Background About 30% of psychiatric out-patients with major depression demonstrate partial remission. Aims To explore whether the addition of cognitive therapy (CT) had any differential effect on residual symptoms or ...
详细信息
Background About 30% of psychiatric out-patients with major depression demonstrate partial remission. Aims To explore whether the addition of cognitive therapy (CT) had any differential effect on residual symptoms or social adjustment. Method Patients with residual symptoms of major depression (n=158) were randomised to receive clinical management (CM) alone, or CM plus 18 sessions of CT. Subjects' depressive symptoms and social functioning were assessed regularly over 16 months. Results The addition of CT produced statistically significant differential effects on: two out of four measures of overall severity of depression;specific psychological symptoms (guilt, self-esteem and hopelessness);and social functioning (including dependency, interpersonal behaviour and friction). Conclusions In patients showing only partial response to antidepressants, the addition of CT produced modest improvements in social and psychological functioning. The implications for research on the mechanisms of action of CTare discussed. Declaration of interest Supported by grants from the Medical Research Council and an additional grant from the Oxford and Anglia Region.
Clinical and preclinical data suggest that unrestrained secretion of corticoctropin-releasing hormone (CRH) in the CNS produces several signs and symptoms of depression and anxiety disorders through continuous activat...
详细信息
Clinical and preclinical data suggest that unrestrained secretion of corticoctropin-releasing hormone (CRH) in the CNS produces several signs and symptoms of depression and anxiety disorders through continuous activation of CRH1 receptors. This led to the development of drugs that selectively antagonize CRH1 receptors suppressing anxiety-like behavior in rats and also in monkey models of anxiety. These findings led to a clinical development program exploring the antidepressive potential of R121919, a water-soluble pyrrolopyrimidine that binds with high affinity to human CRH1 receptors and is well absorbed in humans. This compound was administered to 24 patients with a major depressive episode primarily in order to investigate whether its endocrine mode of action compromises the stress-hormone system or whether other safety and tolerability issues exist. The patients were enrolled in two dose-escalation panels: one group (n = 10) where the dose range increased from 5-40 mg and another group (n = 10) where the dose escalated from 40 to 80 mg within 30 days each. Four patients dropped out because of withdrawal of consent to participate (three cases) or worsening of depressive symptomatology in one case. We found that R121919 was safe and well tolerated by the patients during the observation period. Moreover, the data suggested that CRH1-receptor blockade does not impair the corticotropin and cortisol secretory activity either at baseline or following an exogenous CRH challenge. We also observed significant reductions in depression and anxiety scores using both, patient and clinician ratings. These findings, along with the observed worsening of affective symptomatology after drug discontinuation, suggests that the pharmacological principle of CRH1-receptor antagonism has considerable therapeutic potential in the treatment and the prevention of diseases where exaggerated central CRH activity is present at baseline or following stress exposure. (C), 2000 Elsevier Science
Elderly patients are particularly susceptible to the potential side effects of current antidepressants due to age-related physiologic changes. We report a pilot study to examine the tolerability of increasing doses of...
详细信息
Elderly patients are particularly susceptible to the potential side effects of current antidepressants due to age-related physiologic changes. We report a pilot study to examine the tolerability of increasing doses of reboxetine, a selective noradrenaline reuptake inhibitor (selective NRI), in elderly depressed patients. Twelve elderly female patients (75-87 years) with either major depression or dysthymia received reboxetine titrated to 8 mg/day over a 4-week period. Tolerability was assessed and included the measurement of vital signs. Electrocardiograms were recorded at baseline and on days 14 and 28. Newly emergent signs and symptoms were recorded throughout the study. Efficacy was assessed using four rating scales, including the Clinical Global Impression (CGI) scale and Hamilton Depression Rating Scale (HAM-D). Eleven patients completed the study, nine received the maximal dose of reboxetine 8 mg/day, and two received maximum doses of reboxetine 6 mg/day due to cardiac rhythm changes in week 3. A total of five patients experienced tachycardia (including two with cardiac rhythm changes in week 3). At the end of the study, seven patients were "much" to "very much" improved on the CGI scale with a concomitant decrease in HAM-D total score of 22% to 41%. Reboxetine was well tolerated by the majority of patients and efficacy outweighed side effects in 75% of patients. Reboxetine 4 mg/day, increasing to 6 mg/day on the basis of individual patient tolerability, may be considered as a safe dose range for testing the efficacy and tolerability of reboxetine in long-term controlled clinical trials in elderly patients with depression.
Epidemiologic data are used as a framework to discuss the pharmacologic and cognitive-behavioral management of anxiety disorders in late life. Generalized anxiety disorder (GAD) and phobias account far most cases of a...
详细信息
Epidemiologic data are used as a framework to discuss the pharmacologic and cognitive-behavioral management of anxiety disorders in late life. Generalized anxiety disorder (GAD) and phobias account far most cases of anxiety in late life. The high level of comorbidity between GAD and major depression, and the observation that the anxiety usually arises secondarily to the depression, suggests that antidepressant medication should be the primary pharmacologic treatment for many older people with GAD. Most individuals with late-onset agoraphobia do not have a history of panic attacks and the illness often starts after a traumatic event. Exposure therapy is the treatment of choice for agoraphobia without panic. It is uncommon for obsessive-compulsive disorder (OCD) and panic disorder to start for the first time in old age, but these disorders can persist from younger years into late life. Case reports and uncontrolled case series suggest that elderly people with OCD or panic disorder can benefit from pharmacologic and cognitive-behavioral treatments that are known to be effective in younger patients. However, it is not known whether the rate of response among elderly patients is adversely affected by the chronicity of these disorders. The prevalence and incidence of post-traumatic stress disorder in late life are not known. Uncontrolled data support the use of selective serotonin reuptake inhibitors in war veterans with chronic symptoms of post-traumatic stress disorder;other treatments for this condition await evaluation in the elderly.
暂无评论