The aim of this study was to verify the effects of the selective serotonin reuptake inhibitor escitalopram on the recognition of facial emotional expressions.

Twelve healthy males completed two experimental sessions each, separated by at least 2 weeks, in a randomized, balanced order, double-blind design. An oral dose of escitalopram (10 mg) or placebo was given 3 hours before the task. Face recognition task: Subjects 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.

Volunteers recognized more accurately negative emotions in female faces than in male faces, whereas happiness was identified more easily in male faces. In general, the acute administration of a single dose of escitalopram increased the accuracy of the recognition of angry and sad faces. When the gender of the faces was analyzed, escitalopram facilitated the recognition of sad expressions and impaired the recognition of happy faces in male, but not in female faces. A global order effect has also been found; the administration of escitalopram in the second experimental session facilitated the recognition of emotional expressions.

These results indicate that serotonin modulates the recognition of emotional faces. Previous experience and gender of the emotional face interact with this modulation.

To compare the quality of life using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) in patients with MDD or GAD, before and after treatment and to compare remission based on symptoms versus functioning.

Q-LES-Q and symptom-specific MADRS and HAMA data from 8 published randomised, 8-week, double-blind, placebo-controlled clinical trials with escitalopram were used. The short form of the patient-rated Q-LES-Q was used to assess patients’ perceived quality of life and satisfaction at baseline and at last assessment. ANCOVA was used, adjusting for study, centre, baseline value, and treatment. MADRS and HAMA total scores were equated to Q-LES-Q using the method of equipercentile linking.

MDD or GAD patients report a substantial degree of impairment in their quality of life (64% and 76% of community norm, respectively). Treatment with escitalopram resulted in statistically and clinically significant improvement in patient quality of life. The improvement was greater in remitters (MADRS<=12 or HAMA<=7) than in non-remitters and greater in patients treated with escitalopram than in patients treated with placebo. There was a strong correlation between each symptom scale (MADRS, HAMA) and the Q-LES-Q. The present analyses suggest that scores as low as 3-8 on the MADRS and 5-10 on the HAMA (complete remission) correspond to a Q-LES-Q score of 58 (+/- 10%), found in community comparison subjects.

Treatment with escitalopram results in a statistically significant improvement of quality of life in patients with MDD or GAD.

Evidence in the literature supports the introduction of interventions to enhance adherence to antidepressant therapy, especially in patients with major depression.

The objectives of this study are; (1) to examine patient and population-based research on patient's adherence to antidepressants and (2) to develop and psychometrically assess a four-item instrument to measure adherence to antidepressants.

Although causes for non-adherence are multifatorial, drug omissions could occur in one or more, of main four mechanisms; forgetting, carelessness, stopping the drug when feeling worse, or stopping the drug when feeling better. To our knowledge, no reliable valid instruments were developed to measure adherence to antidepressants. Authors modified an instrument that was developed by (Morisky 1986), to measure adherence to antihypertensive drugs. The modified instrument was distributed to experts in depression (n=12), to rate the instruments’ relevancy, as a measure of patients’ adherence to antidepressants, and was administered to patients (n=63), who are on antidepressants.

The modified instrument has an improved reliability (Chronbachs’ Alpha = 0.66), there is 90 %, overall agreement among experts, that the instrument relevant to measure adherence in outpatients with depression, supporting a strong evidence for content validity, and there is also strong evidence for convergent and criterion related validities.

The developed instrument is short, both reliable and valid, and could be completed in approximately 3 minutes. Although it was developed for with outpatients, it could be applied in different sittings, with wide range of psychiatric population who suffer from depression.

SEROQUEL® (quetiapine) is an atypical antipsychotic in the dibenzothiazepine class. Clinical studies have demonstrated consistent efficacy in the treatment of schizophrenia, bipolar mania, and bipolar depression. Further clinical results suggest robust efficacy in the long-term treatment of bipolar disorder and major depressive disorder. This broad spectrum of clinical effect has not been fully predicted based on quetiapine's preclinical pharmacology. However, norquetiapine, a recently discovered major active human metabolite of quetiapine, has unexpected properties that may explain the observed clinical antidepressant and mood-stabilizing effects.

Radioligand binding and functional assays using rat and human tissue were used to characterize receptor interactions. Positron emission tomography (PET) studies performed on cynomolgus monkeys and man explored the relationship between clinically relevant plasma exposures and occupancy at serotonin 5HT2A and dopamine D2 receptors and the norepinephrine transporter (NET).

Norquetiapine had high affinity for and potently inhibited the NET, a property shared by tricyclic antidepressants and SNRIs but not other atypical antipsychotics at clinically relevant doses. In addition, norquetiapine had moderate-to-high affinity for D2, 5HT1A, 5HT2A, and 5HT2C receptors and shared some commonality with SSRIs. PET studies confirmed the properties of norquetiapine including occupancy of D2 and 5HT2A receptors as well as the NET at clinically relevant plasma exposures.

A unique combination of direct and indirect effects at noradrenergic, serotonergic, and dopaminergic receptors by quetiapine and norquetiapine provides a putative mechanism of action for the broad spectrum of clinical efficacy observed with SEROQUEL® in psychiatric disorders.

Two-month head-to-head clinical trials of escitalopram and venlafaxine demonstrated similar efficacy and better tolerability for escitalopram. However, as routine practice may differ from controlled trial, it is necessary to investigate the translation of clinical trial findings into real life. This work aims at comparing treatment early discontinuation (ED) at 1 and 2 months and its economic consequences at 6 months, under venlafaxine and escitalopram.

Using US denominator-based claims database PharMetrics (includes data from 86 managed care health plans covering 45 million patients), we included adult patients diagnosed with depression who started venlafaxine or escitalopram between January 1st and December 31st 2004. ED was compared at 1 and 2 months using Cox proportional hazard models and healthcare costs at 6 months, using log-linear regression. Propensity scoring was used to account for baseline differences.

13,227 patients started escitalopram; 5,922 patients started venlafaxine. ED at 2 months was 47% for venlafaxine, 45% for escitalopram. At 1 month, venlafaxine patients had 50% more risk of ED than escitalopram patients (Hazard Ratio=0.493 [95%CI 0.432-0.564]); while this difference decreased at 2 months, (Hazard Ratio=0.955 [95%CI 0.912-0.999]). Continuing treatment at 2 months doubled the chance of still being on treatment at 6 months. Moreover 1) ED at 2 months incurred more costs over 6 months (+US$173); 2) 6-month healthcare costs were higher with venlafaxine (+US$626, p<0.001).

Early discontinuation rate was higher with venlafaxine than escitalopram, possibly due to intolerance to venlafaxine. ED was shown to affect later continuation and incurred costs.

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.