[4th meeting in psychiatry: schizophrenias today].
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Forecasting↗
Biomedical subjects
Christian Spadone
Publications and source records attributed to Christian Spadone.
Onset of action of escitalopram compared with other antidepressants: results of a pooled analysis.
In general, antidepressant drugs are regarded as too slow acting. Most patients who benefit from treatment require more than 2 weeks of therapy to respond to treatment. An efficacious and well-tolerated antidepressant drug with an earlier onset of effect would be of greater interest to clinicians and patients. To study the onset of effect of escitalopram, a selective serotonin reuptake inhibitor (SSRI), data were pooled from controlled randomized clinical double-blind trials comparing this drug with other antidepressant drugs (SSRIs and venlafaxine XR) in major depressive disorder (MDD), with assessments of the primary efficacy parameter [mean change in the Montgomery-Asberg Depression Rating Scale (MADRS) total score from baseline, using last observation carried forward]. The mean change in MADRS total scores was significantly higher for escitalopram-treated patients than for patients treated with the comparators on day 7 (-3.9 versus -3.4, respectively, P = 0.029). This difference remained significant and in favour of escitalopram at all subsequent assessments. Using secondary outcomes (Clinical Global Impression of Improvement and Severity scales and early improvement), the results consistently showed a statistically significantly faster onset of effect of escitalopram compared to other antidepressants. In conclusion, by using the MADRS scale and pooling data from the escitalopram clinical trials in MDD comparing escitalopram with other active antidepressant drugs, escitalopram was shown to be a fast-acting antidepressant with a more rapid onset of effect than the comparators, particularly other SSRIs.
Antidepressive Agents↗
[Evolution of depressive disorders].
A MAJOR RISK RECURRENCE: The sparcity of data in the absence of treatment renders assessment of the natural course of depressive disorders difficult. Naturalist studies have identified various elements that characterise the evolution. After an episode of depression, usually lasting 6 to 8 months, the disorder is marked by a high risk of recurrence. Fifty to 85% of the patients having exhibited an episode of major depression will relapse at least once in their life. A CHRONIC DISEASE: The propensity in the repetition of depression and the socio-professional and family impact that results has led to an increasing number of authors to consider the problem as a chronic disease, like asthma or diabetes. IN TERMS OF MANAGEMENT: It is important to replace depression in the progressive perspective of a chronic disease and to avoid, after the first episode, the risk of relapses and recurrences. During treatment of the acute phase, we recommend treatment to be continued up to 12 months after complete remission, so as to reduce the risk of relapse. Regarding prevention of recurrences, treatment should be continued for more than 12 months in patients who have had 3 episodes of depression or, in certain cases, only two. THE CONSEQUENCES OF A LACK OF INFORMATION: Research work has shown that depressive disorders have been insufficiently treated: either the doses are too low or the prescription is withdrawn too quickly, or the patient does not fully comply. In the majority of cases, insufficient management stems from a lack of knowledge on the course of depressive disorders and on treatment modalities, as far as not only the practitioner but also the patient are concerned.
Aged↗
Efficacy and safety of hydroxyzine in the treatment of generalized anxiety disorder: a 3-month double-blind study.
BACKGROUND: The prevalence of generalized anxiety disorder (GAD) represents an important public health issue. Hydroxyzine, an antagonist of histamine receptors, showed both efficacy and safety in previous short-term double-blind studies over placebo in this pathology. The aim of the current study was to confirm those positive results over a 3-month period in adult outpatients. METHOD: This multicenter, parallel (hydroxyzine [50 mg/day]; bromazepam [6 mg/day]), randomized, double-blind, placebo-controlled trial included 2 weeks of single-blind run-in placebo, 12 weeks of double-blind randomized treatment, and 4 weeks of single-blind run-out placebo. Three hundred thirty-four of 369 selected outpatients with a diagnosis of GAD according to DSM-IV criteria and a Hamilton Rating Scale for Anxiety (HAM-A) total score >/= 20 were randomized before entering the double-blind period. The primary outcome criterion was the change in the HAM-A score from baseline to 12 weeks of double-blind treatment with hydroxyzine compared with placebo. RESULTS: In the intent-to-treat analysis, the mean +/- SD change in HAM-A scores from baseline to endpoint was -12.16 +/- 7.74 for hydroxyzine and -9.64 +/- 7.74 for placebo (p =.019). Results at endpoint for percentage of responders (p =.003) and remission rates (p =.028), Clinical Global Impressions-Severity scale score (p =.001), maintenance of efficacy (p =.022), and Hospital Anxiety and Depression scale score on day 84 (p =.008) also confirmed the efficacy of hydroxyzine over placebo. The study showed no statistically significant difference between hydroxyzine and bromazepam. Except for drowsiness, which was more frequent with bromazepam, safety results were comparable in the 3 groups. CONCLUSION: Hydroxyzine showed both efficacy and safety in the treatment of GAD and appears to be an effective alternative treatment to benzodiazepine prescription.
Adult↗