ABSTRACT
The aim of this study was to evaluate the clinical characteristics and diagnostic stability of children and adolescents with bipolar disorder. In this prospective study, 257 subjects with bipolar disorder who were consecutively admitted to Roozbeh Hospital [Tehran, Iran] were enrolled. Demographic characteristics, diagnosis, treatment, comorbid disorders and mood and psychotic symptoms were extracted from the patients' admission files and the information questionnaire, which had been filled in the admission time by the patients. In the further assessment, diagnostic evaluation was done using the Schedule for Affective Disorders and Schizophrenia for School-aged children present and lifetime version [K-SADS-PL], for the patients under 18, and the Schedule for Affective Disorders and Schizophrenia [SADS] for the patients older than 18. Severity of the symptoms in the acute phase of mood disorder was evaluated by the Young Mania Rating Scale [Y-MRS] in manic phase and Beck Depression Inventory [BDI] for patients older than 16 or Children Depression Inventory [CDI] for the patients under 16 in depressive phase. Also, current and past levels of functioning were evaluated by the Global Assessment of Functioning [GAF] scale for patients older than 18 and the Child Global Assessment Scale [CGAS] for the patients under 18. The most common symptom, irritability, was accompanied by elated mood in most cases. 73.2% of the patients had at least one comorbid disorder and the most common comorbid disorder wasAttention Deficit Hyperactivity Disorder [44.2%]. Diagnostic stability in all periods of illness was higher than 80%. This study supports the high diagnostic stability of bipolar disorder in both children and adolescents.
ABSTRACT
Depression is a major health problem, which is not only underrecognized and undertreated, but is also associated with significant morbidity and mortality. It has been suggested that combination therapy rapidly reduces depressive symptoms in patients with moderate to severe depression and is more effective than monotherapy; but this suggestion remains controversial. Serotonergic and noradrenergic enhancement may be synergistic and more effective than serotonergic enhancement alone in the management of depression. The objective of this double blind, placebo-controlled study was to investigate the efficacy and tolerability of the combination of citalopram and nortriptyline for the treatment of moderate to severe major depression. 45 patients, who met the DSM-IV criteria for major depressive disorder based on the clinical interview, were included in the study. Patients had a baseline Hamilton Depression Rating Scale score of at least 20. In this trial, patients were randomly assigned to receive nortriptyline 50 mg/day plus citalopram 40 mg/day [group 1] or placebo plus citalopram 40 mg/day [group 2], for an 8 week, double-blind, placebo-controlled trial. Both protocols significantly decreased the score of Hamilton Depression Rating Scare over the trial period, but the combination of nortriptyline and citalopram showed a significant superiority over citalopram alone in the treatment of moderate to severe major depressive disorder [t = 3.34, d. f. = 36. p = 0.001]. The difference between the two groups in the frequency of side effects was not significant. The results of this study suggest that combination of nortriptyline and citalopram is more effective than citalopram alone in the treatment of depression. This advantage is probably the result of reuptake inhibition of both serotonin and norepinephrine