Broek, W.W. van den

Model-based electron microscopy: From images toward precise numbers for unknown structure parameters (Article)

2012-03-01T00:00:00Z

Statistical parameter estimation theory is proposed as a method to quantify electron microscopy images. It aims at obtaining precise and accurate values for the unknown structure parameters including, for example, atomic column positions and types. In this theory, observations are purely considered as data planes, from which structure parameters have to be determined using a parametric model describing the images. The method enables us to measure positions of atomic columns with a precision of the order of a few picometers even though the resolution of the electron microscope is one or two orders of magnitude larger. Moreover, small differences in averaged atomic number, which cannot be distinguished visually, can be quantified using high-angle annular dark field scanning transmission electron microscopy images. Finally, it is shown how to optimize the experimental design so as to attain the highest precision. As an example, the optimization of the probe size for nanoparticle radius measurements is considered. It is also shown how to quantitatively balance signal-to-noise ratio and resolution by adjusting the probe size.

Post-dexamethasone cortisol as a predictor for the efficacy of electroconvulsive therapy in depressed inpatients (Article)

2011-09-01T00:00:00Z

Background: Although several variables have been studied as a possible predictor for the efficacy of ECT, results regarding hypercortisolism have been inconsistent. This prospective study evaluates the relation between pre-treatment cortisol levels and the efficacy of ECT in a population of drug-free inpatients with severe major depression. Methods: At the inpatient depression unit, 18 patients meeting the DSM-IV criteria for depressive disorder, and with scores of at least 18 on the 17-item Hamilton Rating Scale for Depression (HAM-D), were treated with bilateral ECT twice weekly. The HAM-D evaluated depression severity and was performed within 3 days prior to ECT, weekly during the course of ECT, and within 3 days after the last treatment. The outcome criterion was defined a priori as the change on the HAM-D score. Salivary cortisol was assessed within 3 days prior to ECT at two time points, followed by 0.5 mg dexamethasone ingestion. The following day, salivary cortisol was again assessed at two time points. The generalized linear model was used to assess the relation between salivary cortisol levels and reduction in HAM-D score as continuous variables. Results: Higher levels of salivary cortisol at 9 AM after 0.5 mg dexamethasone ingestion are associated with a greater reduction in HAM-D score (B = -0.279, 95% CI: -0.557 to -0.01, s.e. = 0.13, p = 0.049; R square = 0.23; adjusted R square = 0.13). Conclusion: This study suggests that higher levels of post-dexamethasone salivary cortisol at 9 AM are predictive of ECT efficacy.

Retrograde amnesia after electroconvulsive therapy: A temporary effect? (Article)

2011-07-01T00:00:00Z

Objective: Although electroconvulsive therapy (ECT) is generally considered effective against depression, it remains controversial because of its association with retrograde memory loss. Here, we assessed memory after ECT in circumstances most likely to yield strong retrograde amnesia. Method: A cohort of patients undergoing ECT for major depression was tested before and after ECT, and again at 3-months follow-up. Included were 21 patients scheduled to undergo bilateral ECT for severe major depression and 135 controls matched for gender, age, education, and media consumption. Two memory tests were used: a verbal learning test to assess anterograde memory function, and a remote memory test that assessed memory for news during the course of one year. Results: Before ECT the patients' scores were lower than those of controls. They were lower again after treatment, suggesting retrograde amnesia. At follow-up, however, memory for events before treatment had returned to the pre-ECT level. Memory for events in the months after treatment was as good as that of controls. Limitations: The sample size in this study was not large. Moreover, memory impairment did not correlate with level of depression, which may be due to restriction of range. Conclusions: Our results are consistent with the possibility that ECT as currently practiced does not cause significant lasting retrograde amnesia, but that amnesia is mostly temporary and related to the period of impairment immediately following ECT.

Throughput maximization of particle radius measurements through balancing size versus current of the electron probe (Article)

2011-06-01T00:00:00Z

In this paper we investigate which probe size maximizes the throughput when measuring the radius of nanoparticles in high angle annular dark field scanning transmission electron microscopy (HAADF STEM). The size and the corresponding current of the electron probe determine the precision of the estimate of a particle's radius. Maximizing throughput means that a maximum number of particles should be imaged within a given time frame, so that a prespecified precision is attained. We show that Bayesian statistical experimental design is a very useful approach to determine the optimal probe size using a certain amount of prior knowledge about the sample. The dependence of the optimal probe size on the detector geometry and the diameter, variability and atomic number of the particles is investigated. An expression for the optimal probe size in the absence of any kind of prior knowledge about the specimen is derived as well.

The efficacy of ultrabrief-pulse (0.25 millisecond) versus brief-pulse (0.50 millisecond) bilateral electroconvulsive therapy in major depression (Article)

2011-03-01T00:00:00Z

Objectives: Electroconvulsive therapy (ECT) is an effective treatment for patients with major depression but carries the risk of memory impairment. Bilateral ECT with ultrabrief pulses, instead of brief pulses, seems to result in a significant decrease in memory impairment. This study explores whether patients treated with ultrabrief-pulse bilateral ECT achieve a similar treatment effect compared with patients treated with regular brief-pulse bilateral ECT. Methods: This retrospective study included 65 patients with major depression treated with bilateral ECT, in the period 2002 to 2008. The patients were divided into 2 groups, depending on whether they received a pulse-width treatment of 0.5 (46 patients) or 0.25 millisecond (19 patients). Depressive symptoms were assessed with the 17-item Hamilton Rating Scale for Depression (HAM-D) score. Treatment outcomes were mean decrease in HAM-D score and treatment response rates and remission rates. Results: The mean decrease in HAM-D score in the 0.25- and 0.50-millisecond groups was 20.1 (SD, 8.9) and 19.3 (SD, 9.2), respectively (difference not significant); response rates were 73.6% and 75.6%, and final remission rates were 42.1% and 45.6%, respectively. Thus, the decreases in HAM-D score and the response and remission rates were very similar in both groups. Conclusions: In this study population, the use of ultrabrief-pulse (0.25 millisecond) bilateral ECT resulted in equivalent treatment outcome and efficacy compared with bilateral ECT with a brief pulse (0.50 millisecond). Copyright

Lithium addition to a tricyclic antidepressant results in optimal efficacy (Article)

2011-01-01T00:00:00Z

Antidepressant Pharmacotherapy Failure and Response to Subsequent Electroconvulsive Therapy: A Meta-Analysis (Article)

2010-10-01T00:00:00Z

Abstract: Failure to respond to antidepressants probably is the most common indication for electroconvulsive therapy (ECT). The literature seems to be divided as to whether medication resistance has a negative influence on the efficacy of subsequent ECT. Therefore, we performed a systematic review to investigate the effect of previous pharmacotherapy failure on the efficacy of ECT. Relevant cohort studies were identified from systematic search of the PubMed electronic database. Seven studies were included in this meta-analysis: the overall remission rate amounts to 48.0% (281/585) for patients with and 64.9% (242/373) for patients without previous pharmacotherapy failure. An exact analysis with the Mantel-Haenszel method (fixed effect model) shows a reduced efficacy of ECT in patients that received previous pharmacotherapy (OR, 0.52; 95% confidence interval [CI], 0.39Y0.69). In conclusion, the efficacy of ECT is significantly superior in patients without previous pharmacotherapy failure as compared with medication-resistant patients. Because this finding is based on observational studies, it might be caused by a confounding factor, for example, the presence of psychotic features or the duration of the index episode. Electroconvulsive therapy seems to be an effective treatment for severely depressed patients as well as for patients with previous pharmacotherapy failure.

The course of depressive symptoms in unipolar depressive disorder during electroconvulsive therapy: A latent class analysis (Article)

2010-07-01T00:00:00Z

Abstract BACKGROUND: Research examining the course of depressive symptoms during electroconvulsive therapy (ECT) is relatively scarce. OBJECTIVE: To classify patients according to the course of their depressive symptoms while receiving ECT. METHODS: The sample consisted of 156 consecutive patients receiving ECT for unipolar depressive disorder. Depressive symptoms were measured weekly with the Montgomery-Asberg Depression Rating Scale. Latent class analysis was applied to identify distinct trajectories of symptom improvement. RESULTS: We identified five classes of different trajectories (improvement rates) of depressive symptoms, i.e. fast improvement (39 patients), intermediate improvement (47 patients), slow improvement (30 patients), slow improvement with delayed onset (18 patients), and finally a trajectory with no improvement (20 patients). The course of depressive symptoms at the end of the treatment within the trajectories of intermediate improvement, slow improvement and slow improvement with delayed onset, was still improving and did not achieve a plateau. CONCLUSION: The different courses of depressive symptoms during ECT probably contribute to mixed results of prediction studies of ECT outcome. Data suggest that for a large group of patients no optimal clinical endpoint can be identified, other than full remission or no improvement at all, to discontinue ECT.

Long-term response to successful acute pharmacological treatment of psychotic depression (Article)

2010-06-01T00:00:00Z

Background: Data about follow-up after acute pharmacological treatment of psychotic depression are scarce. Methods: A 4 month open follow-up was done, preferentially with same medication as during acute treatment, of patients (n=59) with DSM-IV-TR major depressive disorder with psychotic features, aged 18 to 65 years, who had completed as responders an acute doubleblind 7 week trial with imipramine, venlafaxine or venlafaxine plus quetiapine. Main outcome measures were Hamilton Rating Scale for Depression and Clinical Global Impression Scale. Results: Six patients dropped out during the 4 month follow-up. Almost all patients (86.4%; 51/59) remained responder while remission rate increased from 59.3% (35/59) to 86.8% (46/53), independent of treatment. Relapse rate was low (3.8%; 2/53). Tolerability was good. Weight increased with all treatments. Limitations: Limitations were the limited sample size and consequent limited statistical power. The treatment during follow-up was not double-blind. Conclusions: Continuation treatment with the same medication that was effective in the acute treatment trial, remained effective during the 4 month follow-up in many patients leading to further improvement, and was well tolerated.

Influence of gender and menopausal status on antidepressant treatment response in depressed inpatients (Article)

2010-04-01T00:00:00Z

Abstract: The present study investigated the influence of gender and menopausal status on treatment response in depressed inpatients, treated with either imipramine or fluvoxamine. The patients were divided into three groups: men, premenopausal women and postmenopausal women. A multivariate analysis was performed using the difference in Hamilton score (pretreatment - post-treatment) for imipramine and fluvoxamine as dependent variable. The following independent variables were used: the baseline Hamilton score, the antidepressant used, the gender-group and the interaction between the type of antidepressant and gender. In total, 138 patients with a DSM IV diagnosis of depressive disorder were analysed. Men responded more favorably to imipramine (B = 7.12, P = 0.005). Premenopausal women had a better response rate to fluvoxamine than men (B = -8.66, P = 0.027). In depressed inpatients, men respond more favorably to imipramine than to fluvoxamine. Premenopausal women respond more frequently to fluvoxamine than men.

Prevalence of trait anxiety in a sample of depressed inpatients and its influence on response to antidepressants (Article)

2010-04-01T00:00:00Z

Depression and anxiety frequently occur together or in extension of each other. According to a previous study in depressed inpatients, a high trait anxiety level correlated with a positive response to the diazepam test (DT) and a low trait anxiety level with a negative response to the test. The aim of this study is to investigate whether positive reaction to the DT is related to a positive response to fluvoxamine and whether a negative reaction to the test is related to positive response to imipramine. The DT was performed in 130 patients diagnosed with a depressive disorder. Following the DT, the patients were randomly assigned to double-blind treatment with either imipramine or fluvoxamine. Doses of both antidepressants were adjusted to attain predefined blood levels, and the outcome was evaluated 4 weeks after attaining these blood levels. Twenty-two patients had a positive response to the DT, whereas 108 patients had a negative response. Although a positive DT is correlated with a high level of trait anxiety, no differences in depressive symptomatology and antidepressant response were found between patients with a positive and a negative DT.

Severe bradycardia after anesthesia before electroconvulsive therapy (Article)

2010-03-01T00:00:00Z

Abstract Postanesthesia bradycardia or asystole before electroconvulsive therapy (ECT) occurs very infrequently but is a potentially fatal complication of pre-ECT anesthesia. The optimal strategy for the prevention of its recurrence is unclear because the use of premedication with atropine may not always be successful. In this article, we present the case of a 21-year-old man with schizophrenia who developed bradycardia directly after receiving succinylcholine during the first 3 ECT sessions. Replacing succinylcholine with mivacurium seemed to be a successful strategy in preventing bradycardia during the final 9 ECT sessions.

Treatment of unipolar psychotic depression: a randomized, double-blind study comparing imipramine, venlafaxine, and venlafaxine plus quetiapine (Article)

2010-03-01T00:00:00Z

Abstract. OBJECTIVE: It remains unclear whether unipolar psychotic depression should be treated with an antidepressant and an antipsychotic or with an antidepressant alone. METHOD: In a multi-center RCT, 122 patients (18-65 years) with DSM-IV-TR psychotic major depression and HAM-D-17 > or = 18 were randomized to 7 weeks imipramine (plasma-levels 200-300 microg/l), venlafaxine (375 mg/day) or venlafaxine-quetiapine (375 mg/day, 600 mg/day). Primary outcome was response on HAM-D-17. Secondary outcomes were response on CGI and remission (HAM-D-17). RESULTS: Venlafaxine-quetiapine was more effective than venlafaxine with no significant differences between venlafaxine-quetiapine and imipramine, or between imipramine and venlafaxine. Secondary outcomes followed the same pattern. CONCLUSION: That unipolar psychotic depression should be treated with a combination of an antidepressant and an antipsychotic and not with an antidepressant alone, can be considered evidence based with regard to venlafaxine-quetiapine vs. venlafaxine monotherapy. Whether this is also the case for imipramine monotherapy is likely, but cannot be concluded from the data.

Treatment of unipolar psychotic depression: an open study of lithium addition in refractory psychotic depression. (Letter To Editor)

2009-10-01T00:00:00Z

Trait anxiety and defensive functioning in relation to antidepressant treatment outcome (Article)

2009-10-01T00:00:00Z

Background: Depression can occur in patients with or without trait anxiety. Although it is assumed that assessment of defenses can be useful in planning biological treatment, no studies have confirmed this hypothesis. In this study we focus on the relation between trait anxiety and defensive functioning, and on the combined influence of these personality characteristics on response to antidepressants among inpatients with a major depressive episode. Methods: Major depressive episode was diagnosed using the Schedule for Affective Disorders and Schizophrenia (SADS) and the severity of the depression was measured with the Hamilton Rating Scale for Depression (HAM-D). The level of trait anxiety was assessed using a questionnaire with 34 questions pertaining to trait anxiety. The Defense Style Questionnaire (DSQ 88) was used to assess defensive functioning followed by a weighted overall defensive functioning score (ODF). Partial correlations and multiple regression analyses were used to analyze the data. Results: The final sample included 85 patients. A significant negative effect of trait anxiety by ODF (p: 0.000) was found on the outcome score, i.e. the combination of a high score on trait anxiety and a low score on the ODF resulted in a significantly higher final score on the HAM-D. Conclusions: The most important finding in this study is that the combination of a high level of trait anxiety and immature defensive functioning evidently had a negative effect on antidepressant treatment outcome. Copyright

Electroconvulsive therapy in the Netherlands: A questionnaire survey on contemporary practice (Article)

2009-09-01T00:00:00Z

Objective: To investigate contemporary Dutch practice of electroconvulsive therapy (ECT) and adherence to national and international ECT guidelines. Methods: Among psychiatrists from all Dutch ECT sites in university and general hospitals (n = 24) and psychiatric hospitals (n = 11), a survey was conducted regarding (1) characteristics of practitioners and institutions, (2) clinical practice of ECT, and (3) technical aspects of ECT. Adherence to 16 criteria selected from (inter)national guidelines was scored. Results: Response rate was 94% (all 24 university and general hospitals and 9 of 11 psychiatric hospitals). Most respondents had extensive experience with ECT (median, 10 years; interquartile range, 4-15 years). Annually, approximately 8.5 sessions of ECT per 10,000 inhabitants were administered. In all ECT sites, 24% used exclusively bilateral electrode placement, 26% used ultrabrief pulse width, and 36% used dosage titration methods. Many practitioners had no knowledge of pulse width (42%) or of current characteristics (12%). Of the 16 investigated criteria, 14 were followed in at least 75% of the institutions. Conclusions: Although still increasing, the use of ECT in the Netherlands remains modest. Electroconvulsive therapy is generally practiced according to (inter)national guidelines. Electroconvulsive therapy is mostly started unilaterally, and generally, age-dependent dosage methods are being used. Knowledge on pulse width and current characteristics is limited. The implementation of updated guidelines might offer the opportunity to further improve practice and stimulate availability of ECT.

Efficacy of venlafaxine compared with tricyclic antidepressants in depressive disorder: a meta-analysis (Article)

2009-08-01T00:00:00Z

Abstract With respect to the pharmacological characteristic, venlafaxine is comparable with tricyclic antidepressants (TCAs), and venlafaxine might be comparable in efficacy. We performed a systematic review investigating the relative efficacy and tolerability of venlafaxine compared with TCAs (imipramine, clomipramine, amitriptyline, nortriptyline and desipramine). Relevant double-blind randomised trials were identified from systematic searches of electronic databases. An exact analysis of the estimated odds ratios of response of the TCA relative to venlafaxine showed no overall significance of treatment effect (P = 0.38). The odds ratios were not homogenous across studies (P = 0.0213). The average dose of venlafaxine was 103.5 mg/day and for the TCA 106.1 mg/day. An exact analysis of the estimated odds ratios of the withdrawals and side effects in the trials with a TCA relative to venlafaxine showed no overall significance of withdrawal. From our review, no significant difference in treatment effect between low dose of both venlafaxine and the TCAs could be found. In our opinion, because of the heterogeneity of the odds ratios, one cannot conclude that they are of equal efficacy.

Het Tijdschrift op Twitter (Article)

2009-01-01T00:00:00Z

Intro
In een interview naar aanleiding van mijn weblog (doktershock.nl) werd mij gevraagd of ik mijn computermijdende collega’s een stap voor was. Nee, waarschijnlijk is het niet erg als psychiaters zich niet massaal op de nieuwe digitale sociale media storten: er zal niet opeens een beschrijving van een nieuwe psychiatrische ziekte of behandeling voor het eerst op internet verschijnen. De ontwikkelingen in de psychiatrie gaan niet zo snel dat ze voor de gemiddelde psychiater niet te volgen zijn. Andere media voldoen vaak uitstekend om op de hoogte te blijven. De nieuwe sociale media zoals blogs, wiki’s, Facebook, Linkedin en sinds kort ook Twitter maken wel een enorme groei door. Het bloggen is voor mij vooral een hobby en ik verdoe er een hoop tijd mee. Zijn er voor een psychiater dan geen voordelen aan al dat gesurf en geblog? Volgens mij zeker wel en in dit redactioneel wil ik daarom wat dieper ingaan op Web 2.0 oftewel de verandering van websites naar een platform voor interactieve applicaties.

Symptomen bij een depressie; bevindelijk gereformeerde versus niet-kerkelijke patiënten (Article)

2009-01-01T00:00:00Z

Achtergrond: Cultuur kan een belangrijke invloed hebben op de manier waarop een depressie beleefd, geuit of gepresenteerd wordt. Bevindelijk gereformeerden vormen een orthodoxprotestantse culturele minderheid in Nederland. Mogelijk presenteert deze groepering zich met andere symptomen tijdens een depressie dan niet-kerkelijke patiënten. Doel: Nagaan of bevindelijk gereformeerde patiënten met een depressie andere symptomen hebben dan niet-kerkelijke patiënten. Methode: Aan 70 autochtone volwassenen met een depressie in de ambulante geestelijke gezondheidszorg werd gevraagd een depressie-zelfscorelijst (Beck Depression Inventory II, bdiii) in te vullen. Totaalscore en scores op symptoomclusters bij bevindelijk gereformeerden en nietkerkelijken werden met elkaar vergeleken. Resultaten: Bevindelijk gereformeerden hadden vergeleken met niet-kerkelijken op de bdi-ii een lagere totaalscore en in het bijzonder een lagere score op de symptoomclusters suïcidaliteit en beperking in functioneren. Conclusie: Bevindelijk gereformeerden verschillen van niet-kerkelijken in de wijze hoe zij zich presenteren op een depressie-zelfscorelijst tijdens een depressie. Omdat bevindelijk gereformeerden mogelijk dissimuleren en langer doorgaan, lopen ze een verhoogde kans op onderdiagnostiek en -behandeling. Dit onderzoek illustreert dat inzicht in de religieuze achtergrond van (autochtone) patiënten van belang kan zijn voor goede psychiatrische diagnostiek.

Reply to Dr Baldessarini's comments on "efficacy of imipramine in psychotic versus nonpsychotic depression" (Article)

2008-12-01T00:00:00Z

Efficacy of Imipramine in Psychotic Versus Nonpsychotic Depression (Article)

2008-04-01T00:00:00Z

The purpose of the present study is to compare the efficacy of imipramine in the treatment of psychotic versus nonpsychotic depression. Previous studies report varying results of monotherapy with antidepressants in psychotic depression. Because psychotic depression is seriously underinvestigated, performing a post hoc analysis of randomized clinical trials consisting of both psychotic and nonpsychotic depressed patients may contribute to the discussion on the optimal treatment of depressed patients with mood-congruent psychotic features. A total of 112 patients diagnosed with major depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) (40 with psychotic depression and 82 without psychotic features) received treatment with imipramine for 6 weeks after a washout period of 7 days. Imipramine doses were adjusted to attain a predefined fixed plasma level. Treatment response was assessed with the Hamilton Rating Scale for Depression (HAM-D). A logistic regression analysis showed a significantly larger reduction in HAM-D score in the sample with psychotic features compared with the nonpsychotic sample (regression coefficient, -3.47; SE, 1.7; P = 0.04). According to the primary outcome criterion, that is, the change in HAM-D score, imipramine was significantly more effective in the sample with psychotic depression compared with the nonpsychotic depressed patients. The contradiction between our results and those of several previous studies may be due to the fixed plasma level dosing of imipramine refraining from concurrent psychotropic medication or limiting our patient sample to patients with mood-congruent psychotic features

Changes in everyday and semantic memory function after electroconvulsive therapy for unipolar depression (Article)

2007-09-01T00:00:00Z

OBJECTIVES: This long-term prospective study focuses on the effects of electroconvulsive therapy (ECT) on everyday memory function and on semantic memory function. METHODS: Results of memory test from 96 consecutive inpatients treated for unipolar depression were analyzed prospectively before ECT, after ECT treatment, and at 3- and 12-month follow-up. Everyday memory function was assessed by means of the Rivermead Behavioural Memory Test (RBMT) and semantic memory by 2 forms of the word fluency test. RESULTS: In our study, age had a constant and significant negative effect on everyday memory (RBMT score) over time. Bilateral electrode placement mainly influenced everyday memory, which was significantly improved at 3-month follow-up. One year after discharge, the RBMT scores were not significantly different from pretreatment levels, indicating that ECT does not affect everyday memory on the longer term.Scores on both word fluency tests for semantic memory were significantly influenced by age over time. The effect of age changed from a negative influence directly after ECT to a positive effect at follow-up. This advantage of higher age indicates that the semantic memory of older patients receiving ECT for severe mood disorder shows greater improvement at follow-up compared with younger patients. Over time, the scores on only 1 of the word fluency tests were significantly influenced by mainly bilateral electrode placement. CONCLUSIONS: A small but reversible decrease in everyday memory occurs after ECT in depressed patients, which is influenced by age and electrode placement. Semantic memory shows a fluctuating but recovering course, which is also influenced by age and electrode placement. During follow-up, the improvement in semantic memory was greater in the older patients.

Lithium addition in antidepressant-resistant depression: Effects on platelet 5-HT, plasma 5-HT and plasma 5-HIAA concentration (Article)

2007-06-30T00:00:00Z

The efficacy of the addition of lithium to an established course of antidepressant treatment can be explained by a synergistic effect of the two drugs on central 5-HT neurotransmission. In the present study we investigated the effect of lithium addition on the 5-HT concentration in plasma and platelets and the concentration of 5-HIAA. Thirty-nine depressed inpatients who fulfilled the DSM-IV criteria for major depressive disorder and who did not respond to monotherapy with either imipramine or fluvoxamine participated in this study. Concentration of 5-HT in both plasma and platelets did not change significantly during lithium addition. The 5-HT ratio (plasma concentration/platelet concentration) shows a small non-significant increase after 3 weeks lithium addition. The mean concentration of 5-HIAA shows a significant increase during lithium addition; with no difference between the imipramine and the fluvoxamine sample. The increments in 5-HIAA concentration during lithium addition are indicative of an increased 5-HT turnover.

Depression in patients with primary biliary cirrhosis and primary sclerosing cholangites (Article)

2007-06-01T00:00:00Z

Our aim was to study the prevalence of depression in a Dutch population with PBC and PSC. In addition, to investigate the effects of using an additional diagnostic structured psychiatric interview, after screening with the Beck Depression Inventory (BDI), a self-report severity scale instrument used in former studies. Patients with PBC and PSC (n = 92)completed the BDI. Patients with scores of 10 or higher (n = 39) were interviewed using a structured psychiatric interview. Patients with scores lower than 10 were at random (30/53, 57%) also interviewed using a structured psychiatric interview. Results: Of the 92 patients that were included 42% had depressive symptoms according to the BDI. However, of these patients only 3.7% had a depressive syndrome according to the DSM-IV criteria as assessed with the structured psychiatric interview. Conclusions: The prevalence of a depressive disorder in patients with PBC and PSC is not higher than in the general population. Fatigue in patients with PBC and PSC cannot be explained by depression.

Time-Dependent Clearance Decrements of Fluvoxamine in Depressed Inpatients (Letter To Editor)

2007-04-01T00:00:00Z

Beta-Blocking Agents and Electroconvulsive Therapy (Article)

2007-04-01T00:00:00Z

In this review we want to summarize the results of the placebo-controlled randomized clinical trials with betablocking adrenergic agents during electroconvulsive therapy (ECT), and review the effect on seizure duration and cardiovascular variables. We searched for studies in the electronic databases Medline. Keywords combined in the search were: “beta-adrenergic blocking agents” and “electroconvulsive therapy”. The only limitation specified in the search was that the publications should include only randomized controlled trials. Esmolol and other beta-blocking adrenergic agents can have a significant effect on seizure duration during ECT, it shortens seizure duration, and this effect is probably dose dependent. Therefore routine administration is not recommended. Since the relation between seizure duration and efficacy of ECT is dependent on electrode placement it seems advisable to use bilateral electrode placement with patients with cardiovascular risk factors and an indication for use of esmolol during every session before seizure induction. In the absence of cardiovascular risk factors but with prolonging hypertension or tachycardia during ECT sessions, esmolol also is again preferred. Labetalol is an alternative although, especially in high dose, the longer half-life can be considered as a disadvantage. Experiences with landiolol are limited.

Time-dependent clearance decrements of fluvoxamine in depressed inpatients: A clinical evaluation [16] (Article)

2007-04-01T00:00:00Z

Long-term follow-up after successful electroconvulsive therapy for depression: A 4- to 8-year naturalistic follow-up study (Article)

2007-03-01T00:00:00Z

OBJECTIVES:: A long-term follow-up of depressed patients responsive to electroconvulsive therapy (ECT) with intensive pre-ECT pharmacotherapy treatment failure who also participated in a 6-month trial directly post-ECT in which imipramine was compared with placebo for relapse prevention. METHODS:: A total of 26 patients responsive to ECT who participated in the 6-month continuation trial were invited 4 to 8 years later to assess their follow-up status. The groups with and without relapse within 6 months were compared with regard to recurrence of depression up to 8 years later. Recurrence was defined as a new episode of depression that needed antidepressant medication and/or readmission in hospital and/or a new ECT course. RESULTS:: At the time of follow-up (mean duration, 6.8 years), the recurrence rate of depression for the total sample was 42.3%. There was no significant difference in the recurrence rates and number of recurrences between the nonrelapse and relapse groups.The small study population limits generalization of the results; the design of the study is naturalistic and retrospective. CONCLUSION:: In our small sample of depressed patients with pharmacotherapy treatment failure, recurrence is not influenced by relapse after terminating ECT. Continuation of medication started immediately after ECT seems to be an important factor in preventing recurrence.

Comparison of two-phase treatment with imipramine or fluvoxamine, both followed by lithium addition, in inpatients with major depressive disorder. (Article)

2004-11-01T00:00:00Z

OBJECTIVE: This study was designed to compare the efficacy of two two-phase pharmacological treatment strategies for inpatients with DSM-IV major depressive disorder. METHOD: During phase I, patients participated in a double-blind study of the effects of imipramine versus fluvoxamine, with final evaluation of response 4 weeks after patients attained the target plasma level. In phase II, for patients without treatment response or with partial response in phase I, lithium was added to imipramine or fluvoxamine. Final evaluation of response was made 3 weeks after the patients attained the target plasma level of lithium (0.6-1.0 mmol/liter). RESULTS: One hundred thirty-eight patients were enrolled in the study. At the end of phase I, remission, defined as a final Hamilton Depression Rating Scale score < or =7, was achieved by 16 (23%) of 70 imipramine-treated patients and 10 (15%) of 68 fluvoxamine-treated patients. At the end of phase II, 41 (59%) of 70 imipramine-treated patients versus 27 (40%) of 68 fluvoxamine-treated patients qualified for remission, a significant difference in favor of the imipramine strategy. Only a small minority of both groups received concomitant medication. In both phase I and phase II, the discontinuation rate was low (5% and 10%, respectively). CONCLUSIONS: Imipramine with subsequent lithium addition is superior to a similar strategy with fluvoxamine for treatment of severely depressed inpatients. Both strategies were well tolerated.

Fluvoxamine for fatigue in primary biliary cirrhosis and primary sclerosing cholangitis: a randomised controlled trial [ISRCTN88246634]. (Article)

2004-07-13T00:00:00Z

BACKGROUND: Fatigue is a major clinical problem in many patients with primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). An effective treatment has not been defined. Recently, a large proportion of patients with these diseases was found to have symptoms of depression. Because fatigue is a frequent symptom of depression and there is some evidence that treatment with an antidepressant improves fatigue in patients with fibromyalgia, we hypothesised that the antidepressant fluvoxamine might improve fatigue related to PBC and PSC. METHODS: Fatigued patients were randomised to receive fluvoxamine (75 mg BID) or placebo for a six-week period. Fatigue and quality of life were quantified using a visual analogue scale, the Fisk Fatigue Severity Scale, the Multidimensional Fatigue Inventory and the SF-36. RESULTS: Seventeen and 16 patients were allocated to fluvoxamine and placebo, respectively. There was no statistically significant beneficial effect of fluvoxamine on fatigue or quality of life. The median VAS scores in the fluvoxamine and placebo groups were 7.40 and 7.45 at day 0, 6.9 and 7.15 at day 14, 7.45 and 7.65 at day 42 and 7.8 and 8.0 four weeks after treatment discontinuation. CONCLUSION: We found no evidence for a beneficial effect of fluvoxamine on fatigue in these patients with cholestatic liver disease and severe chronic fatigue.

Low-dose esmolol bolus reduces seizure duration during electroconvulsive therapy: a double-blind, placebo-controlled study (Article)

1999-01-01T00:00:00Z

We have measured the effect of a bolus dose of esmolol 80 mg i.v. on heart rate, and systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressures during electroconvulsive therapy (ECT). We also assessed seizure duration using both the cuff method and two-lead EEG. We studied 20 patients in a double-blind, placebo-controlled, within-patient blocked randomized study. No patient was receiving psychotherapeutic drugs or had cardiovascular disease. Esmolol significantly reduced heart rate, SAP and MAP before the stimulus, and also significantly reduced the increases in these variables during the convulsion, compared with placebo. However, seizure duration was also significantly reduced, possibly making ECT less effective. The reduction in seizure duration was 5.83 s when monitored clinically and 9.9 s when measured by the EEG. Because of the reduction in seizure duration, routine administration of esmolol is not advisable because it may interfere with the efficacy of ECT, but administration of esmolol during ECT could be useful to reduce tachycardia and hypertension in high-risk patients.