Fluvoxamine for somatoform disorders: an open trial

Although the pharmacologic treatment of somatoform disorders has scarcely been investigated, there is reason to believe that antidepressants might be useful. We examined the response of 29 patients with somatoform disorders from a general medicine clinic to a selective serotonin reuptake inhibitor, fluvoxamine. The drug was administered in doses of up to 300 mg daily for 8 weeks. Sixty-one percent of the patients who took medication for at least 2 weeks were at least moderately improved. In addition to antidepressant effects, fluvoxamine had other beneficial effects and was well-tolerated. The benefits of drug therapy were modest but appear to warrant a placebo-controlled trial.     

文拉法辛缓释剂治疗抑郁症急性期患者临床疗效的开放性研究

目的 评价5-羟色胺及去甲肾上腺素双重再摄取抑制剂文拉法辛缓释剂治疗抑郁症急性期门诊患者的临床疗效。方法 对11所医院的217例抑郁症急性期门诊患者予以文拉法辛缓释剂治疗，75mg／d，疗程共8周，治疗前后采用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)评分观察疗效，以及观察相关实验室检查及记录不良反应。结果 文拉法辛缓释剂治疗急性期门诊抑郁症的临床治愈率和总有效率分别为60.4％和89.4％，HAMD和HAMA治疗前后的减分率分别为76．7％和77.1％；不良反应出现率为27.2％，其中89.6％的患者的不良反应在疗程结束时消失。结论 文拉法辛缓释剂能有效缓解抑郁和焦虑症状，对大多数门诊抑郁症患者在急性期治疗后能达到临床治愈，并有较好的耐受性和依从性。     

Bupropion sustained release for bereavement: results of an open trial

OBJECTIVE: The present study was conducted to assess whether DSM-IV-defined bereavement responds to bupropion sustained release (SR). METHOD: Twenty-two subjects who had lost their spouses within the previous 6 to 8 weeks and who met DSM-IV symptomatic/functional criteria for a major depressive episode were evaluated. Subjects completed the Hamilton Rating Scale for Depression (HAM-D), the Clinical Global Impressions scale, the Texas Revised Inventory of Grief, and the Inventory of Complicated Grief at baseline and follow-up. Subjects were treated with bupropion SR, 150 to 300 mg/day, for 8 weeks. RESULTS: Improvement was noted in both depression and grief intensity. For the intent-to-treat group. 59% experienced a reduction of > or = 50% on HAM-D scores. The correlations between changes in the HAM-D scores and the grief scale scores were high, ranging from 0.61 (p = .006) to 0.44 (p = .054). CONCLUSION: Major depressive symptoms occurring shortly after the loss of a loved one (i.e., bereavement) appear to respond to bupropion SR. Treatment of these symptoms does not intensify grief; rather, improvement in depression is associated with decreases in grief intensity. The results of this study challenge prevailing clinical wisdom that DSM-IV-defined bereavement should not be treated. Larger, placebo-controlled studies are indicated.     

Psychoeducation for major depressive disorders: A randomised controlled trial

Various psychological therapies have been shown to be effective for the treatment of mood disorders. Among them, family psychoeducation has demonstrated efficacy in reducing symptom severity and extending the time to relapse. We tested the efficacy of adding psychoeducation focussed on how to deal with the family's expressed emotion to treatment as usual (TAU) to prevent relapse among patients with remitted major depression. A total of 34 patients with major depressive disorders in full or partial remission were randomised to receive either group psychoeducation over six sessions, each consisting of a didactic lecture and group problem-solving (n=19), plus TAU or TAU alone (n=15). The primary outcome was relapse by Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM–IV) criteria. Masked raters administered the Hamilton Rating Scale for Depression-17 (HRSD-17). As many as 18 patients in the intervention group and 14 patients in the control group completed the study. Time to relapse was significantly longer in the intervention group than in the control group, with a risk ratio (RR) of relapse by 9 months of 0.12. At 9 months, there was a significantly greater decrease in the HRSD-17 score in the intervention group than in the control group. We demonstrated the effectiveness of patient psychoeducation on the course and outcome of major depressive disorders.     

Escitalopram in seasonal affective disorder: results of an open trial

OBJECTIVE: The aim of this study was to evaluate the efficacy and tolerability of escitalopram in the treatment of seasonal affective disorder (SAD, fall-winter depression). METHODS: Twenty SAD patients were included in an 8-week drug surveillance. Patients were treated with open-label escitalopram at a dosage of 10 to 20 mg per day. Efficacy assessments included the Structured Interview Guide for the Hamilton Depression Rating Scale (SAD version; SIGH-SAD), the Clinical Global Impression (CGI) and the Social Adaptation Self Evaluation Scale (SASS). Side effects were monitored with the UKU Side Effect Rating Scale. RESULTS: From week 2 onwards, escitalopram significantly reduced SIGH-SAD score and CGI severity score (p<0.001). From week 4 onwards, the SASS score was also significantly improved (p<0.05). The response rate (SIGH-SAD<50% of baseline value) after treatment for 8 weeks was 95%, the rate of remission (SIGH-SAD < or =7) was 85%. Side effects were mild to moderate and did not lead to cessation of therapy. CONCLUSION: These results suggest that escitalopram is an efficacious and altogether safe treatment for seasonal depression.     

Fluoxetine treatment of anorexia nervosa: an open clinical trial

Six patients with chronic, refractory anorexia nervosa were treated with fluoxetine. Depressive symptoms diminished in all patients, and this was associated with weight gain. Subjects, despite frequent medical comorbidity, tolerated fluoxetine well, even in dosages greater than those used for depression.     

Yoga-based intervention in patients with somatoform disorders: an open label trial

Abstract

Somatoform disorders are common mental disorders associated with impaired functioning and increased utilization of health resources. Yoga-based interventions have been used successfully for anxiety, depression, and chronic pain conditions. However, literature on the use of yoga in treatment of somatoform disorders is minimal. The current study assessed the effect of a specific yoga-based intervention in patients with somatoform disorders. Consenting patients meeting ICD-10 criteria for somatoform disorders were offered a specific yoga module (1?h per day) as a treatment. Assessments including Visual Analogue Scale (VAS), Brief Pain Inventory (BPI), and others were carried out at baseline and after 2, 6, and 12 weeks. Sixty-four subjects were included in the study and 34 completed 12 weeks follow-up. Significant improvement was noted in pain severity from baseline to 12 weeks after regular yoga sessions. The mean VAS score dropped from 7.24 to 2.88. Worst and average pain score in the last 24?h on BPI dropped from 7.71 to 3.26 and from 6.12 to 2.0,7 respectively. Results of the study suggest that yoga-based intervention can be one of the non-pharmacological treatment options in somatoform disorders. These preliminary findings need replication in larger controlled studies.     

Interpersonal and social rhythm therapy for adolescents with bipolar disorder: treatment development and results from an open trial

Background: In adolescents and adults, bipolar disorder (BD) is associated with significant morbidity, mortality, and impairment in psychosocial and occupational functioning. IPSRT is an empirically supported adjunctive psychotherapy for adults with bipolar disorder, which has been shown to help delay relapse, speed recovery from a bipolar depressive episode, and increase occupational and psychosocial functioning in adults with BD. This study is designed to describe the adolescent‐specific developmental adaptations made to IPSRT (i.e., IPSRT‐A) and to report the results from an open trial of IPSRT‐A with 12 adolescents with a bipolar spectrum disorder. Method: Interpersonal and Social Rhythm Therapy was adapted to be developmentally relevant to adolescents with bipolar disorder. Twelve adolescents (mean age 16.5±1.3 years) diagnosed with a bipolar spectrum disorder participated in 16–18 sessions of adjunctive IPSRT‐A over 20 weeks. Manic, depressive, and general symptoms and global functioning were measured at baseline, monthly during treatment, and at post‐treatment. Adolescent satisfaction with treatment was also measured. Results: Feasibility and acceptability of IPSRT‐A were high; 11/12 participants completed treatment, 97% of sessions were attended, and adolescent‐rated satisfaction scores were high. IPSRT‐A participants experienced significant decreases in manic, depressive, and general psychiatric symptoms over the 20 weeks of treatment. Participants' global functioning increased significantly as well. Effect sizes ranged from medium‐large to large. Conclusions: IPSRT‐A appears to be a promising adjunctive treatment for adolescents with bipolar disorder. A current randomized controlled trial is underway to examine effects of adjunctive IPSRT‐A on psychiatric symptoms and psychosocial functioning. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Antidepressant efficacy in HIV-seropositive outpatients with major depressive disorder: an open trial of nefazodone

BACKGROUND: Treatment studies of major depression in patients who are seropositive for the human immunodeficiency virus (HIV) have shown comparable efficacy for both tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). Nefazodone appears to be more tolerable than TCAs and similar to SSRIs. This study examined the efficacy and tolerability of nefazodone in an open 12-week trial of HIV-seropositive outpatients with major depressive disorder. METHOD: Fifteen HIV-seropositive patients with DSM-IV major depressive disorder and a 21-item Hamilton Rating Scale for Depression (HAM-D) score of > or =18 were treated with open-label nefazodone for 12 weeks. Hamilton Rating Scale for Anxiety, HAM-D, Clinical Global Impressions scale, and Systematic Assessment for Treatment Emergent Events general inquiry (for safety and tolerability) scores were obtained at weeks 2, 4, 6, 8, and 12. RESULTS: Of 15 patients receiving nefazodone, 4 discontinued treatment (1 for adverse effects). Of 11 patients who completed the trial, 8 (73%) were classified as full responders with a 50% reduction in HAM-D scores and final CGI score of 1 or 2, and 10 (91%) were classified as partial responders (only 50% reduction in HAM-D scores). Nefazodone-treated subjects experienced few total adverse effects (mean = 1.5), no sexual side effects, and low rates of adverse-effect-related dropout (1 subject, 7%). CONCLUSION: Depressed HIV-seropositive outpatients respond to nefazodone comparably to other outpatient populations and have few adverse effects, suggesting that nefazodone may have a role in the treatment of depression in HIV-seropositive patients. Potential drug interactions with protease inhibitors indicate that it is essential to evaluate for appropriate dosing to avoid adverse effects and increase overall antidepressant efficacy.     

Bromocriptine treatment of depressive disorders

Fifteen depressed patients were treated with increasing doses of bromocriptine in an open study. Twelve were treated for 5 weeks (final dose 20–60 mg daily) and nine of these recovered almost completely. As expected from a dopamine agonist, bromocriptine decreased the level of homovanillic acid (HVA) in cerebrospinal fluid (CSF) by 15 % (P < 0.05) and 23% (P < 0.01) after 2 and 5 weeks of treatment, respectively. After 2 but not after 5 weeks of treatment there was also a small but significant decrease (13%; P < 0.001) of the noradrenaline metabolite HMPG in CSF. Although there was no mean effect on 5-HIAA in CSF, there was a significant relationship between the HVA and 5-HIAA levels (as % of pretreatment level) both after 2 and 5 weeks of treatment (r = 0.96 and r = 0.62, respectively). This may indicate that the drug has an effect on the serotonin system secondary to the dopamine receptor stimulation. The amelioration of depression was not related to HVA, but did correlate to HMPG in CSF (r = 0.65; P < 0.05) both metabolites measured before treatment These results indicate that bromocriptine may have antidepressant effects possibly mediated through the noradrenergic system rather than the dopaminergic system.     

Pimozide treatment of the negative schizophrenic syndrome: an open trial

Reports over the last 20 years suggest that pimozide, a neuroleptic of the diphenylbutylpiperidine (DPBP) group, might be helpful in the treatment of negative symptoms of schizophrenia, which are considered less responsive to standard neuroleptics than are positive symptoms. Research suggests that neuroleptic drugs of the DPBP group possess a unique property--potent calcium channel antagonism--which could explain their ability to relieve negative symptoms. Earlier reports, however, used measures not specifically designed to assess the negative syndrome. The Positive and Negative Syndrome Scale (PANSS) was developed and standardized to measure the negative syndrome in schizophrenia. The authors used the PANSS to study the effects of pimozide in a 6-week, open clinical trial with 10 neuroleptic-resistant schizophrenic inpatients who had prominent deficit features. Negative but not positive symptoms improved significantly, suggesting that the drug might target the negative profile. The authors discuss possible pharmacologic mechanisms for pimozide's potentially distinct clinical properties.     

The efficacy of bupropion in winter depression: results of an open trial.

BACKGROUND: Seasonal affective disorder (SAD) refers to regularly recurring episodes of affective illness bearing a fixed relationship to season. Wintertime depression is its most widely recognized form. This study was undertaken to assess the efficacy of bupropion as a treatment for this disorder. METHOD: Fifteen consecutively presenting patients were treated with bupropion (200 to 400 mg/day). All met DSM-III-R criteria for major depression with a seasonal pattern. All were moderately to severely depressed. A modified version of the Hamilton Rating Scale for Depression (mHAM-D) including ratings of hypersomnia, increased appetite and carbohydrate craving, and weight gain was used to quantify the severity of illness. Up to 5 weeks of treatment was allowed before the subjects were categorized as nonresponders, partial responders, or responders. RESULTS: The mean +/- SD mHAM-D scores before and after treatment were 25.5 +/- 6.4 and 4.1 +/- 3.1, respectively. Ten (66.7%) of the subjects had a complete response to treatment (mHAM-D score less than or equal to 5). The other 5 (33.3%) had a partial response (mHAM-D score = 6-10). Five of the subjects had chronic pain and 3 had panic attacks restricted to episodes of depression. These problems resolved simultaneously with the symptoms of depression. CONCLUSION: The results of this open trial suggest that bupropion is an effective treatment for winter depression. However, controlled studies are required to confidently determine whether this is the case.     

Amantadine in depressive patients with Borna disease virus (BDV) infection: an open trial

Objective: Originally introduced into pharmacotherapy as an antiviral compound, amantadine was shown to also have multiple pharmacological effects on the central nervous system. In addition, only a few studies reported on certain antidepressive properties of amantadine. This effect was highlighted by the discovery of its antiviral effect on Borna disease virus (BDV), which is hypothesized to be an etiopathogenetic factor to subtypes of affective disorders. Therefore, the therapeutical use of amantadine in BDV-infected depressive patients was investigated.

Methods: In this open trial, amantadine was added to antidepressive and/or mood-stabilizing compounds treating BDV-infected depressed patients (n=25) with bipolar or major depressive disorders. Amantadine was given twice a day (100–300 mg/day) for a mean of 11 weeks. Antidepressive treatment response was measured on the Hamilton rating scale for depression (HAM-D) and/or with an operationalized diagnostic criteria system (OPCRIT; version 3.31). Virological response was measured by expression of BDV infection parameters in blood samples.

Results: The overall response rate of the amantadine augmentation in the BDV-infected patients with regard to depressive symptoms was 68% after a mean of 2.9 weeks of treatment. Bipolar I patients improved faster and did not show any following hypomania. In addition, the decrease of depression tended to correspond with the decrease in viral activity.

Conclusion: Amantadine appears to show a remarkable antidepressive efficacy in BDV-infected depressive patients. The antidepressive effect in this open trial appeared to be comparable to standard antidepressives, possibly being a result of its antiviral effect against BDV as a potentially relevant etiopathogenetic factor in these disorders.     

An open trial of plasma exchange in childhood-onset obsessive-compulsive disorder without poststreptococcal exacerbations

Patients with childhood-onset obsessive-compulsive disorder (OCD) with symptom exacerbations following streptococcal infections benefit from treatment with plasma exchange. In this study, 5 patients with treatment-refractory OCD without a history of streptococcus-related exacerbations underwent an open 2-week course of therapeutic plasma exchange. Behavioral ratings, completed at baseline and 4 weeks after the initial treatment, included the Clinical Global Impressions Scale and the Yale-Brown Obsessive Compulsive Scale. All 5 patients completed the trial with few side effects, but none showed significant improvement. Plasma exchange does not benefit children and adolescents with OCD who do not have streptococcus-related exacerbations.     

Controlled trial of bright light for nonseasonal major depressive disorders.

Psychotropic drug-free hospitalized veterans with nonseasonal major depressive disorders or depressed forms of bipolar disorder were treated with light for 1 week. Twenty-five patients were randomly assigned to bright white light treatment (2000-3000 lux), and 26 patients were randomized to dim red light placebo control treatment. Unlike those treated with dim red light, those treated with bright white light showed declines in three measures of depression during treatment. Partial relapse appeared within 2 days. A global depression score showed a statistically significant (p = 0.02) difference favoring bright white light treatment. Two bright-light-treated patients became mildly hypomanic, but side effects were mild. Improvement was not correlated with patient expectations; indeed, patients expected somewhat greater benefit from the placebo. Patients treated in summer responded as well as those treated in winter. Baseline electroencephalogram (EEG) sleep stage data (e.g., rapid eye movement; REM latency) did not predict treatment responses. These 1-week treatment results suggest that bright light might produce benefits for patients with nonseasonal depression. Bright light should not be recommended for routine clinical application before additional assessments with longer treatment durations are done.     

Topiramate as a treatment for pain in multisomatoform disorder patients: an open trial

Multisomatoform disorder (MSD), defined as 3 or more medically unexplained, currently distressing physical symptoms in addition to a long (> OR =2 years) history of somatization, is a prevalent and disabling disorder in which few pharmacological trials have been referred to in the literature. Thirty-five MSD patients from the Somatoform Disorders Unit of the Miguel Servet University Hospital, Zaragoza, Spain, with pain of more than 3 months as the main symptom, were treated with topiramate in doses ranging from 300–400 mg/day. Patients were assessed at baseline and at one and six-months follow-up with the McGill Pain Questionnaire (MPQ), Pain Visual Analogue Scale (PVAS), Clinical Global Impresión (CGI), Global Assessment Functioning (GAF) and Hospital Anxiety Depression Scale (HADS). Eight patients (22.8%) dropped from the study, 3 due to side-effects and the other 5 because of lack of efficacy. All the outcome measures showed significant improvements at one-month except the ratings on the Hospital Anxiety Depression Scale. At six-months follow-up, clinician-rated assessments (CGI and GAF) still showed significant differences with baseline but less significant than at one-month follow-up. However, patient-rated assessments (MPQ and PVAS) did not present significant differences with baseline. Despite limitations of the study, topiramate seems to be effective in treating multisomatoform disorder patients with pain as the main symptom and a controlled randomized trial in these patients appears warranted. A possible “decay effect” in patient-rated assessments with any drug in somatoform disorder patients is discussed.     

安非他酮与阿米替林治疗抑郁障碍的双盲对照研究

目的评价国产安非他酮片治疗抑郁障碍的疗效及安全性。方法229例符合中国精神障碍分类与诊断标准第3版的各型抑郁发作患者,随机分为安非他酮组(300mg/d或450mg/d) 115例,阿米替林组(100mg/d或150mg/d)114例,疗程均为6周。以汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及临床大体印象量表进行疗效评估。以治疗中需处理的不良反应量表(TESS)、血常规、尿常规、血生化、心电图及生命体征等进行安全性评估。结果安非他酮组的有效率为74%(67/91),阿米替林组为92%(83/90),差异有统计学意义(P＜0.05)。安非他酮组HAND分数下降[(-16±8)分]少于阿米替林[(-20±7)分],P＜0.01。安非他酮组HAMD的焦虑/躯体化和睡眠障碍及HAMA的精神性焦虑等靶症状的疗效不如阿米替林组(P＜0.01)。安非他酮组的与药物相关的不良事件发生率为65.2%、阿米替林组为88.6%。安非他酮组的思睡、口干、心动过速及体质量增加较阿米替林组少见(P＜0.05)。结论国产安非他酮片治疗抑郁障碍有效,不良反应少于阿米替林,但疗效尤其是抗焦虑等作用不如阿米替林。