
•
Antidepressants: Lithuanian psychiatrists' opinion and agents impacting selection of the treatment approach
O. Jankuviene*, B. Burba, A. Kunigeliene, V. Grigaliuniene.
Kaunas Medical University, Psychiatty, Kaunas, Lithuania Study object: to ascertain psychiatrists' opinion on antidepressant drug (efficacy, tolerability), treatment approach (if it depends on the psychopathological structure of depression), to define factors impacting antidepressant selection. Methods: a questionnaire deals with 30 questions orientated to the psychiatrists' opinion about 14 antidepressants, to define factors that most often impact choice of antidepressant treatment, reliance of antidepressants selection according to the structure of the depression psychopathology. The data was analysed applying the data analysis system SPSS for Windows (version 10). Variance and distribution of data was analyzed; groups were compared for significant differences. Descriptive statistics (mean) and distribution percentages were calculated. Results: A total of 133 psychiatrists participated. Groups of antidepressants most often chosen by Lithuanian psychiatrists were selective serotonin reuptake inhibitors (SSRI), tricyclic antidepressants (TCA) and blocker of serotonin receptors and presynapses alpha-2 adrenoreceptors noradrenergic and specific serotonergic antidepressant (NaSSA). The best rated antidepressants by the respondents are as follows: mirtazapine, escitalopram, citalopram and amitriptyline according to their efficiency and escitalopram, citalopram, sertraline and mirtazapine according to tolerability (chart 1). Mostly it was specified that antidepressant is prescribed considering the character of the depression symptoms, tolerability and safety of the medication, comorbid disorders, preceding response to treatment, and personal experience in specific antidepressant treating. The study results showed that there is no unanimous opinion among the psychiatrists about the antidepressant selection wide data scattering was received in the course of the study while rating AD selection according to psychopathological structure of depressions. Moreover the study results showed that opinion of practitioners-respondents about the prescribed antidepressant impacts their choice very much, a part of respondents prescribe the most effective in their opinion antidepressant for treatment of all depression types. Then criteria of selection of their treatment approach remain not very clear, it is obvious that the psychopathological structure of depression is ignored in such
$398
conclude that while d-amphetamine does produce subjective and physiological effects congruent with those observed in bipolar mania, it does not appear to induce changes in brain PI-cycle neurochemistry.
References [1] Silverstone, P.H., McGrath, B.M., Kim, H., 2005. Bipolar Disorder and Myo-Inositol: A Review of the Magnetic Resonance Spectroscopy (MRS) Findings. Bipolar Disorders 7(1), 1 10. [2] Berridge, M.J., hwine, R.E, 1989. Inositol phosphates and cell signaling. Nature 341, 197 205. [3] Jacobs, D., Silverstone, T., 1986. Dextroamphetamine-induced arousal in human subjects as a model for mania. Psychol Med 16, 323 329.
•
Galactorrhea and selective serotonin reuptake inhibitors
A. Wessels-van Middendorp 1 *, L. Timmerman 2. ]Adhesie
GGZ Midden Overijssel, Clinical psychiatty, Deventet; The Netherlands; 2Twenteborg Ziekenhuis, Clinical psychiatty, The Netherlands I n t r o d u c t i o n : In this report the relationship between selective
serotonin reuptake inhibitors (SSRIs) and galactorrhea is described. The SSRI- dependent side effects are mostly characterised by serotonin potentiation. Both SSRIs and tricyclic antidepressants can also cause extrapyramidal side effects. The occurrence of movement disorders such as akathisia, dystonia and Parkinsonism after use of SSRIs was described. Furthermore, descriptions of deterioration of Parkinson's disease after use of fluoxetine, fluvoxamine or paroxetine, can be found in literature. Medication with serotonergic effects can cause a prolactin level elevation through an indirect mechanism. Two mechanisms are considered to explain the prolactin release induced by the serotonergic system: the presynaptic inhibition of dopamine discharge by the serotonergic receptors or the direct stimulation of the hypothalamic postsynaptic serotonergic receptors [1]. Case: We present a 33 year old Turkish woman with a depressive disorder. Because of hyperthyroidism, she received a PTU (propylthiouracyl) treatment and a radioactive iodine treatment, after which she developed hypothyroidism. She reported galactorrhea complaints (bilateral), alongside amenorrhea and headache. Laboratory research showed an elevation of serum prolactin. Because of the galactorrhea, the citalopram treatment was suspended. In this period the thyroid medication was adjusted too. After this, the galactorrhea complaints ceased. D i s c u s s i o n : In certain phases of life galactorrhea is a frequently occurring and harmless phenomenon. Sometimes however, a serious illness is the cause. Furthermore, many different medications can cause galactorrhea. Galactorrhea is caused by the prolactin level, which is regulated by different inhibiting and stimulating factors. Dopamine is the most important prolactin inhibiting factor (PIF) and thyrotropin-releasing hormone (TRH) and oxytocin are well-known prolactin releasing factors (PRF). Many other neurotransmitters and hormones have an effect on dopamine secretion through the tuberoinfundibular dopaminergic system and thereby directly influence prolactin secretion [2]. Literature data concerning galactorrhae under SSRIs are scarce. This case report describes the relation between the occurrence of galactorrhea and the use of SSRIs (citalopram). The internal medicine specialist did not take into account that galactorrhea can be a side effect of citalopram use and supposed hypothyroidism to be the cause of the galactorrhea. In the presented case, there is a striking relationship
between tapering off citalopram, and the reduction of galactorrhea related complaints. C o n c l u s i o n : Psychiatrists often see galactorrhea as an antipsychotics mediated side-effect. However, SSRIs can also cause galactorrhea. Although galactorrhea often is an innocent phenomenon, which can be provoked by the use of medication, the cause of galactorrhea must always be thoroughly investigated. When patients using SSRIs develop galactorrhea and hyperprolactinemia, it's a serious option to stop the medication. With thanks to: Mw Monster- Simons, LAREB.
References [1] Damsa, C.M.D., et al., 2004. Dopamine- dependent side effects of selective serotonin reuptake inhibitors: A clinical review. J Clin PsychiatL2¢, 65: 1064--1068. [2] Assies, J., 1990. Galactorroe. Ned Tijdschr Geneeskd, 134: 184(~1843.
~ U s e
of olanzapine in the treatment of bipolar mania, a naturalistic setting
D. Lecompte 1 *, J. Hulselmans 2, W. Pitchot 3, S. Wyckaert 4, S. Reiter 5, K. De Bruyckere 5. ]Brugmann University Hospital
Brussels, Dep. of Psychiatty, Brussel, Belgium; 2AZ Stuyvenberg Antwerp, Dep. of Psychiatty, Belgium; 3CHU Li@e, Dep. of Psychiatty, Belgium; eUPC St. Jozef Kortenberg, Dep. of Psychiatty, Belgium; 5Eli Lilly, Medical Dep., Belgium I n t r o d u c t i o n : Olanzapine is the first atypical antipsychotic approved for the treatment of mania and for prevention of bipolar relapse. The aim of this study is to describe the clinical characteristics, possible prognostic factors and outcome of manic or hypomanic patients treated with olanzapine in a naturalistic setting, and to compare the physician's evaluation with the patient's self-evaluation. M e t h o d s : This was a multicenter, Belgian study, using an anonymous data collection form and patient questionnaire. All demographic and clinical data were collected at hospital discharge in patients who received a treatment with olanzapine for at least 2 weeks or in ambulatory patients after 4 weeks of treatment with olanzapine. In this publication we will present the clinical profile of the patients and their outcome, evaluated by the physician, using the Clinical Global Impression-Improvement (CGI-I) rating scale. Results: Three hundred eighteen patients (55% female) received a treatment with olanzapine for an acute manic or hypomanic episode. Most (56%) of the patients had an age between 35 and 55 years, and 19% were first episode patients. The mean age of the patients at first symptoms of bipolar disorder was 29.4 years; the mean age at first treatment for mood symptoms was 32.0 years, and the mean age at diagnosis of bipolar disorder was 33.4 years. Diagnostic subtypes of mania were defined by the physician: 20% hypomania, 29% euphoric mania, 29% dysphoric mania and 22% mixed mania. Almost one third of the patients (31%) initiated a treatment with olanzapine in monotherapy (mean dose: 16.6 mg/d); 69% received olanzapine in combination therapy (mean dose: 15.1mg/d). Two thirds of the patients (65%) had received a previous treatment for current episode, of which 46% was a mood stabilizer, 20% an antipsychotic, 34% a combination. The use of olanzapine in mono- or combination therapy was not different following the mania subtypes. Most (87%) patients received some kind of psycho-education. There was a high satisfaction (78%) with the treatment results among physicians, 19% was partly satisfied and 3% was not satisfied. The mean CGI-I
P2 Affective disorders and antidepressants score (1 7), was 2.1 (SD: 0.8), and was independent of gender, age category, first or multiple episode, use of psycho-education, use of olanzapine in mono- or combination therapy (there was a trend in favor of combination therapy, p 0.076), and time elapsed between first symptoms and diagnosis. There was a relationship between the CGI-I score and the diagnostic subtype of mania (p 0.002). Euphoric mania yielded the most favorable outcome compared to the other mania subtypes (mean CGI-I: 1.9; SD: 0.7). Conclusions: Our results suggest that olanzapine is used equally in all types of mania, mainly in combination therapy. There was a high satisfaction with the treatment result by the physician. The diagnostic subtype of mania was the only prognostic factor for outcome on the basis of the CGI-I, with euphoric mania patients having the most favorable outcome.
•
Tryptophan depletion and kynurenine pathway in depression: the evidence of imbalance neuroprotection-neurodegeneration
A.M. Myint 1 *, R. Verkerk 2, Y.K. Kim 3, S. Scharpe 2, H. Steinbusch 1, B. Leonard 1 . ] University of Maastricht,
PsychiaOy and Neuropsychology, Maastricht, The Netherlands; 2University of Antwerp, Clinical Biochemistty, Belgium," 3Korea University, Psychiatty, Republic of Korea Purpose: Tryptophan is the precursor of serotonin, a brain amine which is important in mood changes and neuronal growth. It is well documented that the tryptophan depletion that leads to low brain serotonin level can induce short-term depressed mood in serotonergically vulnerable subjects. However, the neuroprotection-neurodegeneration imbalance beyond tryptophan depletion has been proposed as neurodegeneration hypothesis of chronic endogenous depression (Myint and Kim, 2003). This study was carried out to test the above hypothesis. Subjects and Methods: A total of 58 depressed patients who were drug naive at the time of admission to the psychiatric department of the general hospital were recruited. A total of 189 normal healthy persons who came to the same general hospital for regular check-up during the same period of time were recruited as controls. On admission or on the first visit and again at discharge, 10 ml of overnight-fasting early morning blood samples were collected in heparinised tubes and plasma samples were collected and stored at 70°C for analyses at a later date. Samples were analysed for (1) tryptophan (mmol/1), (2) competing aminoacids: tyrosine, valine, phenylalanin, isoleucine, leucine, taurine, a-amino-n-butyric acid, and methionine (mmol/1), (3) kynurenine (mmol/1), and (4) kyrenic acid (nmol/1), using High Performance Liquid Chromatography using UV detector and the fluorescent detectors. The tryptophan index (TRPi) which represents the tryptophan availability in the blood (100*tryptophan value/sum of competing amino acids values), tryptophan breakdown index (KYN/TRP) which represents the tryptophan breakdown (kynurenine value/tryptophan value) and neuroprotective ratio (KAKYN) (kynurenic acid valueNynurenine value) were calculated. Statistical analysis was done using SPSS version 11.0. Results: On admission, the tryptophan index in the patients were significantly lower (p <0.05) than the normal controls (9.99±0.26 vs 10.88±0.14), the tryptophan breakdown index in the patients were significantly lower (p < 0.04) than the normal controls (0.03±0.002 vs 0.05±0.02) the plasma kynurenic acid concentrations in the patients were significantly and strongly
$399
lower (p<0.0001) than the normal controls (24.29±1.18 vs 35.96±1.37), and the neuroprotective ratio in the patients were significantly and strongly lower (p <0.0001) than the normal controls (14.08±0.64 vs 19.36±0.61). The univariate analysis showed that the kynurenic acid and neuroprotective ratio were not influenced by age or gender. At the time of discharge, despite recovery following antidepressant treatment, the neuroprotective ratio remained unchanged. Conclusion: There is sustained decreased in neuroprotective pathway of tryptophan catabolism, which may lead to neurodegeneration may play a significant role in pathophysiology of major depression.
References [1] AM Myint, YK Kim (2003). Cytokine-serotonin interaction through IDO: a neurodegeneration hypothesis of depression. Medical Hypothesis; 6195 60:51%525.
•
Antidepressants: Lithuanian psychiatrists' opinion and agents impacting selection of the treatment approach
O. Jankuviene*, B. Burba, A. Kunigeliene, V. Grigaliuniene.
Kaunas Medical University, Psychiatty, Kaunas, Lithuania Study object: to ascertain psychiatrists' opinion on antidepressant drug (efficacy, tolerability), treatment approach (if it depends on the psychopathological structure of depression), to define factors impacting antidepressant selection. Methods: a questionnaire deals with 30 questions orientated to the psychiatrists' opinion about 14 antidepressants, to define factors that most often impact choice of antidepressant treatment, reliance of antidepressants selection according to the structure of the depression psychopathology. The data was analysed applying the data analysis system SPSS for Windows (version 10). Variance and distribution of data was analyzed; groups were compared for significant differences. Descriptive statistics (mean) and distribution percentages were calculated. Results: A total of 133 psychiatrists participated. Groups of antidepressants most often chosen by Lithuanian psychiatrists were selective serotonin reuptake inhibitors (SSRI), tricyclic antidepressants (TCA) and blocker of serotonin receptors and presynapses alpha-2 adrenoreceptors noradrenergic and specific serotonergic antidepressant (NaSSA). The best rated antidepressants by the respondents are as follows: mirtazapine, escitalopram, citalopram and amitriptyline according to their efficiency and escitalopram, citalopram, sertraline and mirtazapine according to tolerability (chart 1). Mostly it was specified that antidepressant is prescribed considering the character of the depression symptoms, tolerability and safety of the medication, comorbid disorders, preceding response to treatment, and personal experience in specific antidepressant treating. The study results showed that there is no unanimous opinion among the psychiatrists about the antidepressant selection wide data scattering was received in the course of the study while rating AD selection according to psychopathological structure of depressions. Moreover the study results showed that opinion of practitioners-respondents about the prescribed antidepressant impacts their choice very much, a part of respondents prescribe the most effective in their opinion antidepressant for treatment of all depression types. Then criteria of selection of their treatment approach remain not very clear, it is obvious that the psychopathological structure of depression is ignored in such