Escitalopram and Mirtazapine for the treatment of depression in HIV Patients: A randomized controlled open label trial

The objective of this study was to compare the safety and efficacy of mirtazapine and escitalopram in HIV patients for the treatment of depression. Methods: In this trial, 70 adult HIV patients with major depression were randomized and assigned to receive 8 weeks of daily open label mirtazapine (5-30mg) or escitalopram (7.5-20 mg). The primary outcome variables were endpoint response in Hamilton Rating Scale for Depression (HAM-D) score and change of HAM-D score from baseline to endpoint. Patients having improvement of > 50% on the HAM-D total scores during treatment were considered to have responded. A final 17-item HAM-D total score of 8 or less defined remission. Results: The response rate was 91.4 % (32/35) in Mirtazapine group and 85.7 % (30/35) in Escitalopram group (p= 0.71). The remission rate was more in escitalopram group (48.6 %, 17/35) compared to Mirtazapine group (34.3 %, 12/35); however it was not statistically significant (Chi square (1, N = 70) = 2.1, p = 0.22). After controlling for baseline score, the median HAMD score at 8 weeks was significantly lower in the Mirtazapine group (Median (Mdn)=4, Interquartile range (IQR)= 11) compared to Escitalopram group (Mdn=13, IQR= 12) (p < 0.001). The number of adverse events reported was more in Escitalopram group (110) than Mirtazapine group (85); however this was not statistically significant (p= 0.34). Conclusions: Both these drugs are useful in the management of depression in HIV patients and need further study.

Psychogenic purpura: a case series and brief clinical review

Psychogenic purpura or Diamond-Gardner Syndrome Is associated with painful bruising and purpura following an auto-sensitization to red blood cells along with imminent psychological and psychosocial factors. Patients with this disorder may present to the dermatologist from where they may be referred to the psychiatrist. A history of psychological stress may be elicited in some cases and psychiatric comorbidity may be seen in others. The psychiatrist, dermatologist and haematologist may have to assess the patient together to reach a diagnosis after a thorough evaluation. The treatment of this condition often involves a team approach involving various medical specialties. We present a series of three cases of psy-chogenic purpura and review the relevant literature