Experience of the use of velaxin (venlafaxine) in anxious depression

Thirty patients (seven men and 23 women, mean age 35.3 ± 7.8 years) with anxious and anxious-apathic depression were studied. Of these, 24 patients were treated in hospital and six in out-patient clinics. Patients were treated for eight weeks with venlafaxine at doses of 225–375 mg/day. Mental state was assessed using a series of scales (CGI, HDRS, BDI, HADS-21). A total of 27 patients (90%) completed treatment. There were 25 (83.3%) responders on the CGI scale: “improvement” in mental state occurred in 16 (59.3%) of patients and “marked improvement” occurred in nine (33.3%). “Insignificant improvement” was seen in two cases (7.4%). Complete elimination of symptoms of depression occurred in 33.3% of cases. Velaxin was found to be safe at intermediate therapeutic doses and there were improvements in laboratory results characterizing patients' somatic status. Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 108, No. 3, pp. 24–28, March, 2008.     

Coaxil (tianeptine) in the treatment of depression in Parkinson’s disease

An open, non-comparative clinical study was performed to assess the efficacy and safety of tianeptine (Coaxil) in Parkinson’s disease (PD). A total of 18 patients with PD were used whose clinical state increased moderately severe and more profound depression (assessed on the Hamilton and Beck scales). After three months of treatment, depression on the Hamilton depression scale was decreased by 34% and on the Beck scale by 31% compared with baseline data (_p < 0.05). Improvements in mental status were noted in 14 of 18 patients (77%); eight patients (44%) showed more than 50% reductions on the Hamilton scale. Analysis of the structure of depressive symptomatology showed that improvement occurred because of decreases in anxiety and the severity of somatoform symptoms and, to a lesser extent, in melancholy and sleep disturbance. There was no significant change in apathy. The decrease in the severity of depression was accompanied by an improvement in the quality of life. The efficacy of Coaxil was greater in patients with less marked depressive and motor symptoms, shorter durations of illness, and less marked cognitive impairments. Coaxil was well tolerated by the patients. The data obtained here provide grounds for recommending the use of Coaxil in the treatment of depression in PD. __________ Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 106, No. 3, pp. 20–25, March, 2006.     

Could treatment with arundic acid (ONO-2506) increase vulnerability for depression?

Arundic acid (ONO-2506) is believed to be neuroprotective because of its actions on glia cells; i.e., its inhibitory effects on the synthesis of a calcium-binding protein S100B. ONO-2506 is undergoing clinical trials for the treatment of patients with stroke and Alzheimer's disease. Recent clinical studies point to a pervasive comorbidity of depression with stroke and Alzheimer's disease. Previously, S100B has been implicated in the pathobiological mechanisms of depression. Preclinical studies have shown that antidepressant treatment significantly increases brain S100B. Here we hypothesize that available data that link S100B with depression, along with the proposed inhibitory action of ONO-2506 on S100B synthesis, indicate that this compound could increase vulnerability for depression in patients at risk for this disorder, and we propose that evaluation of patients with stroke and Alzheimer's disease for the presence of depression should be routine in clinical trials employing ONO-2506. Although it may be open for discussion whether the neuroprotective effects of ONO-2506 are exclusively due to its inhibition of S100B synthesis, the latter action of ONO-2506 warrants studies of the effects of this drug in the pathobiology of depression.     

Cognitive function and the emotional state of stroke patients on antihypertensive therapy

Combined antihypertensive therapy based on 2.5–5 mg of cilazapril (an angiotensin-converting enzyme inhibitor) to normalize arterial pressure (ABP) was studied in 22 patients (12 male, 10 female) aged 49–74 years (mean 63 ± 7 years) with stroke (18 patients) or transient ischemic attacks (three patients). Magnetic resonance tomography (MRT) including perfusion studies, along with neuropsychological studies and assessment of emotional status (Beck depression inventory, Spielberger anxiety scale), were performed before and after treatment. After six months of treatment, patients showed normalization of ABP (systolic pressure decreased from 154.7 ± 12 to 128 ± 23 mmHg, diastolic from 90.3 ± 9.6 to 79.4 ± 23 mmHg). There were no side effects and no patient experienced stroke. MRT revealed no signs of new foci and there were no significant changes in brain blood flow. By the end of treatment, improvements in cognitive functions were noted on the Mini Mental State Examination, the 10-word memory test, the Boston naming test, or the Wisconsin card-sorting test, though there were no changes in the patients’ emotional status. __________ Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Stroke, Supplement issue, No. 15, pp. 39–44, 2005.     

Characteristics of the formation of chronic fatigue syndrome and approaches to its treatment in young patients with focal brain damage

Chronic fatigue is among the manifestations of focal brain lesions. It is most often encountered in multiple sclerosis (MS) and patients with the sequelae of traumatic, inflammatory, and vascular brain damage (encephalopathies). The aim of the present work was to study the mechanisms of formation of this syndrome in 50 patients with focal brain lesions of different origins (in the inactive stage) and to assess the possibility of correcting it using the combined agent Fezam (2 capsules t.i.d. for one month), which contains piracetam and cinarrizine. In patients with encephalopathies, chronic fatigue syndrome was directly associated with the severity of depression. Patients with MS showed changes in the value-sense sphere. Neuropsychological testing showed that the psychological and personality components played a greater role in the origins of chronic fatigue in patients with encephalopathies than in those with MS. Fezam significantly decreased the severity of chronic fatigue, particularly in patients with MS; in the second group (non-MS patients) this was accompanied by a decrease in the severity of depression. Mild side effects (in six patients — 12%) consisted generally of sleep disturbances. These results indicate that Fezam should be used in the treatment of chronic fatigue in patients with focal brain lesions; in encephalopathies it should be combined with psychoactive agents. __________ Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Multiple Sclerosis, Supplement, No. 3, pp. 122–129, 2006.     

Transcranial Magnetotherapy in the Complex Treatment of Affective Disorders in Patients with Alcoholism

Transcranial magnetotherapy (TMT) was used in 32 patients with alcoholism (study group) on the background of basal treatment (nootropes, hepatoprotectors, vitamin/mineral formulations, etc.). The influence of this treatment was compared with a control group (30 subjects), in which TMT was replaced with an appropriate _placebo procedure. All patients, who were aged from 35 to 64 years, had second-degree alcoholism with disease durations of 4–12 years. Patients were in a post-abstinence state during the treatment period. Courses of TMT consisted of 10 daily procedures with exposures of 10–20 min. Somatic, neurological, and laboratory studies were performed before and after treatment and included cardiointervalography, electroencephalography, assessments of the state of the autonomic nervous system, and use of psychometric scales to evaluate levels of anxiety and depression. TMT was followed by improvements in wellbeing, mood, and sleep, with increases in physical exercise tolerance and decreases in alcohol craving in 75% of patients in the study group and 30% of patients in the control group. Improvements in patients’ status were supported by paraclinical investigations (electrophysiological, measures of the state of the autonomic nervous system, etc.) and psychometric scales. Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 108, No. 4, pp. 33–37, April, 2008.     

Influence of Cardiopulmonary Bypass on the State of Cognitive Functions in Patients with Ischemic Heart Disease

Forty patients with ischemic heart disease and undergoing aortocoronary shunting surgery with cardiopulmonary bypass were studied. All patients were subjected to neuropsychological assessment and immunochemical analysis of the production of chemokines (IL-8, IP-10, MCP-1, MCP-3, MIP-1β, SDF-1α) and cytokines (TNF-α and IL-10). The aims of the study were to assess the presence and severity of cognitive deficit developing after surgery with cardiopulmonary bypass and to assess the effects of intraoperative Trasylol on its severity. Cognitive deficit on day 9 after coronary shunting with cardiopulmonary bypass was seen as impairments of attention, hearing-speech memory, visual memory, and dynamic praxis. Trasylol had a marked neuroprotective effect and suppressed the systemic inflammatory response. Patients given intraoperative Trasylol had no clinically significant cognitive deficit in the early post-operative period. __________ Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 105, No. 1, pp. 30–35, January, 2005.     

The modulatory influence of polymorphism of the serotonin transporter gene on characteristics of mental maladaptation in relatives of patients with endogenous psychoses

A number of studies have reported an association between 5-HTTLPR, a polymorphism of the serotonin transporter gene, and the development of depressive states in response to a variety of distal and proximal stressors. We report here studies of the effects of the 5-HTTLPR polymorphism on the probability that an individual will develop mental maladaptation in 224 close relatives of patients with severe chronic mental disorders — schizophrenia and schizoaffective and affective psychoses. The ss genotype of the serotonin transporter gene contributes to the formation predominantly of manifestations of distress, reflected by increases on the hypochondriasis scale of the MMPI scale of factors such as the extent of the autonomic component of anxiety reactions and increased attention to own health, as well as increases in sensitivity. At the same time, the ss genotype was less likely to influence the appearance of depression and anxiety, as determined on the depression scale. These tendencies were more marked in males than females. Furthermore, males with the ss genotype were characterized by some increase in tension, suspicion, detachment, and attention difficulty (on the paranoia and schizophrenia scales). These data can be regarded as supporting the role of the short allele of the serotonin transporter gene in enhancing and modulating psychopathological reactions to chronic stress situations in relatives of mental patients. __________ Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 107, No. 1, pp. 46–51, January, 2007.     

Use of Coaxil (tianeptine) in elderly patients with combined mild cognitive and depressive-anxiety disorders

The studies reported here addressed 20 patients aged 60–69 years whose clinical picture combined the manifestations of mild dementia with those of mild depression and anxiety. Patients were treated with Coaxil (tianeptine) for 60 days at a dose of 37.5 mg/day. Patients were assessed by clinical-psychological investigations with addition of the Hamilton scales and neuropsychological testing by the Luriya method. Coaxil was found to be highly effective in relation to all psychopathological components. Recommendations for the use of Coaxil in elderly patients with cognitive and depressive-anxiety disorders are formulated. Translated from Zhurnal Nevrologii i Psikhatrii imeni S. S. Korsakova, Vol. 108, No. 1, pp. 36–39, January, 2008.     

Comparing outcomes in chronic depression following inpatient psychotherapy for patients continuing versus discontinuing antidepressant medication

Research indicates that combination of psychotherapy and antidepressant medication (ADM) provides cumulative effects and thus outperforms monotherapy in treating chronic depression. In this quasi-experimental study, we explored symptom change for patients with chronic depression treated with ADM when presenting for a 12-week psychotherapeutic inpatient treatment programme. We compared outcomes through treatment and follow-up of patients who continued medication with those who discontinued. We also tested possible moderator effects of initial depression severity on change between the groups. Based on prior research, we hypothesized that combination treatment would yield better results (i.e., more reduction in depression). Patients (N = 112) were referred from general practitioners or local secondary health care. Outcome was measured by Beck Depression Inventory-II (BDI-II), and comparisons were carried out using multilevel modelling. Although 35 patients discontinued ADM during treatment, 77 continued. Both continuers and discontinuers had a significant treatment effect that was maintained at 1-year follow-up. There was no difference in outcome between continuers and discontinuers of ADM. Patients with severe depression had significantly more symptom improvement than patients with moderate depression, but depression severity did not affect outcomes across continuers and discontinuers of ADM differently. The results could indicate that patients had developed resistance and/or tolerance to the prophylactic effects of medication and that ADM did not contribute to the reduction of depressive symptoms. The findings may also indicate that psychotherapy alone in some instances can be a viable alternative to continued combined treatment. Clinicians should carefully assess benefits of patients' ongoing use of antidepressant medication when entering psychotherapy.     

Comparative study of the gamma rhythm in normal conditions,during examination stress,and in patients with first depressive episode

We report here a comparative analysis of measures of spectral power and synchronization of the gamma rhythm (30–40 Hz) in healthy subjects in normal conditions and before examinations (a stress situation) and in patients with major depression (first episode), both without cognitive loading and during performance of tests (arithmetic counting and spatial imagination). The results showed that the power of the gamma rhythm in the frontal and temporal areas of the cortex was significantly greater in patients with depression than in normal subjects. In the stress situation, healthy subjects showed a reduction in the number of differences in this measure as compared with depression patients, both at rest and during performance of the arithmetic counting test. the spatial imagination test resulted in a smaller number of significant differences between patients with depression and healthy subjects, regardless of whether the latter were in normal conditions or in the stress situation. The levels of gamma rhythm synchronization between cortical areas at rest and during cognitive loading were not different in healthy subjects, though synchronization increased in healthy subjects during stress and in patients with depression. Thus, the stress situation in healthy subjects leads to decreases in the differences in EEG measures from those in depression both at rest (power) and during cognitive loading (both measures). This may be evidence that stress is a “trigger mechanism” for depression. __________ Translated from Zhurnal Vysshei Nervnoi Deyatel’nosti imeni I. P. Pavlova, Vol. 56, No. 2, pp. 219–227, March–April, 2006.     

Sequelae of Closed Craniocerebral Trauma and the Efficacy of Piracetam in Its Treatment in Adolescents

The efficacy of piracetam in treating the sequelae of moderate and severe closed craniocerebral trauma (CCT) in adolescents was evaluated in studies of 42 patients aged 12–18 years who had suffered CCT 1.5–5 years prior to the study. Adolescents of the experimental group (20 individuals) received piracetam (Nootropil) at doses of 40–50 mg/kg (daily daily 1600–2400 mg) for one month; patients of group 2 (22 individuals) served as controls. Piracetam was found to have positive therapeutic effects on impairments to higher mental (memory, attention, executive) and motor (coordination) functions and on measures of the speeds of cognitive and motor operations. Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 108, No. 3, pp. 43–48, March, 2008.     

Posttraumatic stress disorder and depression among new mothers at 8?months later of the 2008 Sichuan earthquake in China

On May 12, 2008, a magnitude 8.0 earthquake struck China's southwestern Sichuan province. Recent studies have identified mental health problems among the survivors, but little is known about the impact of the Sichuan earthquake on the mental health of new mothers in the area. The main objective was to assess the impact of the Sichuan earthquake on the posttraumatic stress disorders (PTSD) and depression of new mothers. A total of 317 new mothers were interviewed in the hospital from January 2009 to March 2009. Symptoms of PTSD were measured using the impact of event scale-revised, and symptoms of postpartum depression were measured using the Center for Epidemiologic Studies Depression scale. The prevalence rates of PTSD and postpartum depression were 19.9% and 29.0%, respectively. Women with high earthquake exposure had higher risks of PTSD (odds ratio (OR), 5.91; 95% confidence interval (CI), 1.75–19.97; P < 0.001) and postpartum depression (OR, 7.28; 95% CI, 2.51–21.08; P < 0.001) than women without earthquake experience. In addition, women with low monthly family income and farm workers had a higher risk of having PTSD; women who were unemployed or with lower monthly family income and poor sleep had a higher risk of having depression. Earthquake experience increased the risks of having PTSD and depression among new mothers at 8 months later of the earthquake.     

Recovery from postnatal depression: a consumer’s perspective

To identify factors that women who have recovered from postnatal depression consider to be important in the recovery process and to measure the consensus among recovered women regarding the importance of those factors. A two-panel, three-round adapted Delphi exercise supplemented by a user-led interpretation work-shop. Panel one consisted of ten women who had been treated by a health visitor for and recovered from postnatal depression. Panel two consisted of 158 women who had recovered from postnatal depression who were London based members of a national support group for postnatal depression. There was a strong consensus among the participants about the 37 success factors that were identified. Factors that were identified as ‘essential’ in recovery from postnatal depression included: emotional support from partner; sleep; improved communication with partner; the diagnosis; practical support from partner; emotional support from friends; time to bond with the new baby; and prompt assessment by a health visitor. An interpretation group, made up of seven women who had recovered from postnatal depression, condensed the 37 factors into seven categories: diagnosis; positive action (or reaction) to intervene in the recognized problem; provision of support by people you know; professional or outside agency input; relationship between mother and baby; returning to work and continuity of care. There was a strong level of consensus among recovered women regarding a wide range of recovery factors. While all of the factors were considered to be, at least, ‘important’, social support from family and friends was generally rated more highly than support from health care professionals.     

Metacognitive Training for Depression: Feasibility,safety and acceptability of two new treatment modules to reduce suicidality

Recent evidence favours psychological interventions explicitly targeting suicidality; however, group treatments on suicidality are rare and are assumed to have unfavourable effects. We developed two modules specifically addressing suicidality that replace two existing modules in the Metacognitive Training for Depression (D-MCT). The aim of the current study was to examine the feasibility, safety, and acceptability of this intervention (D-MCT/S). Forty-eight inpatients with depression received eight sessions of D-MCT/S over 4 weeks in addition to standard treatment. Patients were assessed before the training, 4 and 8 weeks later regarding suicidality (primary outcome: Beck Suicide Scale [BSS]), hopelessness, depression (e.g. Hamilton Depression Rating Scale [HDRS]), dysfunctional attitudes, and self-esteem. Negative effects of the modules and subjective appraisal were assessed. Suicidality, hopelessness, and depression decreased over time. Whereas the effects on the BSS only reached trend level, a large effect was observed when the suicide item of the HDRS was used. Two of the 46 patients (4%) reported a deterioration in their symptoms, but this was not associated with the D-MCT/S. Negative effects of the general training were rather low, and acceptability was high. In general, patients evaluated the two new modules on suicidality similarly to the established modules. However, both modules were assessed as distressing by 39% of the patients. When we addressed suicidality in the D-MCT/S, we did not observe any contagious effects. In fact, the pilot versions of the two modules on suicidality are promising in terms of feasibility, safety, and acceptability. The results will be used to improve current shortcomings. The trial was registered with the German Clinical Trials Register (#DRKS-ID: DRKS00010543) on 23 August 2016.     

Electrophysiological characterization of the functional state of the brain in mental disturbances in workers involved in the clean-up following the chernobyl atomic energy station accident

Studies were carried out on 150 workers with mental disturbances, who had been involved in the clean-up of the Chernobyl atomic energy station accident. Visual and computer analyses of EEG traces from 43 workers were compared with traces from 17 healthy subjects and the comparison revealed that the most common features in workers were disorganization of the α-rhythm and strengthening of β-1-acitivity in the sensorimotor cortex. In neurosis-like syndromes (13 patients), there was a significant increase in the power of the α-rhythm in the anterior parts of the cortex; in psycho-organic states, power was significantly reduced (especially in the left hemisphere), contributing to the greater proportion of flat EEG traces in patients with psycho-organic syndromes as compared with other groups of patients. Most patients among the clean-up workers had increased assimilation of flashing light rhythms and weakening of non-specific and skin galvanic responses to a light stimulus. It was concluded that systemic CNS changes occurred in patients from the clean-up worker groups, especially in those with psycho-organic syndrome. State Scientific Center of Psychiatry and Narcology, Ministry of Health and the Medical Industry of the Russian Federation, Moscow. Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 96, No. 3, pp. 41–46, May–June 1996.     

Use of the dopamine receptor agonist Mirapex in the treatment of Parkinson’s disease

We present a review of the literature on dopamine receptor agonists along with our own data on the treatment of Parkinson’s disease (PD) with Mirapex, which was used in 30 patients (mean age 61.8 ± 7.7 years, duration of disease 8.4 ± 1.3 years). Mirapex was used at a dose of 3.5 ± 1.1 mg/day on the background of treatment with levodopa preparations. The efficacy of Mirapex was assessed using quantitative scales. Improvements were demonstrated in general state, motor activity, daily activities, and the quality of life. Attention is drawn to a decrease in the severity of motor fluctuations and dyskinesias and in anxiety and depression, and to improvements in cognitive functions. The significance of the combination of the high efficacy and good tolerance of this agent is emphasized. __________ Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 106, No. 6, pp. 26–33, June, 2006.     

Characteristics of albumin molecule binding centers in patients with anxious depression. Study by the fluorescence quenching method

The state of binding centers in albumin molecule in patients with anxious depression was studied by the method of quenching of fluorescence of molecular probe (dimethylaminonaphthaleic acid carboxyphenylimide) with nitrate ions. Serum samples from 24 donors without somatic and mental diseases and 26 patients were analyzed. In the absence of the quenching agent, specific fluorescence of the probe (standardized by albumin concentration) was lower in patients with depression. The fluorescence quenching constant and the percentage of fluorescence available for quenching were also lower in serum samples from patients. These data indicate that the parameters of binding centers in albumin molecule in patients with anxious depression are significantly modified in comparison with normal subjects. The detected changes can play a role in the pathogenesis of depressive disorders. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 144, No. 11, pp. 514–516, November, 2007     

Basis for a method of dynamic proprioceptive correction in the restorative treatment of patients with residual-stage infantile cerebral palsy

A new method for the restorative treatment of patients with residual-stage infantile cerebral palsy is described; the method is based on proprioceptive correction using an “Adeli-92” device, which is a modified space suit used in weightless conditions. The “Adeli-92” allows intensification and some extent of normalization of afferent proprioceptive mobility-controlling input. Positive clinical effects were obtained in 70% of patients, with improvements in walking and self-care ability. The positive effects of this method were demonstrated objectively using electroencephalography, electroneuromyography, studies of somatosensory evoked potentials, and studies of the vestibular system. Science Research Institute of Pediatrics, Russian Academy of Medical Sciences, Pediatric Clinical Psychoneurological Hospital No. 18, Moscow. Translated from Zhurnal Nevropatologii i Psikhiatrii imeni S. S. Korsakova, Vol. 96, No. 3, pp. 47–50, May–June, 1996.     

Comparison of the metabolic and ventilatory response to hypoxia and H2S in unsedated mice and rats

Hypoxia alters the control of breathing and metabolism by increasing ventilation through the arterial chemoreflex, an effect which, in small-sized animals, is offset by a centrally mediated reduction in metabolism and respiration. We tested the hypothesis that hydrogen sulfide (H₂S) is involved in transducing these effects in mammals. The rationale for this hypothesis is twofold. Firstly, inhalation of a 20–80 ppm H₂S reduces metabolism in small mammals and this effect is analogous to that of hypoxia. Secondly, endogenous H₂S appears to mediate some of the cardio-vascular effects of hypoxia in non-mammalian species. We, therefore, compared the ventilatory and metabolic effects of exposure to 60 ppm H₂S and to 10% O₂ in small and large rodents (20 g mice and 700 g rats) wherein the metabolic response to hypoxia has been shown to differ according to body mass. H₂S and hypoxia produced profound depression in metabolic rate in the mice, but not in the large rats. The depression was much faster with H₂S than with hypoxia. The relative hyperventilation produced by hypoxia in the mice was replaced by a depression with H₂S, which paralleled the drop in metabolic rate. In the larger rats, ventilation was stimulated in hypoxia, with no change in metabolism, while H₂S affected neither breathing nor metabolism. When mice were simultaneously exposed to H₂S and hypoxia, the stimulatory effects of hypoxia on breathing were abolished, and a much larger respiratory and metabolic depression was observed than with H₂S alone. H₂S had, therefore, no stimulatory effect on the arterial chemoreflex. The ventilatory depression during hypoxia and H₂S in small mammals appears to be dependent upon the ability to decrease metabolism.