Comparative psychological aspects of two different types of chemotherapeutic administration (chronotherapy vs. traditional chemotherapy) on quality of life of cancer patients at advanced stage.

In addition to qualitative information, specific quantitative psychiatrics tests (regarding anxiety and depression) and objective psychological tests specific to cancer populations were used to compare psychological variables in two groups of metastatic cancer patients treated with chemotherapy. The study also recorded 24 possible symptoms (somatic and psychic) allowing the self-evaluation of individual quality of life. The evaluation was performed at 7 different times (from before the beginning of treatment up to the 6th course). In comparison to traditional treatment, the results showed a better psychosocial adaptation for patients receiving chronoprogrammed administration of anticancer medication, with better social relations, less feelings of loss of independence, less anxiety, depression, and somatic discomfort.

Controlled comparison of milnacipran and fluoxetine in major depression.

The efficacy and the tolerance of milnacipran (100 mg/day), a second generation antidepressant which equipotently inhibits both noradrenaline and serotonin reuptake, was compared to fluoxetine (20 mg/day), a selective serotonin reuptake inhibitor, in two parallel groups of, respectively, 97 and 93 major depressive outpatients. The duration of the study was 6 weeks, with assessments every 2 weeks by means of the Montgomery and Asberg depression scale (MADRS), the Hamilton depression scale, the clinical global impressions (CGI), and a checklist of symptoms and side-effects. Results showed significant superiority of fluoxetine over milnacipran on most rating instruments: MADRS (P = 0.01) including five individual items, Hamilton depression scale (P = 0.002) including ten individual items, CGI of severity (P = 0.01) and therapeutical index (P = 0.002). On visual analogue scales assessing the clinical profile of the compounds, fluoxetine was rated as exhibiting more psychostimulating activity than milnacipran (P = 0.0008). The tolerance of the two antidepressants was very similar, with the exception of symptoms of dizziness which were more frequently reported with milnacipran (P = 0.01). These differences in efficacy favoring fluoxetine could result from the selection of a dose of milnacipran below the optimal therapeutic dose for this type of psychiatric patients or to the administration of the compounds in single daily intakes, whereas milnacipran possesses a plasma elimination half-life of only 7 h.

A double-blind, comparative, multicentre study comparing paroxetine with fluoxetine in depressed patients.

A randomized, double-blind, parallel-group, 6-week study was undertaken to compare the efficacy and tolerability of once or twice daily administration of the selective serotonin reuptake inhibitors paroxetine and fluoxetine. After a 1-week placebo wash-out, patients suffering from DSM-III major depression and with a score of 18 or more on the 21-item Hamilton Rating Scale for Depression (HRSD) received either paroxetine or fluoxetine. The patients were assessed for efficacy using the HRSD, Montgomery-Asberg Depression Rating Scale and Clinical Global Impression; for tolerability, adverse events were elicited by the use of a non-leading question and a side effects checklist. The groups of patients were comparable on entry to the study. One hundred patients were recruited into the study, of whom 78 were evaluable for the efficacy analysis. Paroxetine and fluoxetine showed comparable efficacy at the end of the 6-week treatment period, but a statistically significant difference in the number of responders at week 3 in favour of paroxetine was observed. This could suggest an earlier onset of action with paroxetine. Also, associated anxiety symptoms were significantly reduced on paroxetine compared with fluoxetine at week 3. Patients on paroxetine reported fewer adverse events than those on fluoxetine. The most commonly reported adverse events were nausea and vomiting in both groups.

A Belgian multicentre study of fluvoxamine in depressive outpatients.

Fluvoxamine, a new antidepressant that specifically inhibits serotonin reuptake, was studied in 272 outpatients in a six-week multicentre trial in Belgium. On the Hamilton Depression Scale, the mean score dropped from 25.2 to 8 after six weeks (p less than 0.00001). The Clinical Global Impression scores showed similar evolution. Fluvoxamine is a real antidepressant with a marked effect on mood. Its effective dosage is 100 mg to 200 mg/day. Its tolerance, notably at the cardiovascular level, is excellent.