RESUMO
BACKGROUND: Cerebrovascular disease may cause "vascular depression" (VaD). Calcium channel-blockers are presumed treatments for cerebrovascular disease and might be expected to improve depression and prevent recurrence. OBJECTIVE: To examine the efficacy and tolerability of the use of nimodipine as an augmentation of fluoxetine in the treatment of VaD. DESIGN: A double-blind, randomized clinical trial in which 101 patients with VaD (Alexopoulos criteria) were treated with fluoxetine at standard doses. Patients were randomized to placebo (n=51) or nimodipine (n=50). Treatment outcomes were assessed using the Hamilton Depression Rating Scale (HDRS) regularly up to 8 months after treatment initiation. RESULTS: Depression was reduced in 63% of patients, but those whose treatment was enhanced with nimodipine had greater improvements overall by repeated measures analysis of covariance (ANCOVA) (F(1.80) = 9.76, p=0.001). In addition, a greater proportion of patients treated with fluoxetine-nimodipine (54% vs. 27%) exhibited full remission (chi2(d.f. 1)= 7.3, p = 0.006), with the number needed to treat (NNT) equal to 4 (95% CI 2-12). Of those experiencing full remission in the first 61 days, fewer patients on fluoxetine-nimodipine (3.7%) developed recurrence of major depression as compared to those on fluoxetine alone (35.7%) (chi2(d.f. 1) = 7.56, p = 0.006), NNT 3 (95% CI 2-9). Side-effects were noted in 33.3% of patients in the control group and 48% of the experimental group (chi2(d.f. 1) = 2.25, p = 0.133). CONCLUSIONS: In treating VaD, augmentation of fluoxetine with nimodipine led to better treatment results and lower rates of recurrence. These findings support the argument that augmentation of antidepressant therapy might be helpful in the treatment of cerebrovascular disease, which is involved in the pathogenesis of this type of depression.
Assuntos
Antidepressivos de Segunda Geração/administração & dosagem , Bloqueadores dos Canais de Cálcio/administração & dosagem , Transtornos Cerebrovasculares/complicações , Transtorno Depressivo/tratamento farmacológico , Fluoxetina/administração & dosagem , Nimodipina/administração & dosagem , Idoso , Argentina , Transtornos Cerebrovasculares/tratamento farmacológico , Transtornos Cerebrovasculares/psicologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Sinergismo Farmacológico , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Prevenção SecundáriaRESUMO
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
Our objective was to study cultural (first language) and innate (handedness) influences on the performance (omissions, site of beginning) of the cancellation test. We studied 71 healthy subjects aged between 18 and 52 years. There were 41 right-handed and 14 left-handed with Spanish as first language in Buenos Aires study site, and 16 right-handed with Hebrew as first language in Israel study site, matched by age and education. We used the Mesulam verbal and non verbal cancellation test, and a modified verbal version in hebrew letters. Omissions in the right side were more frequent in right-handed Spanish-speaking subjects (p < 0.001). We did not find this asymmetry in the individuals from Israel. While all right-handed Spanish-speaking subjects began the test by the left upper corner, most of the left-handed did it by the right upper corner. We conclude that asymmetry in the performance of the cancellation test may have genetic and/or cultural influences.
Assuntos
Atenção/fisiologia , Transtornos Cerebrovasculares/fisiopatologia , Lateralidade Funcional/fisiologia , Adulto , Características Culturais , Dominância Cerebral/fisiologia , Testes Auditivos , Humanos , IdiomaRESUMO
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.
Assuntos
Doença de Alzheimer/complicações , Amitriptilina/administração & dosagem , Amitriptilina/uso terapêutico , Antidepressivos/administração & dosagem , Antidepressivos/uso terapêutico , Transtorno Depressivo/complicações , Transtorno Depressivo/tratamento farmacológico , Fluoxetina/administração & dosagem , Fluoxetina/uso terapêutico , Idoso , Doença de Alzheimer/psicologia , Transtorno Depressivo/psicologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Masculino , Pacientes Desistentes do Tratamento , Resultado do TratamentoRESUMO
El estudio de la dominancia cerebral desempeña un papel importante en el contexto de las desórdenes de las funciones cerebrales superiores. No sólo las neuropsicológicas se encuentran lateralizadas sino también las neuropsiquiátricas. El objetivo de nuestro trabajo es la presentación de tres pacientes con trastornos psiquiátricos secundarios a una lesión del hemisferio cerebral derecho. El caso 1 es una paciente con un síndrome de Capgras, los casos 2 y 3 un síndrome de hemidespersonalización. Es frecuente que lesiones en el hemisferio derecho sean responsables de síndromes neuropsiquiátricas. El hecho de que ni las alteraciones funcionales, ni las estructurales puedan explicar por sí solas todas las características de los síndromes en estos pacientes, hace suponer que es necesaria la conjunción de ambas em proporciones variables según los casos. Probablemente aparezca en un sujeto con terreno paranoide con ligeros desórdenes perceptivos; o a la inversa, en un paciente con importantes alteraciones perceptivas como nuestros pacientes (visual en el caso 1; y sensitivas en los casos 2 y 3), bastará un pequeño trastorno afectivo para que surja la idea delirante.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Cérebro/patologia , Despersonalização/etiologia , Encefalopatias/complicações , Síndrome de Capgras/etiologia , Transtornos da Percepção/etiologiaRESUMO
El estudio de la dominancia cerebral desempeña un papel importante en el contexto de las desórdenes de las funciones cerebrales superiores. No sólo las neuropsicológicas se encuentran lateralizadas sino también las neuropsiquiátricas. El objetivo de nuestro trabajo es la presentación de tres pacientes con trastornos psiquiátricos secundarios a una lesión del hemisferio cerebral derecho. El caso 1 es una paciente con un síndrome de Capgras, los casos 2 y 3 un síndrome de hemidespersonalización. Es frecuente que lesiones en el hemisferio derecho sean responsables de síndromes neuropsiquiátricas. El hecho de que ni las alteraciones funcionales, ni las estructurales puedan explicar por sí solas todas las características de los síndromes en estos pacientes, hace suponer que es necesaria la conjunción de ambas em proporciones variables según los casos. Probablemente aparezca en un sujeto con terreno paranoide con ligeros desórdenes perceptivos; o a la inversa, en un paciente con importantes alteraciones perceptivas como nuestros pacientes (visual en el caso 1; y sensitivas en los casos 2 y 3), bastará un pequeño trastorno afectivo para que surja la idea delirante. (AU)