Comparison of the efficacy of electroconvulsive therapy (ECT) plus agomelatine to ECT plus placebo in treatment-resistant depression.

OBJECTIVE: Electroconvulsive therapy (ECT) is commonly used to treat patients with treatment-resistant depression. We aimed to investigate whether combining an antidepressant agent with ECT might enhance therapeutic efficacy and prevent early relapse. METHOD: During the acute ECT phase, patients (N = 97) with treatment-resistant depression were randomized to receive ECT plus agomelatine 50 mg/day (n = 48) or ECT plus placebo (n = 49). Symptom severity measures, including the 17-item Hamilton Depression Rating Scale (HAMD-17) and other scales, functional impairment, quality of life, neuropsychological tests, adverse events and attitudes toward ECT, were assessed regularly. Remission was defined as a HAMD-17 score ≤7. If patients achieved post-ECT remission, they were prescribed agomelatine 50 mg/day and participated in a 12-week follow-up trial. HAMD-17 was rated at 4-week intervals. Relapse was defined as a HAMD-17 score ≥14, or rehospitalization for a psychiatric reason. RESULTS: The two treatment groups were comparable at (i) baseline variables; (ii) score changes in all symptom measures, functional impairment, quality of life, and neuropsychological tests; (iii) frequency of adverse events and attitudes toward ECT; and (iv) post-ECT response/remission rates. There were no statistically significant differences following ECT in relapse rates and time to relapse between these two groups. CONCLUSION: Adding agomelatine to ECT yielded comparable response/remission rates to ECT without agomelatine in the acute ECT phase. Starting agomelatine in combination with ECT did not seem to be more efficacious in preventing relapse than starting agomelatine after the acute ECT course. More research is needed to guide clinical recommendations.

Clinical and radiographic characteristics in pulmonary endometriosis: based on five cases.

OBJECTIVE: This study aims to improve the diagnostic and therapeutic efficacy through analysis of clinical and radiographic characteristics in pulmonary endometriosis. MATERIALS AND METHODS: This retrospective study was conducted from January 1998 to December 2008. The clinical and radiographic characteristics of five patients diagnosed as pulmonary endometriosis were evaluated. RESULTS: Among the five female patients of reproductive age, one case presented with recurrent pneumothorax, four cases presented with recurrent hemoptysis. Episode of pneumothorax and hemoptysis had the close association with the menstrual cycle. Except for pneumothorax case, the computed tomography (CT) scans during menstruation showed patchy opacification or infiltration (n = 4). Histopathologic examination of the resected specimen conformed typical endometrial tissue in the lungs. Misdiagnosis occurred involving spontaneous pneumothorax (n = 1), pulmonary tuberculosis (TB) (n = 3), and bronchiectasis (n = 1). CONCLUSION: Pulmonary endometriosis is prone to misdiagnosis. The combination of medical history and CT scans in association with menstrual cycle was useful to make the differential diagnosis after effective diagnostic treatment of hormone therapy.