The effectiveness of melissa officinalis l. Versus citalopram on quality of life of menopausal women with sleep disorder: a randomized double-blind clinical trial

Abstract Objective The present study aimed to assess the effect of Melissa Officinalis L. (a combination of lemon balm with fennel fruit extract) compared with citalopram and placebo on the quality of life of postmenopausal women with sleep disturbance. Methods The present study is a randomized, double-blind, placebo clinical trial among 60 postmenopausal women with sleep disturbance who were referred to a university hospital from 2017 to 2019. The participants were randomized to receive M. Officinalis L. (500 mg daily), citalopram (30 mg) or placebo once daily for 8 weeks. The Menopause-Specific Quality of Life (MENQOL) questionnaire was self-completed by each participant at baseline and after 8 weeks of the intervention and was compared between groups. Results The mean for all MENQOL domain scores were significantly improved in the M. Officinalis L. group compared with citalopram and placebo (p < 0.001). The mean ± standard deviation (SD) after 8 weeks in the M. Officinalis L., citalopram and placebo groups was 2.2 ± 0.84 versus 0.56 ± 0.58 versus 0.36 ± 0.55 in the vasomotor (p < 0.001), 1.02 ± 0.6 versus 0.28 ± 0.2 versus 0.17 ± 0.1 in the psychomotor-social (p < 0.001), 0.76 ± 0.4 versus 0.25 ± 0.1 versus 0.11 ± 0.1 in the physical and 2.3 ± 1.0 versus 0.35 ± 0.5 versus 0.41 ± 0.5 in the sexual domain, respectively. Conclusions The results revealed that M. Officinalis L. may be recommended for improving the quality of life of menopausal women with sleep disturbance. Trial registration The present study was registered by the name "Comparison of the efficacy of citalopram and compound of Asperugo procumbens and foeniculum vulgare in treatment of menopausal disorders" with the code IRCT2013072714174N1 in the Iranian Registry of Clinical Trials (IRCT).

Association of BDNF, HTR2A, TPH1, SLC6A4, and COMT polymorphisms with tDCS and escitalopram efficacy: ancillary analysis of a double-blind, placebo-controlled trial

Objective: We investigated whether single nucleotide polymorphisms (SNPs) associated with neuroplasticity and activity of monoamine neurotransmitters, such as the brain-derived neurotrophic factor (BDNF, rs6265), the serotonin transporter (SLC6A4, rs25531), the tryptophan hydroxylase 1 (TPH1, rs1800532), the 5-hydroxytryptamine receptor 2A (HTR2A, rs6311, rs6313, rs7997012), and the catechol-O-methyltransferase (COMT, rs4680) genes, are associated with efficacy of transcranial direct current stimulation (tDCS) in major depression. Methods: Data from the Escitalopram vs. Electrical Current Therapy for Treating Depression Clinical Study (ELECT-TDCS) were used. Participants were antidepressant-free at baseline and presented with an acute, moderate-to-severe unipolar depressive episode. They were randomized to receive escitalopram/tDCS-sham (n=75), tDCS/placebo-pill (n=75), or placebo-pill/sham-tDCS (n=45). General linear models assessed the interaction between treatment group and allele-wise carriers. Additional analyses were performed for each group and each genotype separately. Results: Pairwise group comparisons (tDCS vs. placebo, tDCS vs. escitalopram, and escitalopram vs. placebo) did not identify alleles associated with depression improvement. In addition, exploratory analyses also did not identify any SNP unequivocally associated with improvement of depression in any treatment group. Conclusion: Larger, combined datasets are necessary to identify candidate genes for tDCS response.

Effects of the prophylactic use of escitalopram on the prognosis and the plasma copeptin level in patients with acute cerebral infarction

This study aimed to investigate whether the routine administration of escitalopram for three months would improve the prognosis of patients with ischemic stroke and decrease the plasma copeptin level. A total of 97 patients with acute cerebral infarction were randomly allocated to receive escitalopram (5-10 mg once per day, orally; n=49) or not to receive escitalopram (control group; n=48) for 12 weeks starting at 2-7 days after the onset of stroke. Both groups received conventional treatments, including physiotherapy and secondary prevention of stroke. The National Institutes of Health Stroke Scale (NIHSS) score was used to evaluate the disability of patients at the initial evaluation and at the monthly follow-up visits for three months. Impairment in the daily activities was assessed using the Barthel Index (BI), while cognitive impairment was assessed using Mini-Mental State Examination (MMSE) score. The psychiatric assessment included the administration of the Present State Examination modified to identify Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptoms of depression. The severity of depression was measured using the 17-item Hamilton Rating Scale for Depression (HAMD). During the 3-month follow-up period, 95 patients were included in the analysis (two patients withdrew from the escitalopram group). NIHSS and BI improvement at the 90th day were significantly greater in the escitalopram group (P<0.05), while HAMD and plasma copeptin levels significantly decreased, compared to the control group (P<0.01). In patients with acute ischemic stroke, the earlier administration of escitalopram for three months may improve neurological functional prognosis and decrease copeptin level.

La depresión: un desafío en la práctica médica general / La depresión: un desafío en la práctica médica general

Asociada o no a una enfermedad orgánica, la depresión tiene gran prevalencia en la práctica médica pero es subdiagnosticada. El trastorno del ánimo suele coexistir con variadas quejas somáticas y dolores crónicos, configurando síndromes mixtos con un diagnóstico diferencial complejo. En este artículo se describen distintas presentaciones clínicas de la depresión en medicina general, con énfasis en los estados depresivos atípicos, depresiones enmascaradas muy relevantes por su frecuencia y consecuencias: depresión posquirúrgica, cuadros dolorosos crónicos como cefaleas o lumbago, la fatiga crónica y la fibromialgia. Solo el reconocimiento y diagnóstico de la depresión subyacente posibilitará la implementación de las adecuadas intervenciones terapéuticas. Se revisan también algunas recomendaciones para el uso de antidepresivos en atención primaria y la eventual consulta psiquiátrica. (AU)

Associated or not with an organic disease, depression has a high prevalence in medical practice but is underdiagnosed. The mood disorder usually coexists with varied somatic complaints and chronic pain, forming mixed syndromes with a complex differential diagnosis. This article describes different clinical presentations of depression in general medicine, with emphasis on atypical depressive states, masked depressions very relevant for their frequency and consequences: post-surgical depression, chronic painful conditions such as headaches or lumbago, chronic fatigue and fibromyalgia. Only the recognition and diagnosis of the underlying depression will enable the implementation of appropriate therapeutic interventions. Some recommendations for the use of antidepressant drugs in primary care and the eventual psychiatric consultation are also reviewed. (AU)

Which of available selective serotonin reuptake inhibitors (SSRIs) is more effective in treatment of premature ejaculation? A randomized clinical trial

ABSTRACT Purpose: To compare the efficacy and safety of available selective serotonin reuptake inhibitors (SSRIs) in order to find the most effective drug with the least number of side effects in treatment of premature ejaculation (PE). Materials and Methods: This study was a randomized clinical trial. Four hundred and eighty patients with PE in the 4 groups referred to Imam Reza hospital Tehran, Iran from July 2018 to February 2019 were enrolled in the study. The patients received sertraline 50mg, fluoxetine 20mg, paroxetine 20mg and citalopram 20mg, every 12 hours daily. The intravaginal ejaculatory latency time (IELT) before treatment, fourth and eighth weeks after treatment was recorded by the patient's wife with a stopwatch. Results: Mean IELT before, 4 and 8 weeks after treatment in four groups were: sertraline 69.4±54.3, 353.5±190.4, 376.3±143.5; fluoxetine 75.5±64.3, 255.4±168.2, 314.8±190.4; paroxetine 71.5±69.1, 320.7±198.3, 379.9±154.3; citalopram 90.39±79.3, 279.9±192.1, 282.5±171.1 seconds, respectively. The ejaculation time significantly increased in all groups (p <0.05), but there was no significant difference between the groups (P=0.75). Also, there was no significant difference in drugs side effects between groups (p >0.05). The most common side effects were drowsiness and dyspepsia, which were not severe enough to cause discontinuation of the drug. Conclusions: All available SSRIs were effective and usually had no serious complications. In patients who did not respond to any of these drugs, other SSRI drugs could be used as a salvage therapy.

TeleCondutas: ansiedade / TeleGuides: anxiety

A ansiedade pode ser vista como sintoma psiquiátrico e/ou como reação emocional não patológica associada a diversos contextos de vida. Ela representa um sinal de alarme a determinado estímulo percebido pelo indivíduo como perigoso. Em geral, é composta por uma combinação variável de sintomas físicos, pensamentos catastróficos e alterações de comportamento. A ansiedade pode ser compreendida como mecanismo evolutivo, isto é, uma ferramenta que nos ajuda a detectar o perigo e adotar as medidas necessárias para lidar com ele. No entanto, esse recurso adaptativo muitas vezes encontra-se desregulado, causando sofrimento e prejuízo ao desempenho social e/ou profissional. A ansiedade se torna um transtorno psiquiátrico quando representa emoção desconfortável e inconveniente, surgindo na ausência de um estímulo externo claro ou com magnitude suficiente para justificá-la, e apresenta intensidade, persistência e frequência desproporcionais. Estudos epidemiológicos indicam os transtornos de ansiedade como os mais prevalentes dentre os transtornos psiquiátricos. Na grande maioria dos casos, não há como estabelecer uma causa específica aos transtornos aqui tratados. A interação entre fatores genéticos e ambientais resume a etiologia atualmente proposta e aceita. Esta guia apresenta informação que orienta a conduta para casos de ansiedade no contexto da Atenção Primária à Saúde, incluindo: Diagnóstico, Diagramas diagnósticos, Condições de saúde associadas aos sintomas, Fármacos associados aos sintomas, Abordagem psicoeducativa/psicossocial, Tratamento conforme diagnóstico, Medicamentos e dose, Quando encaminhar.

Análisis de costo-efectividad del escitalopram comparado con paroxetina, sertralina, fluoxetina, imipramina y fluvoxamina como terapia de mantenimiento para pacientes con trastorno de pánico en Colombia / Cost-effectiveness analysis of escitalopram compared to paroxetine, sertraline, fluoxetine, imipramine and fluvoxamine as maintenance therapy for patients with panic disorder in Colombia

Problema de investigación: Describir los costos y la efectividad de escitalopram comparado con paroxetina, sertralina, fluoxetina, imipramina y fluvoxamina como terapia de mantenimiento en adultos con diagnóstico de trastorno de pánico en Colombia. Tipo de evaluación económica: Análisis de costo-efectividad. Población objetivo: Adultos colombianos con diagnóstico de trastorno de pánico. Intervención y comparadores: Intervención: escitalopram, Comparadores: paroxetina, sertralina, fluoxetina, imipramina y fluvoxamina. Horizonte temporal: 32 semanas. Perspectiva: SGSSS de Colombia. Tasa de descuento: No aplica. Estructura del modelo: Se estructuró un árbol de decisión, teniendo en cuenta modelos publicados en la literatura. Fuentes de datos de efectividad y seguridad: Reporte de efectividad y seguridad elaborado en diciembre de 2014 en el IETS, Ensayo s clínicos a leatorizados. Desenlaces y valoración: Ausencia de crisis de pánico, Semanas libres de crisis de pánico. Costos incluidos: Costo de los medicamentos, Costo de procedimientos, Costo de los eventos adversos. Fuentes de datos de costos: SISMED, Manual tarifario ISS 2001. Resultados del caso base: Para el caso base, escitalopram, fluvoxamina y fluoxetina e imipramina fueron tecnologías dominadas por sertralina y paroxetina. El costo adicional por crisis de pánico evitada en tratamiento con paroxetina comparado con trasertralina se estimó en $4.814.953. Análisis de sensibilidad: Los análisis de sensibilidad y el diagrama de tornado muestran a la probabilidad de lograr ausencia de crisis de pánico y la probabilidad de recaída, como a las variables con mayor impacto sobre las estimaciones de la razón de costo-efectividad. Conclusiones y discusión: De acuerdo con los hallazgos aquí presentados, paroxetina, ofrece mayor razón de costo-efectividad, respecto a sus comparadores. No obstante, es \r\nnecesario tener en cuenta que cualquiera de las alternativas aquí estudiadas, puede ser costo-efectiva, debido a que las pequeñas variaciones en la probabilidad de ausencia de crisis de pánico pueden cambiar el resultado. La principal limitación de este estudio es la ausencia de información roveniente de estudios de investigación clínica, que muestre el desempeño comparativo entre las tecnologías, así como el seguimiento de los participantes en los estudios, en escenarios de más largo plazo que los existentes al momento de elaborar este documento.(AU)

Análisis de impacto presupuestal de escitalopram, paroxetina y fluvoxamina como terapia de mantenimiento para pacientes adultos con trastorno de pánico en Colombia / Budget impact analysis of escitalopram, paroxetine and fluvoxamine as maintenance therapy for adult patients with panic disorder in Colombia

Tecnologías evaluadas: Nuevas: escitalopram, paroxetina y fluvoxamina. Actuales: sertralina, fluoxetina e imipramina. Población: Pacientes mayores de 18 años con trastorno de pánico en Colombia. Perspectiva\tLa perspectiva del presente AIP corresponde al tercero pagador, que en este caso es el SGSSS en Colombia. Horizonte temporal: El horizonte temporal de este AIP en el caso base corresponde a un año. Adicionalmente se reportan las estimaciones del impacto presupuestal para los años 2 y 3, bajo el supuesto de la inclusión en el POS en el año 1.Costos incluidos: Precios por mg de los medicamentos analizados. Fuente de costos: Los precios de cada tecnología fueron calculados con la base de datos SISMED. Escenarios: En el escenario 1 se considera una igualación progresiva de las participaciones de mercado de todos los medicamentos analizados, igualándose en el año 3. En el escenario 2, además de dicha igualación de participaciones de mercado, se asume un precio común para las nuevas alternativas, siguiendo las metodologías de inclusión de grupos terapéuticos definidas por el Ministerio de Salud y Protección Social. Resultados: Para la inclusión en el POS de escitalopram, paroxetina y fluvoxamina como terapia de mantenimiento para pacientes con trastorno de pánico en Colombia, se requeriría una inversión estimada de $12.563.676.367 en el año 1 y de $22.925.604.761 en el año 3. En el caso en el que los medicamentos del escenario nuevo sean incluidos con un precio común basado en las metodologías de grupos terapéuticos del Ministerio de Salud y Protección Social, el impacto presupuestal se reduciría a $1.318.634.602 en el año 1 y $2.861.023.939, en el año 3.(AU)

Análisis de impacto presupuestal de escitalopram, paroxetina y venlafaxina como terapia de mantenimiento para pacientes adultos con trastorno de ansiedad generalizada en Colombia / Budget impact analysis of escitalopram, paroxetine and venlafaxine as maintenance therapy for adult patients with generalized anxiety disorder in Colombia

Tecnologías evaluadas: Nuevas: escitalopram, paroxetina y venlafaxina, Actuales: sertralina y fluoxetina. Población: Pacientes mayores de 18 años con trastorno de ansiedad generalizada en Colombia. Perspectiva: La perspectiva del presente AIP corresponde al tercero pagador, que en este caso es el Sistema General de Seguridad Social en Salud (SGSSS) en Colombia. Horizonte temporal: El horizonte temporal de este AIP en el caso base corresponde a un año. Adicionalmente se reportan las estimaciones del impacto presupuestal para los años 2 y 3, bajo el supuesto de la inclusión en el POS en el año 1. Costos incluidos: Costos por mg de los medicamentos analizados. Fuente de costos: Los precios de cada tecnologías considerada fueron calculados con la base de datos SISMED. Escenarios: En el escenario 1 se considera una igualación progresiva de las participaciones de mercado de todos los medicamentos analizados, igualándose en el año 3. En el escenario 2, además de dicha igualación de participaciones de mercado, se asumen un precio común para las nuevas alternativas, siguiendo las metodologías de inclusión fe grupos terapéuticos definidas\r\npor el Ministerio de Salud y Protección Social. Resultados: Para la inclusión en el POS de escitalopram, paroxetina y venlafaxina como terapia de mantenimiento para pacientes con trastorno de ansiedad\r\ngeneralizada en Colombia, se requeriría una inversión de $5.874.138.950 en el año 1 y de $5.795.867.954 en el año 3. En el caso en el que los medicamentos del escenario nuevo sean incluidos con un precio común\r\nbasado en las metodologías de grupos terapéuticos del Ministerio de Salud y protección Social, el impacto presupuestal se reduciría a $664.806.300 en el año 1 y $631.634.228, en el año 3.(AU)

Análisis de impacto presupuestal de escitalopram, paroxetina y venlafaxina como terapia de mantenimiento para pacientes adultos con trastorno de fobia social en Colombia / Budget impact analysis of escitalopram, paroxetine and venlafaxine as maintenance therapy for adult patients with social phobia disorder in Colombia

Tecnologías evaluadas: Nuevas: escitalopram, paroxetina y venlafaxina, Actuales: sertralina y fluoxetina. Población:\tPacientes mayores de 18 años con trastorno de fobia social en Colombia. Perspectiva: La perspectiva del presente AIP corresponde al tercero pagador, que en este caso es el Sistema General de Seguridad Social en Salud (SGSSS) en Colombia. Horizonte temporal: El horizonte temporal de este AIP en el caso base corresponde a un año. Adicionalmente se reportan las estimaciones del impacto presupuestal para los años 2 y 3, bajo el supuesto de la inclusión en el POS en el año 1. Costos incluidos: Costos por mg de los medicamentos analizados. Fuente de costos: Los precios de cada tecnologías considerada fueron calculados con la base de datos SISMED. Escenarios: En el escenario 1 se considera una igualación progresiva de las participaciones de mercado de todos los medicamentos analizados, igualándose en el año 3. En el escenario 2, además de dicha igualación de participaciones de mercado, se asumen un precio común para las nuevas alternativas, siguiendo las metodologías de inclusión fe grupos terapéuticos definidas\r\npor el Ministerio de Salud y Protección Social. Resultados: Para la inclusión en el POS de escitalopram, paroxetina y venlafaxina como terapia de mantenimiento para pacientes con trastorno de fobia social en\r\nColombia, se requeriría una inversión de $44.181.317.390 en el año 1 y de $34.102.843.305 en el año 3. En el caso en el que los medicamentos del escenario nuevo sean incluidos con un precio común basado en las\r\nmetodologías de grupos terapéuticos del Ministerio de Salud y protección Social, el impacto presupuestal se reduciría a $5.822.672.775 en el año 1 y $3.330.318.162, en el año 3.(AU)

Análisis de impacto presupuestal de escitalopram, paroxetina, sertralina, fluoxetina, fluvoxamina y clomipramina como terapia de mantenimiento para pacientes adultos con trastorno obsesivo compulsivo en Colombia / Budget impact analysis of escitalopram, paroxetine, sertraline, fluoxetine, fluvoxamine and clomipramine as maintenance therapy for adult patients with obsessive-compulsive disorder in Colombia

Tecnologías evaluadas: Nuevas: escitalopram, paroxetina, fluvoxamina y clomipramina\r\nActuales: sertralina y fluoxetina. Población: Pacientes mayores\tde\t18 años\tcon trastorno\tobsesivo\r\ncompulsivo en Colombia. Perspectiva: La perspectiva del presente AIP corresponde al tercer pagador,\r\nque en este caso es el Sistema General de Seguridad Social en Salud (SGSSS) en Colombia. Horizonte temporal: El horizonte temporal de este AIP en el caso base es de un año. Adicionalmente, se reportan las estimaciones del impacto presupuestal para los años 2 y 3, bajo el supuesto de la inclusión en el POS en el año 1. Costos incluídos: Costo por mg de los medicamentos. Fuente de costos: SISMED. Escenarios: En el escenario 1 se considera una igualación progresiva de las participaciones de mercado de todos los medicamentos analizados hasta llegar al año 3. En el escenario 2, además de una participación\tde\tmercado\tigual para\ttodos los medicamentos, se asume un precio común para las nuevas alternativas con base en la metodología de inclusión de grupos terapéuticos definida por el Ministerio de Salud y Protección\r\nSocia. Resultados: Para la inclusión en el POS de escitalopram, paroxetina, fluvoxamina y Clomipramina como terapia de mantenimiento para pacientes con diagnóstico de trastorno obsesivo ompulsivo en Colombia, se requeriría una inversión de $99.508.967.049 en el año 1 y de $136.213.036.626 en el año 3. En el caso que los medicamentos del escenario nuevo sean incluidos con un precio igual basado en las metodología de grupos terapéuticos del Ministerio de Salud y protección Social, el impacto presupuestal\r\nse reduciría a $13.170.025.624 en el año 1 y $19.887.249.147, en el año 3.(AU)

The Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study (ELECT-TDCS): rationale and study design of a non-inferiority, triple-arm, placebo-controlled clinical trial / Estudo clínico Escitalopram versus Eletroterapia no Tratamento da Depressão (ELECT-TDCS): racional e desenho de estudo de um ensaio de não inferioridade, de três braços, placebo-controlado

CONTEXT AND OBJECTIVE: Major depressive disorder (MDD) is a common psychiatric condition, mostly treated with antidepressant drugs, which are limited due to refractoriness and adverse effects. We describe the study rationale and design of ELECT-TDCS (Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study), which is investigating a non-pharmacological treatment known as transcranial direct current stimulation (tDCS). DESIGN AND SETTING: Phase-III, randomized, non-inferiority, triple-arm, placebo-controlled study, ongoing in São Paulo, Brazil. METHODS: ELECT-TDCS compares the efficacy of active tDCS/placebo pill, sham tDCS/escitalopram 20 mg/day and sham tDCS/placebo pill, for ten weeks, randomizing 240 patients in a 3:3:2 ratio, respectively. Our primary aim is to show that tDCS is not inferior to escitalopram with a non-inferiority margin of at least 50% of the escitalopram effect, in relation to placebo. As secondary aims, we investigate several biomarkers such as genetic polymorphisms, neurotrophin serum markers, motor cortical excitability, heart rate variability and neuroimaging. RESULTS: Proving that tDCS is similarly effective to antidepressants would have a tremendous impact on clinical psychiatry, since tDCS is virtually devoid of adverse effects. Its ease of use, portability and low price are further compelling characteristics for its use in primary and secondary healthcare. Multimodal investigation of biomarkers will also contribute towards understanding the antidepressant mechanisms of action of tDCS. CONCLUSION: Our results have the potential to introduce a novel technique to the therapeutic arsenal of treatments for depression. .

CONTEXTO E OBJETIVO: O transtorno depressivo maior (TDM) é uma condição psiquiátrica comum, tratada com medicamentos antidepressivos, os quais são limitados devido à refratariedade e efeitos adversos. Descrevemos o racional e o desenho do Estudo Clínico Escitalopram versus Eletroterapia no Tratamento da Depressão (ELECT-TDCS), que investiga um tratamento não farmacológico, conhecido como estimulação transcraniana por corrente contínua (ETCC). DESENHO E LOCAL: Ensaio de fase III, randomizado, de não inferioridade, de três braços, placebo-controlado, em execução em São Paulo, Brasil. MÉTODOS: O estudo compara a eficácia da ETCC ativa/pílula placebo, ETCC simulada/escitalopram 20 mg/dia e ETCC simulada/pílula placebo durante 10 semanas, randomizando 240 pacientes em uma proporção 3:3:2, respectivamente. O objetivo principal é demostrar que a ETCC não é inferior ao escitalopram com uma margem de não inferioridade de pelo menos 50% do efeito de escitalopram em relação ao placebo. Como objetivos secundários, investigamos biomarcadores como polimorfismos genéticos, marcadores séricos, excitabilidade cortical motora, variabilidade da frequência cardíaca e neuroimagem. RESULTADOS: Provar que ETCC é igualmente eficaz a antidepressivos teria um tremendo impacto na psiquiatria clínica, uma vez que a ETCC é praticamente isenta de efeitos adversos. Sua facilidade de uso, portabilidade e preço baixo são outras características atraentes para uso na atenção primária e secundária de saúde. A investigação multimodal de biomarcadores também contribuirá para a compreensão dos mecanismos de ação antidepressivos da ETCC. CONCLUSÃO: Os nossos resultados podem introduzir uma nova técnica no arsenal terapêutico do tratamento da depressão. .

Effect of Amitriptyline in Patients with Functional Dyspepsia / 대한소화기학회지

No abstract available.

Efficacy and Tolerability of Escitalopram for Treating Depression in Parkinson’s Disease.

Introduction: Despite the frequently coexistence and prominent negative effect of depression in Parkinson’s disease, there is currently no evidence-based standard of care. Objective: The purpose of this study was to examine the efficacy and tolerability of individually administered selective serotonin reuptake inhibitor (SSRI) - escitalopram, relative to clinical monitoring (with no new treatment), for depression in this medical population. Method: In this retrospective open label analysis of 28 depressed (based on ICD-10 criteria and Mini International Neuropsychiatric Interview) patients with Parkinson’s disease were treated with escitalopram 10-20 mg/d for duration of 8 weeks. The Hospital Anxiety and Depression Scale (HADS) depression subscale score and Clinical Global Impression-Improvement (CGI-I) score was the primary outcome. Assessments were completed at baseline, 4 (midpoint) and 8 (end of treatment) weeks of follow-up evaluation. Results: Although treatment was well tolerated and correlated with a significant decrease in HADS and CGI score, response and remission rates were 43.4% and 57.2%, respectively. Conclusions: Escitalopram may be a viable approach for the treatment of depression in Parkinson’s disease. Further research is needed to replicate and extend these findings.

Endophenotypes and serotonergic polymorphisms associated with treatment response in obsessive-compulsive disorder

OBJECTIVES: Approximately 40-60% of obsessive-compulsive disorder patients are nonresponsive to serotonin reuptake inhibitors. Genetic markers associated with treatment response remain largely unknown. We aimed (1) to investigate a possible association of serotonergic polymorphisms in obsessive-compulsive disorder patients and therapeutic response to selective serotonin reuptake inhibitors and (2) to examine the relationship between these polymorphisms and endocrine response to intravenous citalopram challenge in responders and non-responders to serotonin reuptake inhibitors and in healthy volunteers. METHODS: Patients with obsessive-compulsive disorder were classified as either responders or non-responders after long-term treatment with serotonin reuptake inhibitors, and both groups were compared with a control group of healthy volunteers. The investigated genetic markers were the G861C polymorphism of the serotonin receptor 1Dβ gene and the T102C and C516T polymorphisms of the serotonin receptor subtype 2A gene. RESULTS: The T allele of the serotonin receptor subtype 2A T102C polymorphism was more frequent among obsessive-compulsive disorder patients (responders and non-responders) than in the controls (p<0.01). The CC genotype of the serotonin receptor subtype 2A C516T polymorphism was more frequent among the non-responders than in the responders (p<0.01). The CC genotype of the serotonin receptor subtype 1Dβ G681C polymorphism was associated with higher cortisol and prolactin responses to citalopram (p<0.01 and p<0.001, respectively) and with a higher platelet-rich plasma serotonin concentration among the controls (p<0.05). However, this pattern was not observed in the non-responders with the same CC genotype after chronic treatment with serotonin reuptake inhibitors. This CC homozygosity was not observed in the responders.

The treatment of major depressive disorders (MDD) in Thailand using escitalopram compared to fluoxetine and venlafaxine: a pharmacoeconomic evaluation.

A decision analytical model was used to compare expected health outcomes and costs of treating patients with major depression using new selective serotonin reuptake inhibitor (SSRI) escitalopram versus the other SSRI fluoxetine and the serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine. The primary health outcome measure was an overall treatment success, defined as a remission (Montgomery-Asberg Depression Rating Scale (MADRS) < or = 12), achieved over the 6 months of treatment. Estimated costs consisted of those directly related to treatment (drug acquisition costs, costs of psychiatric visits, hospital outpatient visits, hospitalization, and electroconvulsive therapy) and indirect costs associated with productivity lost due to depression. Clinical input parameters for the economic analyses were derived from published literatures. Resource utilization estimates were obtained from a survey of psychiatrists, while medical treatment patterns were determined from focus groups participated consisting from both general and family practitioners and psychiatrists. Unit costs (including daily cost of patient's absence from work due to depression) were obtained from the standard sources. The unit cost of hospitalization was derived based on the average of factual service rates charged by the local hospital. The results show that escitalopram is more effective and less costly compared to fluoxetine and venlafaxine. Treatment using escitalopram produced the best-expected success rate and the lowest expected per patient cost. Escitalopram earned a savings of Baht 2,002 and Baht 1,768 compared to fluoxetine and venlafaxine respectively over a six-month period.

A Case of a Patient with Both Chorea and Restless Legs Syndrome

The patient was a 44-yr-old man with end-stage renal disease who had developed chorea as a result of hypoglycemic injury to the basal ganglia and thalamus and who was subsequently diagnosed with depression and restless legs syndrome (RLS). For proper management, the presence of a complex medical condition including two contrasting diseases, chorea and RLS, had to be considered. Tramadol improved the pain and dysesthetic restlessness in his feet and legs, and this was gradually followed by improvements in his depressed mood, insomnia, lethargy, and feelings of hopelessness. This case suggests that the dopaminergic system participates intricately with the opioid, serotoninergic, and noradrenergic systems in the pathophysiology of RLS and pain and indirectly of depression and insomnia.

Response of symptom dimensions in obsessive-compulsive disorder to treatment with citalopram or placebo

OBJECTIVE: There is increasing evidence that the symptoms of obsessive-compulsive disorder lie on discrete dimensions. Relatively little work has, however, explored the relationship between such factors and response to pharmacotherapy. METHOD: Data from a multi-site randomized placebo-controlled study of citalopram in obsessive-compulsive disorder were analyzed. Factor analysis of individual items and symptom categories of the Yale-Brown Obsessive-Compulsive Scale Checklist were undertaken, and the impact of symptom dimensions on treatment outcomes was analysed. RESULTS: Factor analysis of Yale-Brown Obsessive-Compulsive Scale Checklist individual items yielded 5 factors (contamination/cleaning, harm/checking, aggressive/sexual/religious, hoarding/symmetry, and somatic/hypochondriacal). Hoarding/symmetry was associated with male gender, longer duration of obsessive-compulsive disorder and early onset, whereas contamination/cleaning was associated with female gender. Citalopram was more effective than placebo, but high scores on the symmetry/hoarding and contamination/cleaning subscales predicted worse outcome at the end of study while high scores on the aggressive/religious/sexual subscale predicted better outcome. Factor analysis of Yale-Brown Obsessive-Compulsive Scale Checklist symptom clusters yielded a 4 factor solution, but confirmed that symmetry/ordering was associated with male gender, early onset, and long duration of obsessive-compulsive disorder while high scores on the hoarding subscale predicted worse response to pharmacotherapy. CONCLUSION: Citalopram shows good efficacy across the range of obsessive-compulsive disorder symptom dimensions. The relatively worse response of symmetry/hoarding to a selective serotonin reuptake inhibitor is consistent with other evidence that this symptom dimension is mediated by the dopamine system. There may be associations between symmetry/hoarding, male gender, early onset, tics, and particular...

OBJETIVO: Há crescentes evidências de que os sintomas do transtorno obsessivo-compulsivo residem em dimensões discretas. Alguns estudos têm sugerido que esses fatores possuem suportes neurobiológicos específicos. No entanto, poucos trabalhos têm explorado a relação entre tais fatores e a resposta à farmacoterapia. MÉTODO: Foi realizada a análise fatorial dos itens individuais e categorias de sintomas do checklist da Escala de Obsessão e Compulsão de Yale-Brown e foi analisado o impacto da dimensão dos sintomas no desfecho dos tratamentos. RESULTADOS: A análise fatorial exploratória dos itens individuais da Escala de Obsessão e Compulsão de Yale-Brown produziu cinco fatores (contaminação/limpeza, dano/verificação, agressividade/sexual/religioso, colecionismo/simetria e somático/hipocondríaco). Colecionismo/simetria foi associado ao sexo masculino, longa duração do transtorno obsessivo-compulsivo e início precoce, ao passo que contaminação/limpeza foi associado ao sexo feminino. O citalopram foi mais eficaz do que placebo, mas altos escores nas subescalas de simetria/colecionismo e de contaminação/limpeza predisseram desfecho pior ao final do estudo, ao passo que altos escores na subescala agressividade/sexual/religioso predisseram melhor desfecho. Uma análise fatorial de sintomas do checklist da Escala de Obsessão e Compulsão de Yale-Brown produziu uma solução com quatro fatores, mas confirmou que simetria/ordenação estava associado ao sexo masculino, início precoce e longa duração do transtorno obsessivo-compulsivo, enquanto altos escores na subescala colecionismo predisseram uma resposta pior à farmacoterapia. CONCLUSÃO: O citalopram demonstra boa eficácia ao longo das dimensões do espectro de sintomas do transtorno obsessivo-compulsivo. A resposta relativamente pior de simetria/colecionismo a um inibidor seletivo da recaptação da serotonina é consistente com outras evidências de que essa dimensão de sintomas é mediada pelo sistema...

Resposta neuroendócrina aguda ao citalopram e resposta terapêutica no transtorno obsessivo-complusivo / Acute neuroendocrine response to citalopram and therapeutic response in obsessive-compulsive disorder

Testes provocativos com drogas serotonérgicas mostraram resultados conflitantes no TOC. O objetivo deste estudo foi comparar a atividade serotonérgica em pacientes com TOC resistente e respondedor ao tratamento com inibidores de recaptura de serotonina e voluntários saudáveis. Foram estudados 30 sujeitos em cada grupo. Cada um recebeu 20 mg de citalopram intravenoso. Foram dosados: prolactina, cortisol, hormônio de crescimento e serotonina periféricos a cada 20 minutos por 180 minutos. Não houve diferenças nas concentrações de serotonina e de hormônio de crescimento. A droga induziu um pico maior de prolactina no grupo Controle do que nos grupos Resistentes e Respondedores (p<0,05). A secreção de cortisol mostrou-se atenuada apenas no grupo Resistentes (p<0,05), sugerindo maior disfunção serotonérgica neste grupo...

Serotonergic pharmacological challenge tests have conflictant results in OCD. The aim of this study was to compare the serotonergic activity in serotonin reuptake inhibitors treatment resistant and responsive OCD patients and healthy volunteers. Thirty subjects were included in each group. Each one has received 20 mg of intravenous citalopram. Prolactin, cortisol, growth hormone and serotonin were determined peripherically at 20 minutes intervals for 180 minutes. No changes were observed either in serotonin or growth hormone concentration. Citalopram has induced an increase in prolactin secretion in the Control group, not observed in Resistant and Responsive groups (p<0.05). The cortisol response to citalopram was attenuated only in the Resistants (p<0.05), suggesting a more disrupted serotonergic transmission in this group...