Efficacy of Tianeptine 25-50 mg in Elderly Patients With Recurrent Major Depressive Disorder: An 8-Week Placebo- and Escitalopram-Controlled Study.

OBJECTIVE: The present placebo-controlled study evaluated the efficacy and safety of 8 weeks of treatment with tianeptine 25-50 mg/d in elderly patients suffering from major depressive disorder (MDD) according to DSM-IV-TR. Escitalopram 5-10 mg/d was used as an active comparator. METHODS: Elderly outpatients aged at least 65 years with a primary diagnosis of moderate to severe episode of recurrent MDD were recruited by psychiatrists in 44 clinical centers in 10 countries from October 2013 to January 2016. Patients were randomly assigned to receive tianeptine (n = 105), placebo (n = 107), or escitalopram (n = 99) for 8 weeks. The primary outcome measure was the 17-item Hamilton Depression Rating Scale (HDRS17) total score. RESULTS: Tianeptine improved depressive symptoms, as evaluated by the HDRS17 total score in terms of absolute change from baseline (week 0) to week 8 (placebo-tianeptine difference [SE] of 3.84 [0.85] points, P < .001, using a last-observation-carried-forward approach) and response to treatment (tianeptine: 46.7%; placebo: 34.0%, estimate [SE] = 12.70% [6.70], P = .06). A sensitivity analysis using a mixed model for repeated measures confirmed the main results on HDRS total s​core. The placebo-tianeptine difference (SE) was 0.66 (0.15) for Clinical Global Impressions-Severity of Illness (95% CI, 0.37 to 0.96; P < .001) and 0.57 (0.14) for Clinical Global Impressions- Improvement (95% CI, 0.30 to 0.83; P < .001). Positive results were also obtained with the active control escitalopram (HDRS17 total score placebo-escitalopram difference of 4.09 ± 0.86 points, P < .001), therefore validating the sensitivity of the studied population. Tianeptine was well tolerated, with only minimal differences in tolerability from placebo. CONCLUSIONS: The present study provides robust evidence that an 8-week treatment period with tianeptine 25-50 mg is efficacious and well tolerated in depressed patients aged 65 years or older. TRIAL REGISTRATION: EudraCT identifier: 2012-005612-26​.

Sexsomnia: an uncommon variety of parasomnia.

Sexsomnia is considered a particular form of parasomnia characterized by atypical sexual behaviour during sleep. Only a few cases have been reported in the literature. We describe here two cases of sexsomnia that took place in adult women whose personal history was remarkable for traumatic sexual psychological stress during childhood. In addition, the first patient had a medical history of alcoholism during adolescence and current sleepwalking. In the second patient, drug consumption was reported during adolescence, and psychiatric assessment found a major depressive disorder. Neurological examination was normal for both patients. The sexual behaviour was reported by the bed partner because of total amnesia of the event by the patients. Events included moaning, vocalizations with dirty talk, masturbation, sexual assault, and sexual intercourse. The behaviour was harmful for the bed partner in the second case. For both patients, electroencephalogram and brain magnetic resonance imaging were normal whereas nocturnal polysomnography recordings revealed several abrupt and spontaneous arousals from slow-wave sleep. Patients were successfully treated by serotonin reuptake inhibitors. Our observations underline the fact that efforts need to be made to increase awareness of the issue of sexsomnia, in order to identify patients suffering from this atypical parasomnia, which can be associated with adverse psychological consequences and serious medico-legal issues.

Involuntary masturbation and hemiballismus after bilateral anterior cerebral artery infarction.

Ischemia of the areas supplied by the anterior cerebral artery is relatively uncommon. In addition, combined hemiballismus and masturbation have rarely been reported in patients with cerebrovascular disease. We describe herein a 62-year-old right-handed man simultaneously exhibiting right side hemiballismus and involuntary masturbation with the left hand after bilateral infarction of the anterior cerebral artery territory. Right side hemiballismus was related to the disruption of afferent fibers from the left frontal lobe to the left subthalamic nucleus. Involuntary masturbation using the left hand was exclusively linked to a callosal type of alien hand syndrome secondary to infarction of the right side of the anterior corpus callosum. After 2 weeks, these abnormal behaviours were completely extinguished. This report stresses the wide diversity of clinical manifestations observed after infarction of the anterior cerebral artery territory.

[Depression and temporal epilepsy. The possible role of laterality of the epileptic foci and of gender]. / Dépression et épilepsie temporale. Rôle possible de la latéralité du foyer épileptique et du sexe.

From a prospective study of 47 epileptic patients (26 men and 21 women) 25 with a left and 22 with a right temporal epileptic focus, the authors show that depression measured by the HARD score, is more severe in males, with a left epileptic focus. These results and the vulnerability to depression of left temporal lobe epileptic patients are analyzed.

[Value of local cerebral hypoperfusion in the diagnosis of frontal syndromes. Importance in medical expert assessment of head injuries]. / L'apport de l'étude des débits sanguins locaux dans le diagnostic des syndromes frontaux. Son intérêt dans les expertises médicales des traumatisés du crâne.

The importance of the symptoms linked to a frontal disorder in the intellectual and behavioral sequelas of severe cranial trauma, is now measured carefully because these troubles are one of the most important obstacle to the social and professional come-back. The handicap linked to a disorder of the frontal lobe is not well known in all its neurological, mental and sociological dimensions because the diagnosis is not easy. To help to this diagnosis, the study of cerebral blood flow with SPECT is usefull in medical practice. We present here 4 clinical cases of post-trauma frontal syndrome not easy to measure. With a measure of cerebral blood flow with SPECT, it was observed a decrease of frontal blood flow, that allowed to link the neuropsychological symptom to a frontal lobe disorder. It seems that in these conditions the post-trauma frontal syndrome is not so uncommon.

Depression and partial epilepsy: relevance of laterality of the epileptic focus.

In a prospective study of 50 epileptic patients (20 with a left hemisphere epileptic focus, 20 with a right one and 10 with a cryptogenic generalized epilepsy), the authors show that depression as appreciated by the H.A.R.D. score, is more frequent and severe in partial epilepsy in males, and when the epileptic focus is localized on left hemisphere. This association is related to the duration of epilepsy, the number of seizures, but not to age or medication status. Vulnerability of left hemisphere to depression is analysed, and neuro-chemical mechanisms are discussed.

[REM-sleep behavior disorder and olivo-ponto-cerebellar atrophy: a case report]. / Trouble du comportement du sommeil paradoxal et atrophie olivo-ponto-cérébelleuse: un cas.

The authors report the observation of REM-sleep behavior disorder in a patient also suffering from an olivo-ponto-cerebellar atrophy. They discuss the place of this sleep disorder among the parasomnias, its pathophysiological basis and its features similar to those of the somnambulism. Only a polysomnography study can help to make the diagnosis.