- Email: [email protected]
SSRI, L-Tryptophan and serotonin syndrome. Experience with 75 patients
0- 20 Alzheimer 's Disease and Dementia study after 4 weeks of drug therapy, although treatment could be extended [0 week 12 on request. Patients were assessed for sleep, depressive symptoms (MADRS) and adverse experiences by their general practitioners at Baseline and Week 4 (and Week 12). At Baseline, Day 4 and Week 4, each patient was also asked to undertake a driving test (break reaction time and steering travel) and psychomotor performance tests (divided attention task, digital symbol coding, critical flicker fusion frequency, visual analogue scale) at the Psychopharmacology Research Unit, Rozelle Hospital. This paper describes the trial results. The statistical analysis explores the differences from Baseline at Day 4 and Week 4, both within groups for paroxetine and amitriptyline and between groups.
143 comparing the patient's phenomenology with the side-effect profileof the drug, while considering the patient's present weight status. [II Fernstrom MH. Ann New York AcadSci 1989 15731-40 [2] Orzack MH , Friedman LM, Darby DW. Psychopharmacol Bull 1990 26 327330 [3] Kerry L. Clissold D, Clissold SP. Drugs 1991 4 J 225-253 (4 ) Fitton A. Faulds D, Goa KL. Drugs 1992 4356 1-59
10 .20 I Alzheimer's Disease and Dementia
I0-19-91
SSRI, L-Tryptophan and Serotonin Syndrome. Experience with 75 Patients J. Ciprian-Ollivier, M. Cetkovich-Bakmas, J. Albin, G. Vazquez. University of Buenos Aires, Academy Unit Hospital. Braulio Moyano, Francisco de Vittoria 2324, (1425) Buenos Aires
There are several reports about the so called serotonin syndrome. first described by Sternbachin 1991 . This rare condition may be causedby the serotonin hyperstimulation that follows the administration of SSRI alone or in association with L-Tryptophan. It presents as changes in mental status, restlessness, myoclonus, hyperreflexia, shivering and diarrhea. Hypertension, convulsions and death have been reponed. The incidence and frequency of this interaction are unknowned, The study population consisted of 75 outpatients. The mean age was 50 years old. All received three different SSRI (13 Fluoxetine, 34 Paroxetine and 18 Sertraline). From this group, 41 patients have taken L-Tryptophan and/or Lithium at the same time. There were 31 men and 44 women. 60 of them with DSM IV criteria for Major Depression and the other 15 with Anxiety Disorder. The mean duration of treatment was 13.5 months. Only one drop out was detected due to this syndrome: a female patient. 48 years old, with a diagnostic of Major Depression, because of severe diarrhea and restlessness at the very beginning. She received 0.070 grId of Sertraline and I grId of L-Tryptophan. None of the patients received SSRI and L-Tryptophan at the same intake; the antidepressants were generally given at day time and L-Tryptophan at bed time. We postulated that avoiding the association of SSRI and L-Tryptophan in the same intake and gradual dose rising prevents the appearance of the syndrome.
I 0-20-1 I Similarities in Cognitive Impairment Profiles between Mild Dementia of Alzheimer Typeand Anticholinergic Agent Y. Morokawa, H. Watanabe, T. Ohta, N, Yamaguchi, A. Aoba, Department of Psychiatry. Sr. Marianna University School ofMedicine. Kanagawa, Japan
To investigate the effects of plasma anticholinergic level on cognitive dysfunction induced by biperiden, an anticholinergic agent, The cognitive function test battery was administerd to four groups of subjects, a dementia of the Alzheimer's type (DAT) group (N = II ), a chronic biperiden administration group (CBPR, N " II ), an acute biperiden administration group (ABPR, N = 11 ) and an age-matched control group (CTL, N = 10). the cognitive function test battery included the following six items: immediate verbal recall (IVR), delayed verbal recall (DVR), delayed verbal recognition (DVRG), letter cancellation test (LIT), reaction time (RT) and code substitution (CS). Plasma anticholinergic level was also determined by radioreceptor assay using ' H-QNB before and I. 3 and 7 hours after the biperiden injection. The average values of plasma anticholinergic activity were significantly increased and average IVR. DVR, DVRG and LCf scores were significantly decreased one hour after the injection. No significant differences in cognitive function test scores between the ABPR and ADT groups were observed. The similarities of the cognitive dysfuction profiles between these two groups strongly support the acetylcholine hypothesis of dementia of Alzheimer type.
I0-19-10 I Antidepressants and Weight: A Comparative
I0-20-2 1 Alzheimer's Use of Anticholinergic Eye Dropsin Differentiating Disease and Depression
A.F. Joubert 1, CA. Gagiano 1. G. Joubert 2.
I. Schweitzer, V. Chang,J. Kabov, D. Ames, A. Vingrys, V. Tuckwell, University of Melbourne Departments of Psychiatry and Optometry, Melbourne, Australia
Study of Four Antidepressants and their Effect on Weight 1 Department
of Psychiatry, Unive rsity of Orange Free State, Bloemf ontein, South Africa; 2 Department of Biostatistics. University of the Orange Free State, Bloemf ontein. South Afr ica
Major depression has an effect on a patient's weight, as do antidepressants which could lead to poor compliance. Tricyclic antidepressants such as amitriptyline are known to increase weight] l ], Studies have shown that fluoxetine may cause a decrease in weight [2J_ while paroxetine [31 and moclobemide [4J have minor effects on weight. Aims: To compare the effect that amitriptyline and the "new anti-depressants", fluoxetine, paroxetine and moclobemide, have on the weight of patients over a period of 6 weeks; to determine whether these effects are maintained or further enhanced while treatment is continued for another 18 weeks; to set guidelines, when choosing an antidepressant for a patient with an existing weight problem. Method: This comparative, retrospective study used clinical records of double-blind trials done on the specific antidepressants. The DSM-I1I-R diagnostic criteria for major depression were applied. Records of 314 patients were drawn for demographic data and weights, for the initial 6-week period and the 18-week-extension period. Results: Amitriptyline resulted in a statistically significant increase in weight within the first week, which increased furtherduring the following 5 weeks. Fluoxetine had a statistically significant decrease in weight by week 4, which decreased further until week 24. Paroxetine and moclobemide caused weight increases which were not statistically significant. Conclusion: The comparative knowledge of specific antidepressants' affect on body weight advocates a scientific selection of an antidepressant,
Scinto et al [I J found a markedly hypersensitive pupillary dilatation response to tropicarnide, a cholinergic antagonist, in patients with probable Alzheimer's disease. The objectives of our study are: to evaluate the validity of this test in diagnosing Alzheimer's disease. to evaluate its utility in differentiating Alzheimer's disease and depression; and to determine the dose related cholinergic response to tropicamide in the different subject groups. Four groups of subjects are being studied: those with probable Alzheimer's disease, major depression, normal controls and diagnostically doubtful individuals. All subjects are having a clinical assessment with the CAMDEX, Hamilton Depression Rating Scale and a physical examination, Routine physical investigations are being performed to exclude organic causes of dementia. MRI scans are also performed. A dose response curve to tropicamide is being determined using different concentrations of tropicamide solutions. Simultaneous photography of the pupils occurs at 0.10. 20.30 and 40 minutes and the pupil size is being measured. The data from our pilot trial is consistent with that represented by Scinto et al, with Alzheimer's disease patients having cholinergic supersensitivity to tropicamide, Furthermore, our data suggests patients with Major Depression have subnormal sensitivity to tropicamide, Results of our larger study and clinical implications will be presented and discussedat the meeting, [I] Scinto L, Daffner K, Dressler D,et al. Apotential non-invasive neurobiological lest for Alzheimer's disease Science 266 (1994) 1051 -1053
143 comparing the patient's phenomenology with the side-effect profileof the drug, while considering the patient's present weight status. [II Fernstrom MH. Ann New York AcadSci 1989 15731-40 [2] Orzack MH , Friedman LM, Darby DW. Psychopharmacol Bull 1990 26 327330 [3] Kerry L. Clissold D, Clissold SP. Drugs 1991 4 J 225-253 (4 ) Fitton A. Faulds D, Goa KL. Drugs 1992 4356 1-59
10 .20 I Alzheimer's Disease and Dementia
I0-19-91
SSRI, L-Tryptophan and Serotonin Syndrome. Experience with 75 Patients J. Ciprian-Ollivier, M. Cetkovich-Bakmas, J. Albin, G. Vazquez. University of Buenos Aires, Academy Unit Hospital. Braulio Moyano, Francisco de Vittoria 2324, (1425) Buenos Aires
There are several reports about the so called serotonin syndrome. first described by Sternbachin 1991 . This rare condition may be causedby the serotonin hyperstimulation that follows the administration of SSRI alone or in association with L-Tryptophan. It presents as changes in mental status, restlessness, myoclonus, hyperreflexia, shivering and diarrhea. Hypertension, convulsions and death have been reponed. The incidence and frequency of this interaction are unknowned, The study population consisted of 75 outpatients. The mean age was 50 years old. All received three different SSRI (13 Fluoxetine, 34 Paroxetine and 18 Sertraline). From this group, 41 patients have taken L-Tryptophan and/or Lithium at the same time. There were 31 men and 44 women. 60 of them with DSM IV criteria for Major Depression and the other 15 with Anxiety Disorder. The mean duration of treatment was 13.5 months. Only one drop out was detected due to this syndrome: a female patient. 48 years old, with a diagnostic of Major Depression, because of severe diarrhea and restlessness at the very beginning. She received 0.070 grId of Sertraline and I grId of L-Tryptophan. None of the patients received SSRI and L-Tryptophan at the same intake; the antidepressants were generally given at day time and L-Tryptophan at bed time. We postulated that avoiding the association of SSRI and L-Tryptophan in the same intake and gradual dose rising prevents the appearance of the syndrome.
I 0-20-1 I Similarities in Cognitive Impairment Profiles between Mild Dementia of Alzheimer Typeand Anticholinergic Agent Y. Morokawa, H. Watanabe, T. Ohta, N, Yamaguchi, A. Aoba, Department of Psychiatry. Sr. Marianna University School ofMedicine. Kanagawa, Japan
To investigate the effects of plasma anticholinergic level on cognitive dysfunction induced by biperiden, an anticholinergic agent, The cognitive function test battery was administerd to four groups of subjects, a dementia of the Alzheimer's type (DAT) group (N = II ), a chronic biperiden administration group (CBPR, N " II ), an acute biperiden administration group (ABPR, N = 11 ) and an age-matched control group (CTL, N = 10). the cognitive function test battery included the following six items: immediate verbal recall (IVR), delayed verbal recall (DVR), delayed verbal recognition (DVRG), letter cancellation test (LIT), reaction time (RT) and code substitution (CS). Plasma anticholinergic level was also determined by radioreceptor assay using ' H-QNB before and I. 3 and 7 hours after the biperiden injection. The average values of plasma anticholinergic activity were significantly increased and average IVR. DVR, DVRG and LCf scores were significantly decreased one hour after the injection. No significant differences in cognitive function test scores between the ABPR and ADT groups were observed. The similarities of the cognitive dysfuction profiles between these two groups strongly support the acetylcholine hypothesis of dementia of Alzheimer type.
I0-19-10 I Antidepressants and Weight: A Comparative
I0-20-2 1 Alzheimer's Use of Anticholinergic Eye Dropsin Differentiating Disease and Depression
A.F. Joubert 1, CA. Gagiano 1. G. Joubert 2.
I. Schweitzer, V. Chang,J. Kabov, D. Ames, A. Vingrys, V. Tuckwell, University of Melbourne Departments of Psychiatry and Optometry, Melbourne, Australia
Study of Four Antidepressants and their Effect on Weight 1 Department
of Psychiatry, Unive rsity of Orange Free State, Bloemf ontein, South Africa; 2 Department of Biostatistics. University of the Orange Free State, Bloemf ontein. South Afr ica
Major depression has an effect on a patient's weight, as do antidepressants which could lead to poor compliance. Tricyclic antidepressants such as amitriptyline are known to increase weight] l ], Studies have shown that fluoxetine may cause a decrease in weight [2J_ while paroxetine [31 and moclobemide [4J have minor effects on weight. Aims: To compare the effect that amitriptyline and the "new anti-depressants", fluoxetine, paroxetine and moclobemide, have on the weight of patients over a period of 6 weeks; to determine whether these effects are maintained or further enhanced while treatment is continued for another 18 weeks; to set guidelines, when choosing an antidepressant for a patient with an existing weight problem. Method: This comparative, retrospective study used clinical records of double-blind trials done on the specific antidepressants. The DSM-I1I-R diagnostic criteria for major depression were applied. Records of 314 patients were drawn for demographic data and weights, for the initial 6-week period and the 18-week-extension period. Results: Amitriptyline resulted in a statistically significant increase in weight within the first week, which increased furtherduring the following 5 weeks. Fluoxetine had a statistically significant decrease in weight by week 4, which decreased further until week 24. Paroxetine and moclobemide caused weight increases which were not statistically significant. Conclusion: The comparative knowledge of specific antidepressants' affect on body weight advocates a scientific selection of an antidepressant,
Scinto et al [I J found a markedly hypersensitive pupillary dilatation response to tropicarnide, a cholinergic antagonist, in patients with probable Alzheimer's disease. The objectives of our study are: to evaluate the validity of this test in diagnosing Alzheimer's disease. to evaluate its utility in differentiating Alzheimer's disease and depression; and to determine the dose related cholinergic response to tropicamide in the different subject groups. Four groups of subjects are being studied: those with probable Alzheimer's disease, major depression, normal controls and diagnostically doubtful individuals. All subjects are having a clinical assessment with the CAMDEX, Hamilton Depression Rating Scale and a physical examination, Routine physical investigations are being performed to exclude organic causes of dementia. MRI scans are also performed. A dose response curve to tropicamide is being determined using different concentrations of tropicamide solutions. Simultaneous photography of the pupils occurs at 0.10. 20.30 and 40 minutes and the pupil size is being measured. The data from our pilot trial is consistent with that represented by Scinto et al, with Alzheimer's disease patients having cholinergic supersensitivity to tropicamide, Furthermore, our data suggests patients with Major Depression have subnormal sensitivity to tropicamide, Results of our larger study and clinical implications will be presented and discussedat the meeting, [I] Scinto L, Daffner K, Dressler D,et al. Apotential non-invasive neurobiological lest for Alzheimer's disease Science 266 (1994) 1051 -1053