RESUMO
INTRODUCTION: Major depression and insomnia are among the most frequent neuropsychiatric syndromes in the geriatric population. Although most SSRI antidepressants affect sleep continuity, mirtazapine has been found to improve sleep continuity in patients with depression. The aim of the present study was to assess by actigraphic recordings changes in sleep patterns of geriatric patients with major depression before and during treatment with mirtazapine (30 mg). METHODS: Patients aged 60 years or more with major depressive disorder were recruited at the outpatient service of a specialized mental health centre. Severity of depression was rated with the Montgomery-Asberg depression rating scale and subjective perception of sleep was assessed with the Pittsburgh sleep quality index (PSQI). Actigraphic parameters were registered 4 days before the onset of mirtazapine treatment (patients were drug free in this period of time) and recorded at day 60 of treatment with mirtazapine. RESULTS: A significant decrease was observed in the sleep fragmentation index. While a significant improvement was observed in the subjective assessment of quality after treatment with mirtazapine, actigraphic measures of sleep parameters did not show changes in line with mirtazapine treatment. DISCUSSION: Mirtazapine produces minimal changes on actigraphic measures in the sleep of elderly outpatients. Sleep produced by mirtazapine indicates a more pronounced effect in ≥ 80-year-old patients. This differential response should be considered during treatment of this clinical population.
Assuntos
Transtorno Depressivo Maior/tratamento farmacológico , Mianserina/análogos & derivados , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Transtornos do Sono do Ritmo Circadiano/complicações , Sono/efeitos dos fármacos , Actigrafia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Transtorno Depressivo Maior/complicações , Feminino , Humanos , Masculino , Mianserina/efeitos adversos , Mianserina/farmacologia , Mianserina/uso terapêutico , Pessoa de Meia-Idade , Mirtazapina , Atividade Motora/efeitos dos fármacos , Inibidores Seletivos de Recaptação de Serotonina/farmacologia , Transtornos do Sono do Ritmo Circadiano/induzido quimicamenteAssuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Calcinose/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/patologia , Calcinose/complicações , Calcinose/patologia , Humanos , Infarto da Artéria Cerebral Média/etiologia , Infarto da Artéria Cerebral Média/patologia , Masculino , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologiaRESUMO
BACKGROUND: A high frequency of cigarette smoking has been reported among individuals with major depression. In a previous study, transdermal nicotine produced short-term improvement in the mood of depressed patients. This study was undertaken to determine the effects of 4 days' administration of transdermal nicotine on mood in nonsmoking patients with major depression. METHOD: The effects of nicotine patches (17.5 mg) on 12 nonmedicated outpatients with major depression (DSM-III-R) were studied for 4 continuous days. Patients had to score 18 points or more on the Hamilton Rating Scale for Depression (HAM-D) (21 items) for admission into the study. The HAM-D (10 items), a visual analog scale, and a side effects scale were scored daily during the trial (baseline, 4 days of nicotine patches, and 4 days of follow-up). RESULTS: Two patients dropped out of the study owing to nausea and vomiting. Results of the visual analog scale and HAM-D (10 items) showed a significant (p < .01) improvement in depression after the second day of nicotine patches. Patients relapsed 3 or 4 days after the last nicotine dose. The side effects observed were an increase in saliva production, nausea, loss of appetite, and mild insomnia. CONCLUSION: Nicotine patches produced short-term improvement of depression with minor side effects. Because of nicotine's high risk to health, nicotine patches are not recommended for clinical use in depression. Analogue drugs may be developed in the future that may help improve depression without the risk of other major health problems.