Mild cognitive disorder and depression:treatment with association between galantamine and escitalopram

2011 ◽  
Vol 26 (S2) ◽  
pp. 1297-1297
Author(s):  
J. Zarra ◽  
L. Schmidt
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Therapeutic Response ◽  
Rating Scale ◽  
Acetylcholinesterase Inhibitor ◽  
Cognitive Disorder ◽  
Clinical Impression ◽  
List Type ◽  
Cholinergic Systems ◽  
Cholinergic Agent ◽  
Group 2

IntroductionTo evaluate the efficacy of galantamine-paroxetine association in patients with Mild Cognitive Disorder and Depression. So there is a possible relation between the deficit in executive and cognitive cerebral function and depression or relation between the serotonin system and cholinergic system in relation with disease comorbidity cognitive-depression.ObjectiveTo evaluate the therapeutic response in patients with comorbility between Mild Cognitive Disorder and Depression in treatment with Galantamine (acetylcholinesterase inhibitor) with Escitalopram (Selective serotonin reuptake inhibitors) and the two drugs associated.MethodA group of 705 patients with symptoms of Mild Cognitive Disorder and Depression (DSM IV-TR criteria) were separated in 3 groups of 235 patients. Each group received different treatment in an 12 months period:Group 1: Galantamine 16 mg/day.Group 2: Escitalopram 10 mg/day.Group 3: both drugs, same dose.ResultsThe therapeutic response evaluated in Hamilton Scale for Depression (HAM-D), Montgomery and Äsberg Depression Rating Scale (M.A.D.R.S.), Mini Mental State Examination (M.M.S.E.) and Global Clinical Impression (G.C.I.) scores during 12 months. In the third group who received the two drugs associated, had much better response than the others and “brain enhancer”.ConclusionThe group who received the association of the cholinergic agent Galantamine with antidepressant (SSRIs) Escitalopram had a relevant satisfactory therapeutic response: the best result, so there is a possible relation between the deficit in cholinergic systems and depression. Could be cerebral cholinergic systems deficit a generator of Depressive Disorder?

A comparison of the ‘Hamilton Rating Scale for Depression’ and the ‘Montgomery-Asberg Depression rating Scale’

1999 ◽  
Vol 11 (1) ◽  
pp. 34-37 ◽  
Author(s):  
I.P.A.M. Huijbrechts ◽  
P.M.J. Haffmans ◽  
K. Jonker ◽  
A. van Dijke ◽  
E. Hoencamp
Keyword(s):  
Clinical Practice ◽  
Clinical Global Impression ◽  
Rating Scale ◽  
Reliability And Validity ◽  
Structured Interview ◽  
Clinical Impression ◽  
Clinical Relationship ◽  
Hamilton Rating Scale ◽  
Depressive States

SummaryAlthough the Hamilton Rating Scale for Depression (HRSD) is the most frequently used rating scale for quantifying depressive states, it has been criticized for its reliability and its usability in clinical practice. This criticism is less applying to the Montgomery-Asberg Depression Rating Scale (MADRS). Goal of the present study is to investigate the reliability and validity, and clinical relationship between the HRSD and the MADRS. For 60 out-patients with diagnosed depression (DSM IV296.2x, 296.3x, 300.40 and 311.00), the HRSD and MADRS were scored at baseline and 6 weeks later by an independent rater according to a structured interview. Also the Clinical Global Impression (CGI) was assessed by a psychiatrist. Satisfying agreement was found between the totalscores (r= .75, p>.000 en r=.92, p>.000 respectively, at baseline and 6 weeks later). Furthermore agreement was found between the items of both scales, and these agree with the clinical impression. The reliability of the MADRS is more stable than the reliability of the HRSD (α = .6367 and α =.8900 vs α = .2193 and α = .8362 at baseline and at endpoint respectively). Considering the ease of scoring both scales in one interview and the widely international use of the HRSD, scoring both the HRSD and the MADRS to measure the severity of a depression seems to be an acceptabel covenant.

EEG Synchronized TMS for Individualized Therapy in Major Depressive Disorder

2011 ◽  
Vol 26 (S2) ◽  
pp. 1144-1144
Author(s):  
Y. Jin ◽  
J. Phillips ◽  
Yueqin Huang ◽  
Steven Heurta
Keyword(s):  
Major Depressive Disorder ◽  
Side Effects ◽  
Depressive Disorder ◽  
Active Treatment ◽  
Rating Scale ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Stimulus Frequency ◽  
List Type ◽  
Major Depressive ◽  
Double Blind

IntroductionEfficacy of conventional repetitive transcranial magnetic stimulation (rTMS) in major depressive disorder (MDD) is limited. The authors report here on an alternative treatment using low energy synchronized TMS (sTMS) at the intrinsic frequency of subjects’ alpha electroencephalogram (EEG).ObjectivesEstablish efficacy and safety profile of sTMS in MDD.Aim(1)Examine the clinical effectiveness of sTMS.(2)Identify adverse effects associated with sTMS.MethodsFifty-two MDD subjects with 17-item Hamilton Depression Rating Scale (HAMD17) scores >17 were enrolled into a randomized, sham controlled, double-blind trial. Current medication remained unchanged during the trial. Depressive symptoms were evaluated by HAMD17 administered weekly.EEGs were recorded at baseline to determine the stimulus frequency and at week 4 to evaluate the physiological effect. sTMS was delivered through three 6000-G cylindrical neodymium magnets synchronously rotating at a rate equal to the subject's intrinsic alpha frequency.ResultsForty-five subjects completed at least 1 week of treatment and were evaluable. Those who received active treatment had superior clinical response to sham (t = 2.54, P = 0.01), where 55.2% in the active treatment group were clinical responders versus 12.5% in sham (X2 = 7.82, P = 0.005). No significant side effects were reported. The clinical improvement was correlated with the degree of EEG improvement (r = .46, P = 0.009).ConclusionsA therapeutic effect in MDD subjects can be achieved through administration of sTMS at the subject's alpha EEG frequency. Because of minimal side effects, this appears to be a safe and effective treatment option.

scholarly journals The use of an antagonist 5-HT2a/c for depression and motor function in Parkinson' disease

2009 ◽  
Vol 67 (2b) ◽  
pp. 407-412 ◽  
Author(s):  
Antonio Luiz dos Santos Werneck ◽  
Ana Lucia Rosso ◽  
Maurice Borges Vincent
Keyword(s):  
Parkinson Disease ◽  
Motor Function ◽  
Rating Scale ◽  
Statistical Significance ◽  
Psychotic Symptoms ◽  
Initial Moment ◽  
The Mean ◽  
Group 2 ◽  
To Receive ◽  
Group 1

OBJECTIVE: To test the ability of a 5HT2a/c (trazodone) antagonist, to improve depression and motor function in Parkinson' disease (PD). METHOD: Twenty PD patients with and without depression were randomly assigned to receive trazodone (group 1) or not (group 2). They were evaluated through UPDRS and Hamilton Depression Rating Scale (HAM-D). RESULTS: For the UPDRS the mean score of group 2 was 33.1 ± 19.7 and 37.1 ± 18.0 at the end. For the group 1, the corresponding scores were 31.4 ± 11.3 and 25.9 ± 13.7. The variations in the Mann-Whitney test were 0.734 at the initial moment and 0.208 at the final moment. The variation in the comparison of the initial moment with the final moment was 0.005 providing statistical significance. For the HAM-D, the mean score went up 4 points in group 2, contrary to a 5.5 points decrease in group 1. CONCLUSION: Data analysis shows that this agent significantly improves depression, but the motor function improved only in the depressed patients. Because of the known anti-dopaminergic property of the 5-HT2c receptors, a possible approach for depression in PD could be the use of 5-HT2c antagonists, similarly to the use of atypical neuroleptics in case of psychotic symptoms.

scholarly journals The effect of electroacupuncture on hemodialysis patients with restless legs syndrome (RLS): study protocol for a randomized crossover trial

2020 ◽  
Author(s):  
Jia-Ming Chen ◽  
Ping-Fang Chiu ◽  
Yu-Jun Chang ◽  
Po-Chi Hsu ◽  
Chia-Chu Chang ◽  
...  
Keyword(s):  
Restless Legs Syndrome ◽  
Rating Scale ◽  
Severity Index ◽  
Hemodialysis Patients ◽  
Restless Legs ◽  
The Subject ◽  
Group 2 ◽  
And Control ◽  
The Relationship ◽  
Registration Date

Abstract Background The aim of the present study was to evaluate the effects of electroacupuncture (EA) in hemodialysis patients with restless leg syndrome (RLS) by heart rate variability (HRV) monitor. Methods112 subjects who were hemodialysis patients with RLS will be divided into 2 groups: experimental and control. Each subject will receive the treatment relevant to their group 2 times a week for 4 weeks. After 4 weeks of treatment the subject will enter a 2-week washout period, after which the subjects will switch groups. Measurements will include HRV recordings, International Restless Legs Syndrome Rating Scale (IRLSRS) and Insomnia Severity Index (ISI). DiscussionThis study is the first investigation to analyze the relationship between EA and the change of HRV by an objective monitor. If the findings of the current trial are positive, this study will also help support an effective, safe and cheap approach to clinical treatment of this challenging disorder, help foster improved understanding the relationship between RLS and HRV, and ultimately contribute to elucidate the mechanisms of EA. Trial registrationClinicalTrials.gov Identifier: NCT04356794; registration date: April 22, 2020.

scholarly journals 14 Differentiating functional cognitive disorder from early neurodegeneration: a clinic-based study

2020 ◽  
Vol 91 (8) ◽  
pp. e13.1-e13
Author(s):  
Harriet A Ball ◽  
Marta Swirski ◽  
Margaret Newson ◽  
Elizabeth Coulthard ◽  
Catherine Pennington
Keyword(s):  
Minnesota Multiphasic Personality Inventory ◽  
Systemic Disease ◽  
Verbal Learning ◽  
Management Strategies ◽  
Cognitive Disorder ◽  
Cognitive Testing ◽  
List Type ◽  
Cognitive Symptoms ◽  
Delayed Recall ◽  
Two Samples

Objectives/AimsFunctional Cognitive Disorder (FCD) describes distressing or disabling cognitive symptoms that can be positively identified as internally inconsistent with recognised brain or systemic disease processes. FCD is common amongst attendees to cognitive or memory clinics. We aimed to improve the clinical characterisation of such patients, and identify means to differentiate them from patients with early neurodegeneration.MethodsWe identified two samples of patients recruited from a specialist cognitive clinic, classified on the basis of consensus expert clinical opinion following relevant investigations: FCD, (n=21), and neurodegenerative Mild Cognitive Impairment ‘MCI’, (n=17). We also recruited healthy control participants (n=25). All participants completed a cognitive battery: Montreal Cognitive Assessment (MoCA), Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test part B (TMT-B); and the Minnesota Multiphasic Personality Inventory (MMPI-2RF). Analyses included regression models controlling for age and gender. Analysis of the personality data focused on specific hypotheses generated from previous work on functional disorders.ResultsAs expected, the FCD participants were younger than the MCI participants (mean age 58 vs 72), and were more likely to be occupationally active (35% vs 6%).As described previously in this sample*, subjective cognitive symptoms were equally elevated in FCD and MCI compared to controls. Both the FCD and MCI groups were impaired in comparison to controls on MoCA, TMT-B and the initial recall component of HVLT-R. However, FCD participants demonstrated a dip in scores from free recall to recognition on HVLT-R, which was not seen in MCI (p<0.05). FCD and MCI groups scored equally high relative to controls on anxiety and depression, and on four personality indices: emotional or internalising dysfunction, somatic complaints (cognitive and non-cognitive analysed separately), and negative emotional experiences. There were no group differences in ‘introversion/low positive emotionality’.ConclusionsCognitive symptoms, basic bedside cognitive testing, personality analysis, and mood symptoms are all similar across both early neurodegenerative and FCD groups, making them hard to disentangle clinically. We hope that by highlighting certain testing modalities that can illustrate internal inconsistency (such as delayed recall spared relative to recognition, as opposed to consistently poor delayed recall and recognition that is more typical of Alzheimer’s neurodegeneration), we can improve diagnosis and thereby management strategies. It is unclear why both mood and non-cognitive somatic symptoms are elevated in both FCD and MCI; this could reflect an epiphenomenon of distress surrounding the cognitive symptoms, despite diverse origins of the cognitive symptoms.ReferencePennington C, Ball HA, Swirski M. Functional cognitive disorder: diagnostic challenges and future directions.Diagnostics 2019; 9: 131.

scholarly journals Item-based analysis of the effects of duloxetine in depression: a patient-level post hoc study

2019 ◽  
Vol 45 (3) ◽  
pp. 553-560 ◽  
Author(s):  
Alexander Lisinski ◽  
Fredrik Hieronymus ◽  
Jakob Näslund ◽  
Staffan Nilsson ◽  
Elias Eriksson
Keyword(s):  
Depressed Mood ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Rating Scale ◽  
Early Response ◽  
Controlled Trials ◽  
Early Effect ◽  
Patient Level ◽  
Response Profile ◽  
Effect Parameter ◽  
Meta Analyses

Abstract Oft-cited trial-level meta-analyses casting doubt on the usefulness of antidepressants have been based on re-analyses of to what extent the active drug has outperformed placebo in reducing the sum score of the Hamilton Depression Rating Scale (HDRS-17-sum) in clinical trials. Recent studies, however, suggest patient-level analyses of individual HDRS items to be more informative when assessing the efficacy of an antidepressant. To shed further light on both symptom-reducing and symptom-aggravating effects of a serotonin and noradrenaline reuptake inhibitor, duloxetine, when used for major depression in adults, we hence applied this approach to re-analyse data from 13 placebo-controlled trials. In addition, using patient-level data from 28 placebo-controlled trials of selective serotonin reuptake inhibitors (SSRIs), the response profile of duloxetine was compared to that of these drugs. Duloxetine induced a robust reduction in depressed mood that was not dependent on baseline severity and not caused by side-effects breaking the blind. A beneficial effect on depressed mood was at hand already after one week; when outcome was assessed using HDRS-17-sum as effect parameter, this early response was however masked by a concomitant deterioration with respect to adverse event-related items. No support for a suicide-provoking effect of duloxetine was obtained. The response profile of duloxetine was strikingly similar to that of the SSRIs. We conclude that the use of HDRS-17-sum as effect parameter underestimates the true efficacy and masks an early effect of duloxetine on core symptoms of depression. No support for major differences between duloxetine and SSRIs in clinical profile were obtained.

scholarly journals A Comparative Clinical Evaluation of the efficacy of two Desensitizing dentifrices in Relieving Dentine Hypersensitivity

2020 ◽  
Vol 22 (1-2) ◽  
pp. 33-38
Author(s):  
Rojin Joshi ◽  
S Gautam ◽  
B Joshi
Keyword(s):  
Clinical Condition ◽  
Rating Scale ◽  
Potassium Nitrate ◽  
Chemical Compositions ◽  
Management Options ◽  
Chi Square ◽  
Sensitivity Score ◽  
Significant Difference ◽  
Group 2 ◽  
Dentinal Hypersensitivity

Dentinal hypersensitivity has been defined as a short, sharp pain arising from exposed dentine in response to stimuli thermal, evaporative, tactile, chemical or osmotic and which cannot be ascribed to any other form of dental defect or pathology. This is a common clinical condition which may cause patients more distress due to exposure of dentin. There are various management options for this clinical condition which can be either home applied or in office techniques. Various dentifrices are commercially available in the market. The chemical compositions of the dentifrices are different. We conducted this study to compare the effectiveness of a potassium nitrate containing dentifrice and a Novamin based dentifrice in relieving dentinal hypersensitivity. The patients were divided into two experimental groups; group 1-potassium nitrate containing dentifrice and group 2-Novamin containing dentifrice. The sensitivity score was analyzed by using a verbal rating scale at baseline, at three weeks and at six weeks after using the dentifrices. Statistical analysis was done using SPSS version 17. Chi-square test showed that there was no significant difference between the effectiveness and efficacy of the two dentifrices. The results were highly significant (p<0.001). Hence, potassium nitrate and Novamin were equally effective in reducing dentinal hypersensitivity.

Escitalopram Versus SNRI Antidepressants in the Acute Treatment of Major Depressive Disorder: Integrative Analysis of Four Double-Blind, Randomized Clinical Trials

CNS Spectrums ◽  
2009 ◽  
Vol 14 (6) ◽  
pp. 326-333 ◽  
Author(s):  
Susan G. Kornstein ◽  
Dayong Li ◽  
Yongcai Mao ◽  
Sara Larsson ◽  
Henning F. Andersen ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Randomized Clinical Trials ◽  
Rating Scale ◽  
Severe Depression ◽  
Major Depressive ◽  
Double Blind ◽  
Madrs Score ◽  
Treatment Difference

AbstractIntroduction: Recent data suggest that escitalopram may be more effective in severe depression than other selective serotonin reuptake inhibitors.Methods: Individual patient data from four randomized, double-blind comparative trials of escitalopram versus a serotonin/norepinephrine reuptake inhibitor (SNRI) (two trials with duloxetine and two with venlafaxine extended release) in outpatients (18–85 years of age) with moderate-to-severe major depressive disorder were pooled. The primary efficacy parameter in all four trials was mean change in the Montgomery-Asberg Depression Rating Scale (MADRS) score.Results: Significantly fewer escitalopram (82/524) than SNRI (114/527) patients prematurely withdrew from treatment due to all causes (15.6% vs. 21.6%, Fisher Exact: P=.014) and adverse events (5.3% vs. 12.0%, Fisher Exact: P <.0001). Mean reduction in MADRS score from baseline to Week 8 was significantly greater for the escitalopram group versus the SNRI group using the last observation carried forward (LOCF) approach [mean treatment difference at Week 8 of 1.7 points (P <.01)]. Similar results were observed in the severely depressed (baseline MADRS score ≥30) patient subset (mean treatment difference at Week 8 of 2.9 points [P <.001, LOCF]). Observed cases analyses yielded no significant differences in efficacy parameters.Conclusion: This pooled analysis indicates that escitalopram is at least as effective as the SNRIs (venlafaxine XR and duloxetine), even in severe depression, and escitalopram treatment was better tolerated.

scholarly journals Efficacy and tolerability of venlafaxine compared with selective serotonin reuptake inhibitors and other antidepressants: A meta-analysis

2002 ◽  
Vol 180 (5) ◽  
pp. 396-404 ◽  
Author(s):  
David Smith ◽  
Carrie Dempster ◽  
Julie Glanville ◽  
Nick Freemantle ◽  
Ian Anderson
Keyword(s):  
Systematic Review ◽  
Effect Size ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Rating Scale ◽  
Remission Rate ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Randomised Trials ◽  
Double Blind

BackgroundIn individual studies and limited meta-analyses venlafaxine has been reported to be more effective than comparator antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs).AimsTo perform a systematic review of all such studies.MethodWe conducted a systematic review of double-blind, randomised trials comparing venlafaxine with alternative antidepressants in the treatment of depression. The primary outcome was the difference in final depression rating scale value, expressed as a standardised effect size. Secondary outcomes were response rate, remission rate and tolerability.ResultsA total of 32 randomised trials were included. Venlafaxine was more effective than other antidepressants (standardised effect size was −0.14, 95% Cl −0.07 to −0.22). A similar significant advantage was found against SSRIs (20 studies) but nottricyclic antidepressants (7 studies).ConclusionsVenlafaxine has greater efficacy than SSRIs although there is uncertainty in comparison with other antidepressants. Further studies are required to determine the clinical importance of this finding.

scholarly journals Impact of resilience on the improvement of depressive symptoms after cognitive therapies for depression in a sample of young adults

2018 ◽  
Vol 40 (3) ◽  
pp. 226-231 ◽  
Author(s):  
Caroline Elizabeth Konradt ◽  
Taiane de Azevedo Cardoso ◽  
Thaíse Campos Mondin ◽  
Luciano Dias de Mattos Souza ◽  
Flavio Kapczinski ◽  
...  
Keyword(s):  
Negative Correlation ◽  
Therapeutic Response ◽  
Rating Scale ◽  
Post Intervention ◽  
Resilience Scale ◽  
Lower Severity ◽  
Weak Negative Correlation ◽  
Hamilton Anxiety Rating Scale ◽  
Cognitive Therapies

Abstract Introduction Few studies have evaluated positive measures for therapeutic response. Thus, the objective of this study was to assess the effects of resilience on severity of depressive and anxious symptoms after brief cognitive psychotherapy for depression. Methods This was a clinical follow-up study nested in a randomized clinical trial of cognitive therapies. The Resilience Scale was applied at baseline. The Hamilton Anxiety Rating Scale (HARS) and the Hamilton Depression Rating Scale (HDRS) were used at baseline, post-intervention, and at six-month follow-up. Results Sixty-one patients were assessed at baseline, post-intervention and at six-month follow-up. Resilience scores were significantly different between baseline and post-intervention assessments (p<0.001), as well as at baseline and at six-month follow-up (p<0.001). We observed a weak negative correlation between baseline resilience scores and HDRS scores at post-intervention (r=-0.295, p=0.015) and at six-month follow-up (r=-0.354, p=0.005). Furthermore, we observed a weak negative correlation between resilience scores and HARS scores at post-intervention (r=-0.292, p=0.016). Conclusion Subjects with higher resilience scores at baseline showed a lower severity of symptoms at post-intervention and at six-month follow-up.

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