[Clinical evaluation of the antidepressive action of azafen].
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Biomedical subjects
Publications and source records attributed to M Beresewicz.
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A group of 250 patients with endogenous depression was studied. Amitriptyline proved to be the most effective drug (51% positive responses) followed by noxiptilin (50%), imipramine (42%), dibenzepin (43%). Clomipramine, desipramine, and nomifensine appeared to be the least effective. Demographic or clinical factors such as age, sex, type of affective illness, severity of depressive syndrome or its particular symptoms (depression, fear, anxiety, psychomotor impairment or biological rhythm alteration) did not show any potential for prediction of the treatment outcome. Worse therapeutic results were observed in patients who had already been given antidepressant treatment for the current depressive cycle before the assessment.
Evaluation of a group of 250 patients with endogenous depression in the course of affective illness suggest that reactions of patients to tricyclic antidepressants in an early phase of the treatment may supply interesting prognostic data. Improvement of mental state (reduction of the Hamilton Depression Scale score) on the seventh day and especially on the 14th day of treatment points to a high probability of positive response to the treatment. Lack of such a reaction or worsening of the mental state in the early phase of pharmacotherapy (on the seventh day) frequently is an early sign of lack of positive response to the treatment. The survey considered following antidepressant drugs: amitriptyline, noxiptilin, clomipramine, dibenzepin and desipramine.
Studies conducted on a group of 38 patients with endogenous depression demonstrated that a reaction to sleep-deprivation presenting as improved well-being has a significant predictive potential for treatment with imipramine. Patients who displayed the reaction also significantly more frequently displayed improvement of clinical course (remission; good response). Risk of switching from depression to mania also increased among these patients. Patients responding to sleep-deprivation with improved well-being belonged mainly to the bipolar affective disorder. Neither clinical manifestations of depression, nor the number of relapses, nor the duration period of the disorder, nor basic demographic patterns did show distinct features; nor did they differ significantly from patients who did not respond to sleep-deprivation with improved well-being.
In the group of 115 endogenous depression patients 84 responded to tricyclic antidepressant medication and 31 remained drug-resistance. The changes of platelet MAO activity and serum DBH activity in the latter group were found. Among drug-resistant patients, 40% showed low MAO/DBH index (.6) and in 36% the index was within the medium range (.6-1.9). The low value of the index is predominantly connected with the increase of DBH and decrease of MAO activity, and it may become the potential predictive factor for the pharmacotherapy in endogenous depression. The results show the influence of the disturbances of catecholamines synthesis and degradation on the phenomenon of drug-resistance to tricyclic antidepressants.
The influence of some selected demographic and clinical characteristics on the formation of resistance to antidepressant drugs were studied in the group of 115 patients with affective disorders. Drug resistance occurs as frequently in women as in men. It appears much frequently in patients after 40 (about 30%). Persons under 30 are not or very rarely affected. Type I of bipolar affective disorder and the occurrence of affective disorder in relatives are positive prognostic factors. The long relapses (greater than 20 weeks) are of the worse prognostic value than shorter ones (less than 3 months). Previous poor efficiency of antidepressant drugs predicts very often an identical response during current episode. Alcohol abuse is an unfavourable prognostic factor in men with endogenous depression.
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The normothymic effect of carbamazepine administered alone or in combination with lithium in patients with affective disorders was studied. The incidence and time-course of carbamazepine-induced side effects was analyzed.