To evaluate the efficacy and safety of venlafaxine HCL sustained release capsules in treatment of depression in adolescents.

A randomized，double blind and double dummy clinical trial enrolled 60 adolescents patients with depression, who were randomized 1:1 to administer venlafaxine HCL sustained release capsules 150 mg or fluoxetine 20 mg daily for 8 weeks．The efficacy of both treatment groups was evaluated based on the Hamilton Depression Scale and Clinical General Impression Scale pre- and post-treatment.

The scores of Hamilton Depression Scale at the end of therapy were significantly reduced compared with the baseline in both groups(P<0.01).The efficacy rate of venlafaxine HCL sustained release capsules versus fluoxetine treatment was 70.0％ and 65.5％, respectively;the P value showed no statistical difference(P>0.05).The common adverse reactions included dry mouth，insomnia，dizziness，and loss of appetite.

Venlafaxine HCL sustained release capsules is efective and safe agent for adolescents with major depression.

To evaluate the efficacy and safety of escitalopram in an open- label, 8 weeks study.

Twenty seven (27) elderly patients suffering from MDD, according to DSMIV, were included in the study (17 female/10 male, average age 76.3). All patients were treated with escitalopram (dose range 10-20 mg, mean daily dose 16.48 mg). The assessment of antidepressant efficacy was performed using 17-item Hamilton Depression Rating Scale (HAMD17) and Geriatric Depression Scale (GDS). Safety measures included adverse events, vital signs and body weight. All the evaluations were performed at baseline and at week 8.

Twenty five (25) patients concluded the study and two (2) patients discontinued treatment prematurely due to non-compliance. Escitalopram showed significant reduction in both HAMD-17 (-8.2) and GDS total score (-7.2). The percentage at endpoint of HAMD17 response was 44% and remission rates 24%. The most frequent adverse events were nausea in two patients (8%) and headache in four patients (16%). No significant changes were observed regarding vital signs. The mean body weight at baseline was 72.3 and at endpoint 73.1.

Escitalopram was well tolerated and efficacious in reducing symptoms of depression in elderly patients over the 8 week treatment period.

Evaluation of efficacy and tolerability of fluvoxamine in outpatients with Anxiety disorders (F40 to F49 according to ICD-10 Classification of Mental Disorder).

Female and male outpatients older than 18 years of age treated in Psychiatry Clinic Clinical Hospital Center Split, previously without therapy or treated with other psychopharmacological treatment, to which one of the following Anxiety disorders (F40 to F49 according to ICD-10 Classification of Mental Disorder) was diagnosed.

Exclusion criteria

1. - Hypersensitivity to fluvoxamine

2. - Pregnancy and lactation

3. - Hepatic or kidney insufficiently

4. - Unstable epilepsy

5. - Discontinuation of the treatment with irreversible monoamine oxidize inhibitors less than 14 days prior to introduction of fluvoxamine therapy

6. - Discontinuation of moclobemide therapy less than one day prior to introduction of fluvoxamine therapy.

Descriptive statistics was used for the analysis of demographic data and incidence of adverse events.

Repeated Measures Analysis of Variance was used for data analysis (Statistical software SPSS).

Statistical significance was defined as p≤0,05.

Treatment of old - age patients requires antidepressants with high efficacy, but safety from view of pharmacokinetics and pharmacodynamics.

Milnacipran is a specific serotonin and noradrenaline reuptake inhibitor antidepressant, which is devoid of antagonist activity at muscarinic, histamine and adrenergic receptors, resulting in a benign side-effect profile.

evaluate efficacy and tolerability of milnacipran over a 8 -week treatment period in patients older 60 years suffering from reccurent or single episode of major depression.

24 patients with mild or moderate major depression were included in the study. Patients had been suffering from depression from 2 to 20 years and had had one or two depressive episodes in the last two years. The study was open label. Milnacipran was administered as a single daily dose of 50 mg and subsequently as 50 mg bid (100 mg/day).

After six weeks all patients had a reduction of the Hamilton score of at least 40% with a mean reduction of 54.6%. After eight weeks, the mean Hamilton rating score was 8.1 with most patients in remission with a score of 8 or less. Adverse events were reported infrequently. Constipation and excessive sweating occurred in four patients and headache in one patient. These adverse events occurred early in the treatment and lasted less than 14 days.

Good efficacy and good tolerance suggests that milnacipran is a suitable candidate for first line treatment of mild to moderate major depression.

Sertraline is an antidepressant of the SSRI class, and shared common side effects and contraindications with other members of SSRI class.

Aim of this study is to show how Sertraline is effective in treatment of distinguish psychiatric disorders, observing side effects as well.

This prospective study covered 30 patients, randomly selected at Psychiatric Clinic University of Sarajevo.

SCID-I and CGI was used as instruments. Dose vary related to clinical state (25-150 mg/day)

Out of total number of patients (30); 22 (73.3%) are female and 8 (267%) males with disorders as follows: Depression (667%),Panic Disorder and PTSD (33% each) and OCD (6,7%).

Starting Sertraline dose was 25 mg/day, which is increased in 90% of cases to 50mg/day, and 100 mg/day (6.7%) after one week of treatment resulting with average dose of 52.5 mg/day (average change 27.5). During second follow up there is a further increase of dose to the average of 76.67 mg/day ranging from 25 to 150 mg/day (average 25). Duration of follow up was 3-6 months. 43.3% of patients in our sample were taking concomitant pharmacotherapy in form of anxiolitic and antidepressants.

Sertraline is significantly effective as therapy for Depression, Panic disorder, OCD. None of the patients reported some side effects from the Sertraline therapy. In 90.0% of cases final evaluation of response was excellent with 10% of very good response to treatment

There are no obvious data to sustain that the association of venlafaxine and mirtazapine would produce for the resistant depression patients the conversion to a manic-like episode.

DSM-IV TR describes the manic-like episodes produced after the anti-depressive treatment.

The case occurrence is not strong, but the clinical implications are important.

Case Report: 63 years old patient, with repeated hospitalization for severe depression episodes from 2000; he never had manic episodes; the precedent episodes were treated with venlafaxine or mirtazapine (not in combination) producing partial remissions.

This case report brings additional information about venlafaxine and mirtazapine association in treating a depressive resistant episode. The patient has been hospitalized before and treated with two different clases of antidepressants without therapeutic response When admitted the patient had severe depressive episode with strong psychomotor retard .

The treatment with venlafaxine 300mg associated with mirtazapine 30 mg was initiated; the clinical evolution turned rapidly to a maniacal clinical appearance, after 20 days; there were no adverse reactions .

The antidepressant treatment discontinuation was necessary as it was also the beginning of the manic-like episode treatment.

For a MDD severe episode, treatment resistant, venlafaxine associated with mirtazapine had the power to induce a manic-like episode in a nonbipolar patient

This post-hoc study examined the effectiveness of the noradrenaline and dopamine reuptake inhibitor (NDRI) bupropion (at European-approved dose levels up to 300mg per day) versus selective serotonin reuptake inhibitors (SSRIs) in the resolution of sleepiness and fatigue in patients with Major Depressive Disorder (MDD).

Data were pooled from six double-blind, randomised MDD trials comparing bupropion (n=662) with an SSRI (n=655). 343 patients dosed with bupropion at 300mg per day or less, were compared with all SSRI-treated patients. Hypersomnia score was defined as the sum of scores of the Hamilton Depression Rating Scale (HDRS) items 22, 23 and 24. Fatigue score was defined as item 13 score of the HDRS.

A similar proportion of bupropion- and SSRI-treated patients achieved remission at study endpoint (49.3% for bupropion and 49.4% for SSRIs, LOCF, p=0.45, OR = 0.9, 95% CI: 0.69 - 1.18). A smaller proportion of bupropion-remitters had residual symptoms of sleepiness (18.9% vs. 32.1%; p<0.01) and fatigue (19.5% vs. 30.2%; p<0.05) compared to SSRI-remitters. There was greater improvement (mean change from baseline) in sleepiness (p<0.05) and fatigue scores (p<0.01) among bupropion-remitters at endpoint, compared to SSRI-remitters and these benefits were evident from week 2 for sleepiness (p<0.01) and from week 4 for fatigue (p<0.01).

This analysis indicates bupropion treatment (≤300mg per day) offers advantages over SSRIs in the resolution of sleepiness and fatigue in patients who have achieved remission from MDD. These findings support a selective advantage offered by a dual acting dopaminergic/noradrenergic agent over serotonergic based treatment.

The incidence of SSRI´s induced hyponatremia may occur in about 0, 5% to 32%.Recent results identified newer agents like duloxetine as a cause for hyponatremia. The risk factors for SSRI´S induced hyponatremia are: age, female sex, low body mass, using diuretics, and low levels of serum sodium.

To report a case of recurrent hyponatremia after switching from one class of antidepressant to another.

A 71-years-old women with recurrent depression disorder (treated since 6 years with different antidepressant trials) began recurrence treatment with duloxetine. Four weeks later presenting a symptomatic hyponatremia and hypokaliemia she's hospitalized. On physical examination patient was euvolemic and had no evidence of iatrogenic, malignancy, renal, hepatic, adrenal or thyroid disease. The hypothesis of duloxetine induced hyponatremia (not the hypokaliemia) was considered and duloxetine was suspended. Due to the persistence of depression, treatment with sertralina was initiated. Twenty days later Na+ was 127mEq/L, sertraline was discontinued and mianserine introduced .Patient maintained hyponatremia and developed confusion, agitation, and psychotic symptoms (mystic delirious) being admitted in a psychogeriatric inpatient unit. Antidepressant was suspended. Patient became maniac and efficient treatment with a mood stabilizer and atypical antipsychotic initiated. She was discharged after serum sodium concentration normalized, psychotic symptoms and mood disorder stabilized.

Psychiatrists should be aware from the risk of developing antidepressant-induced hyponatremia mainly in elderly patients. Electrolyte measurements concentrations should be monitored, not only in the first weeks of treatment, but throughout the full course, mainly if risk factors are present.

This abstract reports the first phase of a two-phase project that examines utilization and identifies patterns of antidepressants treatment (Phase-I), and compares physician and patient reasons for treatment patterns (Phase-II).

Prescription database of a US national pharmacy chain was queried to identify treatment-naïve patients receiving a new prescription for an SSRI or SNRI. Date of new prescription served as the index date. Patients were classified based on utilization patterns over a 3-month follow-up period post index date. A multinomial logit model was used to predict antidepressant treatment pattern. Statistical analyses were performed with two-tailed alpha 0.05.

The sample consisted of 108,229 patients, with mean age of 43 years, majority females (71%) and with 82% initiating a SSRI treatment at index. Average index copayment for the antidepressant was $23, and 90% of the sample had third-party insurance. Over the follow-up period, 40%, 58%, 2%, and <1% were classified as continuers, discontinuers, switchers and augmenters, respectively. Compared with continuers, augmenters were 34% less likely (95%CI=0.46-0.95) and discontinuers and switchers were 4 and 29% more likely (95%CI=1.00-1.07 and 1.12-1.48) to have an index SNRI vs. SSRI. Discontinuers were 62% more likely than continuers to be cash-paying vs. third-party-paying (95%CI=1.55-1.69). Compared to continuers, augmenters/discontinuers/switchers were more likely (19-79%) to have received their index-prescription from a psychiatrist vs. an internist (p<.05).

Patient, physician, drug and economic factors predicted change in the utilization of antidepressant prescription, discontinuation being the most prevalent. Determinants of discontinuation (lack of efficacy/tolerability/feeling better) will be further explored.

Serotonin has been implicated in the pathophysiology of several mental disorders, such as anxiety and depression which have gender differences in their prevalence and clinical features The aim of this study was to verify the effects of the selective serotonin reuptake inhibitor escitalopram administered acutely on the recognition of facial emotional expressions in healthy women, considering the effects on the gender of the faces.

An oral dose of escitalopram (20 mg) or placebo was given to eighteen non-clinical women in a randomized, balanced order, double-blind design. Three hours later, the participants were presented with pictures of faces from the Pictures of Facial Affect Series (Ekman and Friesen, 1976). Faces with six basic emotions (anger, disgust, fear, happiness, sadness and surprise) had been morphed between neutral (0%) and each standard emotion (100%), in 10% steps. Accuracy was analyzed through MANOVA with repeated measures. Values of p < 0.05 were considered significant.

The acute administration of a single dose of escitalopram impaired the accuracy of the recognition of happy faces of both genders. Moreover, escitalopram facilitated the recognition of sad expressions in female faces but not in male faces..

These results indicate that serotonin modulates the recognition of emotional faces and interacts with the gender of the faces. This has implications for our understanding of disorders characterized by serotonergic dysfunction and clinical differences between genders.

Evaluate the efficacy and tolerability of escitalopram in outpatients with moderate to severe depression in naturalistic settings.

Open label 24 weeks study. Efficacy assessment was based on MADRS, HAM-D, HAM-A, CGI-S and VAS scales. Tolerability was evaluated by spontaneously reported adverse events and treatment discontinuation rates. Statistical analysis was based on an intent-to-treat dataset (ITT - at least one valid post-baseline MADRS measurement, prediction of previous visits using multiple linear regression) and observed cases (OC -MADRS measurements at all 6 visits).

A total of 112 patients between 18 and 65 years old were enrolled. 52 patients (46.4%) suffered from moderate depression (22£ MADRS<30) and 60 (53.6%) from severe depression(MADRS 330). Patients had a significant improvement in their symptoms at the end of the study, as measured by a mean change in MADRS total score of 21.2 ± 7.1 (ITT, multiple linear regression). Change from baseline was bigger in regards to severity of illness (p<0.001). In addition, 89.1% of patients were evaluated as responders (at least 50% decrease in MADRS total score) and 68.2% were evaluated as remitters (MADRS£12) at the end of the study (ITT, multiple linear regression). The results were similar in the OC analysis as well. In total 33 patients (29.5%) withdrew from the study for any reason, -6 of them (5.4%) due to adverse events and 1 (0.9) due to lack of efficacy.

Escitalopram displayed very good efficacy and tolerability in a group of depressed outpatients suffering from moderate to severe illness.

Sexual dysfunction or difficulties(SDOD) exist in one-third of patients with untreated depressed outpatients with PTSD(posttraumatic stress disorder).

SDOD manifested by decreased libido, erectile dysfunction or delayed ejaculation.

This study investigated antidepressant activity and sexual functioning in depressed patients with PTSD taking mirtazapine. In our open-label study mirtazapine was administered for 6-10 weeks to 56 (11 women and 45 men) sexually active adult outpatients. Mirtazapine was titrated from 7,5 mg to 45 mg daily. Efficacy was assessed weekly by 21-item HAMD (Hamilton Depression Rating Scale). Sexual functioning was assessed weekly using Arizona Sexual Experiences Scale (ASEX), 5-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm.

In start of treatment individual HAMD scores were between 18 and 29, none of them experienced any sexual dysfunction prior to treatment.

After 6 weeks of treatment, the individual HAMD scores were between 9 and 17, after 10 weeks HAMD scores were between 7 and 14, indicating significant improvement in depressive symptoms.

None of the patients reported any sexual dysfunction symptoms. Five of the patients reported some unspecific sexsual difficulties and weight gain in three patient.

treatment with mirtazapine was effective in both depressed women and men and no effect on sexual function.

To assess the efficacy of desvenlafaxine succinate (DVS) treatment in patients with major depressive disorder (MDD).

Seven randomized, double-blind, placebo-controlled, short-term studies were pooled to evaluate the efficacy of DVS in MDD. Adult outpatients with DSM-IV MDD were enrolled in all studies. Eligible patients were randomly assigned to DVS (n=1186) at doses of 100–400 mg/d, or placebo (n=797) for 8 weeks. The 17-item Hamilton Depression Rating Scale (HAM-D17) was the primary efficacy variable. Other efficacy variables were the Clinical Global Impressions scale (CGI), HAM-D6, Montgomery Åsberg Depression Rating Scale (MADRS), Covi Anxiety scale, Sheehan Disability Scale (SDS), WHO-5 Well-Being Index, and the Visual Analog Scale–Pain Intensity (VAS-PI). A mixed-effect model for repeated measures (MMRM) analysis was used to analyze continuous variables. Logistic regression was used to analyze response and remission rates.

An adjusted mean difference of –2.8 points on HAM-D17 total score at end point for DVS vs placebo (95% confidence limits: –2.2, –3.4; P<0.001) was demonstrated. Response and remission rates were significantly elevated for DVS-treated patients compared with placebo (P<0.001) across rating scales (HAM-D17, MADRS, and CGI). For other secondary measures at end point, including the CGI, HAM-D6, MADRS, Covi, SDS, WHO-5, and VAS-PI, significant differences from placebo were also observed. No additional benefit was observed for DVS doses above 100 mg/d in analyses of fixed-dose studies.

DVS was efficacious in treating MDD based on standard depression rating scales and measures of anxiety, global severity/improvement, functioning, well being, and pain.

To assess the efficacy of desvenlafaxine succinate (DVS) treatment in reducing symptoms of anxiety in patients with major depressive disorder (MDD).

Data were pooled from 7 randomized, double-blind, placebo-controlled, 8-week DVS trials. All studies enrolled adult outpatients with DSM-IV MDD. Patients were excluded if an anxiety disorder was the primary diagnosis. Eligible patients were randomly assigned to treatment with 100–400 mg/d DVS (n=1186) or placebo (n=797) for 8 weeks. The primary efficacy outcomes in this analysis were the 17-item Hamilton Rating Scale for Depression (HAM-D17) item 10 (Anxiety/Psychic) and the Covi Anxiety total score (measured in 6 of the 7 trials). Patients with a Covi Anxiety score >9 or whose Covi score exceeded their Raskin Depression total score were not enrolled. Changes from baseline were analyzed using a mixed-effects model for repeated measures (MMRM) analysis, which included the fixed, categorical effects of treatment, protocol, visit, and the treatment-by-visit interaction, as well as the continuous, fixed covariate of baseline score. Secondary analyses evaluated changes from baseline to end point using analysis of covariance (ANCOVA, using last-observation-carried-forward [LOCF] and observed cases [OC] analyses).

Improvement from baseline at week 8, the study end point, was significantly greater for the DVS group than for the placebo group on both the HAM-D17 Anxiety/Psychic item and Covi Anxiety total scores in both the MMRM and ANCOVA (LOCF and OC) analyses.

In this pooled analysis, DVS was significantly superior to placebo in the treatment of anxiety symptoms associated with depression.