- Email: [email protected]
Paroxetine in the treatment of depression with associated anxiety: A naturalistic study conducted in German private practice
P.I Affective disorders and antidepressants
$212
features in persons with inadequate premorbid personality. Factor 3 corresponds to the subaffective dysthymia subtype, that is seen in younger, actively employed patients with milder depressive symptoms and pathological personality traits, who sometimes also suffer from nonaffective psychiatric disorders (basieaUy anxious disorders), are inadequately treated and in whom hypomania can occur during the antidepressant treatment. The last factor that represents chronic secondary dysphoria comprised poor response to antidepressant treatment, high levels of comorbidity with nonaffective axis I, axis II and somatic disorders, as well as the chronic stressful situations. Conclusions: factors showed striking similarity with Akiskal's subtypes of chronic depressions, Results indicate that Akiskal's classification of chronic depressions is clinically relevant in the population of chronically depressed inpatients that also meet severity criteria for major depression.
References [1] Judd LL. The clinical course of unipolar major depressive disorders. Arch Gen Psychiatry, 11: 989-99, 1997. [2] Akiskal HSA.: Dysthymie disorder: psychopathology of proposed chronic depressive subtypes, Am J Psychiatry, 140: 11-20; 1983.
•
Emergence of manic episodes in citaloprem treated depressed patients
Y. Barak 1,3, R. Kim_hi1,3, R. Weizman 2'3. lAbarbanel Mental Health Center, Bat Yam; 2Tel Aviv Community Mental Health Center, Tel Aviv; 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel To determine whether selectivity for serotonin reuptake plays a role in antidepressant-associated mania (AAM), we evaluated the frequency of treatment-emergent mania in patients with unipolar depression who received either eitalopram, a highly selective serotonin uptake inhibitor, or the adrenergic tetracyelic antidepressants (TTCAs) maprotiline and mianserin, or placebo. Data were collected from post-marketing reports of adverse events, three placebo-controlled trials and four doubleblind comparative trials. Of the total 4,004 depressed patients treated with citalopram (2,482 from post-marketing data, 840 from placebocontrolled studies and 682 from TTCAs comparative studies), 25 (0.62%) had manic episodes. The rate of AAM in the comparative trials was significantly lower in the citalopram-treated patients (1/682, 0.15%) than in the TTCA-treated patients (5/389, 1.29%) (p = 0.03). In the placebo-controlled studies, no manic episodes were reported in the patients given placebo, but one manic episode occurred in a citalopramtreated patient (1/840, 0.12%). The citalopram-treated patients in whom AAM developed were significantly older than those in whom it did not (about 10 years, p < 0.001); gender distribution was similar. In conclusion, despite its limitations, our study apparently indicates that citalopram, a highly selective serotonin reuptake inhibitor, is associated with a significantly lower rate of treatment-emergent manic episodes than TTCAs, which have noradrenergic activity, but a similar rate to that reported for less selective SSRIs.
•
Making valid inferences from claims data: a comparison of SSRI treatment costs
J.M. Russell, E.R. Berndt, R.J. Mieeli, A.N. Grudzinski, S.V. Colucci. University of Texas Medical Branch at Galveston, Department of Psychiatry and Behavioral Sciences, Galveston, Texas, USA Introduction: Several previous analyses have compared SSRIs when sertraline and paroxetine were unavailable or newly approved agents, likely resulting in biased treatment cost estimates. We employ more recent (1995-96) data when all three SSRIs were well established and examine the sensitivity of findings to alternative treatments of selectivity or non-random sampling. Method: Following a six-month antidepressant medication free period, claims records from a national database (HCIA) of 1663 patients
diagnosed with depression who began treatment with an SSRI in 1995 met inclusion criteria. During the subsequent 12 months, total and depression-related healthcare costs were examined using bivariate, multivariate, and sample selectivity to adjust for observed and unobserved selection biases. Results: Six hundred sixty-two (662) finoxetine (F), 402 paroxetine (P), and 599 sertraline (S) patients met inclusion criteria. Age, gender, and treatment course characteristics were similar, except the higher treatment discontinuation rate (27.1%; p < 0.001) and shorter treatment duration (median = 90 days; p < 0.001) for paroxetine. A high percentage (43.2%) of patients in all three cohorts were titrated, resulting in a significantly higher proportion of finoxetine patients taking two or more capsules per day (F = 28.0%, P = 11.1%, S = 15.4%; p < 0.001). Consequently, mean antidepressant and associated depression-relatedtreatment costs were significantly higher for finoxetine ($1473 versus $991 and $1053 for paroxetine and sertraline, respectively; p < 0.001). The fluoxetine cohort did not have lower total bealthcare costs to offset the higher pharmaceutical acquisition costs. Conclusions from median, multivariate, and selectivity analyses were robust to these findings. Conclusion: When fluoxetine, paroxetine, and sertraline were well established agents, multivariate and sample selectivity analyses revealed similar and consistent results. Fluoxetine treated patients, as a result of the higher proportion of patients taking two or more capsules per day, have significantly higher pharmaceutical acquisition costs which result in higher total depression-related healthcare costs. Supported in part by Pfizer, Inc.
References [1] Crogan, T.W., Lair, T.J., Engelhart, L., et al. (1997) Effect of antidepressant therapy on health care utilization and costs in primary care. Psychiatric Services. 48 (11), 1420-1426. [2] Hylan, T.R., Crown, W.H., Meneades, L., et al. (1998) Tricyclic antidepressant and selective serotonin reuptake inhibitors antidepressant selection and health care costs in the naturalistic setting: a multivariate analysis. Journal of Affective Disorders. 47, 71-79.
•
Paroxetine in the treatment of depression with associated anxiety: a naturalistic study conducted in German private practice
R. Zaninelli, W. Meister. Clinical Research CNS, Smithkline Beecham Pharma Leopoldstrafle 175, D-80804 Munich, Germany Introduction: Although it is well-documented that depression in the primary-care setting is frequently associated with a manifest or subthreshold anxiety disorder (1), there have been few treatment studies concerning whether general practitioners (GPs) and privately practicing psychiatrists actually recognize and adequately treat eases of depression comorbid with anxiety. The purpose of the present study was to allow physicians to screen depressed patients for the presence of anxiety symptoms and to follow the changes in symptomatology during the course of treatment with paroxetine. Methods: In this naturalistic study, patients diagnosed by their GP or psychiatrist as suffering from a depressive episode according to ICD-10 criteria were assessed prior to beginning treatment for the presence of anxiety symptoms using the Clinical Anxiety Scale (CAS) (2). Patients demonstrating measurable anxiety on the CAS were entered into the protocol and treated for 8 weeks with paroxetine. Changes in the severity of anxiety symptoms and in the general severity of the patient's condition were assessed using the CAS and the Clinical Global Impression (CGI) after 2, 4 and 8 weeks treatment. Results: 524 GPs and 82 psychiatrists participated in the study. Of the 1047 evaluable cases, 893 (85%) were treated by GPs, 154 (15%) by psychiatrists. In both groups, 60% of patients were diagnosed with "moderate" and 25% with "severe" depression at baseline, and similar proportions of patients were judged to be "clearly" or "seriously" ill on the CGI (mean score 5.1). The mean CAS score at baseline was 16.7 in the GP group and 16.2 in the psychiatrist group. During the course of treatment, the mean CAS and CGI scores decreased linearly,
P1 Affective disorders and antidepressants
$213
with significant changes relative to baseline apparent after 2 weeks, and after 8 weeks' treatment were 6.1 and 2.9, respectively. There was no difference between the GP and psychiatrist groups with respect to treatment response. At baseline, 30% of all patients were taking one or more psychotropic medications. These patients had significantly higher baseline CAS and CGI scores than patients not on psychotropics. Conclusions: A previous controlled trial comparing paroxetine and clomipramine showed that both medications relieved depression and associated anxiety (3). However, that study excluded patients taking concomitant psychotropic drugs. The results of the present naturalistic study in an unselected population provide luther evidence that paroxetine is effective in the treatment o f depressed patients exhibiting comorbid anxiety and that privately practicing physicians can successfully incorporate a standardised assessment of anxiety symptoms into their daily practice.
This observation is consistent with the in vitro data for the compounds and the proposed mechanism of action o f S SRIs in the treatment of depression.
References
•
[1] Sartorius, N., l]stiin T.B., Lecrubier Y., Wittchen, H.-U. (1996) Depression comorbid with anxiety: Results from the WHO study on psychological disorders in primary health care. Brit J Psychiat, 168 (suppl. 30), 38-43 [2] Snaith, R.P., Baugh, S.J., Clayden, A.D., Husain, A., Sipple, M.A. (1982) The Clinical Anxiety Scale: An instrument derived from the Hamilton Anxiety Scale. Brit J Psyhiat, 141, 518-523 [3] Ravindran, A.V., JBdge, R., Hunter, B.N., Bray, J., Morton, N.H. (1997) A double-blind, mulficenter study in primary care comparing paroxetine and clomipramine in patients with depression and associated anxiety. J Clin Psyehiat 58 (3), 112-118
•
antidepressant effects Tmediated h e of cltslopram are by the S-(+)- and not the R(-)-enantiomer
S. Hogg, C. Sfinchez. Department of Psychopharmacology, Pharmacological Research, H. Lundbeck A/S, Ottiliaoej 9, 2500 Copenhagen- Valby, Denmark The most selective of the serotonin renptake inhibitors (SSIRs), citalopram (cit), has proven clinical efficacy in the treatment of depression, panic anxiety and obsessive compulsive disorder. The compound is a racemate with the enantiomers differentially inhibiting the uptake of 5HT in vitro; ICs0 values for the inhibition of 5-HT reuptake 3.9, 2.1 and 275 tiM for the racemate, S- and R-enantiomers, respectively. The objective of the studies reported here was to firstly to establish whether the in vivo reuptake inhibition and the antidepressant-like effects of the compound are different for the two enantiomers. Administration of L-5-HTP (454 ~tmol/kg s.c. in mice) in combination with a 5-HT reuptake inhibitor results in a characteristic syndrome (head weaving, tremor and hind limb abduction). Animals were tested with either of S- and R-cit. S-cit produced a dose dependent potentiation of the effects of L-5-HTP (max potentiation: 3.1 ~tmol/kg s.c.), R-cit was without effect. Thus S- and not R-cit inhibits 5-HT reuptake in vivo. The antidepressant potential of the enantiomers and racemic cit was assessed in the forced swim test, this model relies on the fact that a rapidly learned behavioural despair is inhibited by antidepressants. Adult male NMRI mice (MellegArd, Denmark) were tested individually, testing consisted of placing the animals into a 21 pyrex beaker half filled with water (23°C) for 6 min. During the final 3 rain of the test the duration for which the animals remained immobile was assessed. Vehicle (0.9% saline) or active compound was administered s.c. 30 min prior to the start of the test. The effects of citalopram, S- citalopram and R citalopram were assessed. The data, expressed as percentage of vehicletreated control are presented in the Table, the values given are mean (± sere) for 9 animals/group [*P < 0.05 vs control: ANOVA followed by Dunnett's t-test] Thus, 12, 24 and 49 ~tmol/kg of S-citalopram and 24 and 49 ~tmol/kg R/S-citalopram significantly reduced the duration of immobility in the mouse forced swim test. The magnitude of the effects of S- and racemic citalopram were comparable. A reduction in duration of immobility is indicative of an antidepressant-like effect and implies that the clinical effects of racemic citalopram are likely to be mediated by the S- and not the R-enantiomer.
Drug
dose (~tmol/kg) 3.1 6.2
citalopram S-citalopram
98.3 47.5
R-citalopram
95.1 412.2 106.6 4- 3.4
12
24
49
85.0 412.8 72.6 47.5* 106.1 4- 7.9
54.3 4- 52.1 47.8* 8.1" 59.6 4- 46.2 :t: 8.1" 6.7* 121.7 95.1 44- 8.0 4.8
98
116.1 4- 9.3
Light therapy is not effective in nonseasonal affective disorder
G.J. Schut, J. Dirkx, J.G. Goekoop, L. Timmerman. Delta Psychiatric
Hospital, Poortagaal, The Netherlands Introduction: Since bright light as a treatment for seasonal affective disorder (SAD) has come into use several studies were done to prove its effect. The highest improvement was measured by Thal6n et al (1). They found, in contrast with earlier studies, a 53% improvement (criterium: 50% reduction on the Hamilton Depression Rating Scale (HRSD) in a SAD group and a 14% improvement in a Non-SAD (nonseasonal affective disorder) group. They used a l0 day, 2 hour, 1500 lux regime. More recently a 10000 lux lightbox was introduced. We were interested in whether a much shorter exposure-time at a higher intensity is also effective, and can prove also a different outcome between SAD and Non-SAD. Aim: The aim of this study was to evaluate the effects of light therapy, using a 5 day, ½ hour, 10000 lux regime, on SAD and Non-SAD. Method: Bright white light with an intensity of 10000 lux and a exposure time of only 5 day's - ½ hour at morning was given to one group with SAD (n = 15) and one group with non-SAD (n = 20). Effects were scored with the HRSDadd (dutch version, 7 atypical symptoms added) (2), and the dutch version form the SAM SAD. Results: When 50% HRSDadd reduction was taken as criterium for improvement, in the SAD group 53% responded, whereas in the NonSAD group only 10% responded. When measured with the SAM SAD we found the same 53% to 10%-difference. The difference between both patient groups was highly statistically significant (p < 0.001). Coneluslon: In this study it appeared that it is usefull to treat seasonal affective disorder with the here described method of light therapy. For nonseasonal affective disorder light therapy appeared to be not usefull.
References [1] Thal6n BE, Kjellman BF, Mmkid L, Wibom R, Wetterberg L. (1995) Light treatment in seasonal and nonseasonal depression. Acta Psychiatrica Scandinavica 91: 352-360. [2] Meesters Y, Jansen JHC. (1993) Assessing atypical seasonal affcctive disorder complaints by means of selfrating. Acta Psychiatrica Scandinavica 88: 361363. [3] Lain RW. (1994) Seasonal affective disorders. Current Opinion in Psychiatry 7: 9-13.
$212
features in persons with inadequate premorbid personality. Factor 3 corresponds to the subaffective dysthymia subtype, that is seen in younger, actively employed patients with milder depressive symptoms and pathological personality traits, who sometimes also suffer from nonaffective psychiatric disorders (basieaUy anxious disorders), are inadequately treated and in whom hypomania can occur during the antidepressant treatment. The last factor that represents chronic secondary dysphoria comprised poor response to antidepressant treatment, high levels of comorbidity with nonaffective axis I, axis II and somatic disorders, as well as the chronic stressful situations. Conclusions: factors showed striking similarity with Akiskal's subtypes of chronic depressions, Results indicate that Akiskal's classification of chronic depressions is clinically relevant in the population of chronically depressed inpatients that also meet severity criteria for major depression.
References [1] Judd LL. The clinical course of unipolar major depressive disorders. Arch Gen Psychiatry, 11: 989-99, 1997. [2] Akiskal HSA.: Dysthymie disorder: psychopathology of proposed chronic depressive subtypes, Am J Psychiatry, 140: 11-20; 1983.
•
Emergence of manic episodes in citaloprem treated depressed patients
Y. Barak 1,3, R. Kim_hi1,3, R. Weizman 2'3. lAbarbanel Mental Health Center, Bat Yam; 2Tel Aviv Community Mental Health Center, Tel Aviv; 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel To determine whether selectivity for serotonin reuptake plays a role in antidepressant-associated mania (AAM), we evaluated the frequency of treatment-emergent mania in patients with unipolar depression who received either eitalopram, a highly selective serotonin uptake inhibitor, or the adrenergic tetracyelic antidepressants (TTCAs) maprotiline and mianserin, or placebo. Data were collected from post-marketing reports of adverse events, three placebo-controlled trials and four doubleblind comparative trials. Of the total 4,004 depressed patients treated with citalopram (2,482 from post-marketing data, 840 from placebocontrolled studies and 682 from TTCAs comparative studies), 25 (0.62%) had manic episodes. The rate of AAM in the comparative trials was significantly lower in the citalopram-treated patients (1/682, 0.15%) than in the TTCA-treated patients (5/389, 1.29%) (p = 0.03). In the placebo-controlled studies, no manic episodes were reported in the patients given placebo, but one manic episode occurred in a citalopramtreated patient (1/840, 0.12%). The citalopram-treated patients in whom AAM developed were significantly older than those in whom it did not (about 10 years, p < 0.001); gender distribution was similar. In conclusion, despite its limitations, our study apparently indicates that citalopram, a highly selective serotonin reuptake inhibitor, is associated with a significantly lower rate of treatment-emergent manic episodes than TTCAs, which have noradrenergic activity, but a similar rate to that reported for less selective SSRIs.
•
Making valid inferences from claims data: a comparison of SSRI treatment costs
J.M. Russell, E.R. Berndt, R.J. Mieeli, A.N. Grudzinski, S.V. Colucci. University of Texas Medical Branch at Galveston, Department of Psychiatry and Behavioral Sciences, Galveston, Texas, USA Introduction: Several previous analyses have compared SSRIs when sertraline and paroxetine were unavailable or newly approved agents, likely resulting in biased treatment cost estimates. We employ more recent (1995-96) data when all three SSRIs were well established and examine the sensitivity of findings to alternative treatments of selectivity or non-random sampling. Method: Following a six-month antidepressant medication free period, claims records from a national database (HCIA) of 1663 patients
diagnosed with depression who began treatment with an SSRI in 1995 met inclusion criteria. During the subsequent 12 months, total and depression-related healthcare costs were examined using bivariate, multivariate, and sample selectivity to adjust for observed and unobserved selection biases. Results: Six hundred sixty-two (662) finoxetine (F), 402 paroxetine (P), and 599 sertraline (S) patients met inclusion criteria. Age, gender, and treatment course characteristics were similar, except the higher treatment discontinuation rate (27.1%; p < 0.001) and shorter treatment duration (median = 90 days; p < 0.001) for paroxetine. A high percentage (43.2%) of patients in all three cohorts were titrated, resulting in a significantly higher proportion of finoxetine patients taking two or more capsules per day (F = 28.0%, P = 11.1%, S = 15.4%; p < 0.001). Consequently, mean antidepressant and associated depression-relatedtreatment costs were significantly higher for finoxetine ($1473 versus $991 and $1053 for paroxetine and sertraline, respectively; p < 0.001). The fluoxetine cohort did not have lower total bealthcare costs to offset the higher pharmaceutical acquisition costs. Conclusions from median, multivariate, and selectivity analyses were robust to these findings. Conclusion: When fluoxetine, paroxetine, and sertraline were well established agents, multivariate and sample selectivity analyses revealed similar and consistent results. Fluoxetine treated patients, as a result of the higher proportion of patients taking two or more capsules per day, have significantly higher pharmaceutical acquisition costs which result in higher total depression-related healthcare costs. Supported in part by Pfizer, Inc.
References [1] Crogan, T.W., Lair, T.J., Engelhart, L., et al. (1997) Effect of antidepressant therapy on health care utilization and costs in primary care. Psychiatric Services. 48 (11), 1420-1426. [2] Hylan, T.R., Crown, W.H., Meneades, L., et al. (1998) Tricyclic antidepressant and selective serotonin reuptake inhibitors antidepressant selection and health care costs in the naturalistic setting: a multivariate analysis. Journal of Affective Disorders. 47, 71-79.
•
Paroxetine in the treatment of depression with associated anxiety: a naturalistic study conducted in German private practice
R. Zaninelli, W. Meister. Clinical Research CNS, Smithkline Beecham Pharma Leopoldstrafle 175, D-80804 Munich, Germany Introduction: Although it is well-documented that depression in the primary-care setting is frequently associated with a manifest or subthreshold anxiety disorder (1), there have been few treatment studies concerning whether general practitioners (GPs) and privately practicing psychiatrists actually recognize and adequately treat eases of depression comorbid with anxiety. The purpose of the present study was to allow physicians to screen depressed patients for the presence of anxiety symptoms and to follow the changes in symptomatology during the course of treatment with paroxetine. Methods: In this naturalistic study, patients diagnosed by their GP or psychiatrist as suffering from a depressive episode according to ICD-10 criteria were assessed prior to beginning treatment for the presence of anxiety symptoms using the Clinical Anxiety Scale (CAS) (2). Patients demonstrating measurable anxiety on the CAS were entered into the protocol and treated for 8 weeks with paroxetine. Changes in the severity of anxiety symptoms and in the general severity of the patient's condition were assessed using the CAS and the Clinical Global Impression (CGI) after 2, 4 and 8 weeks treatment. Results: 524 GPs and 82 psychiatrists participated in the study. Of the 1047 evaluable cases, 893 (85%) were treated by GPs, 154 (15%) by psychiatrists. In both groups, 60% of patients were diagnosed with "moderate" and 25% with "severe" depression at baseline, and similar proportions of patients were judged to be "clearly" or "seriously" ill on the CGI (mean score 5.1). The mean CAS score at baseline was 16.7 in the GP group and 16.2 in the psychiatrist group. During the course of treatment, the mean CAS and CGI scores decreased linearly,
P1 Affective disorders and antidepressants
$213
with significant changes relative to baseline apparent after 2 weeks, and after 8 weeks' treatment were 6.1 and 2.9, respectively. There was no difference between the GP and psychiatrist groups with respect to treatment response. At baseline, 30% of all patients were taking one or more psychotropic medications. These patients had significantly higher baseline CAS and CGI scores than patients not on psychotropics. Conclusions: A previous controlled trial comparing paroxetine and clomipramine showed that both medications relieved depression and associated anxiety (3). However, that study excluded patients taking concomitant psychotropic drugs. The results of the present naturalistic study in an unselected population provide luther evidence that paroxetine is effective in the treatment o f depressed patients exhibiting comorbid anxiety and that privately practicing physicians can successfully incorporate a standardised assessment of anxiety symptoms into their daily practice.
This observation is consistent with the in vitro data for the compounds and the proposed mechanism of action o f S SRIs in the treatment of depression.
References
•
[1] Sartorius, N., l]stiin T.B., Lecrubier Y., Wittchen, H.-U. (1996) Depression comorbid with anxiety: Results from the WHO study on psychological disorders in primary health care. Brit J Psychiat, 168 (suppl. 30), 38-43 [2] Snaith, R.P., Baugh, S.J., Clayden, A.D., Husain, A., Sipple, M.A. (1982) The Clinical Anxiety Scale: An instrument derived from the Hamilton Anxiety Scale. Brit J Psyhiat, 141, 518-523 [3] Ravindran, A.V., JBdge, R., Hunter, B.N., Bray, J., Morton, N.H. (1997) A double-blind, mulficenter study in primary care comparing paroxetine and clomipramine in patients with depression and associated anxiety. J Clin Psyehiat 58 (3), 112-118
•
antidepressant effects Tmediated h e of cltslopram are by the S-(+)- and not the R(-)-enantiomer
S. Hogg, C. Sfinchez. Department of Psychopharmacology, Pharmacological Research, H. Lundbeck A/S, Ottiliaoej 9, 2500 Copenhagen- Valby, Denmark The most selective of the serotonin renptake inhibitors (SSIRs), citalopram (cit), has proven clinical efficacy in the treatment of depression, panic anxiety and obsessive compulsive disorder. The compound is a racemate with the enantiomers differentially inhibiting the uptake of 5HT in vitro; ICs0 values for the inhibition of 5-HT reuptake 3.9, 2.1 and 275 tiM for the racemate, S- and R-enantiomers, respectively. The objective of the studies reported here was to firstly to establish whether the in vivo reuptake inhibition and the antidepressant-like effects of the compound are different for the two enantiomers. Administration of L-5-HTP (454 ~tmol/kg s.c. in mice) in combination with a 5-HT reuptake inhibitor results in a characteristic syndrome (head weaving, tremor and hind limb abduction). Animals were tested with either of S- and R-cit. S-cit produced a dose dependent potentiation of the effects of L-5-HTP (max potentiation: 3.1 ~tmol/kg s.c.), R-cit was without effect. Thus S- and not R-cit inhibits 5-HT reuptake in vivo. The antidepressant potential of the enantiomers and racemic cit was assessed in the forced swim test, this model relies on the fact that a rapidly learned behavioural despair is inhibited by antidepressants. Adult male NMRI mice (MellegArd, Denmark) were tested individually, testing consisted of placing the animals into a 21 pyrex beaker half filled with water (23°C) for 6 min. During the final 3 rain of the test the duration for which the animals remained immobile was assessed. Vehicle (0.9% saline) or active compound was administered s.c. 30 min prior to the start of the test. The effects of citalopram, S- citalopram and R citalopram were assessed. The data, expressed as percentage of vehicletreated control are presented in the Table, the values given are mean (± sere) for 9 animals/group [*P < 0.05 vs control: ANOVA followed by Dunnett's t-test] Thus, 12, 24 and 49 ~tmol/kg of S-citalopram and 24 and 49 ~tmol/kg R/S-citalopram significantly reduced the duration of immobility in the mouse forced swim test. The magnitude of the effects of S- and racemic citalopram were comparable. A reduction in duration of immobility is indicative of an antidepressant-like effect and implies that the clinical effects of racemic citalopram are likely to be mediated by the S- and not the R-enantiomer.
Drug
dose (~tmol/kg) 3.1 6.2
citalopram S-citalopram
98.3 47.5
R-citalopram
95.1 412.2 106.6 4- 3.4
12
24
49
85.0 412.8 72.6 47.5* 106.1 4- 7.9
54.3 4- 52.1 47.8* 8.1" 59.6 4- 46.2 :t: 8.1" 6.7* 121.7 95.1 44- 8.0 4.8
98
116.1 4- 9.3
Light therapy is not effective in nonseasonal affective disorder
G.J. Schut, J. Dirkx, J.G. Goekoop, L. Timmerman. Delta Psychiatric
Hospital, Poortagaal, The Netherlands Introduction: Since bright light as a treatment for seasonal affective disorder (SAD) has come into use several studies were done to prove its effect. The highest improvement was measured by Thal6n et al (1). They found, in contrast with earlier studies, a 53% improvement (criterium: 50% reduction on the Hamilton Depression Rating Scale (HRSD) in a SAD group and a 14% improvement in a Non-SAD (nonseasonal affective disorder) group. They used a l0 day, 2 hour, 1500 lux regime. More recently a 10000 lux lightbox was introduced. We were interested in whether a much shorter exposure-time at a higher intensity is also effective, and can prove also a different outcome between SAD and Non-SAD. Aim: The aim of this study was to evaluate the effects of light therapy, using a 5 day, ½ hour, 10000 lux regime, on SAD and Non-SAD. Method: Bright white light with an intensity of 10000 lux and a exposure time of only 5 day's - ½ hour at morning was given to one group with SAD (n = 15) and one group with non-SAD (n = 20). Effects were scored with the HRSDadd (dutch version, 7 atypical symptoms added) (2), and the dutch version form the SAM SAD. Results: When 50% HRSDadd reduction was taken as criterium for improvement, in the SAD group 53% responded, whereas in the NonSAD group only 10% responded. When measured with the SAM SAD we found the same 53% to 10%-difference. The difference between both patient groups was highly statistically significant (p < 0.001). Coneluslon: In this study it appeared that it is usefull to treat seasonal affective disorder with the here described method of light therapy. For nonseasonal affective disorder light therapy appeared to be not usefull.
References [1] Thal6n BE, Kjellman BF, Mmkid L, Wibom R, Wetterberg L. (1995) Light treatment in seasonal and nonseasonal depression. Acta Psychiatrica Scandinavica 91: 352-360. [2] Meesters Y, Jansen JHC. (1993) Assessing atypical seasonal affcctive disorder complaints by means of selfrating. Acta Psychiatrica Scandinavica 88: 361363. [3] Lain RW. (1994) Seasonal affective disorders. Current Opinion in Psychiatry 7: 9-13.