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1.
Acta Psychiatr Scand ; 113(1): 31-5, 2006 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-16390366

RESUMEN

OBJECTIVE: Postpartum depression (PPD) affects 10-15% of mothers. Omega-3 fatty acids are an intriguing potential treatment for PPD. METHOD: The efficacy of omega-3 fatty acids for PPD was assessed in an 8-week dose-ranging trial. Subjects were randomized to 0.5 g/day (n = 6), 1.4 g/day (n = 3), or 2.8 g/day (n = 7). RESULTS: Across groups, pretreatment Edinburgh Postnatal Depression Scale (EPDS) and Hamilton Rating Scale for Depression (HRSD) mean scores were 18.1 and 19.1 respectively; post-treatment mean scores were 9.3 and 10.0. Percent decreases on the EPDS and HRSD were 51.5% and 48.8%, respectively; changes from baseline were significant within each group and when combining groups. Groups did not significantly differ in pre- or post-test scores, or change in scores. The treatment was well tolerated. CONCLUSION: This study was limited by small sample size and lack of placebo group. However, these results support further study of omega-3 fatty acids as a treatment for PPD.


Asunto(s)
Depresión Posparto/tratamiento farmacológico , Depresión Posparto/psicología , Ácidos Grasos Omega-3/uso terapéutico , Adulto , Depresión Posparto/diagnóstico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Ácidos Grasos Omega-3/administración & dosificación , Femenino , Humanos , Madres/psicología , Embarazo , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Resultado del Tratamiento
2.
J Clin Psychiatry ; 61(10): 712-21, 2000 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-11078031

RESUMEN

BACKGROUND: For years, investigators have tried to determine the speed of onset of antidepressant drugs. Claims that particular drugs may produce a faster response in patients than other agents have been made, but such claims have never been confirmed. METHOD: The authors reviewed reports from studies of the speed of onset of antidepressant therapies and other studies that revealed information on this topic. We compiled a list of factors that can affect the results of such studies and interpretations of study results. In addition, we reviewed literature concerned with methods of speeding up antidepressant responses. RESULTS: No antidepressant medication currently available has been shown conclusively to have a more rapid onset of action than any other. However, some methods of augmentation may have the potential to speed responses. Somatic therapies such as electroconvulsive therapy, phototherapy, and therapeutic sleep deprivation may be the fastest options available at this time. CONCLUSION: All available antidepressant medications are usually taken for several weeks before future responders will display a significant therapeutic benefit. If a patient does not show at least a 20% improvement within the first 2 to 4 weeks of treatment, the treatment regimen should be altered. For patients who do show early benefits from a medication trial, one can expect additional benefits to accrue over an 8- to 12-week period and to improve overall outcome compared with those slower to respond. Future trials need to address methodological confounds, but a truly "faster antidepressant" will probably require new neuroscience technology.


Asunto(s)
Antidepresivos/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Antidepresivos/administración & dosificación , Antidepresivos/farmacología , Ensayos Clínicos como Asunto , Terapia Combinada , Trastorno Depresivo/psicología , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Humanos , Efecto Placebo , Análisis de Regresión , Proyectos de Investigación , Análisis de Supervivencia , Factores de Tiempo , Resultado del Tratamiento
3.
J Clin Psychiatry ; 59(11): 589-97, 1998 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-9862605

RESUMEN

BACKGROUND: Chronic depressions are common, disabling, and undertreated, and prior chronicity predicts future chronicity. However, few studies directly inform the acute or maintenance phase treatments of chronic depressions and even less is known about the effects of treatment on psychosocial functioning. METHOD: We describe the design and rationale for 2 parallel double-blind, randomized, multicenter acute and maintenance phase treatment trials. One focused on DSM-III-R major depression currently in a chronic (> or = 2 years) major depressive episode, the other on DSM-III-R major depression with concurrent DSM-III-R dysthymia ("double depression"). RESULTS: Considering the critical knowledge deficits, we designed a 12-week acute phase safety and efficacy trial of sertraline versus imipramine, followed by a 16-week continuation treatment phase for subjects with a satisfactory therapeutic response. Patients receiving sertraline who successfully completed the continuation phase entered a 76-week maintenance trial to compare sertraline with placebo; those taking imipramine continued without a placebo substitution. As part of the acute trial, subjects completing but failing to respond to the initial 12-week acute phase medication were crossed over (double-blind) to the alternative medication for a 12-week acute phase trial. We obtained naturalistic follow-up data (up to 18 months) for subjects exiting the protocol at any time. CONCLUSION: Multiphase protocols for chronic depression can test efficacy by randomized contrasts as well as shed light on key clinical issues such as the degree of response or attrition expected at particular times in a trial or the preferred medication sequence in a potential multistep treatment program.


Asunto(s)
Antidepresivos Tricíclicos/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Imipramina/uso terapéutico , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Sertralina/uso terapéutico , Enfermedad Crónica , Protocolos Clínicos , Comorbilidad , Estudios Cruzados , Trastorno Depresivo/prevención & control , Trastorno Depresivo/psicología , Método Doble Ciego , Esquema de Medicación , Trastorno Distímico/tratamiento farmacológico , Trastorno Distímico/psicología , Estudios de Seguimiento , Humanos , Pacientes Desistentes del Tratamiento , Calidad de Vida , Proyectos de Investigación , Resultado del Tratamiento
4.
Psychopharmacol Bull ; 30(1): 27-38, 1994.
Artículo en Inglés | MEDLINE | ID: mdl-7972626

RESUMEN

Research on bipolar disorder continues to indicate that recurrent episodes of mania and depression have a deteriorative effect on patient functioning, response to treatment, and prognosis. Lithium is the treatment of choice for both acute affective episodes and long-term maintenance, but not all patients respond adequately to lithium therapy. Alternatives or adjuncts to lithium in acute mania include carbamazepine, valproate, electroconvulsive therapy (ECT), and clozapine. For acute depression, antidepressants often are added to lithium treatment or used alone; nonpharmacologic options include ECT and light therapy. Studies suggest that carbamazepine and valproate may be as effective as lithium in maintenance therapy and that thyroid supplementation may increase response in rapid-cycling patients. Using psychosocial intervention in addition to maintenance pharmacologic treatment may increase medication compliance, decrease hospitalizations, and increase overall functioning.


Asunto(s)
Trastorno Bipolar/tratamiento farmacológico , Antimaníacos/uso terapéutico , Trastorno Bipolar/psicología , Trastorno Bipolar/terapia , Terapia Electroconvulsiva , Humanos , Litio/uso terapéutico
6.
Psychopharmacol Bull ; 29(4): 447-56, 1993.
Artículo en Inglés | MEDLINE | ID: mdl-8084977

RESUMEN

Nearly one percent of adults in the United States suffer from bipolar disorder, a severe, chronic, and life-threatening disease. This disorder involves periodic episodes of mania and depression. At least 80 percent of patients who have an initial episode of mania will have one or more subsequent episodes. Because recurring episodes have a cumulative deteriorative effect on functioning and treatment response, the sooner bipolar patients are diagnosed and treated, the better their changes are for recovery. With optimal treatment, a bipolar patient can regain approximately 7 years of life, 10 years of effective major activity, and 9 years of normal health, which otherwise would have been lost due to the illness. For treatment purposes, bipolar disorder is divided into three stages: acute mania, acute depression, and maintenance. Lithium is the standard treatment for acute mania, and its effectiveness is solidly supported by experimental evidence. Rigorous studies over the past 40 years involving hundreds of patients have repeatedly shown the efficacy of lithium therapy, with approximately 80 percent of subjects responding favorably. For those who do not, several other drugs and nonpharmacologic therapies are available that have shown high success rates in well-standardized trials. The anticonvulsant drug carbamazepine has been associated with improved symptoms in approximately 60 percent to 70 percent of subjects in double-blind trials comparing it against placebo, neuroleptics, and/or lithium. Valproate, another anticonvulsant, has been shown to be comparable to lithium and superior to placebo in treating acute mania in several double-blind, placebo-controlled trials. Electroconvulsive therapy (ECT) is another effective treatment for acute mania, with a positive response rate of approximately 80 percent. Acute bipolar depression has been successfully treated with a number of agents, including monoamine oxidase inhibitors (e.g., tranylcypromine), lithium, tricyclic antidepressants, and second-generation antidepressants (e.g., bupropion). Nonpharmacologic approaches such as ECT, sleep deprivation, and light therapy have been effective as supplemental therapy in many patients. For maintenance therapy, lithium is again the drug of choice. Clinical research has shown that maintenance lithium lessens the frequency and severity of episodes of mania and depression in bipolar patients and helps stabilize mood between episodes. Long-term lithium treatment also reduces the risk of mortality for bipolar patients: without treatment, mortality is two to three times higher than that of the general population; with treatment, it is not significantly different. Several other drugs have been studied as alternatives or adjuncts to lithium therapy.(ABSTRACT TRUNCATED AT 400 WORDS)


Asunto(s)
Trastorno Bipolar/terapia , Trastorno Bipolar/tratamiento farmacológico , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/terapia , Humanos , Resultado del Tratamiento
7.
Psychopharmacology (Berl) ; 108(3): 327-32, 1992.
Artículo en Inglés | MEDLINE | ID: mdl-1523282

RESUMEN

No longer prescribed only for vegetative signs of depression, tricyclic antidepressants also lessen depressive cognitive distortions. Less clear is whether they ameliorate depressed patients' other cognitive deficits in memory, information processing speed, and psychomotor performance. We tested the alternative hypothesis that amitriptyline, because of its anticholinergic and sedative properties, would exacerbate depressed patients' cognitive disturbances. Depressed outpatients received double-blind placebo (n = 15), amitriptyline (n = 10), or clovoxamine fumarate (n = 10), a serotonin reuptake inhibitor relatively lacking in anticholinergic properties. Depression, memory, and psychomotor performance were assessed at baseline and after 7 and 28 days of drug treatment. Depression was alleviated after all treatments, including placebo. Only amitriptyline impaired performance on tests of memory, producing a significant decrement, relative to placebo, after 4 weeks of treatment. None of the treatments adversely affected performance on psychomotor tasks. These findings add to the evidence that antidepressant drugs with high anticholinergic activity can impair memory, despite alleviation of depression.


Asunto(s)
Amitriptilina/uso terapéutico , Antidepresivos/uso terapéutico , Cognición/efectos de los fármacos , Trastorno Depresivo/psicología , Oximas/uso terapéutico , Estimulación Acústica , Adulto , Trastorno Depresivo/tratamiento farmacológico , Método Doble Ciego , Femenino , Humanos , Masculino , Memoria/efectos de los fármacos , Escalas de Valoración Psiquiátrica , Desempeño Psicomotor/efectos de los fármacos , Tiempo de Reacción/efectos de los fármacos
8.
J Clin Psychiatry ; 50 Suppl: 17-22; discussion 45-7, 1989 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-2689433

RESUMEN

Since Cade first described the role of lithium in the treatment of manic-depressive patients 40 years ago, there has not been consistent agreement on the relationship between the serum level of lithium during maintenance therapy and clinical outcome. This is a comprehensive review of literature reporting on lithium dose-response relationships, with particular emphasis on a consideration of serum levels of lithium. Efficacy studies are systematically discussed as are those that consider the relationship between serum level and adverse effects. Even after 40 years of lithium use, the relationship between serum levels of lithium during maintenance therapy and clinical outcome, including the development of side effects, remains obscure.


Asunto(s)
Trastorno Bipolar/tratamiento farmacológico , Litio/sangre , Trastorno Bipolar/sangre , Trastorno Bipolar/prevención & control , Ensayos Clínicos como Asunto , Trastorno Depresivo/sangre , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/prevención & control , Esquema de Medicación , Humanos , Litio/uso terapéutico
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