ABSTRACT
Background: Glutamate modulators are having immense potential and are newer entities for treating drug resistant depression. The objectives were to generate statistical evidence on basis of existing data of ketamine, memantine, riluzole and d-cycloserine in resistant depression.Methods: A total of 14 RCTs following PRISMA guidelines and matching inclusion and exclusion criteria were collected of ketamine (5), memantine (3), riluzole (2) and d-cycloserine (4) vs placebo in drug resistant depression. Only RCTs with primary diagnosis of drug resistant depression (Previously on two standard antidepressant therapy) were included. Studies with treatment response rate, 50% reduction in total score of the depression rating scale-Montgomery-Åsberg Depression Rating Scale or the Hamilton Depression Rating Scale or Beck Depression Inventory was chosen as clinical outcome measure. RevMan 5.3 software was used for the analysis.Results: In ketamine group using random effect model SMD was 2.122 (95% CI 0.659-3.584). P-value was statistically significant (random effect p <0.005 and in fixed effect <0.001). In memantine group, using random effect model -0.963 was SMD and (95% CI -1.958-0.0324). P-value was <0.001, significant in fixed effect. In riluzole group, SMD was -0.564 with (95% CI -3.927-2.799) in random effect. P-value was 0.741. In d-cycloserine group SMD was 0.316 with (95% CI -1.252-1.885) in random effect. P-value was 0.690.Conclusions: Ketamine showed best efficacy followed by memantine. Riluzole and DCS as such have no efficacy although its acts by same glutamate pathway. More molecular based research is required in use of glutamate modulators in resistant depression.
ABSTRACT
Objetivo: Realizar uma revisão da literatura sobre o efeito da D-cicloserina (DCS) no tratamento do Transtorno de estresse pós-traumático (TEPT). Métodos: Foram revisados 14 ensaios clínicos, revisões sistemáticas e meta-análises selecionados na base de dados PubMed que correspondessem aos descritores D-cicloserina e Transtorno de estresse pós-traumático. Resultados: Os resultados mostram-se heterogêneos, incluindo resultados com e sem benefícios clínicos para o uso da DCS, provavelmente devido à diferença de métodos utilizados nos estudos realizados. Entretanto, a DCS apresenta efeito benéfico quando administrada em pacientes com quadros mais graves de TEPT e quando associada à terapia de exposição com realidade virtual. Conclusão: A DCS tem se mostrado uma opção terapêutica promissora quando associada à terapia de exposição; entretanto, mais estudos devem ser realizados para comprovar sua efetividade no tratamento do TEPT.
Aim: To review the literature about the effect of D-cycloserine (DCS) on the treatment of Post-traumatic stress disorder (PTSD). Methods: Were reviewed fourteen clinical trials, systematic reviews and meta-analyzes selected in the PubMed database that corresponded to the descriptors D-cycloserine and Post-traumatic stress disorder. Results: The results are heterogeneous, including results with and without clinical benefit for the use of DCS, probably due to the different methods used in the studies. However, DCS has a beneficial effect when administered to patients with severe PTSD and when associated with virtual reality exposure therapy. Conclusion: It has been shown that DCS is a promising therapeutic choice when associated with exposure therapy, however further studies should be performed to prove its effectiveness in the treatment of PTSD.
Subject(s)
Humans , Stress Disorders, Post-Traumatic/drug therapy , CycloserineABSTRACT
OBJECTIVE: Recently, there are many reports that glutamate receptors have close relationships with a pathophysiology of schizophrenia. The purpose of this study was to assess the effects of D-cycloserine, which is glycine site partial agonist in NMDA receptor on psychopathologic symptoms and cognitive functions. METHODS: This study was done for chronic schizophrenic inpatients taking typical antipsychotics for more than 4 months. Exclusion criteria were patients with over 8 points according to Simpson-Angus scale for EPS or those with over 17 points of Hamilton Depression Scale. Patients were randomized to classify into two groups; D-cycloserine group (n=13) and placebo group (n=13). Each group received D-cycloserine 100 mg or placebo separately for 8 weeks. Psychopathology was evaluated with PANSS at baseline, 2nd week, fourth week and eighth week. Cognitive function was evaluated with KWIS at baseline and eighth week. RESULTS: Total 26 patients completed this trial. The average period of morbidity was 10.39+/-3.87 years and the average doses of antipsychotic was 1228.35+/-720.30 mg based on chlorpromazine equivalent. In positive subscale, negative subscale, general psychopathology subscale, total PANSS scale and KWIS, there were no significant differences between D-cycloserine and placebo groups. However, negative subscale scores had decreased from 24.92+/-3.64 (Baseline) to 23.46+/-3.41 (week 8) (p=0.077). CONCLUSION: There were no clear changes in positive symptom, negative symptom, memory, language function, and performance intelligence when D-cycloserine 100 mg was given with antipsychotic medication. However, some patients showed clear improvement in negative symptom, especially blunted affect. Therefore, D-cycloserine combination therapy could be effective for negative symptom. In future, study that can show effectiveness in psychopathology and cognitive function according to drug dosage is needed.