Psychopathology in Elderly COVID-19 Survivors and Controls.

BACKGROUND: The highly infectious and pathogenic coronavirus-19 (COVID-19) has emerged to cause a global pandemic. In this cross-sectional comparative study, our objective is to compare the depression and anxiety symptoms in elderly COVID-19 survivors with a control group. METHOD: 69 elderly COVID-19 survivors (age 65 or older) within 2 weeks post-discharge were assessed for anxiety and depression symptoms by a package of self-rating scales (Geriatric Anxiety Scale-10 (GAS-10), Geriatric Depression Scale-15 (GDS-15) and General Health Questionar-28 (GHQ-28)). Their scores were compared with a group of aged-matched residents without COVID-19 in their community. RESULTS: The mean scores on GAS-10, GDS-15 and GHQ-28 in the COVID-19 survivors group and control group were 12.06 vs. 6.53 (p < .001), 12.48 vs. 5.73 (p < .001), 52.7 vs. 29.8 (p < .001), respectively. All of the COVID-19 survivors and 60% of the controls had scores in the pathological range of GHQ-28 scale. A total of 93.2% of COVID-19 survivors revealed anxiety symptoms in GAS-10 scale. This rate was 60% in the control group. A total of 86.6% of COVID-19 survivors compared to 46.6% of the controls reported symptoms of depression in GDS-15 scale. CONCLUSION: The rate of depression and anxiety symptoms in elderly COVID-19 survivors and controls found to be high during the pandemic. However, COVID-19 survivors significantly suffered more.

Is quetiapine effective for obsessive and compulsive symptoms in patients with bipolar disorder? A randomized, double-blind, placebo-controlled clinical trial.

BACKGROUND: The aim of this study is to examine the effects of quetiapine as an adjuvant treatment for obsessive-compulsive (OC) symptoms in patients with bipolar disorder (BD) type I. METHODS: In this 8-week double-blind placebo-controlled randomized clinical trial, 47 patients with BD in euthymic phase that had OC symptoms were randomly allocated to receive either quetiapine or placebo plus their routine medications (lithium + clonazepam). Yale-Brown Obsessive-Compulsive Scale (YBOCS) was used to assess the outcomes. Adverse effects were also recorded. RESULTS: Of 47 BD patients with OC symptoms that were randomly allocated in two groups of quetiapine (n = 24) and placebo group (n = 23), 40 patients (20 in quetiapine group and 20 in placebo group) completed the trial. Throughout the trial, the mean score of YBOCS in the quetiapine group dropped from 24.37 ± 1.51 to 15.26 ± 1.16 (P < .001) and in the placebo group decreased from 24.21 ± 1.33 to 23.94 ± 1.66 (P = 1.97). At the end of the study, 12 (60%) patients in the quetiapine group and 1 (5%) patient in the placebo group had more than 34% decline in YBOCS score (P < .001). No serious adverse effects were reported in two groups. CONCLUSIONS: Our double-blind placebo-controlled clinical trial showed that quetiapine may be an effective adjuvant agent for reducing OC symptoms in BD patients.

Effects of COVID-19 pandemic and lockdown on mental health of Iranian people.

INTRODUCTION: The highly contagious novel coronavirus disease 2019 (COVID-19) emerged recently as a global pandemic. An efficient way to mitigate the spread of the disease is lockdown and quarantine. OBJECTIVE: This study aimed to evaluate the Iranian population's mental health under lockdown during the COVID-19 pandemic. MATERIAL AND METHODS: The General Health Questionnaire-28 (GHQ-28) was utilized to assess the mental health and psychosocial wellbeing of Iranian residents through an online survey. The questionnaire was sent on April 3, 2020, and remained open to responses until April 10, 2020. This period was the time of complete lockdown in Iran. Inclusion criteria included either gender, reading Farsi, internet access, and being between the ages of 18 and 65. Respondents with scores ≥ 24 were classified as having psychiatric problems. RESULTS: Of 35,529 completed surveys, 28,790 were eligible for analysis. 73.4% of the respondents were female. The majority of the participants were between the ages of 26 to 45. Of the participants, 35.5% had scores in the pathological range. We found that females, younger residents, singles, and individuals with lower education had higher levels of psychopathology. CONCLUSIONS: Our study suggests that the psychological impacts of the COVID-19 pandemic and quarantine are wide-ranging, substantial, and can be long-lasting.

Is Sitagliptin Effective for Modulating Metabolic Disturbances Associated With Olanzapine in Schizophrenia Patients? A Double-blind Placebo-controlled Clinical Trial.

PURPOSE/BACKGROUND: The mortality rate of patients with schizophrenia due to metabolic disturbances is high. Our aim is to survey the effects of sitagliptin on metabolic disturbances associated with olanzapine in patients with schizophrenia. METHODS/PROCEDURES: In this 12-week double-blind placebo-controlled clinical trial, 71 patients taking olanzapine (10 to 30 mg) for at least 1 month were randomly allocated to enter 1 of the 2 treatment groups (olanzapine plus placebo or olanzapine plus sitagliptin). Sitagliptin was added to patients 'current medications with the dose of 100 mg/d. Physical examinations and measurement of anthropometric (body mass index and waist circumference) and laboratory parameters (fasting blood sugar, glycated hemoglobin, total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride) were measured at baseline, week 4, and week 12. The patients were assessed for any side effects of the medications in each visit. FINDINGS/RESULTS: Sixty-one patients (30 in the sitagliptin and 31 in the placebo group) completed the trial. The anthropometric measurements at the end of the study did not differ between the 2 groups. glycated hemoglobin and total cholesterol were significantly lower in the sitagliptin group after 12 weeks. Other metabolic profile revealed either no change or minimal magnitude changes. No major side effect was reported. IMPLICATIONS/CONCLUSIONS: Metabolic disturbances associated with olanzapine treatment in patients with schizophrenia can be modulated by sitagliptin.

Pregabalin augmentation for resistant obsessive-compulsive disorder: a double-blind placebo-controlled clinical trial.

BACKGROUND AND OBJECTIVE: Glutamate dysfunction has been shown to be associated with pathophysiology of obsessive-compulsive disorder (OCD). Our objective is to survey the effects of pregabalin (a glutamate-modulating agent) as an augmenting treatment for resistant OCD. PATIENTS AND METHODS: In this 12-week double-blind placebo-controlled clinical trial, 56 patients with resistant OCD were randomly allocated to receive either pregabalin or placebo plus their current medication (sertraline). Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to evaluate the outcomes. Adverse effects were also registered. RESULTS: Of the 56 patients with resistant OCD who were randomly allocated in 2 groups of pregabalin (n = 28) and placebo group (n = 28), 42 patients (22 in pregabalin group and 20 in placebo group) completed the trial. Throughout the trial, the mean score decreased from 26.13± 7.03 to 8.81 ± 3.47 in the pregabalin group (p < 0) and from 26.85 ± 4.34 to 17.63 ± 4.22 in the placebo group (p < 0). At the end of trial, 16 (57.14%) patients in the pregabalin group and 2 (7.14%) patients in the placebo group showed more than 35% decline in YBOCS (p < .01). The pregabalin group showed good tolerability and safety. CONCLUSIONS: Our study revealed that pregabalin, as an augmenting medication, is more effective than placebo in the treatment of patients with resistant OCD.

Memantine as an Adjuvant Treatment for Obsessive Compulsive Symptoms in Manic Phase of Bipolar Disorder: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

PURPOSE/BACKGROUND: The aim of this study is to examine the effects of memantine as an adjuvant treatment for obsessive compulsive (OC) symptoms in patients with bipolar disorder (BD) type I, manic phase. METHODS/PROCEDURES: In this 16-week double-blind placebo-controlled randomized clinical trial, 58 patients in the manic phase of BD who had OC symptoms were randomly allocated to receive memantine or placebo plus their routine medications (lithium + olanzapine + clonazepam). The Yale Brown Obsessive Compulsive Behavior Scale was used to assess the outcomes. Adverse effects were also recorded. FINDINGS/RESULTS: Thirty-eight patients (19 in the memantine group and 19 in the placebo group) completed the trial. Throughout the trial, the mean score decreased from 20.26 ± 5.91 to 9.73 ± 5.44 in the memantine group (P < 0.000) and from 22.89 ± 5.70 to 16.63 ± 4.00 in the placebo group (P < 0.000). At the end of the study, 15 (78.94%) patients in the memantine group and 7 (36.84%) patients in the placebo group demonstrated more than 34% decline in the Yale Brown Obsessive Compulsive Behavior Scale score (P < 0.01). No serious adverse effects were reported. IMPLICATIONS/CONCLUSIONS: Our double-blind controlled clinical trial showed that memantine is an effective adjuvant agent for reducing OC symptoms in patients with BD. However, it needs to be noted that our study is preliminary, and larger double-blind controlled studies are needed to confirm the results.

Duloxetine Augmentation in Resistant Obsessive-Compulsive Disorder: A Double-Blind Controlled Clinical Trial.

INTRODUCTION: The aim of this study is to evaluate the efficacy of duloxetine augmentation in treatment of resistant obsessive-compulsive disorder (OCD). METHODS: This augmentation trial was designed as an 8-week randomized controlled, double-blind study. Forty-six patients experiencing OCD who had failed to respond to at least 12 weeks of treatment with a selective serotonin reuptake inhibitor (fluoxetine, citalopram, or fluvoxamine) were randomly allocated to receive duloxetine or sertraline plus their current anti-OCD treatment. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure. Treatment response was defined as 25% or more decrease in scores of Y-BOCS. The mean dosage of duloxetine was 44.4 mg/d (range, 20-60 mg/d), and the mean dosage of sertraline was 123.8 mg/d (range, 50-200 mg/d). RESULTS: Forty-six patients (24 of 30 in duloxetine group and 22 of 27 in sertraline group) completed the trial. Both groups showed improvement during the 8-week study period (mean Y-BOCS total score at week 8 as compared with baseline: P < 0.001 & P < 0.001) without significant difference (P = 0.861). Those receiving duloxetine plus their initial medications experienced a mean decrease of 33.0% in Y-BOCS score, and the patients with sertraline added to their initial medication experienced a mean decrease of 34.5% in Y-BOCS. DISCUSSION: Our double-blind controlled clinical trial showed duloxetine to be as effective as sertraline in reducing obsessive and compulsive symptoms in patients with resistant OCD. However, it needs to be noted that our study is preliminary, and larger double-blind placebo-controlled studies are necessary to confirm the results.

Is mirtazapine augmentation effective for patients with obsessive-compulsive disorder who failed to respond to sertraline monotherapy? A placebo-controlled, double-blind, clinical trial.

Mirtazapine upsurges serotonergic activity by a mechanism different from reuptake inhibition. Our aim is to assess the efficacy of mirtazapine augmentation for patients with obsessive-compulsive disorder (OCD) who did not respond to sertraline monotherapy. Sixty-one patients suffering from OCD who were resistant to sertraline monotherapy were randomly allocated to receive mirtazapine (mean dosage = 39.56 mg/day) or placebo plus their current anti-OCD treatment (sertraline: average dose = 251.37 mg/day and 255.10 mg/day in the mirtazapine and placebo groups, respectively; P = 0.871). The primary outcome was OCD symptom severity as measured by Yale-Brown Obsessive-Compulsive Scale (YBOCS). Forty-five patients (22 in the mirtazapine group and 23 in the placebo group) completed the trial. Average YBOCS score decreased in the mirtazapine group from 27.14 ± 8.05 at baseline to 11.13 ± 4.27 at week 12. In the placebo group, average YBOCS score declined from 28.15 ± 3.27 at baseline to 18.94 ± 3.88 at week 12. Nine patients (40.90%) in the mirtazapine group and only one patient (4.34%) in the placebo group revealed at least a 35% decrease in YBOCS ( P < 0.000). We found that mirtazapine adds to the effect of sertraline in improving obsessive and compulsive symptoms in OCD patients.

Comparison of topiramate and risperidone for the treatment of behavioral disturbances of patients with Alzheimer disease: a double-blind, randomized clinical trial.

INTRODUCTION: Behavioral disturbances are determining factors in handling patients with Alzheimer dementia. The current pharmacotherapy for behavioral symptoms associated with dementia is not satisfactory. Our goal was to compare a new anticonvulsant, topiramate, with a usually used medication, risperidone, for controlling behavioral disturbances of patients with Alzheimer dementia. METHOD: Elderly patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of Alzheimer disease and significant behavioral disturbances were randomized to receive, for a period of 8 weeks, a flexible dose of either topiramate (25-50 mg/d) or risperidone (0.5-2 mg/d). Outcome measures were the Cohen-Mansfield Agitation Inventory, Neuropsychiatry Inventory parts 1 and 2, and the Clinical Global Impression. RESULT: Forty-eight patients were randomized to treatment with either topiramate or risperidone, and 41 patients (21 of 25 in topiramate group and 20 of 23 in risperidone group) completed the trial. Both groups showed significant improvement in all outcome measures without important difference (Neuropsychiatry Inventory total score P < 0.531, Z = 0.62; Cohen-Mansfield Agitation Inventory P < 0.927, Z = 0.09; Clinical Global Impression, P < 0.654, Z = 0.48). There were no significant changes in the cognitive status of patients (assessed by Mini-Mental Status Examination) taking topiramate or risperidone during the trial. CONCLUSION: Treatment with a low dose of topiramate (25-50 mg/d) demonstrated a comparable efficacy with risperidone in controlling behavioral disturbances of patients with Alzheimer dementia.

Topiramate Augmentation in Resistant OCD: A Double-Blind Placebo-Controlled Clinical Trial.

OBJECTIVES: Glutaminergic dysfunction has been shown to be related to the pathphysiology of obsessive-compulsive disorder (OCD). Topiramate is an antiepileptic that inhibits glutaminergic action. The aim of this study is to evaluate the efficacy of topiramate augmentation in patients with treatment resistant OCD. METHODS: This augmentation trial was designed as a 12-week randomized, placebocontrolled, double-blind study. Forty-nine patients suffering from OCD who had failed to respond to at least 12 weeks of treatment of an adequate and stable dose of a selective serotonin reuptake inhibitor (SSRI) were randomly allocated to receive topiramate or placebo plus their current anti OCD treatment. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure. Treatment response was defined as 25 % or more decrease in scores of Y-BOCS. The mean dosage of topiramate was 180.15 mg/day (range 100-200 mg/day). RESULTS: Forty-one patients (20 of 24 in topiramate group; 21 of 25 in placebo group) completed the trial. The topiramate group showed significant improvement over the study period (mean Y-BOCS score at week 12 as compared with baseline: P=.000). Those receiving topiramate experienced a mean decrease of 32.0% in Y-BOCS score, compared with 2.4% decrease for those receiving placebo. Twelve patients in the topiramate group versus no patient in the placebo group were rated as responder. CONCLUSION: The results of our study demonstrated that topiramate may augment the therapeutic effect of SSRIs in treatment-resistant OCD patients. However, it should be noted that our study is preliminary and larger double-blind studies are needed to confirm these results.

Mental Health Patient Portals Aimed at Depression: A Picture Close to Reality.

Patient portals can have positive consequences in the empowerment of people with depression by raising awareness about their condition. Patient portals are important yet challenging technologies in the field of mental health care. We conducted a scoping review aiming to investigate some important characteristics and features of the mental health websites and related patient portal services for the target audience including people with depression. For this purpose, two reviewers independently entered the keywords in the popular search engines including Google, Yahoo, and Bing in April 2019, in order to find mental health websites that provide patient portal service targeting depression. Examination of the inclusion and exclusion criteria led finally to the selection of 31 websites. We found out that some features of patient portals including the online questionnaires, messaging between the patient and the healthcare provider, and medication refill were more consistent with the areas on which the mental healthcare providers focus, and thus can be effective in improving the progression of these areas. It is essential for patient portal providers to put more focus on expressing the patient portal's features and objectives on their websites. Besides, it is also necessary to conduct further research to investigate the obstacles and facilitators of the interactive features of the patient portals in the field of mental health care, particularly depression.

Are patients with Darier and Haily-Haily diseases susceptible to Alzheimer's disease? A theory based on abnormal intraneuronal Ca2+ homeostasis.

Calcium is one of the most important intracellular messengers in human brain. Studies show that there is a relationship between altered Ca2+-homeostasis, especially elevation of intracellular calcium, and formation of the hallmark pathological lesions of Alzheimer's disease. Additionally, Ca2+ is crucial for normal function of the skin, and an abnormal rise in intracellular Ca2+ can consequently lead to the development of two skin disorders: Darier and Hailey-Hailey diseases. As these mutated genes are also highly expressed in the brain and these patients are reported to experience some neuropsychiatric problems, we have hypothesized that patients with these dermatologic diseases may be more prone to the development of Alzheimer's disease. Further investigation may give us clues to find novel therapeutic targets and agents for modulation of intracellular calcium in neurons.

Fluvoxamine combination therapy with tropisetron for obsessive-compulsive disorder patients: A placebo-controlled, randomized clinical trial.

BACKGROUND: About 50% of obsessive-compulsive disorder patients still suffer significant symptoms even after the recommended first-line therapy. This demonstrates the necessity to investigate strategies to improve alleviation of symptoms. OBJECTIVE: The main objective of this study was to investigate the efficacy of a 5-hydroxytryptophan 3 receptor antagonist, tropisetron, as an adjuvant therapy to selective serotonin reuptake inhibitors, in ameliorating obsessive-compulsive disorder symptoms. METHODS: Men and women between the ages of 18-60 years diagnosed with obsessive-compulsive disorder, based on DSM5, who had a Yale-Brown obsessive compulsive scale score of more than 21 were recruited in a double-blinded, parallel-group, placebo-controlled, clinical trial of 10 weeks to receive either tropisetron (5 mg twice daily) and fluvoxamine (100 mg daily initially followed by 200 mg daily after week 4) or placebo and fluvoxamine. The primary outcome of interest in this study was the Yale-Brown obsessive compulsive scale total score decrease from baseline. RESULTS: One hundred and eight participants were equally randomized into two groups; 48 participants in each group finished the trial. The Yale-Brown obsessive compulsive total score significantly dropped in both groups while the tropisetron group participants experienced a significantly higher decrease in their scores (Greenhouse-Geisser F(1.53-65.87)=3.516, p-value=0.04). No major adverse effect was observed in any of the groups. CONCLUSION: This trial showed a significant efficacy for tropisetron over placebo in treatment of obsessive-compulsive disorder symptoms when added to fluvoxamine.

Do memory complaints represent impaired memory performance in patients with major depressive disorder?

Memory complaints are found to be associated with depression. However, the question is, "How much these subjective complaints indicate objective memory impairments?" The aim of this study is to determine whether subjective memory complaints represent objective memory impairments and to establish the demographic and clinical characteristics of patients with major depressive disorder (MDD) and subjective memory complaints. Sixty-four patients with MDD were assessed for objective memory performance through subtests of the Wechsler Memory Scale-III. Memory complaints also were assessed in these patients with a structured interview. Thirty healthy controls were also included in the study to compare memory performance among groups. The Hamilton Rating Scale for Depression was used to measure the severity and characteristics of depression. Patients with MDD who had longer duration and earlier onset of depression reported more memory complaints. MDD patients with memory complaints had more hypochondriac concerns but not more depression severity compared with those without memory complaints. There was no relationship between subjective memory complaints and objective memory performance in MDD patients. Patients with MDD with and without memory complaints had lower scores on the Wechsler Memory Scale-III than the control group. Subjective memory complaints are not a valid indictor of objective memory impairments, and the diagnostic value of self-reported memory is being questioned in patients with MDD. The cognitive status of MDD patients should be assessed routinely, regardless of the patient awareness of his or her cognitive deficits.

Role of insulin metabolism disturbances in the development of Alzheimer disease: mini review.

Alzheimer disease (AD) is the most common form of dementia. Different pathogenic processes have been studied that underlie characteristic changes of AD, including A beta protein aggregation, tau phosphorylation, neurovascular dysfunction, and inflammatory processes. Insulin exerts pleiotropic effects in neurons, such as the regulation of neural proliferation, apoptosis, and synaptic transmission. In this setting, any disturbance in the metabolism of insulin in the central nervous system (CNS) may put unfavorable effects on CNS function. It seems that disturbances in insulin metabolism, especially insulin resistance, play a role in most pathogenic processes that promote the development of AD. In this article, the relationships of disturbances in the metabolism of insulin in CNS with A beta peptides aggregation, tau protein phosphorylation, inflammatory markers, neuron apoptosis, neurovascular dysfunction, and neurotransmitter modulation are discussed, and future research directions are provided.

Comparison of clinical characteristics of opium-induced and independent major depressive disorder.

Psychiatric disorders and among them depression are common in substance dependent patients. The aim of this study is to compare the clinical characteristics of those that appear to have substance-induced depression and those that have independent major depression. One-hundred eighty-four independent and 187 opium-induced (OID) depressed male patients that met the DSM-IV criteria for major depressive disorder were randomly selected. Standard demographic data, including age, marital, employment and education status, were collected. The primary measure of depressive signs and symptoms was Hamilton Depression Scale (HAMD-21). The two groups were compared with each other for the HAMD total and subscales scores. The two groups were matched regarding age, educational level and marital status. Opium-induced depressed patients were more severely depressed and motor retarded and also they had more social and occupational problems. Gastrointestinal, sexual and somatic complaints were more common among them too. MDD patients had better insight than the other group. The results demonstrate that it is possible to differentiate between substance-induced and independent depression. Such differentiation might be important for establishing prognosis and optimal treatment.

Aripiprazole as an adjuvant treatment for obsessive and compulsive symptoms in manic phase of bipolar disorder: A randomized, double-blind, placebo-controlled clinical trial.

BACKGROUND AND OBJECTIVE: Our Objective is to study the effects of aripiprazole as an adjuvant treatment for obsessive and compulsive (OC) symptoms in patients with bipolar disorder (BD) type I, manic phase. PATIENTS AND METHODS: In this 8-week, double-blind, placebo-controlled randomized clinical trial, 56 patients with BD who had OC symptoms were randomly allocated to receive aripiprazole or placebo plus their routine medication regimen (lithium + clonazepam). Yale Brown obsessive compulsive behavior scale (YBOCS) was administered to evaluate the outcomes. Adverse effects were also registered. RESULTS: Of 56 BD patients with OC symptoms which were randomly allocated in two groups of aripiprazole (n = 29) and placebo group (n = 27), 46 patients (23 in aripiprazole group and 23 in placebo group) completed the trial. Throughout the trial, the mean score of YBOCS in the aripiprazole group decreased from 21 ±â€¯4.81 to 9.6 ±â€¯2.2 (P < 0.001) and in the placebo group dropped from 20.46 ±â€¯4.8 to 17.32 ±â€¯3.7 (P < 0.001). At the end of the study, 21 (91.30%) patients in the aripiprazole group and 1 (4.34%) patient in the placebo group had >34% decline in YBOCS score (P < 0.01). No serious adverse effects were reported in any groups. CONCLUSIONS: The results of our study revealed that aripiprazole can be used as an effective adjuvant agent for treatment of obsessive and compulsive symptoms in manic patients.

Comparing escitaloipram with sertraline for obsessive and compulsive symptoms in patients with obsessive compulsive disorder: A comparative double blind clinical trial.

BACKGROUND: Escitalopram has some unique features among selective serotonin reuptake inhibitors. The aim of this survey is to compare the efficacy of escitalopram with sertraline on obsessive and compulsive symptoms in patients with Obsessive Compulsive Disorder (OCD). METHODS: In this 12-week double blind controlled randomized clinical trial, 57 patients with OCD were randomly allocated to receive escitalopram or sertraline. Yale Brown obsessive compulsive behavior scale (YBOCS) was used to assess the outcomes. Adverse effects were also recorded. RESULTS: 41 patients (20 in the escitalopram group and 21 in the sertraline group) completed the trial. In the escitalopram group 15 (70%) patients and in the sertraline group 16 (76.19%) patients showed more than 34% decrease in mean YBOCS score at the end of the trial (P=0.531). The two groups revealed significant decrease in YBOCS scores without significant difference (P=0.861) at week 12. No serious adverse effects were reported. CONCLUSIONS: Our results demonstrated that escitalopram is as effective as sertraline in treatment of obsessions and compulsions in patients with OCD. However, it needs to be noted that our study is preliminary and larger double blind controlled studies are needed to confirm the results.

Comparing the Effects of Sertraline with Duloxetine for Depression Severity and Symptoms: A Double-Blind, Randomized Controlled Trial.

BACKGROUND AND OBJECTIVE: Selecting the most effective treatment for major depressive disorder (MDD) is a challenge for clinicians. The aim of this study was to compare the effects of sertraline with duloxetine on major depression signs and symptoms. METHODS: The trial was a 6-week, randomized, controlled, double-blind study. Sixty-three patients with diagnosis of MDD according to DSM-IV-TR criteria were randomly assigned to receive either duloxetine (31 patients) or sertraline (32 patients). The mean dosage of duloxetine was 55 mg/day (range 40-60 mg/day) and the mean dosage of sertraline was 146 mg/day (range 50-200 mg/day). Subjects were assessed at baseline, and at the end of week 6. Depression severity and symptoms were assessed by 21-item Hamilton Depression Rating Scale (HAM-D). RESULTS: Of 63 patients who were randomized to treatment, 54 patients including 28 in the sertraline group and 26 in the duloxetine group completed the trial. The HAM-D total score for both groups was significantly reduced at the end of the trial period without significant difference from each other (p = 0.463). Of the symptoms studied, psychomotor retardation, general somatic symptoms and sexual problems improved more in the duloxetine group. On the other hand, agitation, anxiety symptoms and hypochondriasis ameliorated better in the sertraline group. There was no difference between the two groups regarding the other symptoms. CONCLUSIONS: Our study shows that the antidepressant mechanism of action has influence on its effects on different signs and symptoms. Clinician awareness of an antidepressant's special effects can help in selecting appropriate medicine.

Study the effects of saffron on depression and lipid profiles: A double blind comparative study.

UNLABELLED: Depression is a one of the most prevalent psychiatric disorder. Despite several pharmacological treatments, still treating depression is a challenge. Herbal medicine that is better culturally accepted may play an important role in treatment of depression. In this double blind placebo controlled clinical trial, 40 patients that were suffering from major depression according to DSM-IV criteria were randomly allocated to take either fluoxetine and saffron (20 patients) or fluoxetine and placebo (20 patients). The patients of the two groups were evaluated with Beck depression scale at the beginning of the study and after four weeks. Lipid profile (total Triglyceride (TG) level, total cholesterol level, low density lipoprotein (LDL) level and high density lipoprotein (HDL) level) of the patients also was measured at the beginning and end of the trial. 30 patients (19 in saffron group and 11 in placebo group) completed the study. The two groups improved significantly in depression severity at the end of the study without significant difference (P: 0.560). The lipid profile of the two groups did not change significantly. Our study did not demonstrate antidepressive effects for saffron. We did not observe any lipid lowering effect in saffron group too. Of note is that our study is preliminary and larger studies with more patients and longer duration are needed to prove our results. CLINICAL TRIAL REGISTRATION NUMBER: IRCT 2013110915334.