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P.2.079 Escitalopram and citalopram in the treatment of outpatients with major depressive disorder
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P2 Affective disorders and antidepressants
DESS increase 1.62 for escitalopram versus 3.34 for paroxetine) in MDD; a significantly lower number of discontinuationemergent symptoms for escitalopram than for paroxetine was also seen in social anxiety disorder (DESS increase 1.39 for escitalopram versus 3.34 for paroxetine) and generalised anxiety disorder (DESS increase 1.20 for escitalopram versus 3.78 for paroxetine). No differences in discontinuation symptoms were observed between the three conditions. There was no evidence for increased symptom incidence with increased length of treatment. Conclusions: These comparative data show that discontinuation profiles differ between antidepressants of the same class (selective serotonin reuptake inhibitors) and that these profiles are broadly similar in different diagnoses. No evidence was seen for a higher discontinuation burden with longer treatment.
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Escitalopram and citalopram in the treatment of outpatients with major depressive disorder
N. Moore 1 *, H. Verdoux 2, D. Fantino 3. ]INSERM U657,
Pharmacology, 33076 Bordeaux, Bordeaux, France; 2INSERM U657, Adult Psychiatty, 33076 Bordeaux, France; 3ADIM, Lyon, France Purpose: To study the efficacy and tolerability of fixed doses of
escitalopram versus citalopram in outpatients suffering from major depressive disorder (MDD) in France. M e t h o d s : This was a prospective, multicentre, randomised, double blind 8-week study in outpatients aged 18 65 years who fulfilled DSM-IV criteria for MDD and had a baseline Montgomery-Asberg depression Rating Scale (MADRS) total score ?30 at baseline. Efficacy assessments were performed at baseline, week 1, 4, and 8. Tolerability was based on the incidence of reported adverse events (AEs). The primary efficacy measure was change from baseline to end of study in MADRS total score, using ANCOVA of the intent-to-treat (ITT) population and the last-observation-carried-forward method (LOCF). Results: The ITT population consisted of 280 patients (n 138: escitalopram 20 rag/day and n 142: citalopram 40 rag/day), with 259 patients completing treatment (n 132, escitalopram, n 127, citalopram). The mean MADRS score at baseline was approximately 36, which decreased by 22.4 point in the escitalopram group, and 20.3 points in the citalopram group a statistically significant ( p < 0 . 0 5 ) and clinically relevant difference of 2.1 points (95%-CI: 0.01 to 4.21). There were significantly more responders (?50% decrease in MADRS score) in the escitalopram versus the citalopram group (76.1% versus 61.5%; p < 0 . 0 1 ) , giving a NNT of 7 (95%-CI: 4 to 26). The corresponding remission rates (MADRS?12) were 56.1% (escitalopram) and 43.6% (citalopram) (p < 0.05 !. AEs were reported by 46 patients, with only headache with an incidence > 5%. Tolerability was similar between treatment groups, with 13 patients (4.6%) withdrawn due to AEs, and with no significant differences in the incidence of AEs, or reason for withdrawal. Conclusions: This randomised double trial confirms the superior efficacy of escitalopram 20rag/day compared to citalopram 40 rag/day in the treatment of patients with MDD.
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Citalopram treatment of depression in myasthenia gravis patients - an open study
I.D. Kulaksizoglu 1 *, D. Aldemir 2, Y. Parman 2, F. Degmeer 2, R Serdaroglu 2. ]Istanbul Medical Faculty, PsychiaO'y, Istanbul,
Turkey; 2Istanbul Medical Faculty, Neurology, Turkey Introduction: Myasthenia Gravis (MG) involves many psychiatric consequences associated with its symptoms such as anxiety and depression. Treatment of these psychiatric conditions improves the quality of life in the MG patients. Many of the drugs interact with M G due to their anticholinergic effects. Aim: Aim of this prospective study was to evaluate the effect of an SSRI antidepressant, citalopram, treatment of major depression associated with MG, in regard to effectiveness and improvement in the quality of life of the patients as well as symptomatic interaction of the drug in MG. M e t h o d s and Material: Hospital Depression and Anxiety Scale was administered to all patients being followed up in the MG Clinic at the Istanbul Medical Faculty for a 18 month period. All patients with high anxiety and depression scores were pscyhiatrically interviewed. Those patients that fullfilled major depression criteria according to DSM-IV were included in the study. Other inclusion criteria included stabile disease in terms on MG, no medication alteration necessity over the last 3 months. All patients were given 20 30rag/day doses of oral citalopram. The study design was a 12 week open ended study. Patients were called uopn every other week for neurological examination and psychiatric follow-up. Treatment efficacy was surveyed by the Deck's Depression Inventory and the Global Improvement Scale. Results: 20 consecutive patients that fullfilled the inclusion criteria were included in the study. Neurological examinations did not reveal any worsening of the symptoms associated with MG. All psychiatric parameters showed statistically significant improvements both in terms of anxiety and depression. Patient compliance was good and there were minor side effects with the use of citalopram. Conclusion: Major depression associated with Myasthenia Gravis can be treated successfully by citalopram, without interfering or complicating the MG treatment. Tiredness and lack of energy that may also be due to depression and anxiety in the M G patients may be aleviated with citalopram treatment and thus unvealing the actual neurological profile of the patients. Most important of all the quality of life in M G patients can be improved with the recognition and treatment of depression and anxiety.
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Heart rate variability in patients with major depression and effects of antidepressant treatment with SSRI
K.J. Lee 1 *, Y.C. Chung 1, H. Kim 1, J.S. Park 2. ]htje University Ilsan Paik Hospital, Neuropsychiatry, Goyang-si, Republic of Korea; 2Dn Park's Clinic, Neuropsychiatry, Republic of Korea S t a t e m e n t on the p u r p o s e of the study: A high sympathetic and
a low cardiovagal activity in patients with major depression (MD) may contribute to the higher cardiac morbidity and mortality of MD patients. However, previous studies on the relationship between HRV and MD have revealed conflicting results. And the pharmacological effects of antidepressants may contribute to alterations in autonomic cardiac functioning, but detailed cardiovascular studies in humans involving serial standardized
P2 Affective disorders and antidepressants
DESS increase 1.62 for escitalopram versus 3.34 for paroxetine) in MDD; a significantly lower number of discontinuationemergent symptoms for escitalopram than for paroxetine was also seen in social anxiety disorder (DESS increase 1.39 for escitalopram versus 3.34 for paroxetine) and generalised anxiety disorder (DESS increase 1.20 for escitalopram versus 3.78 for paroxetine). No differences in discontinuation symptoms were observed between the three conditions. There was no evidence for increased symptom incidence with increased length of treatment. Conclusions: These comparative data show that discontinuation profiles differ between antidepressants of the same class (selective serotonin reuptake inhibitors) and that these profiles are broadly similar in different diagnoses. No evidence was seen for a higher discontinuation burden with longer treatment.
•
Escitalopram and citalopram in the treatment of outpatients with major depressive disorder
N. Moore 1 *, H. Verdoux 2, D. Fantino 3. ]INSERM U657,
Pharmacology, 33076 Bordeaux, Bordeaux, France; 2INSERM U657, Adult Psychiatty, 33076 Bordeaux, France; 3ADIM, Lyon, France Purpose: To study the efficacy and tolerability of fixed doses of
escitalopram versus citalopram in outpatients suffering from major depressive disorder (MDD) in France. M e t h o d s : This was a prospective, multicentre, randomised, double blind 8-week study in outpatients aged 18 65 years who fulfilled DSM-IV criteria for MDD and had a baseline Montgomery-Asberg depression Rating Scale (MADRS) total score ?30 at baseline. Efficacy assessments were performed at baseline, week 1, 4, and 8. Tolerability was based on the incidence of reported adverse events (AEs). The primary efficacy measure was change from baseline to end of study in MADRS total score, using ANCOVA of the intent-to-treat (ITT) population and the last-observation-carried-forward method (LOCF). Results: The ITT population consisted of 280 patients (n 138: escitalopram 20 rag/day and n 142: citalopram 40 rag/day), with 259 patients completing treatment (n 132, escitalopram, n 127, citalopram). The mean MADRS score at baseline was approximately 36, which decreased by 22.4 point in the escitalopram group, and 20.3 points in the citalopram group a statistically significant ( p < 0 . 0 5 ) and clinically relevant difference of 2.1 points (95%-CI: 0.01 to 4.21). There were significantly more responders (?50% decrease in MADRS score) in the escitalopram versus the citalopram group (76.1% versus 61.5%; p < 0 . 0 1 ) , giving a NNT of 7 (95%-CI: 4 to 26). The corresponding remission rates (MADRS?12) were 56.1% (escitalopram) and 43.6% (citalopram) (p < 0.05 !. AEs were reported by 46 patients, with only headache with an incidence > 5%. Tolerability was similar between treatment groups, with 13 patients (4.6%) withdrawn due to AEs, and with no significant differences in the incidence of AEs, or reason for withdrawal. Conclusions: This randomised double trial confirms the superior efficacy of escitalopram 20rag/day compared to citalopram 40 rag/day in the treatment of patients with MDD.
•
Citalopram treatment of depression in myasthenia gravis patients - an open study
I.D. Kulaksizoglu 1 *, D. Aldemir 2, Y. Parman 2, F. Degmeer 2, R Serdaroglu 2. ]Istanbul Medical Faculty, PsychiaO'y, Istanbul,
Turkey; 2Istanbul Medical Faculty, Neurology, Turkey Introduction: Myasthenia Gravis (MG) involves many psychiatric consequences associated with its symptoms such as anxiety and depression. Treatment of these psychiatric conditions improves the quality of life in the MG patients. Many of the drugs interact with M G due to their anticholinergic effects. Aim: Aim of this prospective study was to evaluate the effect of an SSRI antidepressant, citalopram, treatment of major depression associated with MG, in regard to effectiveness and improvement in the quality of life of the patients as well as symptomatic interaction of the drug in MG. M e t h o d s and Material: Hospital Depression and Anxiety Scale was administered to all patients being followed up in the MG Clinic at the Istanbul Medical Faculty for a 18 month period. All patients with high anxiety and depression scores were pscyhiatrically interviewed. Those patients that fullfilled major depression criteria according to DSM-IV were included in the study. Other inclusion criteria included stabile disease in terms on MG, no medication alteration necessity over the last 3 months. All patients were given 20 30rag/day doses of oral citalopram. The study design was a 12 week open ended study. Patients were called uopn every other week for neurological examination and psychiatric follow-up. Treatment efficacy was surveyed by the Deck's Depression Inventory and the Global Improvement Scale. Results: 20 consecutive patients that fullfilled the inclusion criteria were included in the study. Neurological examinations did not reveal any worsening of the symptoms associated with MG. All psychiatric parameters showed statistically significant improvements both in terms of anxiety and depression. Patient compliance was good and there were minor side effects with the use of citalopram. Conclusion: Major depression associated with Myasthenia Gravis can be treated successfully by citalopram, without interfering or complicating the MG treatment. Tiredness and lack of energy that may also be due to depression and anxiety in the M G patients may be aleviated with citalopram treatment and thus unvealing the actual neurological profile of the patients. Most important of all the quality of life in M G patients can be improved with the recognition and treatment of depression and anxiety.
•
Heart rate variability in patients with major depression and effects of antidepressant treatment with SSRI
K.J. Lee 1 *, Y.C. Chung 1, H. Kim 1, J.S. Park 2. ]htje University Ilsan Paik Hospital, Neuropsychiatry, Goyang-si, Republic of Korea; 2Dn Park's Clinic, Neuropsychiatry, Republic of Korea S t a t e m e n t on the p u r p o s e of the study: A high sympathetic and
a low cardiovagal activity in patients with major depression (MD) may contribute to the higher cardiac morbidity and mortality of MD patients. However, previous studies on the relationship between HRV and MD have revealed conflicting results. And the pharmacological effects of antidepressants may contribute to alterations in autonomic cardiac functioning, but detailed cardiovascular studies in humans involving serial standardized