[Tianeptin (coaxil) in therapy of depression in cardiovascular patients].

AIM: To study clinical efficacy, tolerance and safety of antidepressant coaxil in the treatment of patients with cardiovascular disease (CVD) and depression; to compare efficacy of combined (somatotropic plus psychotropic) therapy and monotherapy with somatotropic drugs in the above diseases. MATERIAL AND METHODS: Of 86 participants of the study, 24 had arterial hypertension (AH) and depression, 25--AH, coronary artery disease and depression. They received combined treatment. 37 patients of the control subgroups received monotherapy. Somatic condition of the patients was examined with clinical, device and laboratory methods, antidepressant efficiency was examined with the clinicopsychopathological method and psychometric scales--HDRS, HARS, MADRS and CGI-S. RESULTS: Combined treatment with coaxil provided target blood pressure in 79.5% patients, monotherapy--in 65.7%. The response in the test subgroups reached 73.9 and 64.0%. By side effects, the difference between the groups was not significant. Somatotropic monotherapy in most control patients failed to reduce psychopathological disorders. CONCLUSION: Combined treatment with coaxil proved more effective than somatotropic monotherapy in CVD patients with depression. Coaxil treatment is safe as it has no side effects.

[The role of psychopharmacotherapy in combined treatment of patients with metabolic syndrome and depression].

AIM: To evaluate efficacy and tolerance of combined treatment with antidepressant cipramil in patients with metabolic syndrome (MS). MATERIAL AND METHODS: We examined 23 MS patients with depression (mean age 47 +/- 7.4 years). For diagnosis and somatic state evaluation we used clinical, device and laboratory tests. The clinicopsychopathological method, MADRS and CGI scales were applied for assessment of mental state and treatment efficacy. RESULTS: We achieved positive effects of 12-week combined somatotropic and psychotropic therapy on carbohydrate metabolism: a significant decrease of fasting blood glucose from 6.6 +/- 1.4 to 6.2 +/- 0.7 mmol and postprandial (2 hours after meal) glucose from 8.6 +/- 1.5 to 7.8 +/- 0.8 mmol/l, of waist circumference from 106.0 +/- 11.93 to 103.5 +/- 12.3 cm, body mass index from 32.5 +/- 4.54 to 31.4 +/- 4.76 kg m2, systolic blood pressure from 154.52 +/- 7.4 to 137.91 +/- 13.8 mm Hg and diastolic blood pressure from 90.1 +/- 6.2 to 81.0 +/- 6.6 mm Hg. A significant change in the levels of total cholesterol and triglycerides was not registered. CONCLUSION: Administration of antidepressant in MS patients relieved depression. This improved carbohydrate metabolism, lowered blood pressure and body mass index.

[Psychopharmacotherapy of patients with arterial hypertension complicated with metabolic disturbances and depression].

Thirty-six patients with arterial hypertension complicated with disturbances of carbohydrate metabolism (from changes of tolerance to glucose to diabetes mellitus type II), lipid metabolism (obesity of different degree) and depression have been studied. In 23 cases (main group), a combined therapy with somatotropic and psychotropic drugs was used while 13 patients were (control group) treated only with somatotropic medications. Citalopram, a selective inhibitor of serotonin reuptake, was the main psychopharmacological drug used in the treatment of the main group. In some cases other medications (neuroleptics, benzodiazepines) were used. Patient's state was assessed by the results of the somatic and psychopathological examination using psychometric scales and by a number of indices obtained in the instrumental and laboratory (biochemical etc) study. The results suggest the higher efficacy of the combined therapy by all parameters--arterial pressure, indices of carbohydrate and lipid metabolism, severity of affective disorders.

[Platelet activation and inflammation markers in patients with coronary heart disease and depression].

AIM: To study morphological features and functional activity of platelets, their relations with the level of inflammation markers in coronary heart disease (CHD) patients with depression. MATERIAL AND METHODS: The study group consisted of 33 CHD patients with stable effort angina (NY-HA FC I-III), 14 had depression, 19 were free of depression. Sixteen healthy volunteers comprised the control group. Platelet aggregation was registered by a mean size of aggregates and turbidometrically. Platelets shape, leukocytic-thrombocytic and erythrocytic-thrombocytic aggregates (LTA, ETA) in the whole blood were studied electron-microscopically. The levels of IL-2, IL-6, TNF-alpha, sVCAM, hsCRP were measured in the blood, serotonin--in platelets. RESULTS: Spontaneous aggregation enhanced in 52.6% CHD patients (p < 0.05). The blood contained reticular platelets, high number of prothrombocytes (p < 0.05), mean volume of thrombocytes was greater (p < 0.05). This reflected changes in megakaryocytopoiesis. Some of the patients had LTA and ETA. Out of inflammation markers, only IL-6 and sVCAM were elevated (p < 0.01), hsCRP concentration rose, but not above normal range. Serotonin in platelets was the same in the patients and controls. Depression aggravated the disorders and elevated other indices. Spontaneous aggregation was high in 71.4% of depressive CHD patients. The count of reticular platelets, prothrombocytes, mean volume platelets were also elevated. LTA and ETA were high in all the depressive patients. Elevated were also concentrations of IL-6, sVCAM, IL-2, hsCRP. Serotonin in platelets was low (p < 0.05). CONCLUSION: Depression stimulates functional activity of platelets, is a factor of risk of intravascular inflammation and contributes to development of thrombotic complications in CHD patients.