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P.2.g.014 Repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression and negative symptoms in schizophrenia
S448
P.2.g. Affective disorders and antidepressants − Other (clinical)
To our knowledge there is no data with VNS associated somnolence and OSA in depression. Method: We report a 30 year old woman with a long history of recurrent unipolar depression with suicidality since her adolescence and consecutive several − on the long run − insufficient pharmacological and nonpharmacological treatments. The affective disorder is accompanied by a hashimoto thyroiditis and adipositas. Under continuing the SSRI medication and L-thyroxin the VNS implantation (outcome 1.50 mA) at the age of 23 ameliorated efficiently the depressive symptoms for 5 years until chronic stress triggered a new depressive episode (HAMD21:18). Adaptation of the VNS output current to 2.0 mA reached a complete remission (HAMD21:1) but was rapidly paralleled by a progredient daytime somnolence and detoriation of professional performance. A first respiratory examination revealed no significant sleep associated breathing or moving disorder but a high index of autonomous arousals. About 6 months later she was unable to follow her ITprofession without any further depressive symptoms but snoring was observed. A follow up examination than showed a significant obstructive sleep apnea syndrome with an AH-index of 25.4 (ODI 14; Snore% 6.84) including obstructive and central events. In a second split-night investigation VNS was turned off. The AHindex was immediately reduced to 12.9 (ODI 13; Snore% 9.68); the second half of the night (still pausing VNS) CPAP titration was started and showed a further reduction of AH-index to 6.3 (ODI 11; Snore% 079). CPAP treatment was continued with VNS activation for 35 days and showed a slight worsening of AH-index to 10.2 but a restored performance and a completely suspend of daytime somnolence. Conclusion: We suggest that a respirography in terms of sleep associated breathing disorders before VNS implantation should be considered and a careful clinical examination along with the VNS treatment should be mentioned in terms of minimizing possible risk factors for relapse in depression. Short term effects of e.g. night-adapted VNS stimulation on breathing parameters need to be further investigated. References [1] Malow, B.A., Edwards, J., Marzec, M., Sagher, O., Fromes, G., 2000. Effects of vagus nerve stimulation on respiration during sleep: a pilot study. Neurology 55, 1450–1454. [2] Gschliesser, V., H¨ogl, B., Frauscher, B., Brandauer, E., Poewe, W., Luef, G. 2009. Mode of vagus nerve stimulation differentially affects sleep related breathing in patients with epilepsy.Seizure 18, 339–342. [3] Holmes, H.D., Chang, M., Kapur, V. 2003. Sleep apnea and excessive daytime somnolence induced by vagal nerve stimulation. Neurology 61, 1126–1129.
P.2.g.014 Repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression and negative symptoms in schizophrenia N.V. Maslenikov1 ° , E.E. Tsukarzi1 , S.N. Mosolov1 . 1 Moscow Research Institute of Psychiatry, Department for treatment of mental disorders, Moscow, Russia Objective: Depression is an important co-occurring syndrome in schizophrenia associated with increased morbidity and mortality rates. Pharmacological treatment of this condition has certain difficulties and brain stimulation techniques may be considered as methods of choice. The aim of the study was to estimate the effectiveness of rTMS for the treatment of depression and probably negative symptoms in schizophrenia patients.
Methods: 66 patients with schizophrenia (ICD-10) stabilized on antipsychotic medication and with the prevalence of negative symptoms were included in the study. All the patients had major depression (CDSS score 6). Patients were randomized in 2 groups. 32 patients of the 1st group received 15-Hz rTMS on the left dorsolateral prefrontal cortex (100% intensity, 6-second trains, 60-second intervals, and 20-train session). Sessions were given 5 times a week during 3 weeks. 34 patients of the 2nd group were treated with antidepressant (SSRI) which was added to antipsychotic therapy (this group was an active control for the 1st group). Patients were assessed weekly with PANSS, CDSS and CGI-S. The criterion of efficacy was the 50% CDSS score reduction. Nonparametric statistical methods were used. Results: The number of responders was 20 (62.5%) in rTMS group and 18 (52.9%) in the active control group. Depressive symptoms were reduced faster in rTMS group. Mean CDSS score reduction after the 1st week of treatment was 39.4% (p < 0.05) in the group of rTMS and 34.6% (p < 0.05) in the active control group. rTMS was more effective in the treatment of severe depression (CDSS11) than SSRI therapy: 58.8% vs. 50% of responders. The disadvantage of rTMS was unstable effect, in 35% of responders in the 1st group depressive symptoms relapsed in two weeks after discontinuation of the therapy. PANSS negative subscale score reduction was 15.5% (p < 0.05) in rTMS group and 5.8% (p < 0.05) in the active control group. The most reduced negative symptoms in rTMS group were “Poor rapport” − 21.6%, “Emotional withdrawal” − 19.5%, “Blunted affect” − 17.6%, “Passive apathetic social avoidance” − 12.2% of reduction. Changes of each item of PANSS negative subscale in rTMS group were statistically significant (p < 0.05). Correlations between reduction of PANSS negative subscale and CDSS were found. It means that mostly the secondary negative symptoms associated with depression were reduced in both groups. There weren’t any significant changes in positive symptoms. rTMS was good tolerable, the most common side effect was headache (90.6%). Headaches mostly were mild and unstable. Only one patient was excluded from the study due to this reason. Conclusion: Our results have shown that antidepressive effect of rTMS in schizophrenia is comparable to conventional methods of pharmacological treatment. Good tolerability, rapid onset of action and more potent reduction of negative symptoms were the prominent features of rTMS action. rTMS can be used in the treatment of depressions of different severity in stabilized schizophrenia patients without acute psychosis. Prolongation of rTMS course or usage of this method combined with antidepressants probably can be considered to achieve more stable effect.
P.2.g.015 Escitalopram vs duloxetine in major depressed patients with pain A. Baloescu1 ° , V. Baloescu2 , J. Sichitiu1 . 1 Euroclinic Hospital, Psychiatry, Bucharest, Romania; 2 Aeromed Clinic, Psychiatry, Bucharest, Romania Objective: To evaluate the efficacy and tolerability of escitalopram and duloxetine in depressive patients with pain. Depression and painful somatic symptoms commonly occur together. Depression and chronic pain can have devastating effects on a patient’s health, productivity, and overall quality of life. The moderate to severe pain can impair patient function making treatment more difficult or resistant and increases severity in depressive symptoms. Studies reveal that approximately 80% of
P.2.g. Affective disorders and antidepressants − Other (clinical)
To our knowledge there is no data with VNS associated somnolence and OSA in depression. Method: We report a 30 year old woman with a long history of recurrent unipolar depression with suicidality since her adolescence and consecutive several − on the long run − insufficient pharmacological and nonpharmacological treatments. The affective disorder is accompanied by a hashimoto thyroiditis and adipositas. Under continuing the SSRI medication and L-thyroxin the VNS implantation (outcome 1.50 mA) at the age of 23 ameliorated efficiently the depressive symptoms for 5 years until chronic stress triggered a new depressive episode (HAMD21:18). Adaptation of the VNS output current to 2.0 mA reached a complete remission (HAMD21:1) but was rapidly paralleled by a progredient daytime somnolence and detoriation of professional performance. A first respiratory examination revealed no significant sleep associated breathing or moving disorder but a high index of autonomous arousals. About 6 months later she was unable to follow her ITprofession without any further depressive symptoms but snoring was observed. A follow up examination than showed a significant obstructive sleep apnea syndrome with an AH-index of 25.4 (ODI 14; Snore% 6.84) including obstructive and central events. In a second split-night investigation VNS was turned off. The AHindex was immediately reduced to 12.9 (ODI 13; Snore% 9.68); the second half of the night (still pausing VNS) CPAP titration was started and showed a further reduction of AH-index to 6.3 (ODI 11; Snore% 079). CPAP treatment was continued with VNS activation for 35 days and showed a slight worsening of AH-index to 10.2 but a restored performance and a completely suspend of daytime somnolence. Conclusion: We suggest that a respirography in terms of sleep associated breathing disorders before VNS implantation should be considered and a careful clinical examination along with the VNS treatment should be mentioned in terms of minimizing possible risk factors for relapse in depression. Short term effects of e.g. night-adapted VNS stimulation on breathing parameters need to be further investigated. References [1] Malow, B.A., Edwards, J., Marzec, M., Sagher, O., Fromes, G., 2000. Effects of vagus nerve stimulation on respiration during sleep: a pilot study. Neurology 55, 1450–1454. [2] Gschliesser, V., H¨ogl, B., Frauscher, B., Brandauer, E., Poewe, W., Luef, G. 2009. Mode of vagus nerve stimulation differentially affects sleep related breathing in patients with epilepsy.Seizure 18, 339–342. [3] Holmes, H.D., Chang, M., Kapur, V. 2003. Sleep apnea and excessive daytime somnolence induced by vagal nerve stimulation. Neurology 61, 1126–1129.
P.2.g.014 Repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression and negative symptoms in schizophrenia N.V. Maslenikov1 ° , E.E. Tsukarzi1 , S.N. Mosolov1 . 1 Moscow Research Institute of Psychiatry, Department for treatment of mental disorders, Moscow, Russia Objective: Depression is an important co-occurring syndrome in schizophrenia associated with increased morbidity and mortality rates. Pharmacological treatment of this condition has certain difficulties and brain stimulation techniques may be considered as methods of choice. The aim of the study was to estimate the effectiveness of rTMS for the treatment of depression and probably negative symptoms in schizophrenia patients.
Methods: 66 patients with schizophrenia (ICD-10) stabilized on antipsychotic medication and with the prevalence of negative symptoms were included in the study. All the patients had major depression (CDSS score 6). Patients were randomized in 2 groups. 32 patients of the 1st group received 15-Hz rTMS on the left dorsolateral prefrontal cortex (100% intensity, 6-second trains, 60-second intervals, and 20-train session). Sessions were given 5 times a week during 3 weeks. 34 patients of the 2nd group were treated with antidepressant (SSRI) which was added to antipsychotic therapy (this group was an active control for the 1st group). Patients were assessed weekly with PANSS, CDSS and CGI-S. The criterion of efficacy was the 50% CDSS score reduction. Nonparametric statistical methods were used. Results: The number of responders was 20 (62.5%) in rTMS group and 18 (52.9%) in the active control group. Depressive symptoms were reduced faster in rTMS group. Mean CDSS score reduction after the 1st week of treatment was 39.4% (p < 0.05) in the group of rTMS and 34.6% (p < 0.05) in the active control group. rTMS was more effective in the treatment of severe depression (CDSS11) than SSRI therapy: 58.8% vs. 50% of responders. The disadvantage of rTMS was unstable effect, in 35% of responders in the 1st group depressive symptoms relapsed in two weeks after discontinuation of the therapy. PANSS negative subscale score reduction was 15.5% (p < 0.05) in rTMS group and 5.8% (p < 0.05) in the active control group. The most reduced negative symptoms in rTMS group were “Poor rapport” − 21.6%, “Emotional withdrawal” − 19.5%, “Blunted affect” − 17.6%, “Passive apathetic social avoidance” − 12.2% of reduction. Changes of each item of PANSS negative subscale in rTMS group were statistically significant (p < 0.05). Correlations between reduction of PANSS negative subscale and CDSS were found. It means that mostly the secondary negative symptoms associated with depression were reduced in both groups. There weren’t any significant changes in positive symptoms. rTMS was good tolerable, the most common side effect was headache (90.6%). Headaches mostly were mild and unstable. Only one patient was excluded from the study due to this reason. Conclusion: Our results have shown that antidepressive effect of rTMS in schizophrenia is comparable to conventional methods of pharmacological treatment. Good tolerability, rapid onset of action and more potent reduction of negative symptoms were the prominent features of rTMS action. rTMS can be used in the treatment of depressions of different severity in stabilized schizophrenia patients without acute psychosis. Prolongation of rTMS course or usage of this method combined with antidepressants probably can be considered to achieve more stable effect.
P.2.g.015 Escitalopram vs duloxetine in major depressed patients with pain A. Baloescu1 ° , V. Baloescu2 , J. Sichitiu1 . 1 Euroclinic Hospital, Psychiatry, Bucharest, Romania; 2 Aeromed Clinic, Psychiatry, Bucharest, Romania Objective: To evaluate the efficacy and tolerability of escitalopram and duloxetine in depressive patients with pain. Depression and painful somatic symptoms commonly occur together. Depression and chronic pain can have devastating effects on a patient’s health, productivity, and overall quality of life. The moderate to severe pain can impair patient function making treatment more difficult or resistant and increases severity in depressive symptoms. Studies reveal that approximately 80% of