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Biomedical subjects

S A Montgomery

Publications and source records attributed to S A Montgomery.

At least 19 recordsLinked to original sources
PubMed1992

Fluvoxamine in the treatment of obsessive compulsive disorder.

Obsessive compulsive disorder is a chronic, often severe condition that is associated with considerable long term morbidity and suffering. Potent serotonin reuptake inhibitors are now regarded as first line treatments and their efficacy has been established in a series of placebo-controlled studies. The first of these compounds to become available, clomipramine, has undesirable effects on a number of other receptor systems and is associated with marked anticholinergic side effects. Of the selective serotonin reuptake inhibitors fluvoxamine is the most widely studied, with three small positive placebo-controlled and two recent large multicentre studies. These two studies show that fluvoxamine is associated with significant improvement on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the National Institute of Mental Health Obsessive Compulsive Scale (NIMH-OC) and the Global Improvement item of the Clinical Global Impression (CGImp) Scale, compared with placebo.

Combined Modality Therapy↗
PubMed1992

The advantages of paroxetine in different subgroups of depression.

Paroxetine is a selective serotonin reuptake inhibitor that is now licensed in various countries in Europe. It has comparable efficacy with the reference tricyclic antidepressants and is well tolerated with few adverse effects which are usually mild, transient and do not appear to compromise treatment. Paroxetine has a number of advantages as an antidepressant; of particular interest is its ability to improve sleep early in treatment without daytime sedation or interference with psychomotor function. Paroxetine appears effective compared with placebo in different subgroups of depression: it is effective in both endogenous and reactive depression, as well as being effective in moderate and severe depression. Paroxetine appears particularly effective in treating the anxiety associated with depression and has been shown to have greater efficacy than imipramine. There is some evidence that the onset of antidepressant action occurs slightly earlier with paroxetine than with imipramine. As well as being effective in the acute episode, placebo-controlled, long-term data are available indicating paroxetine to be of value in the prevention of depressive relapse.

Anxiety↗
PubMed1992

Inadequate treatment response to des-enkephalin-gamma-endorphin compared with thioridazine and placebo in schizophrenia.

The possibility of an involvement of peptidergic systems in schizophrenia has been under investigation for a number of years. Studies of the efficacy of des-tyr-gamma-endorphin were equivocal; more recent studies with des-enkephalin-gamma-endorphin have reported some activity but the peptide has only been investigated as an adjunct to neuroleptic medication, apart from one very small active reference comparator study. In the multicentre study reported here, 96 patients suffering from schizophrenia (DSM-III with a current exacerbation if chronic) were allocated randomly to double-blind treatment with either des-enkephalin-gamma-endorphin (DE-gamma-E) (Org 5878) 10 mg given as a once daily intramuscular injection for 4 weeks, thioridazine 400 mg orally in 2 divided doses or placebo using a double-dummy technique to preserve blindness. There was a significant advantage for thioridazine compared with placebo registered on all measures at weeks 3 and 4. There was no difference between DE-gamma-E and placebo. There was a significant difference between thioridazine and DE-gamma-E at weeks 3 and 4 registered on the MSS and at week 3 registered on the BPRS. The lack of efficacy of DE-gamma-E suggests that the theories that the endorphins have an important role in schizophrenia have to be revised. The need for well designed placebo controlled studies for assessing efficacy in schizophrenia is emphasized.

Adult↗
PubMed1992

Suicide and antidepressants.

Depression is associated with a risk of suicide 13 to 30 times greater than in the general population, and antidepressants are among the drugs most frequently implicated in fatal overdose, resulting in a dilemma for the clinician. Suicidal thoughts are a core symptom of depression, and there is evidence that the selective serotonin (5-hydroxytryptamine) reuptake inhibitors (SSRIs), including fluvoxamine, are of particular benefit in reducing their occurrence. Data from controlled studies indicate that the SSRIs do not exacerbate suicidal ideation; on the contrary, SSRIs protect against the emergence of suicidal thoughts, which reflect the natural history of the disease. The SSRIs also appear to be particularly effective in patients who are highly suicidal at treatment initiation, and to be more effective than the tricyclic antidepressants in treating severe depression and improving anxiety symptoms associated with depression. Thus, fluvoxamine, in common with other SSRIs, is of particular benefit in treating depression in patients with prominent suicidal thoughts or who are at increased risk of suicide.

Antidepressive Agents↗
PubMed1992

Features of recurrent brief depression.

Recurrent brief depression, characterised by frequently occurring brief depressive episodes, lasting less than two weeks, is now recognised as a common and disabling illness with a chronic relapsing course and a significant suicide risk. The episodes have a mean duration of 3 days, but otherwise fulfill the symptomatic criteria for DSM III-R major depression. Some two thirds of episodes satisfy severity criteria for at least moderate depression and about a third for severe depression. They recur erratically with a mean period of 18 days between the start of one episode and the next. Because of the frequency of the episodes patients may report longer continuous periods of depression than was the case and may be mistakenly perceived as dysthymia as major depression. It is important to identify these patients as treatment response appears to differ. The episodes are too short to be able to assume efficacy with conventional antidepressants; it is necessary to adopt a prophylactic strategy for treatment aiming to reduce the severity, the frequency, or the duration of episodes.

Depressive Disorder↗
PubMed1992

Pharmacotherapy in the prevention of suicidal behavior.

Prevention or reduction of suicide remains a serious challenge for the medical community. Psychotherapeutic and psychosocial interventions have not been shown to reduce the incidence of suicide attempts and analytic psychotherapy has been shown to increase suicidal behavior. The efficacy of pharmacotherapy in reducing suicide attempts in patients with a history of repeated suicidal behavior has been shown with low doses of the neuroleptic agent flupenthixol compared with placebo. Supporting findings have been reported with trifluoperazine. There is evidence to suggest that some antidepressants may not be neutral in their effect on suicidal behavior. Maprotiline, for example, was associated with an increase in suicide attempts compared with placebo in a large long-term treatment study despite its significant efficacy in preventing relapse of depression. Differential lethality indices taken from large community studies support the notion that noradrenergic drugs such as maprotiline, desipramine, and nortriptyline are associated with a higher than expected incidence of death from overdose, and the suicide-provoking potential may relate to some noradrenergic property. The studies of serotonergic antidepressants do not suggest that they are suicide-provoking agents; rather they appear to be neutral or protective. Prospective prophylactic studies are needed to test the ability of potential treatments for the reduction of suicidal behavior.

Antidepressive Agents↗