#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Therapy of Hospitalized Patients with Depression – are Antidepressives sufficient?


Authors: E. Češková
Authors‘ workplace: Psychiatrická klinika LF MU a FN, Brno přednostka prof. MUDr. E. Češková, CSc.
Published in: Čes. a slov. Psychiat., 105, 2009, No. 5, pp. 196-201.
Category: Original Article

Overview

Most of the patients hospitalized with depression are suffering from severe and pharmacoresistant depressive disorder. The aim of the study was to assess the diagnostic spectrum and treatment modalities of in-patients suffering from recurrent depressive disorder.

Charts of patients consecutively hospitalized with this diagnosis between January 2005 and December 2006 were reviewed. During the 2-year period totally 115 patients (87 females 28 males) were hospitalized 150 times. 79.2% of hospitalizations were for moderate and severe depression, 11.3 % for psychotic depression. A monotherapy with antidepressants (AD) was used in 52/150 (34.6%) of hospitalizations, a monotherapy with antipsychotics in 17/150 (11.3 %) of hospitalizations. The most frequently used ADs were mirtazapine and escitalopram, the most frequently used antipsychotic olanzapine and quetiapine. A combination of two ADs was found in 18/150 (12%) of hospitalizations. The most frequently used combination was the combination of mirtazapine with SSRIs or venlafaxine. The most frequently used treatment strategy was augmentation with atypical APs - in 54/150 (36%) of hospitalizations. The most frequently augmented ADs were SSRIs and ADs were most frequently augmented with olanzapine and sulpiride or amisulpride. In addition to mentioned treatment strategies an augmentation with mood stabilizers in 36/150 (24%) and with electroconvulsive therapy 27/150 (18%) of hospitalizations was used. The mean daily doses of olanzapine and quetiapine were significantly lower in combinations with ADs compared to the monotherapy.

Key words:
recurrent depressive disorder, monotherapy, antidepressants, atypical antipsychotics, augmentation, combination.


Sources

1. Anderson, I. M., Ferrier, I. N., Baldwin, R. C. et al.: Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines. J. Psychopharmacol., 22, 2008, pp. 343-396.

2. Altschuler, L. L., Bauer, M., Frye M. et al.: Does thyreoid supplementation accelerate tricyclic antidepressant response? A review and meta-analysis of the literature. Am. J. Psychiatry, 158, 2001, pp. 1617-1622.

3. Bauer, M., Nizar El-Khalili, N., Liebowitz, M. et al.: Extended release quetiapine fumarate (QNuetiapine XR) as adjunct to antidepressant therapy in patients with major depressive disorder (MDD): A Pooled Analysis of Studies MDD 6 (Pearl) and MDD 7 (Onyx). Postere prezentovaný na 47. ACNP (American College of Neuropsychopharmacology, 47th Annual Meeting), 7.-11. 12. 2008, Scottsdale, Arizona

4. Berman, R. M., Marcus, R. N., Swanink, R. et al.: The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, double-blind, placebo-controlled study. J. Clin. Psychiatry, 68, 2007, pp. 843-853.

5. Carpenter, L. L., Yasmin, S., Price, L. H.: A double-blind, placebo-controlled study of antidepressant augmentation with mirtazapine. Biol. Psychiatry, 51, 2002, pp. 183-188.

6. Česková E.: Amisulprid – nové benzamidové antipsychotikum II. generace. (Souhrnné sdělení). Čes. a slov. Psychiat., 96, 2000, s. 418-415.

7. Češková, E.: Deniban v léčbě dystymie. Čes. a slov. Psychiat. 103, 2007, s. 73-79.

8. Chaput, Y., Mangan, A., Gendron, A.: The co-administration of quetiapine or placebo to cognitive-behavior therapy in treatment refractory depression: a preliminary trial. BMC Psychiatry 28, 2008, p. 73.

9. Crossley, N. A., Bauer, M.: Acceleration and augmentation of antidepressants with lithium for depressive disorders: two meta-analyses of randomized, placebo-controlled trials. J. Clin. Psychiatry, 68, 2007, pp. 935-940.

10. Danish University Antidepressant Group (DUAG): Citalopram: clinical effect profile in comparison with clomipramine. A controled multicenter study. Psychopharmacology, 90, 1986, pp. 131-138.

11. Danish University Antidepressant Group (DUAG): Paroxetine: a selective serotonin reuptake inhibitor showing better tolerance, but weaker antidepressant effect than clomipramine in controlled multicenter study. J. Affect. Disord., 18, 1990, pp. 289-299.

12. Fava, M.: Diagnosis and definition of treatment-resistant depression. Biol. Psychiatry, 15, 2003, pp. 649-659.

13. Gutierrez, R. L., McKercher, R. M., Galea, J., Jamison, K. L.: Lamotrigine augmentation strategy for patients with treatment-resistant depression. CNS Spectr., 10, 2005, pp. 800-805.

14. Hannan, N., Hamzah, Z., Akinpeloye, H. O., Meagher, D.: Venlafaxine –mirtazapine combination in the treatment of persistent depressive illness. J. Psychopharmacol, 21, 2007, pp. 161-164.

15. Leasing, L. V.: Severity of depressive episodes during the course of depressive disorder. Br. J. Psychiatry, 192, 2008, pp. 290-293.

16. Keitner, G. I., Garlow, S. J., Ryan, C. E. et al.: A randomized, placebo.controlled trial of risperidone augmentation for patients with difficult-to treat unipolar, non-psychotic major depression. J. Psychiatr. Res., 43, 2009, pp. 205-214.

17. Khan, A.: The efficacy and safety of aripiprazole s adjunctive therapy in major depressive disorder: A multicenter, randomized, double-blind, placebo-controlled study. J. Clin. Psychiatry, 68, 2007, pp. 843-853.

18. Mahnoud, R. A., Pandina, G. J., Turkoz, I. et al.: Risperidone for treatment–refractory major depressive disorder: a randomized trial. Ann. Intern. Med., 147, 2007, pp. 593-602.

19. Marcus, R. N., McQuade, R. D., Carson, W. H. et al.: The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder. A second multicenter, randomized, double blind, placebo-controlled study. J. Clin. Psychoparmacol., 28, 2008, pp. 156 -65.

20. Miller, B.: Escitalopram versus serotonin reuptake inhibitors. Encephale, 34, 2008, pp. 280-283.

21. Papakostas, G. I., Fava, M., Thase, M. E.: Treatment of SSRI-resistant depression: a meta-analysis comparing within–versus across-class switches. Biol. Psychiatry, 63, 2008, pp. 699-704.

22. Papakostas, G. I., Thase, M. E., Fava, M. et al.: Are antidepressant drugs that combine serotonergic and noradrenergic mechanisms of action more effective than the selective serotonin reuptake inhibitors in treating major depressive disorder? A meta-analysis of studies of newer agents. Biol. Psychiatry, 62, 2007, pp. 1217-1227.

23. Papakostas, G. I., Shelton, R. C., Smith, J., Fava, M.: Augmentatin of antidepressants with atypical antipsychotic medications for treatment –resistant major depressive disorder. A meta-analysis. J. Clin. Psychiatry, 68, 2007, pp. 224-236.

24. Schindler, F., Anghelescu, I. G.: Lithium versus lamotrigine augmentation in treatmetn resistant unipolar depression. A randomized, open-label study. Int. Clin. Psychopharmacol., 22, 2007, pp. 179-182.

25. Shelton, R. C., Williamson, D., Corya, S. A. et al.: Olanzapine/fluoxetine combination for treatment resistant depression. A controlled study of SSRI and nortriptyline resistance J. Clin. Psychiatry, 66, 2005, pp. 1289-1297.

26. Thase, M. E., Corya, S. A., Osuntokun, O. et al.: A randomized, double-blind comparison of olanzapine/fluoxetine combination, olanzapine, and fluoxetine in treatment-resitant major depressive disorder. J. Clin. Psychiatry, 68, 2007, pp. 224-236.

Labels
Addictology Paediatric psychiatry Psychiatry
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#