RESUMO
BACKGROUND: 'Vascular depression' may be caused by cerebrovascular disease. Calcium channel blockers, which are putative treatments for cerebrovascular disease, might be expected to improve depression reduction and to prevent recurrence of depression in this patient population. This clinical trial was designed to test these hypotheses. DESIGN: This was a controlled, double blind, randomized clinical trial in which 84 patients with vascular depression (Alexopoulos criteria) were treated with antidepressants at standard doses. Patients were also randomized to nimodipine (n = 40) or an inactive comparator, vitamin C (n = 44). Treatment outcomes were assessed using the Hamilton depression rating scale (HDRS) regularly up to 300 days after treatment initiation. RESULTS: As expected, depression reduction was successful in most patients. In addition, those treated with nimodipine plus an antidepressant had greater improvements in depression overall in repeated measures ANCOVA (F(1,81) = 8.64, p = 0.004). As well a greater proportion of nimodipine-treated participants (45 versus 25%) exhibited a full remission (HDRS < or = 10) (chi(2)(df, 1) = 3.71, p = 0.054). Among those experiencing a substantial response in the first 60 days (50% reduction in HDRS), fewer patients on nimodipine (7.4%) had a recurrence of major depression when compared to those on antidepressant alone (32%) (chi(2)(df, 1) = 3.59, p = 0.058). CONCLUSIONS: In treating vascular depression, augmentation of antidepressant therapy with a calcium-channel blocker leads to greater depression reduction and lower rates of recurrence. These findings support the argument that cerebrovascular disease is involved in the pathogenesis and recurrence of depression in these patients.
Assuntos
Antidepressivos/administração & dosagem , Bloqueadores dos Canais de Cálcio/administração & dosagem , Transtornos Cerebrovasculares/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Nimodipina/administração & dosagem , Idoso , Análise de Variância , Transtornos Cerebrovasculares/complicações , Transtorno Depressivo/etiologia , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Masculino , Prevenção SecundáriaRESUMO
Major depression is one of the most common medical disorders seen in primary care practice. Management frequently fails to meet recommended standards of treatment. For example, only a minority of patients are treated with antidepressants. The goals of this study were to establish the safety and effectiveness in the real world of a protocol-based pharmacological intervention administered by primary care physicians trained by psychiatrists. This was a naturalistic, open, 8-week, noncomparative, multicenter study of sertraline, 50-100 mg, in the treatment of 469 patients with mild-to-moderate major depression seen in primary care office settings. Effectiveness was assessed using the Hamilton Depression Rating Scale. The mean value of the HDRS declined steadily from 25.4 at baseline to 8.5 at day 56 (p < 0.0001). Fifty-two percent of patients achieved a full remission (HDRS <10 on day 56) and 70% had a positive response (50% reduction in HDRS scores). Only 26% had side effects, most of them mild. Major depression can be successfully diagnosed and treated by primary care physicians when adequately trained and supported by psychiatrists.
Assuntos
Transtorno Depressivo/tratamento farmacológico , Atenção Primária à Saúde , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Sertralina/uso terapêutico , Adolescente , Adulto , Idoso , Protocolos Clínicos , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Esquema de Medicação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Sertralina/efeitos adversos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Great strides have been achieved in recent years in the detection and treatment of major depressive disorder (MDD) in primary care settings. Little is known about the types or patients with MDD seen in primary care as compared with those seen in psychiatric office practice. Few studies have compared clinical outcomes after treatment with antidepressants in these two settings. In Argentina, the authors conducted an open-label treatment study of MDD patients in primary care (n = 469) and psychiatric office practice (n = 299). The patients were compared on baseline sociodemographic and clinical variables. These same patients were treated with sertraline 50-100 mg per day for 8 weeks. At baseline, the patients in psychiatric office practice were younger, more likely to abuse alcohol, less likely to have comorbid medical disorders, and more likely to have failed a prior treatment for depression during the current episode. The two groups did not differ significantly on depression severity or in depressive symptom profile on the Hamilton Depression Rating Scale (Ham-D). After 8 weeks of treatment, mean Ham-D scores were reduced comparably in both groups, from about 25 to about 10. Rates of adverse events were 14%-29%, depending on the follow-up interval. Adherence with treatment was high in both groups (over 95%). The patients in primary care and psychiatry office practice are similar in several ways. Significant reductions in depressive symptoms are possible in both settings, in large numbers of patients, by using doses of sertraline in the 50-100 mg range.
Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Equipe de Assistência ao Paciente , Sertralina/uso terapêutico , Adulto , Idoso , Antidepressivos/efeitos adversos , Argentina , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade , Atenção Primária à Saúde , Sertralina/efeitos adversos , Resultado do TratamentoRESUMO
The objective of this study was to determine the relative efficacy and safety of fluoxetine and amitriptyline in the treatment of major depression complicating Alzheimer's disease (AD). The sample included 37 patients with AD and major depression. The study design was a double-blind, fixed-dose, randomized clinical trial with 45 days of follow-up. The outcome measures were the Hamilton Depression Rating Scale (Ham-D), the Mini-Mental State Exam (MMSE), and the number of dropouts from each arm of the study. Efficacy was similar for fluoxetine and amitriptyline. At Day 45, there was a mean 9.4-point reduction in Ham-D scores (t[df,62] = 9.68, P < 0.0001) and a 2.4-point mean increase in MMSE scores as compared to baseline (t[df,2] = 2.69, P = 0.009). Eleven (58%) of the amitriptyline-treated patients dropped out, compared with 4 (22%) of the fluoxetine-treated patients (chi 2[df,2] = 8.9, P = 0.017). The authors conclude that antidepressant treatment for major depression complicating AD is effective. While fluoxetine and amitriptyline are equally effective, fluoxetine is better tolerated.