Predicting therapeutic results with levoprotiline and maprotiline in major depression: the role of the outcome criteria.

We describe a double-blind study involving 58 in-patients with major depression (DSM-III). After one week on placebo, the patients were randomly assigned to either levoprotiline or maprotiline treatment for three weeks. In the next three weeks, responders were maintained on the same medication and non-responders were shifted to treatment with the complementary drug. After the initial three weeks' treatment, 31% of levoprotiline patients and 58% of maprotiline patients had responded. Both in the initial three-week period and after shifting non-responders to the complementary drug, there were significant differences in favour of maprotiline. The comparison of properties of different outcome criteria in prediction analyses shows that the final score gives the best agreement with global evaluation; using the delta score (final minus baseline) or ratio score (final/baseline) as the outcome criterion may yield paradoxical results.

Dynamics of the effects of levoprotiline and maprotiline on EEG in patients with major depressive episodes (DSM-III-R). / Dynamika ovlivnení EEG levoprotilinem a maprotilinem u nemocných velkou depresívní epizodou (DSM-III-R).

The presented study compares the effect of the well-tested antidepressant maprotiline and a new antidepressant with an atypical pharmacological profile, levoprotiline, on EEG during repeated assessment after single dose administration. From the original number of 34 patients fulfilling the criteria of a major depressive episode (DSM-III-R) on account of a low-voltage record or pathological findings 11 were eliminated. To 12 of the remaining patients levoprotiline was administered and to 11 maprotiline, after a one-week placebo period, in doses of 150 mg. The EEG was recorded after an accommodation session immediately before, 1.5, 3, 4.5, 6 and 24 hours after a single dose administration. The record was taken on a 16-channel average reference montage at rest with closed eyes. Two-minute intervals were divided into 30 four-second periods at a sampling frequency of 128 Hz. From the signal by means of FFT the spectra were estimated and the mean spectrum for the entire recording was calculated. This was then divided into 10 frequency bands. The new method of frequency analysis of alpha-entropy was also used which is a global measure of the difference between two spectra. Three hours after administration of a single dose levoprotiline had an EEG profile corresponding to the profile of tricyclic antidepressants, i.e. it increased the values of the power spectra density in the region of 5-8.5 Hz and in the entire beta band; the decline of power in the alpha band was, however, absent. As regards maprotiline, 3 hours after administration a profile typical for antidepressants was not found; obviously because of the great variance of values of power spectra density as a result of great interindividual differences in the ingestion phase. Changes of the EEG spectrum expressed as values of alpha-entropy during different periods of apparently assessment are not incidental. After the initial rise of values a decline occurs.

[Results of a clinical trial of levoprotiline]. / Výsledky klinického zkousení levoprotilinu.

The authors submit results of a double blind clinical trial of levoprotiline controlled by maprotiline. In the multicentre study (which is processed and interpreted in stages) participated after written informed consent 58 patients with the diagnosis of a major depressive disorder. During the first three weeks the results of levoprotiline and maprotiline (from 26 patients each) were processed. The trial lasted 42 days. The psychopathology of the patients was evaluated by independent blind raters by means of Montgomery and Asberg's scale (MADRS), Hamilton's scale for depression (HRDS) and general clinical impression (CGI). In all patients also the pharmacological and EEG response was assessed. In comparison to maprotiline, levoprotiline was clinically ineffective. Its plasma levels (40 ng/ml) were one third to one half of the values obtained with maprotiline in the same daily dosage (150 mg). Although levoprotiline has an EEG profile typical for classical thymoleptics, its clinical antidepressive action is negligible.

[Reliability of the psychiatric section in the 10th revision of the International Classification of Diseases]. / Reliabilita psychiatrické cásti 10. revize Mezinárodní klasifikace nemocí.

In collaboration with WHO the authors participated in sessions on the reliability of the Vth chapter of mental disease of the 10th revision of the International Classification of Diseases. The object was to evaluate the comprehensibility and utility of the diagnosis of mental disorders, evaluate to what extent the new classification describes adequately disorders of different types of psychiatric patients and to provide information on the extent and type of diagnostic agreement and disagreement. The evaluation was done by four psychiatrists; a total of 38 written case-histories were evaluated (30 patients of the Psychiatric Research Institute and 8 case-histories from other centres). Diagnostic agreement according to Kappa was very good, best in organic mental disorders and schizophrenic disorders, approximately equal in affective and neurotic disorders. It was lowest in personality disorders. The investigation indicates diagnostic agreement practically equal to that in ICD-9. More reliable data will be obtained after summarization of the entire WHO investigation which was implemented in various departments in the world.

[Use of electroshock for vital indications]. / Pouzití elektrosoku ve vitální indikaci.

Electroshock therapy still remains a very controversial problem in the treatment of mental disorders. It is very effective in a narrow range of indications and has not many absolute contraindications. Epilepsy is one of the relative contraindications of electroshock therapy. The authors submit the case-history of an epileptic patient in a severe catatonic state with incipient metabolic breakdown, where electroshock therapy was followed by a rapid effect without any neurological complications. The contraindications of electroshock are rather relative than absolute and it is up to the doctor to consider whether the assumed therapeutic effect will outweigh possible complications.