ABSTRACT
OBJECTIVE: Depression and hostility are significant risk factors for mortality and morbidity after myocardial infarction (MI). Much research is still needed to identify effective ways to reduce emotional distress in patients with cardiovascular disease. This double-blind, placebo-controlled study investigated the efficacy and safety of the antidepressant fluoxetine in patients with depression after their first MI. METHODS: Fifty-four patients with major depression after MI were randomly assigned to receive a flexible-dose regimen of fluoxetine or placebo for the first 9 weeks of a double-blind, placebo-controlled trial. Patients without serious adverse effects who wished to continue participating in the study were given fluoxetine or placebo for an additional 16 weeks. To evaluate the efficacy of fluoxetine, the 17-item Hamilton Depression Rating Scale (HAMD-17) and the Hostility Scale of the 90-item Symptom Check List (SCL-90) were used as primary measures of outcome. To evaluate the safety of fluoxetine, cardiac function was measured before and after treatment with echocardiography and electrocardiography. RESULTS: The a priori difference in antidepressive efficacy (4-point difference in HAMD-17 scores between the fluoxetine and placebo groups) was not met. However, the response rate among patients receiving fluoxetine was significantly greater than that among patients receiving placebo at week 25 (48 vs. 26%, p = .05). Among patients with mild depression (HAMD-17 score < or =21), HAMD-17 scores were significantly different (p < .05) between the fluoxetine and placebo groups at weeks 9 (by 5.4 points) and 25 (by 5.8 points). Also, hostility scores at week 25 were significantly reduced among patients receiving fluoxetine (p = .02). Analysis of electrocardiographic and echocardiographic parameters revealed no decrease in cardiac function as a result of treatment with fluoxetine. CONCLUSIONS: Although the overall difference between the fluoxetine and placebo groups was not significant, there was a trend favoring fluoxetine in this relatively small sample. The response rate in the group receiving fluoxetine was comparable with that observed in other studies of patients with cardiovascular disease. In addition, fluoxetine seemed to be particularly effective in patients with mild depression and was associated with a statistically significant reduction in hostility. The results of this study suggest that fluoxetine can be safely used to treat patients with post-MI depression beginning 3 months after the event.
Subject(s)
Depressive Disorder, Major/drug therapy , Fluoxetine/therapeutic use , Myocardial Infarction/psychology , Adult , Aged , Blood Pressure/drug effects , Depressive Disorder, Major/psychology , Double-Blind Method , Electrocardiography/drug effects , Female , Fluoxetine/adverse effects , Heart Rate/drug effects , Hostility , Humans , Life Change Events , Male , Middle Aged , Risk Factors , Sick Role , Treatment OutcomeABSTRACT
BACKGROUND: Psychomotor retardation in depression has mostly been assessed with tasks requiring both cognitive and motor processes. This study tested whether retardation could be measured if the cognitive demands of the task were minimal. METHODS: 30 inpatients with a major depressive episode were compared one week after the start of antidepressant treatment, to 30 healthy control persons, matched for age, sex and educational level. Tests consisted of ten simple drawing tasks. The kinematics of drawing movements were recorded using a specially designed pen, a graphics tablet and a personal computer. RESULTS: Patients showed marked motor slowing on all the tasks: longer movement durations, longer pauses and lower velocities. CONCLUSIONS: Psychomotor retardation in depressed patients treated with antidepressants occurs during drawing tasks, in which the cognitive demands are minimal and less than those required in the figure copying tasks used in our previous studies. LIMITATIONS: The use of co-medication can have influenced the results, although no correlations were found between the use of medication and the kinematic variables. CLINICAL RELEVANCE: Detailed registration and analysis of drawing movements enable a more precise diagnosis of psychomotor disturbances in depressed patients.
Subject(s)
Depressive Disorder, Major/diagnosis , Psychomotor Disorders/diagnosis , Psychomotor Performance , Adolescent , Adult , Aged , Antidepressive Agents, Second-Generation/administration & dosage , Antidepressive Agents, Tricyclic/administration & dosage , Biomechanical Phenomena , Computer Graphics , Depressive Disorder, Major/drug therapy , Depressive Disorder, Major/psychology , Dose-Response Relationship, Drug , Female , Fluoxetine/administration & dosage , Humans , Male , Middle Aged , Neuropsychological Tests , Psychomotor Disorders/drug therapy , Psychomotor Disorders/psychology , Psychomotor Performance/drug effects , Reaction Time/drug effects , Signal Processing, Computer-AssistedABSTRACT
We studied the effect of olanzapine (1 to 15 mg/d) in 15 nondemented parkinsonian patients with drug-induced psychosis. Psychotic symptoms decreased significantly during treatment, and there was no worsening of extrapyramidal symptoms. These results suggest that olanzapine is a well-tolerated and effective treatment for drug-induced psychosis in nondemented patients with Parkinson's disease.
