Ayşe Devrim Başterzi

Effects of fluoxetine and venlafaxine on serum brain derived neurotrophic factor levels in depressed patients

BACKGROUND Several studies demonstrated that depressed patients had low serum BDNF levels which correlated with the severity of their depression, and antidepressant treatment increases levels of serum BDNF in depressed patients. It was speculated that agents acting on both noradrenergic and serotonergic transporters might have a greater influence on BDNF levels. The aim of our study was to determine effects of venlafaxine vs. fluoxetine on serum BDNF levels in depressive patients. METHODS Forty-three patients diagnosed as major depressive disorder according to DSM-IV are included in the study. Forty-three patients were randomized to take fluoxetine (22 cases) or venlafaxine (21 cases). Serum levels of BDNF were measured by ELISA at baseline and 6 weeks after the start of treatment. RESULTS Baseline levels of BDNF were not significantly different between the patient group and the controls. But male patients and the male controls showed statistical differences with respect to baseline BDNF levels. BDNF levels of the patient group did not change with treatment. Yet, the increase of BDNF levels was close to statistically significant in the fluoxetine group, whereas not significant in the venlafaxine group. There were no significant differences in baseline and 6th week BDNF levels between the responders and the non-responders. CONCLUSION Further studies controlling for a wide variety of confounding variables are needed, which may help to reach a clear conclusion about the potential of BDNF as a biomarker for depression or as a predictor of antidepressant efficacy.

Effects of venlafaxine and fluoxetine on lymphocyte subsets in patients with major depressive disorder: A flow cytometric analysis

BACKGROUND Studies have yielded conflicting results concerning flow cytometric lymphocyte analyses in patients with depression. Data about the effect of antidepressants on lymphocyte subsets are also contradictory. The aim of this study was to determine effects of venlafaxine versus fluoxetine on lymphocyte subsets in depressive patients. METHODS Sixty-nine patients diagnosed with major depressive disorder (MDD) according to DSM-IV and 36 healthy controls are included in the study. Sixty-nine patients were randomized to take fluoxetine (FLX) (n=33) or venlafaxine (VEN) (n=36). Serum lymphocyte subsets included CD3, CD4, CD8, CD16/56, CD19, CD45, Anti-HLA-DR which were measured by flow cytometric analyses at baseline and 6 weeks after the start of treatment. The severity of depression was evaluated with Hamilton rating scale for depression. RESULTS At baseline, patients with MDD had significantly lower CD16/56 ratio and higher CD45 ratio compared to the controls. Although numerically higher in the VEN treated patients, treatment response rates between the FLX (53%) and the VEN (75%) groups were not different statistically. CD45 values decreased significantly in the VEN group at the end of the 6 week treatment period whereas no difference was observed in the FLX group. By the 6th week, treatment responders showed a significantly higher CD16/56 ratio than non-responders. Baseline severity of depression and anxiety was positively correlated with baseline CD45 ratio and negatively correlated with baseline CD16/56 ratio. We did not observe consistent changes in the absolute number of circulating B or T cells, nor in the helper/inducer (CD4) or suppressor/cytotoxic (CD8) subsets. CONCLUSIONS CD16/56 was lower in patients with MDD and increased in treatment responders at 6th week. CD45 ratio was higher in patients with MDD than healthy subjects; it decreased with antidepressant treatment and was positively correlated with the severity of depression. Antidepressant treatment contributes to immune regulation in patients with major depressive disorder.

Venlafaxine-induced mania.

Dear Editor: In bipolar disorders, the shift to mania as a result of using antidepressants constitutes a great trouble for clinicians. It has been known for a long time that tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and even bupropion can cause mania or hypomania (1,2). In clinical studies, venlafaxine, which acts through the blockage of serotonergic or noradrenergic receptors, proved to be an efficient, reliable, and rapidly effective drug that could be used without any problem to treat bipolar depression (3). The literature reveals only a few cases of venlafaxine-induced mania and hypomania (5,7). However, in the case we report, the treatment dosage of venlafaxine resulted in mania. Mr F, aged 38 years, had a diagnosis of bipolar disorder followed in different centres for 16 years. Within this period, he experienced 2 manic and 2 hypomanic attacks. Two years prior to this report, he was taking lithium 1200 mg daily for prophylaxis but gave up taking the drug because he felt healthy. Approximately 1 month before presenting, he began to feel valueless and bad, without any reason. He did not want to do anything, slept all day, and never spoke. He had frequent thoughts that suicide would solve all his troubles but felt it was something he could not do. His appetite decreased, and he lost 4 to 5 kg within this period. Owing to these problems, he was admitted to an outpatient clinic. A general practitioner prescribed venflaxine 75 mg daily. After 10 days, his sleep gradually began to decrease, and he started to speak excessively. He was feeling euphoric. He asserted that he was very handsome and enjoyed aggressive and angry behaviours. He was immediately taken to our emergency service and hospitalized with the diagnosis of bipolar disorder, manic episode. After his relatives provided a history, venlafaxine was stopped, and haloperidol and carbamazepine as a mood stabilizer were prescribed. His clinical picture improved rapidly within the first few days. He stayed in our clinic for a week and was then discharged from the hospital. Thereafter, he and his relatives were informed about the clinical presentation and prodromal symptoms of mania and depression. The elimination of mania symptoms shortly after stopping antidepressant treatment suggests that venlafaxine could have caused the development of mania. Of course, it is also possible that the patients nonuse of a mood stabilizer while using an antidepressant may have led to the development of mania. It is not clear whether these shifts depend on the antidepressant dosage and on the length of use. …

The Psychiatric View of Patients of Aesthetic Surgery: Self-Esteem, Body Image, and Eating Attitude

The patient who presents for aesthetic surgery possesses various demands depending on the characteristic properties of the individual. Evaluation of self-esteem, body image and eating habits in patients of aesthetic surgery could help in understanding patients and their demands. We performed Rosenberg Scale Test for evaluation of self-esteem on 98 patients who presented for any kind of aesthetic surgery. Seventy-five patients who required no operation for body fat tissue were give body imaging scale and eating attitude scale tests. The results of the tests revealed an increase in the self-esteem of the patients, but it was not statistically significant. There was a minor disturbance in the body imaging scale without any statistical significance (p > 0.05).The eating attitude of the patients indicated a disturbance with a ratio of 10% (p < 0.01), and these patients were referred to psychiatrists. Even if patients of aesthetic surgery have no disorder in the perception of their body images, they reflect their aesthetic problems in their eating attitude; however they have no problem in the fat tissue distribution of their body. The aesthetic imperfection could impede the normal daily life of a patient and adaptation to the social life, and this defect is a health problem that should be solved as soon as possible.

Factors Affecting Burnout and Job Satisfaction in Turkish Emergency Medicine Residents

Objective: Despite the increasing concerns on burnout and job satisfaction in health-care professional, very few studies have examined resident physicians in Turkey. This study was aimed to determine the factors affecting burnout and job satisfaction among emergency medicine residents in Turkey. Method: An number of 410 emergency medicine residents including e-mail addresses registered to Emergency Medicine Associations received questionnaire forms previously prepared on an internet-based questionnaire site. Participants were asked to fill out Maslach Burnout Inventory (MBI), Job Satisfaction Scale (JSS) and socio-demographic data form. Results: Decrease in depersonalization grades and increase in personal accomplishment grades with the advancing age were found. Residents who had an experience greater than 10 years in the profession showed lower depersonalization grades in comparison with the beginners. Residents who could not reach a consultant for patient evaluation presented higher emotional exhaustion grades. Also residents who felt appreciated in work place and work in concert with the staff had lower burnout grades and higher job satisfaction grades. An increase in the average number of patients seen per day was found out to boost emotional exhaustion grades. Also the visible increase in the time spent for social activities during the week reduced emotional exhaustion and depersonalization grades while increasing personal accomplishment grades. Residents who were exposed to daily violence had lower job satisfaction grades and higher emotional exhaustion and depersonalization grades than those experienced violence on a monthly basis. Increase of job satisfaction was accompanied by a decreased burnout level. Conclusion: Emergency medicine residents have high burnout levels. For diminished burnout level and enhancement of job satisfaction in emergency medicine, adjustments like social support, workload, workplace stress and prevention of violence would be useful.

Do steroids trigger mania in multiple sclerosis? Not always!

68 Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si: Serhan Sevim MD, Mersin University Faculty of Medicine, Department of Neurology, Mersin, Turkey Phone: +90 532 416 88 94 E-mail: serhansevim@superonline.com Re cei ved/Ge lifl Ta ri hi: 06.11.2013 Ac cep ted/Ka bul Ta ri hi: 21.10.2014 This paper consists of an unusual case history and an overview of the relationship between multiple sclerosis (MS), manic episode and corticosteroid treatment. Bipolar disorder and MS co-occur at a relatively higher rate. A 25-year old woman with a 7-year history of MS was admitted to our hospital with right side weakness. During the examination, she showed some manic behavior patterns and diagnosed as ‘bipolar disorder-manic episode’ by her psychiatrists. She was recommended for high dose steroids for her attack and antipsychotics for the manic episode but she refused the latter. Unexpectedly at the third day of steroid treatment, instead of being exacerbated, almost all of the manic symptoms disappeared. In the literature, this is the first report of a MS patient with bipolar disorder whose manic symptoms were cured after receiving steroids. (Turkish Journal of Neurology 2015; 21:68-70)