[Effectiveness of clonazepam in depressive disorders]. / Ucinnost clonazepamu v indikaci depresívní poruchy.

Clonazepam was administered to 55 patients with depressive disorder (DSM-III-R) in average minimal and maximal doses of 2.40 and 6.54 mg/day for 21-28 days. Complete remission was achieved in 60% patients (Serejskij AB, drop of global HAMD and FKD score by more than 50%), in particular in case of concurrent anxiety. A marked antidepressive effectiveness of clonazepam was suggested also by a drop of the total HAMD and FKD score already after the first week of treatment. All items of the HAMD and FKD scale were significantly positively influenced with the exception of agitation, somatic anxiety, insight, paranoidity, obsession respectively hypochondriasis and paranoidity. No correlation was found between the effect of clonazepam and sex, the patients' age, duration of the depressive disorder, period of the index episode and severity of depression. As to undesirable effects, the authors recorded fatigue and sleepiness (40%) and hypotension (20% of the patients), in particular at the onset of treatment and after larger daily doses. In 3/10 bipolar patients a switch to hypomania was observed.

[Paroxetine in the treatment of depressive disorders (pilot study)]. / Paroxetin v lécbe depresívních poruch. (Pilotní studie).

In an open study, 42 depressive patients (according to DSM-III-R) were administered paroxetine at mean minimal and maximum doses of 21 and 48 mg once daily in the morning. Treatment resulted in complete remission as defined by Serejsky in 57%, and 55% of patients were rated, according to CGI, as improved. Global HAMD and FKD scores significantly dropped compared to baseline values and responders and non-responders differed significantly as early as seven days of treatment, although the onset of the antidepressive effect was not clinically apparent before 2 weeks of treatment. Significant reductions were seen in all items except paranoidity and weight loss and hypochondria using the FKD scale. A substantial reduction in suicidal ideation and tendencies was also noted in the group of non-responders, a finding supporting a non-specific anti-suicidal effect of paroxetine, which was therapeutically significantly more successful in women than in men. Side effects occurring in 10% and more percent of treated subjects included fatiguability, sweating, tremor, dry mouth, obstipation and nausea.

[Citalopram (Seropram) in tablet and infusion forms in the treatment of major depression]. / Citalopram (seropram) v tabletové a infuzní forme v lécbe velkých depresí.

Citalopram i.v. and oral had a reliable antidepressive and anxiolytic effect in 101 hospitalized patients, as apparent from the achievement of complete remission in cca 60% of the patients with major depression after four weeks follow-up. Treatment with citalopram by the intravenous or oral route was most successful in anxious or inhibitory depressions, while atypical forms with hypochondriac or obsedant features responded better to infusions. The global score of HAMD and FKD scales and typical symptoms of depression such as a pathic decreased mood, anhedonia, feelings of guilt, lack of interest, anxiety and suicidal thoughts were positively reduced. The following were not affected: loss of appetite, loss of weight, anosognosia, paranoidity, and hallucinations. The clinical onset of the therapeutic effect was on average apparent on the 10th-12th day of therapy, significantly sooner when the intravenous route was used. The authors did not find significant differences in the therapeutic results in patients under and above 60 years and in those with a mild or severe depression. As regards subjective preference and preference by relatives, infusions were unequivically preferred as they had, no doubt, also a psychological effect. As to the incidence of undesirable effects, the authors did not detect a difference between the two routes of administration of citalopram, which was well tolerated and 50% of the patients did not report any side-effects and the rare ones recorded were not more frequent than in 20% of patients.

[The status of fluvoxamine among the antidepressive agents]. / K postavení fluvoxaminu ve skupine antidepresiv.

Fluvoxamine was administered in an open trial of 50 hospitalized patients with major depression of the melancholic type (DSM-III-R) for an average period of 24.56 days in mean minimal and maximal daily doses of 100-311 mg orally after a wash-out interval of 1-14 days. Treatment achieved complete improvement in 54% and partial improvement in 16% of the patients, significantly more frequently in women than in men. The antidepressant effect of fluvoxamine was confirmed also by a statistically significant reduction of the global HAMD and FKD score, starting on the 7th day of the trial. The therapeutic effect was clinically apparent during the second week of treatment. The best therapeutic effect was achieved in anxiety depressions (65%), to a lesser degree inhibitory depressions (50%) and atypical ones (46%), as apparent from the value of Náhunek's antidepressive index 0.88 which suggests a significant anxiolytic effectiveness of fluvoxamine. Fluvoxamine had a positive effect on the majority of HAMD and FKD items, incl. a depressive mood, anxiety, feelings of guilt, anhedonia, reduced interest and ability, obsession, depressive thoughts and suicidal tendencies. Reduced motor activity, loss of appetite, insight, somatic symptoms, paranoidity and hypochondria were less influenced. At the onset of treatment the preparation did not reduced insomnia and thus in 72% patients hypnotics were added. In the course of fluvoxamine therapy no suicidal attempts were observed although 34 (68%) of the patients initially admitted had suicidal thoughts. Fluvoxamine is well tolerated by patients; as to side-effects gastrointestinal complaints were most frequent (in 28% of the patients).