To evaluate the effectiveness and tolerability of escitalopram in patients suffering from depression with or without comorbid mental and/or physical disorders in a naturalistic setting.

Open-label 3-month study, conducted in 186 investigational sites in Greece. Efficacy assessment was based on CGI-S, MADRS and CGI-I scales. Tolerability was evaluated by spontaneously reported adverse events and treatment discontinuation rates. Statistical analysis was based on a modified intent-to-treat dataset (at least one valid post-baseline CGI-S measurement) and the per protocol dataset (valid CGI-S measurements at all 3 visits).

The analysis dataset of the study included 3,931 patients (mean age 45.5±10.8, 65.8% women, 37.4% with any comorbidity, and baseline mean MADRS 26.7±8.4). Patients with comorbid mental disorders were more severely ill at baseline (p< 0.001, both MADRS and CGI-S). Patients showed significant improvement (p< 0.001) during the treatment period based on both MADRS and CGI-S scores. There was no significant difference between the four groups (no comorbidity, comorbid mental disorder, comorbid physical disorders, comorbid mental and physical disorders). However, for both scales, the change from baseline increased with the severity of illness. Patients in the comorbidity groups had slightly higher overall discontinuation rates (8.2% to 10%) than patients without comorbidity (6.9%), with a total of 7.8% (n=308) Discontinuation due to adverse events was 2.3% (n=92).

Escitalopram was comparably effective and well tolerated in depressed patients with and without mental and/or somatic comorbidity.

To evaluate the efficacy and safety of venlafaxine hydrochloride(HCL) sustained release capsules in treating juvenile with depressive disorder.

A randomized, double blind dummy clinical trial enrolled 60 adolescent patients with depression, who were randomizedly designed to administer venlafaxine HCL sustained release capsules 150 mg or fluoxetine 20 mg daily for 8 weeks. The efficacies 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 gtnups (P< 0.O1). The effective rate of venlafaxine HCL sustained release capsules versus fluoxetine treatmlent was 70.0% and 65.5%, respectively, the P value showed no statistical difference (P>0. OS). The common adverse reactions included dry mouth, insomnia, dizziness, and loss of appetite.

Venlafaxine HCl sustained release capsules is an effective agent for juvenile with major depression.

The examination has shown that the possible side effects of sertraline are rare and mainly of temporary nature, and confirm the effectiveness and safety of sertraline in routine clinical practice.

Depression as a common psychiatric disorder can occur in two types: Endogenous or genetic and exogenous or Reactional. These two types of depression, from the point of view of response speed to treatment and type of appropriate drug for treatment are different. This study has been executed to compare therapeutic effects of different classes of anti-depressant drugs in treatment of genetic and Reactional depression.

Present survey is a clinical-trial study, a completely randomly block type, that has performed on 30 patients (male and female). Selection of study sample accomplished randomly among unipolar depressed patients that has referred to Ardabil’s psychiatry clinic diagnosed based on DSM-IV criteria. Researcher - Made questionnaire, Beck, and Catelle depression test were used to collect data. To analyze data, for completely randomly blocked designs, two-factor variance analysis method and F test were used.

This study showed that Genetical depression does not response treatment Rapidly and its response type is not good and persistent. From the point of view of time, Reactional depression has a delaying response but its response type is good and persistent. In addition, no difference was observed in efficacy of different classes of drugs for treatment of these two types of depression. The results of this research showed that there is no difference between treatment response of two types of depression (Genetical and Reactional).

There is no preference in efficacy of different classes of drugs in treatment of these two types of depression.

Infection with the hepatitis C virus is a global problem with the prevalence of around 3%and a tendency of becoming chronic with 75% of the infected people.

The latest research indicates that chronic hepatitis C is connected with a higher risk of the beginning of depression.It also indicates that depression is more common with patients who have a chronic HCV infegtion as compared with other liver diseases.

The aim of this study was to evaluate the efficiency of tianeptine in depression treatment of people with chronic hepatitis C.

A total of 3o patients with serologically affirmed diagnosis of hepatitis C,aged 30 to 55 years,were included in this study.The level of depression with these patients was measured using MADRS scale.The minimal score value on the MADRS scale during the initial rounds was 25.The patients received 37.5 mg of tianeptine for 8 weeks without the concomitant therapy.Rounds were organized at the beginning of the treatment, after 3 weeks,and after 8 weeks of treatment for all patients.

There is a significant improvement in terms of reduction in depression on the MADRS scale with patients treated with tianeptine after 3 and 8 weeks of treatment as compared with the initial rounds.70% of patients treated with tianeptine reduced the score on the MADRS scale, to 15 and lower after 8 weeks of treatment.

Tianeptine shows considerably useful effects in reduction of depression symptoms with patients with chronic hepatitis C infection.

Akathisia is a side effect generally associated with antipsychotic drugs. However, akathisia is also reported as a side effect of antidepressants, especially of the selective serotonin reuptake inhibitor group. Mirtazapine is an antidepressant that has a special role in relation with akathisia. There have been randomized controlled studies reporting that mirtazapine is effective in treatment of antipsychotic-induced akathisia. However, there have also been few cases in which acute akathisia are induced by mirtazapine. We would like to report a case of mirtazapine induced tardive akathisia.

Mrs. A is a 43-year old woman who applied to psychiatrist four years ago for complaints such as depressive mood, anhedonia, reduced sleep and poor appetite. She was diagnosed as having a major depressive disorder and prescribed 15 mg mirtazapine at night. Mrs. A benefited from the treatment within 1-2 months, complied with medication but did not attend follow-up examinations. About a year later, she started to have severe restlessness, shaking and need to move about one hour after mirtazapine intake. Therefore, patient started use mirtazapine once every three days for the following three years. Akathisia starting after mirtazapine intake disappeared about 8-10 hours later and patient did not have akathisia during two days that she did not have mirtazapine intake.

Mirtazapine might be effective both in treatment and precipitation of akathisia. These effects might be determined by multiple interactions among factors such as duration of mirtazapine treatment, presence of concomitant treatment, neurological basis of the disorder.

Depressive symptoms present quite frequently in in-patients in general hospitals with a variety of organic conditions. The main aim of treatment is to manage the symptoms and prevent them from recurring.

The primary endpoint for this study was to assess the effectiveness of treatment with duloxetine in a group of in-patients with depressive symptoms in the general hospital.

This was an observational study with duloxetine, in which a total of 40 patients were included who presented depressive symptoms while in-patients in a general hospital and who had the established inclusion criteria.

The clinical effectiveness of the treatment was assessed with the Hamilton scale and the Clinical Global Impression scales for severity and change.

A total of 40 patients were treated with duloxetine, 6 of whom (15%) dropped out of the study. The average maintenance dose administered at the baseline visit was 60 mg/day and at discharge was 75 mg/day. At the end of follow-up, there was a reduction with respect to the baseline values of 13.6 points on the Hamilton scale and 2.4 points on the CGI of severity scale. 63.4% of the patients felt “much better” at the final visit, according to the CGI of change scale.

According to the results, it seems that DULOXETINE may be a good treatment option for patients admitted to general hospital for different conditions of organic origin who present depressive symptoms while in hospital, both for its therapeutic effectiveness and for its good tolerability profile.

There is a lot of interference between depression and diabetes - mellitus and vice versa. Therefore, control of blood glucose levels in depressive patients and also to knowing the effect of antidepressants on blood glucose levels is important.

This study was performed to determine the effect of 4 and 8 weeks treatment with Fluoxetine and Imipramine on the fasting blood sugar (FBS) of patient with major depressive disorder.

This study was a parallel randomized clinical trial that was performed in 2006 on out - patients, of the psychiatric ward of Hashemi Senejani Hospital of Arak - Iran, for major depression treatment; there were 40 subjects in each group. These patients had their F.B.S. tested three times, before beginning and 4 and 8 weeks after treatment, respectively.

There were not significant statistical differences between first and second time mean F.B.S. values in group A, but we had a significant decrement in first and third times mean F.B.S. values (p < 0.05). There was also a significant increment in second and third times mean F.B.S. values versus first time mean F.B.S. values in group B (p > 0.05).

In this study, we have found that there is a decrement in F.B.S. mean value after 8 weeks of treatment with Fluoxetine and increment in FBS after 4 and 8 weeks of treatment with Imipramine. Therefore, we recommended Fluoxetine for hyperglycemic depressive patients and Imipramine for hypoglycemic one.

Medication compliance is associated with the treatment outcomes. The reported consequences of non-compliance are chronification, poor psychosocial outcomes and increased suicide rates. We measured the drug compliance using medication event monitoring system (MEMS) and several compliance measures in the outpatients with depressive disorders. In addition, we tried to find out the relationship of antidepressant compliance with other clinical correlates including insight in depressive disorders.

This study was performed in Korea university medical center, Guro hospital. Outpatients diagnosed as having depressive disorders were enrolled. Monitoring was performed in 76 depressive patients who were taking the mono-antidepressant therapy during the at least 4-week evaluation period. 17 item Hamilton Rating Scale for Depression (HRSD), Multidimensional Scale of Perceived Social Support (MSPSS) and the mood disorders insight scale (MDIS) were investigated. Compliance was measured using MEMS, clinician rating scale of antidepressant compliance, pill count, and patient's self-report.

A total of 76 outpatients were enrolled in this study. As the severity of depression increases, patients tended to perceive poor social support from others in the correlation analysis. Level of depression by HRSD was significantly correlated with MDIS scores. Compliance rates for MEMS, pill count, clinician rating scale of compliance and self-report were 51.9%, 71.4%, 79.2% and 75.3% respectively. We did not find any statistical significance between compliance variables and other clinical scale scores (MDIS, HRSD, and MSPSS).

More severely depressed patients have higher scores of insight in case of depression. However, increased perception of insight in depressive patients was not directly related with the increase in treatment compliance. Further investigation is needed to understand other factors affecting the drug compliance especially in depressive patients.

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As practice guidelines recommend to maintain antidepressant treatments for a long duration after improvement of symptoms in order to prevent relapse or recurrence, our objectives were to explore the duration of the antidepressant drug treatment in France and to characterise the antidepressant users with a short duration of treatment.

An observational retrospective cohort study was conducted in the community-dwelling population 18 year-old and over through claims databases of the public health insurance. A random sample of 34.663 outpatients who initiated an antidepressant treatment between the 1st January 2005 and the 31st December 2006 were selected. The dependent variable was the duration of the first episode of antidepressant treatment, categorised a priori in short duration [1-6 months[ versus long duration [6 months and more] according to guidelines. Characteristics independently associated with the treatment duration were investigated using logistic regressions.

Nearly two thirds of the individuals were females. Most patients were not on welfare. Three quarters of them did not present with chronic conditions. The duration of the antidepressant treatment complied with the international recommendations for only one patient of six. Adequate treatment duration was associated with being a female, being older, not being on welfare, presenting with a chronic condition and a treatment introduction by a psychiatrist or a hospital practitioner.

The recommendations concerning the duration of an antidepressant treatment are rarely respected in a real-life setting in France. Further analyses should be conducted to characterise the patterns of prescription according to antidepressant classes and associated treatments.

This paper reviews the novel usage of riluzole, an antiglutamatergic and neuroprotective agent, for affective and behavioral stabilization in autism.

A review of the English-language literature on riluzole usage for pediatric and adult psychopathology, combined with the author's experience with two autistic patients who demonstrated prominent affective stabilization and reduction in self-injury with riluzole.

Riluzole was developed for usage in amyotrophic lateral sclerosis, and is the only drug to slow the progression of this devastating neurological disease. Riluzole inhibits release of glutamate, the primary excitatory amino acid in the brain, and enhances GABA-A receptor function. Riluzole has demonstrated efficacy in open-label trials of adult unipolar and bipolar depression as well as pediatric and adult obsessive-compulsive disorder. Case reports have additionally documented benefit in trichotillomania and self-injury. There is not yet published literature on riluzole usage in autism, but the following cases are presented:

Pt 1: A 20 year-old male with autism, depression with suicidality and self-injury who demonstrated a partial response to electroconvulsive therapy and traditional adjunctive psychopharmacology. Riluzole addition provided sustained remission of residual symptoms.

Pt 2: A 9 year-old male with autism, cyclical mood disturbance and extreme self-injury towards the head requiring extensive protective equipment for safety. Riluzole conferred both affective stabilization and prominent reduction in self-injury.

Riluzole is a new psychopharmacological agent. Efficacy has been demonstrated for mood and anxiety disorders in the typically-developing population. Similar positive benefit may be seen for psychopathology in autism, and merits further investigation.

Hyponatremia (HPN) is a potentially lethal electrolytic disturbance. Certain medical treatments are integrated in the etiology of that sodium disorder. We retrospectively studied the rate of HPN in patients examined in the emergency room (ER) of Alexandra Hospital receiving a selective serotonin reuptake inhibitor (SSRI).

17,410 patients, 55.54% women and 44.46% men were examined in the ER over a one year period. 281 patients (1,61% of total) presented with HPN, 162 were women (57.6%) and 121 (42.3%) men. Plasma Sodium values ≤ 133mEq/l defined HPN. 13 of the 281 patients with HPN (4.6%) with no renal, heart or hepatic impairment were on an SSRI regimen.

11 of 162 women (6.8%) presented with HPN were receiving concurrently SSRI and either thiazide diuretic (3 ) or furosemide (2 ). 2 of 121 men (1.65%) were on SSRI regimen and furosemide. SSRI dosage was in all cases within suggested therapeutic limits. Table 1 demonstrates mean values and standard deviation of all the parameters examined.

SSRI therapy presents a potential cause for HPN principally in women older than 65 years old with increasing risk when diuretic is used concomitantly. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and expression conversion of aquaporin-2 receptors of the collecting ducts are two possible pathophysiologic mechanisms of HPN occurrence.

To evaluate anxiety syndrome prevalence and to investigate the association between anxiety and somatic morbidity in a population-based study of elderly: the “Faenza Project” (De Ronchi, 2005).

6987 cognitively intact subjects living in the Faenza area (mean age 71,88 years; 59,2% women) underwent semi-structured interviews and were clinically assessed in order to evaluate somatic and mental health status (ICD-10 criteria). Multi-morbidity was defined as the presence of two or more somatic diseases (hypertension, diabetes, dyslipidemia, cardiovascular, gastro-intestinal, endocrine diseases, psychiatric disorders, osteoporosis, Parkinson's disease (PD) and stroke). The association between anxiety and somatic morbidity was calculated by Logistic regression analysis estimating Odds Ratios and 95% Confidence Intervals (OR, 95%CI), adjusting for age, education, gender, marital status, socio-economic status, smoking habits and alcohol consumption.

The prevalence of anxiety syndrome was 11,1% (8,6% women vs 2,5% men, p< 0.001). Taking into account possible confounders, anxiety syndrome was associated with depressive syndrome (OR,95%CI=4.55,3.73-5.54), osteoporosis (OR, 95%CI=1.37,1.13-1.65), Parkinson's disease (OR,95%CI=4.18,2.55-6.85) and multi-morbitidy (OR,95%CI=1.75,1.46-2.10). When all these conditions were included simultaneously in the logistic model, however, only depressive syndrome and PD were still significantly associated with anxiety: OR,95%CI=4.10,3.22-5.23 and OR, 95%CI=3.02,1.73-5.28 respectively.

The well known association between depression and anxiety is confirmed in our elderly population independently of other medical factors. Furthermore, a strong association between PD and anxiety resulted independently of co-occurrence of depression.

To assess perception of stigma in patients suffering from combat-related posttraumatic stress disorder.

Sixty one veterans from 1991-1995 war in Croatia (mean age 43,8 years SD 6,3) with diagnosis of PTSD according to the 10th revision of the International Classification of Diseases hospitalized consecutively on acute psychiatric department during 6 months were assessed. Stigma was measured with Internalized Stigma Mental Illness inventory that has five subscales: Alienation; Stereotype Endorsement; Perceived Discrimination; Social Withdrawal and Stigma Resistance, and with Devaluation-Discrimination Scale both rated on four possibilities Likert scale: (1-strongly disagree to 4-strongly agree). Mississippi Scale for Combat-related PTSD was used to determine the severity of PTSD symptoms. It consists of 35 statements that are rated on a 5-point Likert scale (1 - “absolutely incorrect” to 5 - “absolutely correct”). A 100mm long visual analogue scales anchored with “not at all” and “very strongly” were used for assessing religiosity, social support and family problems caused with patient's illness.

Discrimination-devaluation scale was correlated with social support (r=0,373 p=0,003) indicating less discrimination with higher social support and with intensity of PTSD (r=-0,320 p=0,017). ISMI was correlated with intensity of family problems (r=0,299; p=0,019) and M-PTSD (r=0,588; p=0,001). Regression analyses indicated social support as significant predictor of less discrimination (R=0,570; p=0,021), and intensity of symptoms as predictor of high perceived stigma (R=0,653;p=0,001). Unsolved veteran invalidity status was associated with higher number of hospitalizations (t=2,097; df=59; p=0,042).

Stigma perception in PTSD depends on social support and intensity of the symptoms.

Level of anxiety and pain intensity before and after splint treatment of patients with temporomandibular joint disorder (TMJD) was compared.

TMJD in 60 patients (mean age 37.9 years, 80% women) was diagnosed using patient's history and clinical examination, and was confirmed by magnetic resonance imaging of the TMJs. Pain intensity was rated on a visual-analogue scale. The anxiety was confirmed by Spielberger's State-Trait Anxiety Inventory (STAI).

A higher level of anxiety was determined due to the fact that the mean score in STAI 1 was 39.80 and STAI 2 was 41.10. Before visiting a dentist, the patients suffered pain for 8.7 months on average. There is a statistically significant difference between patients depending on how long they previously suffered pain and anxiety values for all patients in STAI 1 and 2 (p< 0.0001). Including only patients with determined anxiety depending on age and gender there was no statistical difference in previous pain duration (p>0.05). There is a correlation between anxiety values on STAI 1 scale and post-treatment pain intensity (p< 0.026), and on STAI 2 scale pain intensity proved to be statistically significant before (p< 0.002) and after (p< 0.049) treatment. There was a statistically significant difference in scores of STAI 2 tests of patients with bruxism behaviour (p< 0.042).

There is a possibility of negative interaction of psychological and psychosocial factors within all forms of musculoskeletal disorders’ treatment, including TMDs. This study confirmed the connection between anxiety and various categories of pain intensity in patients during splint treatment.

Depression, anxiety and self contempt increase in recent years. A number of these patients, who have chest pain, come or refer to cardiovascular clinic without any cardiovascular or other organic disease. Such patients will be deviated from correct therapeutic way. It seems that demographic factors can affect on psychological disorder of these patients and the cause of their refer to cardiovascular clinic.

The aim of this study was to determine the correlation of depression, anxiety and self contempt with demographic factors in cardiovascular clinic referrals in Semnan, IRAN.

In this analytical-descriptive study, data were collected in questionnaire from 400 patients who referred to cardiovascular clinic with chest pain and do not have any cardiovascular or other organic disease and analyzed by t-test, chi-square and men-vitni tests.

Of the 400 patients, 55.8% of women, 57.1% of divorced and 60% persons with less than one million RLS income showed light depression. Also, 73% of persons with less than one million RLS income, showed light anxiety, 36.1% of women showed light self contempt and 30.8% of divorced showed moderate self contempt.

In this study, depression was correlated with sex, divorce and low income, anxiety was correlated only with low income, self contempt was correlated with sex and divorce. Results of this study showed similarity with some studies and differ from other studies. It seems that this difference arises from patient's cultural diversity.