RESUMEN
Signs of an inflammatory process, in particular increased pro-inflammatory cytokines and increased levels of prostaglandine E(2) (PGE(2)), have repeatedly been described in major depression (MD). As cyclooxygenase-2 (COX-2) inhibitors inhibit the PGE(2) production and the production of pro-inflammatory cytokines, we performed a therapeutic trial with the COX-2 inhibitor celecoxib. In a prospective, double-blind, add-on study, 40 patients suffering from an acute depressive episode were randomly assigned to either reboxetine and celecoxib or to reboxetine plus placebo. After a wash-out period, 20 patients received 4-10 mg reboxetine plus placebo and 20 received reboxetine plus 400 mg celecoxib for 6 weeks. The treatment effect was calculated by analysis of variance. There were no significant differences between groups in age, sex, duration or severity of disease or psychopathology, or reboxetine dose or plasma levels. Over 6 weeks, both groups of patients showed significant improvement in scores of the Hamilton Depression Scale. However, the celecoxib group showed significantly greater improvement compared to the reboxetine-alone group. Additional treatment with celecoxib has significant positive effects on the therapeutic action of reboxetine with regard to depressive symptomatology. Moreover, the fact that treatment with an anti-inflammatory drug showed beneficial effects on MD indicates that inflammation is related to the pathomechanism of the disorder, although the exact mechanisms remain to become elucidated.
Asunto(s)
Antidepresivos/uso terapéutico , Inhibidores de la Ciclooxigenasa 2/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Dinoprostona/biosíntesis , Morfolinas/uso terapéutico , Pirazoles/uso terapéutico , Sulfonamidas/uso terapéutico , Inhibidores de Captación Adrenérgica , Adulto , Ansiolíticos/administración & dosificación , Ansiolíticos/uso terapéutico , Antidepresivos/administración & dosificación , Antidepresivos/farmacología , Celecoxib , Inhibidores de la Ciclooxigenasa 2/administración & dosificación , Inhibidores de la Ciclooxigenasa 2/farmacología , Trastorno Depresivo/fisiopatología , Dinoprostona/análisis , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos , Inflamación/tratamiento farmacológico , Inflamación/fisiopatología , Interleucina-6/biosíntesis , Lorazepam/administración & dosificación , Lorazepam/uso terapéutico , Masculino , Persona de Mediana Edad , Morfolinas/administración & dosificación , Pacientes Desistentes del Tratamiento , Proyectos Piloto , Pruebas Psicológicas , Pirazoles/administración & dosificación , Pirazoles/farmacología , Reboxetina , Serotonina/metabolismo , Índice de Severidad de la Enfermedad , Sulfonamidas/administración & dosificación , Sulfonamidas/farmacologíaRESUMEN
Anorexia nervosa is a psychiatric disorder occurring primarily in young women. Especially when chronic or the body mass index is less than 12 kg/m(2), it has a mortality of up to 20%. Often these patients are admitted to emergency units and treated internistically. If they accept psychiatric treatment, they are normally transferred to specialized psychosomatic units for further therapy. If patients are not able to accept necessary further therapy to overcome the danger to health and life, the question arises in terms of guardianship law of whether they are able to handle their personal concerns alone. After several vitally endangered anorexia nervosa patients had been admitted to our closed psychiatric ward, we developed a therapeutic concept for this subgroup of patients, taking the possibilities of guardianship law into account. This concept aims at restoring the body weight continuously and finally enable the patients to be transferred to less restrictive psychosomatic units. The chosen treatment is shown with the therapy courses of 25 patients treated according to this concept.