Kemal Yazici

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.

T102C and -1438 G/A polymorphisms of the 5-HT2A receptor gene in Turkish patients with obsessive-compulsive disorder.

OBJECTIVE This study aimed to investigate the possible association between T102C and -1438 G/A polymorphism in the 5-HT2A receptor gene and susceptibility to and clinical features of obsessive-compulsive disorder (OCD). METHOD Fifty-eight patients with OCD and 83 healthy controls were included in the study. All patients were interviewed and rated by Yale-Brown Obsessive-Compulsive Scale. T102C and -1438 G/A polymorphisms of 5-HT2A receptor gene were determined by PCR technique in DNAs of peripheral leucocytes. RESULTS OCD patients and healthy controls did not show significant differences in genotype distribution for both polymorphisms investigated. We found that frequencies of the TT genotype for T102C polymorphism and the AA genotype for -1438 G/A polymorphism were significantly higher in patients with severe OCD compared to those with moderate or moderate-severe OCD. CONCLUSION The -1438 G/A and T102C polymorphisms of the 5-HT2A receptor gene are not associated with an increased risk of OCD. Our data suggest that the TT genotype of T102C and the AA genotype of -1438 G/A polymorphism might be a factor in clinical severity of OCD.

Different neuroendocrine profiles of remitted and nonremitted schizophrenic patients

BACKGROUND Thyrotropin-releasing hormone (TRH) test and Dexamethasone Suppression Test (DST) are two neuroendocrine tests that have been extensively used in an attempt to predict treatment response and outcome in schizophrenia. The objectives of this study were to investigate (1) the relationship between TRH test and DST and various psychiatric symptoms and (2) the potential value of these tests in prediction of short-term outcome in schizophrenic patients. METHODS TRH test and DST were administered to 58 patients with schizophrenia. All patients were evaluated with a battery of rating scales before neuroendocrine test procedures and at regular intervals for 1 year. Patients were divided into two groups as remitted (RP; n = 30) and nonremitted patients (NRP; n = 28). Baseline results of these two groups were compared with each other and 30 healthy controls. RESULTS Basal levels of total T3 (T3T) and free T3 (T3F) were higher in RP group than controls. Basal prolactin (PRL) level was higher in RP group, but not in NRP, compared to controls. Basal growth hormone (GH) and thyroid-stimulating hormone (TSH) levels of NRP were significantly higher than those of RP. DST nonsuppression was observed at a significantly higher rate in RP than NRP and control group. Blunted TSH response rate in RP group was higher significantly compared to other two groups. CONCLUSIONS The data implicate that higher basal TSH and GH levels may be associated with a poorer treatment response, whereas higher total and free T3 levels, a blunted TSH response to TRH and nonsuppression on the DST may indicate a better response in schizophrenics.

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.

Pulmonary muscle strength, pulmonary function tests, and dyspnea in women with major depression.

OBJECTIVE To evaluate the subjective sensation of dyspnea compared with pulmonary function tests, pulmonary muscle strength, and chest expansion in depressed women and control subjects free of cardiorespiratory disease. METHODS Thirty female patients with major depression (MD) and 30 age-matched female control subjects were included in the study. All subjects were assessed by pulmonary function tests (spirometry) and pulmonary muscle strength measurement (maximum inspiratory and expiratory pressures [MIP and MEP]) by mouth pressure meter (MPM). Chest expansion was measured, and body mass index (kg/m(2)) (BMI) was calculated. The Health Assessment Questionnaire (HAQ) was used to evaluate the activities of daily living, and a dyspnea score was used to determine dyspnea severity. RESULTS There were no significant differences between groups regarding pulmonary function tests, pulmonary muscle strength, and chest expansion. HAQ scores were significantly lower in women, and dyspnea was higher with MD compared with controls (p < 0.05). BMI was also lower in depressed patients (p < 0.05). CONCLUSIONS The subjective sensation of dyspnea is increased in women with MD in the presence of normal lung function and is associated with the level of anxiety rather than that of depression.

Glutamatergic dysfunction in skin-picking disorder: treatment of a pediatric patient with N-acetylcysteine.

To the Editors: Skin-picking disorder (SPD) is characterized by repetitive and compulsive picking behaviors that result in skin lesions. Cognitive behavioral therapy and psychopharmacological agents (ie, selective serotonin reuptake inhibitors, mood stabilizers, typical/atypical antipsychotics, and naltrexone) are generally used to treat SPD, but there is no standardized treatment protocol. N-Acetylcysteine (NAC) is an antioxidant that modulates glutamate (glu) transmission in the brain. N-Acetylcysteine is an effective treatment for patients with obsessive-compulsive disorder (OCD), as glutamatergic dysfunction is known to play a significant role in its pathophysiology. Because of this, NAC has been increasingly prescribed to patients with SPD. In this case report, we discuss the clinical course of a 12-year-old female patient diagnosed with SPD that was treated with NAC.

Atomoxetine-associated akathisia: a case report.

To the Editors: L iterally, the term augmentation refers to the act of enlarging, increasing something. In psychopharmacology, this term is widely used to designate therapeutic strategies that aim at maximizing the efficacy of a monotherapy by adding a second drug. The accepted definition of antidepressant augmentation, validated by international guidelines, assumes that augmentation of antidepressants involves adding a second drug, other than an antidepressant, to the treatment regimen when no response or only partial response has been achieved, with the goal of enhancing treatment. Although enhancing the effectiveness of one another, the adding of an antidepressant to an ongoing antidepressant treatment is designated by the neutral generalist terms: association or combination. To test this definition against the literature, we performed a computerized literature search (National Library of Medicine/Medline) using the following words: ‘‘augmentation’’ and ‘‘antidepressant.’’ Articles included were both in English and non-English and up to January 2014. Abstracts of all retrieved occurrences were carefully read by F.M., F.H., and O.D. The corresponding publications were extracted and scrutinized when necessary. Articles retained had to deal with antidepressant combination strategies in treating depression as well as psychotic or anxiety disorders in humans. We ensured that the use of the term augmentation was not related to a translation error of nonEnglish articles. A total of 1388 occurrences were retrieved, and 531 were excluded as nonrelevant. In 768 publications, the use of the term augmentation was in accordance with the current definition. In 91 studies, the term augmentation was used to designate the combination of 2 antidepressants. The added antidepressant was bupropion in 32 articles, a tricyclic antidepressant in 21 articles, mirtazapine in 16 articles, an selective serotonin reuptake inhibitor (SSRI) in 8 articles, each of mianserin, agomelatine, and trazodone, as well as an monoamine oxidase inhibitor in 3 articles. Augmentation of an SSRI with nortriptyline was reported in 1 article. Although widely accepted as the definition of combining an antidepressant to another drug that is not an antidepressant, the concept of augmentation is used, in some cases, to designate the association of 2 antidepressants. The ‘‘augmenting’’ agent either adds a different mechanism of action (pharmacodynamic augmentation) or affects plasma concentration of the ongoing treatment by modifying its metabolism (pharmacokinetic augmentation). When added to an SSRI, bupropion augmentation is mainly pharmacodynamic because bupropion adds to serotonin reuptake inhibition, norepinephrine reuptake inhibition, and dopamine reuptake inhibition. Even for SSRIs, we could hardly omit that these drugs actually display different mechanisms of action. Fluoxetine is not only a serotonin reuptake inhibitor but also a potent 5-HT2C antagonist. Besides serotonin reuptake inhibition properties, paroxetine has mild anticholinergic (M1 receptor antagonism) and weak norepinephrine reuptake inhibition actions. Theoretically, adding fluoxetine to paroxetine enhances its antidepressant effectiveness by adding new pharmacodynamics mechanisms. Thus, paroxetine and fluoxetine combination should, theoretically, be considered as an augmentation strategy. With a view toward the development of a new antidepressant with innovating mechanism of action and for the sake of clarity, we suggest that the term augmentation should be used whenever the combination of 2 antidepressants results in the enhancement of pharmacodynamic or pharmacokinetic action of the ongoing treatment.

Social Cognition in Child and Adolescents with Anorexia Nervosa

Sosyal bilis, kisinin kendisi ve digerleri arasindaki sosyal etkilesimle ilgili zihinsel surecleri temsil eder. Son yillarda yeme bozuklugu olgularinin sosyal bilis becerilerine yonelik ilgi artmistir. Anoreksiya nervosa, etiyolojisi coklu etmenlerle iliskili olan bir yeme bozuklugu tablosudur. Tedavisi halen tartismalidir. Yeme bozuklugu hastalari icinde en zor iliski kurulan grubun anoreksiya nervosa tanili gencler oldugu bilinmektedir. Calismalar cogunlukla, anoreksiya nervosa olgularinin sosyal bilissel islevlerinde guclukler olduguna isaret etmektedir. Bununla birlikte farkli sonuclarin bildirildigi calismalar da mevcuttur. Goruldugu kadariyla, anoreksiya nervosa olgularinda sosyal bilissel islevleri degerlendiren calismalarin buyuk cogunlugu, eriskin yas grubu ile yapilmis calismalardir. Cocuk ve ergen yas grubu ile yapilmis calismalarin kisitli sayida oldugu dikkati cekmektedir. Bu yazida, literaturdeki, anoreksiya nervosa tanili cocuk ve ergenlerin sosyal bilissel becerileri ile ilgili calismalarin incelenmesi ve genel ozelliklerinin sunulmasi amaclanmistir.

Social Cognition in Child and Adolescent Diagnosed with Anorexia Nervosa

Sosyal bilis, kisinin kendisi ve digerleri arasindaki sosyal etkilesimle ilgili zihinsel surecleri temsil eder. Son yillarda yeme bozuklugu olgularinin sosyal bilis becerilerine yonelik ilgi artmistir. Anoreksiya nervosa, etiyolojisi coklu etmenlerle iliskili olan bir yeme bozuklugu tablosudur. Tedavisi halen tartismalidir. Yeme bozuklugu hastalari icinde en zor iliski kurulan grubun anoreksiya nervosa tanili gencler oldugu bilinmektedir. Calismalar cogunlukla, anoreksiya nervosa olgularinin sosyal bilissel islevlerinde guclukler olduguna isaret etmektedir. Bununla birlikte farkli sonuclarin bildirildigi calismalar da mevcuttur. Goruldugu kadariyla, anoreksiya nervosa olgularinda sosyal bilissel islevleri degerlendiren calismalarin buyuk cogunlugu, eriskin yas grubu ile yapilmis calismalardir. Cocuk ve ergen yas grubu ile yapilmis calismalarin kisitli sayida oldugu dikkati cekmektedir. Bu yazida, literaturdeki, anoreksiya nervosa tanili cocuk ve ergenlerin sosyal bilissel becerileri ile ilgili calismalarin incelenmesi ve genel ozelliklerinin sunulmasi amaclanmistir.

Çocuk Psikiyatrisi Pratiğinde Nadir Bir Durum : Çocukluk Çağı Dezintegratif Bozukluğu

Childhood disintegrative disorder is a very rare pervasive developmental disorder characterized by normal development of verbal and nonverbal communication skills, social interaction, play, bladder and bowel control and motor behavior at least in the first two years, followed by regression between 2-10 years of age in two or more of the mentioned developmental areas. Estimated prevalence of the childhood disintegrative disorder is around 1.1-6.4 per 100.000 children and the common age of onset is 3.36 years. The present report describes a boy who developed childhood disintegrative disorder after approximately 3 years of normal development and clinical features are discussed in the light of the clinical literature.