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D Sechter

Publications and source records attributed to D Sechter.

82 records · Page 5Linked to original sources
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[Yawning and sexual excitation under clomipramine. Role of serotoninergic mechanisms. Apropos of 2 cases].

We report two cases of a singular side effect induced by clomipramine, one in a man, the other in a woman (both patients were beninese). This consisted of the occurring of the association of very frequent yawning and sexual excitation (sexual excitation with vaginal lubrification for the woman and hypogastric feeling of sexual pleasure for the man). It appeared after a few days of ambulatory treatment of a depression with clomipramine 75 mg/day. Clomipramine and demethylclomipramine blood levels were respectively 85 and 95 ng/ml and 70 and 80 ng/ml for the two patients. Three similar cases had been reported in the literature with this same tricyclic antidepressant. Recently a first case has been reported with fluoxetin. On this basis, it could be suggested that serotoninergic mechanisms are involved in the development of such clinical manifestations. But it seems reasonable to consider that serotoninergic mechanism could interact with a dopaminergic one. In favour of this hypothesis is the implication of dopaminergic mechanisms in yawning in man or in the association yawning--penile erections in the rat. Some others clinical arguments are discussed.

Adult↗
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[Interrelations of inhibition and anxiety].

Normal anxiety and inhibition play a role in the development and the structuration of the personality, and in processes of adaptation to the environment. Pathological anxiety and inhibition are expressed by different symptoms, closely associated, essentially during reactional and neurotic troubles, which are denominated "anxiety disorders" in the DSM-III. Their interrelations are important, whatever the etiological approach would be: --between inhibition, symptoms and anxiety, as far as the psychodynamic approach is concerned; --between the awakening process and the ability to delay with a behavioral point of view; --between biochemical modifications, essentially of 5-hydroxy-tryptamine and other neurotransmitters, as far as the biological approach is concerned.

Animals↗
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[Undesirable effects of drugs. Epidemiologic study at a psychiatric service of a university hospital].

The authors reviewed the drug side effects observed in their ward during the 5 last years (1988-92). These alleged effects occurred at a very low incidence, 3 per cent, (116 cases on 3809 hospitalizations). As mentioned in the literature, the occurrence was higher in females (60 per cent), than in males. The age seemed not to be a risk factor in that population, the mean age being 44 for the men and 45 for the women. All side effects disappeared after decreasing or stopping the suspected drug. In 6 cases the suspected drug was not a psychotropic agent. The authors presented some of the more often reported cases, and some of the more recently known, such as extrapyramidal side effects with antidepressants, increase of the libido with serotonergic antidepressants. The problem fo polytherapy is discussed. In half (59/116) of the cases there was a psychotropic association. The side effect may be due to a pharmacokinetic interaction in 16 cases, either with enzymatic inhibitors like dextropropoxyphene, valpromide, valproic acid, fluvoxamine and fluoxetine, or with enzymatic inducers like carbamazepine. The authors compared the side effects of the antidepressants mainly used in their ward (amitriptyline, clomipramine, fluvoxamine and fluoxetine).

Adult↗
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[Action and tolerance of dothiepin hydrochloride (Prothiaden) in depressive states during the evolution of psychotic disorders].

During psychosis evolution, depressions occur frequently with a prevalence between 10% and 70% (average 25%-50%). Depression aggravates psychosis prognosis by increasing the risk of suicide, relapse and hospitalization. So antidepressant and neuroleptic treatments are often associated. Many studies with contradictory results were realized. Some concluded a favourable effect of this association, others considered this concomitant medication aggravates psychotic symptoms and adverse reactions. However this association appears to be efficient especially in deficitary or depressive forms of schizophrenia. The objective of this multicentre, non comparative, open study is to assess during 6 weeks the efficacy and tolerability of dothiepin in the treatment of depression occurring during the evolution of psychosis. The initial score on HDRS (17 items) had to be at least 18. 124 patients (40.7 years, 63.1% male) suffering from chronic psychosis associated with depressive syndrome were included in 29 hospital centres. According to DSM III-R criteria, 71.9% of patients were schizophrenic and 43% were suffering from major depressive illness. 16 patients (12.9%) stopped prematurely the treatment and side effects were reported for 8 of them. Any unexpected side effect occurred and pre-existing psychotic disorders reappeared for one patient. During the whole study, 63% of the population were treated with 75 mg as daily dosage of dothiepin. All concomitant treatments except antidepressant were authorized. 115 patients (95%) received at least one associated neuroleptic treatment and 54 patients (44.6%) a concomitant antiparkinsonian treatment. The significant decrease, between day 0 and day 45, of the global score on HDRS (from 23.78 to 8.48, p < 0.01), confirms the improvement of depression.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Status of thymoleptics in the treatment of bipolar disorders].

The widening of the concept of bipolar disorders to embrace the notion of a "spectrum" of disorders leads to the supposition that almost 5% of the general population may affected. Thymoleptics are the key treatment, but they should be prescribed over many years, and it is necessary to determine the threshold above which treatment should be considered. Lithium salts remain the reference thymoleptic treatment, but they are insufficiently effective in 30 to 60% of patients. They have a narrow therapeutic margin and are frequently accompanied by adverse effects. Numerous studies, mainly open, have confirmed the value of anti-epileptic thymoleptics (carbamazepine and valpromide) in mood disorders. They are comparable in efficacy to lithium salts, both in first-time treatment and in prophylactic use. Their main indications are as follows: marked progression of the mood disorder with the presence of mixed disorders or rapid-cycling disorders, concomitant organic pathology, substance abuse or personality disorder, poor response to lithium salts.

Anticonvulsants↗
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[Fluoxetine and tricyclic antidepressants: clinical tolerance in short-term combined administration].

The tricyclic SSRI antidepressant association is often used in the treatment of resistant depressive illness. The pharmacokinetic interaction existing between these two types of drugs is well known, with as result, an increase of tricyclic antidepressant plasma levels. The aim of this work was to assess the clinical tolerance of the association of fluoxetine and tricyclic antidepressants, prescribed at usual doses. In 10 patients, having a bad response to a tricyclic antidepressant treatment, with in the therapeutic window adjusted plasma levels since 3 weeks, an association of fluoxetine (20 mg/d) to the tricyclic was prescribed. The other associated treatments were unmodified. The clinical evolution was recorded with the MADRS and the UKU scale for side effects, before the tricyclic antidepressant treatment adjustment (D-21) and just before the fluoxetine association (D1) and every 7 days after this association too. The tricyclic plasma levels (amitriptyline and clomipramine) and the patient phenotype CYP 2D6 and 2C19 were determined before and 7 days after the fluoxetine addition. A good clinical evolution was noted since the 7th day after the fluoxetine association to tricyclic (mean MADRS scores on D-21, D1, D7 and D14; 35.4, 33.1, 23.9, 16.8 respectively). In 3 patients, an anxiety increase on day 6, 14 and 16 respectively, after fluoxetine addition, induces a stop of the serotonergic antidepressant. In one patient all the treatment was stopped due to the appearance of a mood inversion. In another patient, after 14 days of antidepressant association, EC were prescribed as asked by the patient, due to an insufficient mood improvement, with a good clinical result and tolerance. The evolution of the side effects was surprising. There was no increase of the UKU score mean during the associated treatment, despite an increase of the tricyclic plasma levels that reached, in three patients, the toxic level (510, 605 and 860 ng/ml of amitriptyline + nortriptyline or clomipramine + demethylclomipramine). The UKU psychic score mean significatively decreased (7.7, 6.8, 5.3, 4 on D-21, D1, D7, D14 respectively). The fluoxetine association did not modify the neurological, neuro-endocrinologic and the skin side effects. None increase of headheck was noted. The increase of anxiety, observed in 3 patients, was not considered as a side effect of the antidepressant association, but an effect of the stimulant potency of fluoxetine in anxious patients. The pharmacogenetic results confirmed the strong inhibition potenty of fluoxetine on the CYP 2D6 isoenzyme. In 5 patients indeed, the extensive metabolizer phenotype was modified in a poor metabolizer phenotype, seven days after the association of fluoxetine. The CYP 2C19 phenotype was unchanged after this association. The patient phenotype did not seem to interfere with the clinical results. In conclusion, in this group of patients, the short-term clinical tolerance of the tricyclic antidepressant and fluoxetine association was very good, despite the pharmacokinetic interaction existing between these two types of drugs.

Adult↗