[Platelet glutathione reductase and glutathione-S-transferase in elderly patients with depression]. / Trombotsitarnye glutationreduktaza i glutation-S-transferaza u bol'nykh s depressiyami v pozhilom vozraste.

OBJECTIVE: To compare the activity of platelet glutathione reductase (GR) and glutathione-S-transferase (GST) in elderly patients with depression and in the control group, and to identify a possible relationship between the activity of these enzymes and clinical parameters of the disease. MATERIAL AND METHODS: We examined 42 elderly patients (60-86 years old) with depressive episodes of various nosological categories according to ICD-10: a single depressive episode (F32.0, F32.1), a depressive episode in recurrent depressive disorder (RDR - F33.0, F33.1), and a depressive episode in bipolar disorder (BD - F31.3). The GR, GST activity and the severity of depression were assessed twice: before the beginning of the course of 28-day antidepressant therapy (day 0) and on the 28th day of the course of therapy, using the Hamilton Depressive Scale (HAMD-17) and the Hamilton Anxiety Scale (HARS). RESULTS: As compared with the control group, a significant decrease in GST activity was found in patients before and after the course of therapy (p<0.0001 and p<0.0003, respectively), no significant difference in GR activity was found. Significant correlations of the platelet GR activity in patients before thetreatment course with the age of disease manifestation (R= -0.44; p=0.004, inverse correlation) and with its duration (R=0.43, p=0.004, direct correlation), estimated after a 28-day course of therapy. A significant inverse correlation of the baseline (before treatment) GR activity with the HAMD score estimated after the course of therapy (R=-0.440; p=0.009) was found only in women subgroup (n=33). CONCLUSION: A pilot study has revealed a decrease in platelet GST activity, and a link between platelet GR activity and the severity of depression after a course of therapy. The results obtained indicate the promise of further study of glutathione metabolism enzymes as a biomarker for assessing the state.

[The link of platelet cytochrome C-oxidase activity with some clinical parameters of depression in elderly patients]. / Svyaz' aktivnosti trombotsitarnoi tsitokhrom s s-oksidazy s otdel'nymi klinicheskimi parametrami depressii u bol'nykh pozhilogo vozrasta.

OBJECTIVE: To search for correlations between platelet cytochrome c-oxidase (COX) activity and the quality of therapeutic outcomes and other clinical parameters of depression in elderly patients. MATERIAL AND METHODS: Twenty elderly women, aged 55-78 years, with depressive episodes in recurrent depressive disorder (RDD) or bipolar affective disorder (BD) were studied. COX activity and severity of depression were evaluated twice: before the beginning of antidepressant treatment and at the 28-th day of the therapy, using the Hamilton Depression Rating Scale (HAMD-17) and the Hamilton Anxiety Rating Scale (HAM-A). RESULTS: Significant correlations were revealed between platelet COX activity and some clinical parameters of the disease and the severity of depression in patients after treatment. The baseline level of the platelet COX activity was correlated with the age of disease onset (R= -0.63, p=0.003) and its duration (R=0.55, p=0.010). Significant negative correlations were also found between the baseline level of COX activity and depression severity (HAMD-17 total score) (R= -0.48, p=0.032) and the severity of anxiety (HARSHAM-A total score) (R= -0.54, p=0.010) after 28-day treatment. CONCLUSION: This pilot study has revealed a link between platelet COX activity and the severity of depression and anxiety after a 28-day antidepressant therapy. The results indicate the prospects for further study of COX as a biomarker of therapeutic outcomes in elderly patients with depression.

[The content of N-acetylaspartate in depressed elderly patients during therapy with antidepressants and actovegin]. / Soderzhanie N-atsetilaspartata u pozhilykh patsientov s depressiei v protsesse terapii antidepressantami i aktoveginom.

AIM: To assess the plasma level of N-acetylaspartate (NAA) before and after combined therapy with antidepressants and actovegin in a group of elderly patients diagnosed with depression. MATERIAL AND METHODS: Nineteen patients, 7 men and 12 women, mean age 70.5±5.8 years, were studied using clinical examination and psychometric scales as well as computed tomography (CT). NAA plasma levels were determined. The duration of treatment with antidepressants (venlafaxine, fluvoxamine) and actovegin was 28 days, patients were examined at baseline and on the 28th day of treatment. RESULTS AND CONCLUSION: The NAA plasma level was reduced in patients compared to healthy volunteers. The increase of this indicator after treatment reflected a significant improvement on clinical and psychometric measures. The dynamics of NAA changes (increase or decrease) showed heterogeneity in the group of patients, which was not related to the efficacy of treatment but was correlated with comorbid diseases, in particular vascular diseases, and CT changes (leukoaraiosis). The authors consider the results of this study as preliminary.

[Augmentation with carnicetine for late depression]. / Augmentatsiia karnitsetinom terapii pozdnikh depressii.

AIM: Comparative evaluation of the efficacy and safety of antidepressant monotherapy and complex antidepressant therapy in combination with carnicetine in the treatment of depression in elderly patients in a psychiatric hospital. MATERIAL AND METHODS: Two groups of hospitalized patients, aged from 60 to 79 years, with mild or moderate depression (according to ICD-10), comparable in basic demographic and clinical characteristics, received mono- or complex (in combination with carnicetine) antidepressant therapy for 8 weeks. Treatment efficacy was assessed with HAM-D, HARS, CGI-S and CGI-I; the level of cognitive activity was assessed with MMSE, the 10-word memory test and clock drawing test. RESULTS: It has been established that the use of complex antidepressants therapy with the inclusion of carnicetine allows to achieve a more rapid and pronounced therapeutic response compared to antidepressant monotherapy. This is confirmed by the earlier (by the 4th week) and significant reduction of depressive and anxiety symptoms (p<0.01), a greater number of responders and better quality of depressive outcomes to the end of treatment and a more rapid improvement in cognitive functioning. CONCLUSION: The results allow us to recommend the inclusion of carnicetine for the augmentation of antidepressant therapy in elderly patients of the psychiatric hospital to achieve a more rapid and complete therapeutic response and reduce the duration of hospitalization.

[Experience of the antidepressive therapy with valdoxan (agomelatine) in a psychogeriatric unit of the psychiatric hospital].

OBJECTIVE: To assess therapeutic efficacy, tolerability and safety of valdoxan (agomelatine) in the treatment of depression in elderly inpatients of the psychiatric hospital. MATERIAL AND METHODS: The study included 20 patients, aged 60 years and older, with depression of varying severity. Patients received valdoxan in standard doses 25-50 mg/day during 42 days. RESULTS: Valdoxan showed a good balanced profile (in terms of indicators of depression, anxiety and anhedonia) of therapeutic response and tolerability in inpatients with mild to moderate depression. The use of valdoxan led to a significant reduction of depressive disorders and anxiety already in the early period of treatment. The severity of anhedonia decreased to the 14th day of treatment. A significant improvement in cognitive functioning of patients was noted to the end of treatment. CONCLUSION: Valdoxan can be recommended for treatment of mild and moderate depression in inpatients of psychiatric hospitals.

[Optimization of the efficacy and safety of antidepressant therapy in patients of a geriatric psychiatric unit].

AIM: A comparative evaluation of the efficacy and safety of monotherapy with one of the modern antidepressants (venlafaxine, agomelatine, or fluvoxamine) and combination treatment of one of the above mentioned antidepressants with acetyl-L-carnitine (ALС, carnicetine) in the geriatric psychiatric unit. MATERIAL AND METHODS: Two groups of elderly patients (aged 60-79 years) with mild or moderate depression, randomized according to a number of demographic and clinical characteristics, were treated with antidepressants in monotherapy or combined therapy (antidepressant/carnicetine) within 8 weeks. RESULTS: Combination therapy with the neurotrophic agent carnicetine proved to be more effective compared to monotherapy. At the end of treatment, the more rapid clinical response has been shown for depression, anxiety, apathy, and cognitive dysfunction. Furthermore, combination therapy provides less adverse effects. CONCLUSION: Antidepressant/carnicetine combination therapy may be recommended for treatment of depression in elderly patients.

[Immunological monitoring of endogenous attack-like psychoses].

To analyze the possibility of using immunological parameters for the assessment of the activity of the process and prediction of the quality and completion of remission, we compared the dynamics of clinical and immunological parameters in 76 patients with endogenous attack-like psychoses during pharmacotherapy of a psychotic episode. Authors confirmed evidence for the activation of innate and adaptive immunity in the acute stage of psychosis as well as the correlation between immunological parameters (leukocyte elastase (LE) activity, alpha(1)-proteinase inhibitor (alpha(1)-PI), the level of autoantibodies to nerve growth factor (Aab-NGF)) and clinical symptoms assessed with the PANSS. The improvement of the clinical state assessed by the reduction in PANSS total score was noted in all patients though there were variations in the dynamics of immunological parameters. The increase of immunological parameters, along with the absence of changes at the discharge from the hospital, suggests that the remission was of low quality and the pathological process did not attenuate. Outpatient examination revealed the different dynamics of psychopathological disorders: stable state in 50% patients, moderate worsening of psychological state in 50% patients. Worsening of clinical symptoms after the discharge and in the outpatient stage was correlated with the elevation of the activity/level of immunological parameters. The changes in LE activity and Aab-NGF level precede the changes in mental state of patients in the following 1-2 months. These parameters may be used for monitoring of patients and prediction of quality and completion of remission.