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Valproato (Depakine Crono) en el tratamiento agudo de pacientes ambulatorios con trastorno de ansiedad generalizada sin otras enfermedades psiquiátricas: Estudio aleatorizado, doble ciego y controlado por placebo

Published online by Cambridge University Press:  01 May 2008

Nadir A. Aliyev
Affiliation:
Clínica Mental Ambulatoria, Bakú, C/U. Chagibekov, 46/50, F.I., Apartado de Correos de Bakú AZ00l0, República de Azerbayán
Zafar N. Aliyev
Affiliation:
Clínica Mental Ambulatoria, Bakú, C/U. Chagibekov, 46/50, F.I., Apartado de Correos de Bakú AZ00l0, República de Azerbayán
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Resumen

Objetivo.

Los trastornos de ansiedad son muy frecuentes en la población de múltiples países europeos. Sin embargo, hasta ahora no se ha estudiado el efecto de valproato (Depakine Crono) sobre el trastorno de ansiedad generalizada (TAG) en un diseño doble ciego controlado por placebo.

Método.

Se eliminaron todas las medicaciones de 80 pacientes (todos hombres). Cada paciente fue aleatorizado para recibir Depakine Crono (40 pacientes) durante 6 semanas o un placebo similar (40 pacientes) de forma doble ciega. Los participantes candidatos, además de cumplir los criterios de TAG del DSM-1V y de tener una puntuación mínima de 25 o más en la Escala de Ansiedad de Hamilton, debían tener entre 18 y 65 años. La respuesta se definió como una reducción del 50% de la puntuación en la escala de ansiedad de Hamilton. La respuesta y los efectos secundarios con Depakine Crono y placebo se compararon por análisis de varianza (ANOVA) y tests de χ 2. Seis pacientes no realizaron ni siquiera una evaluación posterior, por lo que se incluyeron finalmente 74 pacientes (36 tratados con Depakine Crono y 38 con placebo) en el grupo de estudio de variables.

Resultados.

Veintiséis de los 36 participantes tratados con Depakine Crono respondieron antes de 6 semanas, frente a seis de los 38 tratados con placebo (p < 0,001). Los efectos secundarios más comunes y problemáticos en el grupo tratado con Depakine Crono fueron el vértigo y las náuseas.

Conclusiones.

Los autores creen que éste es el primer estudio doble ciego, aleatorizado y controlado por placebo para probar la eficacia de Depakine Crono en el tratamiento de los trastornos de ansiedad. Esto debe ser reproducido con un grupo de estudio más numeroso.

Type
Artículo original
Copyright
Copyright © European Psychiatric Association 2008

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References

Bibliografía

[1]Baetz, MBrowen, RC. Efficacy of divalproex sodium in patients with panic disorder and mood instability who have not responded to conventional therapy. Can J Psychiatry 1998 Feb;43(1):73-7.CrossRefGoogle Scholar
[2]Baldwin, DSAnderson, IMNutt, DJBandelow, BBond, ADavidson, JRT, et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2005; 19(6): 567-96.CrossRefGoogle ScholarPubMed
[3]Balfour, JABryson, HM. Valproic Acid. A review of its pharmacology and therapeutic potential in indication other than epilepsy. CNS Drug 1994; 2: 144-73.Google Scholar
[4]Bandelow, BWedekind, DLeon, T. Pregabalin for the treatment of generalized anxiety disorder: a novel pharmacologic intervention. Expert Rev Neurother 2007 Jul;7(7):769-81.CrossRefGoogle ScholarPubMed
[5]Barre, JBerger, Y. Pharmacokinetics of a newly developed sustained ralease from of sodium valproate. In: Chadwick, D, editor. Proceedings of the Four International Symposium on Sodium Vaproate and Epilepsy, International Congress and Symposiam Series No 152. Royal Society of Medicine Services, London, 1989.Google Scholar
[6]Barros, HMTannhauser, MATannhauser, M. Effect of sodium valporate on the open-field behavior of rats. Braz J Med Biol Res 1992; 25(3): 281-7.Google Scholar
[7]Becker, HCAnton, RF. Valproate potentiates and picrotoxin antagonizes the anxiolytic action of ethanol in a nonshock conflict task. Neuropharmacology 1990 Sep;29(9):837-43.CrossRefGoogle Scholar
[8]Boulenger, JPCapdevielle, D. Pharmacological treatment of generalized anxiety disorders: rationale and limitations. Encephale 2007 Jan-Feb;33(1):8494.CrossRefGoogle ScholarPubMed
[9]Clark, RDCaive, JMCalais, LAQualls, CRTuason, VB. Divalproex in posttraumatic stress disorder: an open-label clinical trial. J Trauma Stress 1999 Apr;12(2):395401.CrossRefGoogle ScholarPubMed
[10]Corbott, RFielding, SCornfoldt, MDunn, RW. GABAmimetic agents display anxiolitic-like effects in the social interaction and elevated plus maze procedures. Psychopharmocology (Berl) 1991; 104(3): 312-6.CrossRefGoogle Scholar
[11]Coryell, W. Panic disorder and mortality. Psychiatr Clin North Am 1988; 11: 433-40.CrossRefGoogle ScholarPubMed
[12]Dalvi, ARodgers, RJ. Anxiolytic effects of valproate and diazepam in mice are differentially sensitive to picrotoxin antagonism. Pharmacol Biochem B 2001 Jan;68(1):2332.CrossRefGoogle ScholarPubMed
[13]Davis, RPeters, DHMcTavish, D. Valproic acid. A reappraisal of its pharmacological properties and clinical efficacy in epilepsy. Drugs 1994; 47(2): 332-72.Google ScholarPubMed
[14]Davis, LLRyan, WAdinoff, BPetty, E. Comprehensive review of the psychiatric uses of valproate. J Clin Psychopharmacol 2000 Feb;20 (1 Suppl. 1):1S-17.CrossRefGoogle ScholarPubMed
[15]De Angelis, L. Effects of valproate and lorazepam on experimental anxiety: tolerance, withdrawal, and role of clonidine. Pharmacol Biochem Behav 1995 Oct;52(2):329-33.CrossRefGoogle ScholarPubMed
[16]First, MBSpitze, RLGibbon, MWilliams, JBW. Structured clinical interview for DSM-IV Avis I disorders, patient edition (SCID-P), and version 2. New York: New York State Psychiatric Institute, Biometrics Research; 1995.Google Scholar
[17]Glantz, AS. Primer of biostatisties. (Russian translation from English by l.A. Danilov) Moscow, Russia; 1999.Google Scholar
[18]Hamilton, M. The assessment of anxiety States by rating. Br J Med Psychol 1959; 32: 50-5CrossRefGoogle ScholarPubMed
[19]Katon, W. Panic disorder: relationship to high medical utilization, unexplained physical symptoms, and medical costs. J Clin Psychiatry 1996; 57(Suppl 10): 11-8.Google ScholarPubMed
[20]Keck, PE JrMcElroy, SLFriedman, LM. Valproate and carbamazepine in the treatment of panic and posttraumatic stress disorders, withdrawal States, and behavioral dyscontrol syndromes. J Clin Psychopharmacol 1992 Feb;12(l Suppl):36S-41.CrossRefGoogle ScholarPubMed
[21]Keck, PE JrMeElroy, SLTugrul KC, Bennet, JASmith, JM. Antiepileptic drugs for treatment of panic disorder. Neuropsychobiology 1993; 27(3): 150-3.CrossRefGoogle ScholarPubMed
[22]Keck, PE JrTaylor, VETugrul, KCMcElroy, SLBennett, JA. Valproate treatment of panic disorder and lactate-induced panic attacks. Biol Psychiatry 1993; 33: 542-6.CrossRefGoogle ScholarPubMed
[23]Kinrys, GPollack, MHSimon, NMWorthington, JJNardi, AEVersiani, M. Valproic acid for the treatment of social anxiety disorder. Int Clin Psychopharmacol 2003 May; 18(3): 169-72.Google ScholarPubMed
[24]Lang, APde Angelis, L. Experimental anxiety and antiepileptics: the effeets of valproate and vigabatrin in the mirrored chamber test. Methods Find Exp Clin Pharmacol 2003 May;25(4):265-71.CrossRefGoogle Scholar
[25]Longo, LPCampbell, THubatch, S. Divalproex sodium (Depakote) for alcohol withdrawal and relapse prevention. J Addict Dis 2002; 21 (2):5564.CrossRefGoogle ScholarPubMed
[26]Lum, MFontaine, RElie, ROntiveros, A. Divalproex sodium's antipanic effect in panic disorder. A placebo-controlled study. Biol Psychiatry 1990; 27: 164A-5A.Google Scholar
[27]Nemeroff, CB. The role of GABA in the pathophysiology and treatment of anxiety disorders. Psychopharmacology Bull 2003; 37(4): 133-46.Google ScholarPubMed
[28]Ontiveros, AFontain, R. Sodium valproate and clonazepam for treatment resistant panic disorder. J Psychiatry Neurosci 1992 June; 17(2):7880.Google ScholarPubMed
[29]Pande, ACFeltner, DEJefferson, JWDavidson, JRPollaack, MStein, MB. Efficacy of the novel anxiolytic pregabalin in social anxiety disorder: a placebo-controlled, multicenter study. J Clin Psychopharmacol 2004; 24(2): 141-9.CrossRefGoogle ScholarPubMed
[30]Primeau, FFontaine, RBeauclair, L. Valporic acid and panic disorder. Can J Psychiatry 1990; 35: 248-50.CrossRefGoogle Scholar
[31]Raevskii, KSAleksandrovekii, IuAPoiurovslii, MVKharlamov, ANNeznamov, GG. [Anxiolytic action of sodium valproate (possible for role of gamma-aminobutric acid in affective disorders)-Article in Russian], Zh Nevropatol Psikiatr Im S S Korsakova 1985;85(4):574-9.Google Scholar
[32]Reed, RCDutta, S. What is best strategy for converting from twicedaily divalproex to a once-daily divalproex ER regimen? Clin Drug Invest 2004; 24(9): 509-21.CrossRefGoogle Scholar
[33]Reoux, JPSaxon, AJMalte, CABaers, JSSloan, KL. Divalproex sodium in alcohol withdrawal: a randomized double-blind placebocontrolled clinical trial. Alcohol Clin Exp Res 2001 Sep;25(9):1324-9.CrossRefGoogle Scholar
[34]Rodina, VIKrupina, NAKryzhanovslii, GN. A new natural model of elevated anxiety in rats (article in Russian). Biull Eksp Biol Med 1993 Aug; 116(8): 127-30.Google Scholar
[35]Roy-Byrne, PPWard, NGDonnely, PJ. Valproate in anxiety and with drawal syndromes. J Clin Psychiatry 1989 Mar;50(Suppl):44-8.Google Scholar
[36]Shepard, RA. Behavioral effeets of GABA agonists in relation to anxiety and bendiazepline action. Life Sci 1987 June 22;40(25): 2429-36.CrossRefGoogle Scholar
[37]Simiand, JKeane, PEMorre, M. The staircase test in mice: a simple and efficient procedure for primary screening agents. Psychopharmacology (Berl) 1984; 84(l): 4853.CrossRefGoogle Scholar
[38]Spila, BSzumillo, A. Gabapentin (GBP) in panic disorders—case report. Psychiatr Pol 2006 Nov-Dec;40(6):1061-8.Google Scholar
[39]Stein, DJSimeon, DFrenkel, MIslam, MNFlollander, E. An open trial of valproate in borderline personality disorder. J Clin Psychiatry 1995 Nov;56(11):506-10.Google ScholarPubMed
[40]Van Ameringen, MMancini, CPipe, BBennet, M.Antiepileptic drugs in the treatment of anxiety disorders: role in therapy. Drugs 2004; 64(19): 2199-220.CrossRefGoogle ScholarPubMed
[41]Weissman, MMBland, RCCanino, GJFaravelli, CGreenwald, S, Hwu H-G, et al. The cross-national epidemiology of panic disorder. Arch Gen Psychiatry 1997; 54: 305-9.CrossRefGoogle ScholarPubMed
[42]Wittchen, HJacobi, E. Size and barden of mental disorders in Europea critical a review and appraisal of 27 studies. Eur Neuropsychopharmacol 2005; 15(4): 357-76.CrossRefGoogle Scholar
[43]Woodman, CLNoyes, R Jr. Panic disorder: treatment with valproate. J Clin Psychiatry 1994 Apr;55(4): 134-6.Google ScholarPubMed