ABSTRACT
OBJECTIVES: To investigate the adjunctive effects of quetiapine on overall treatment response and on specific symptoms in agitated depression. METHODS: Twenty-one patients suffering from an acute agitated major depressive episode were enrolled in the quetiapine/venlafaxine study group (QUET) in the context of a 6-week open-label, flexible dose, non-randomized case-control study. Eighteen matched depressed patients treated with antidepressants only served as controls (CON). Clinical assessment was carried out by the use of Hamilton Rating Scale for Depression (HAM-D) 21 scale. RESULTS: Both groups had high HAM-D scores at baseline (27.6 vs. 27.5; p = 0.94). The QUET group displayed a significantly larger HAM-D decrease already after 1 week of treatment (p = 0.026, d = 0.77). This group difference increased slightly until week 6 (p = 0.005, d = 1.0). The remission rate in the QUET group (70%) was almost double that of the CON group (38.5%), p = 0.022. The overall effect originated from various HAM-D items indicating agitation, sleep problems and anxiety. CONCLUSIONS: Adjunctive quetiapine treatment in agitated depression showed faster and greater response leading to higher remission rates compared with antidepressants alone. Overall clinical improvement was specifically related to single aspects of psychopathology indicating that quetiapine develops its positive effects through a variety of psychopharmacological properties.
Subject(s)
Antidepressive Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Depressive Disorder/drug therapy , Dibenzothiazepines/therapeutic use , Adult , Aged , Analysis of Variance , Case-Control Studies , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Quetiapine Fumarate , Young AdultABSTRACT
BACKGROUND: Adherence to treatment guidelines enhances treatment outcome. However, in clinical practice many patients with depression do not receive appropriate treatment. AIMS: To evaluate the treatment of depression in in-patients of German psychiatric hospitals with respect to treatment outcome and adherence to guidelines. METHOD: We recruited 1202 in-patients with depression from ten different hospitals. Quality data concerning treatment were collected at admission, during the treatment course and at discharge. RESULTS: The level of depression was significantly decreased and most patients were satisfied with treatment. Many aspects of the treatment routine adhered to guideline recommendations. Adherence to guidelines could be improved with respect to adjustment of antidepressant dosage, reduction of benzodiazepine prescription, enhanced use of electroconvulsive therapy and wider use of interpersonal therapy. CONCLUSIONS: The study reveals a high standard of psychiatric treatment of in-patients with depression. Nevertheless there is still room for improvement. Differences between hospitals in adherence to guidelines indicates the need for individual application of quality management tools.
Subject(s)
Depressive Disorder/therapy , Guideline Adherence/statistics & numerical data , Hospitals, Psychiatric/standards , Practice Guidelines as Topic , Adult , Aged , Analysis of Variance , Antidepressive Agents/administration & dosage , Combined Modality Therapy , Depressive Disorder/drug therapy , Drug Administration Schedule , Electroconvulsive Therapy/statistics & numerical data , Female , Germany , Health Services Research , Hospitalization , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Psychotherapy/methods , Treatment OutcomeABSTRACT
BACKGROUND: Recent studies showed an activation of the cytokine system and the HPA axis in major depression, although with inconsistent results. While the non-melancholic subtype displayed a proinflammatory cytokine pattern, the melancholic subtype showed signs of impaired cytokine production. In order to understand the potential pathogenic significance of these systems further, the interplay between the cytokine system and the HPA axis in depressive subtypes as well as potential changes of these systems during the course of disease were investigated. METHODS: N=37 initially unmedicated patients with acute major depression were sub-classified (melancholic vs. non-melancholic) and compared with N=37 matched healthy controls. Upon admission and after complete clinical remission, basal plasma ACTH and serum cortisol levels as well as cytokine productions (IL-1beta, IL-1 receptor antagonist (IL-1RA)) upon mitogen stimulation (PHA) were measured in a whole blood assay. RESULTS: ACTH and cortisol concentrations were significantly elevated on admission in the melancholic but not the non-melancholic subgroup. Non-melancholic patients produced significantly more IL-1beta and IL-1RA upon admission than controls or melancholic patients. The IL-1 RA/IL-1beta ratio was significantly lower in the non-melancholic compared to the melancholic subgroup and increased significantly upon remission. LIMITATIONS: Patient treatment was not standardized. No Dex/CRH test was performed. CONCLUSIONS: Melancholic patients demonstrated an activation of the HPA axis in acute stage with partial normalization upon remission but no signs of inflammation. Non-melancholic patients showed signs of inflammation in acute depression with normalization upon remission while the function of the HPA axis was normal.
