Márcia Britto de Macedo Soares

Psicofarmacologia de antidepressivos

Antidepressant drugs turned depression into a treatable medical problem. In the last five decades, the psychopharmacology of depression has evolved rapidly. Early antidepressants - tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) - were discovered through clinical observation. The TCAs exhibited good antidepressant efficacy due to the enhancement in serotonin and norepinephrine availability. Its use was limited because of unwanted side effects and toxicity risk related to the blockade of histaminergic, cholinergic and alfa-adrenergic receptors. MAOIs can interact with tyramine to cause potentially lethal hypertension and present potentially dangerous interactions with various medications and over-the-counter drugs. The new generation of antidepressants includes the single-receptor selective serotonin or norepinephrine inhibitors and the multiple-receptor-acting antidepressants, such as venlafaxine, bupropion, trazodone, nefazodone, and mirtazapine. They do not act on other receptor sites not related to depression (such as histamine or acetilcholine). This paper reviews the pharmacology of antidepressants, including its mechanism of action, pharmacokinetics, side effects and drug-drug interactions.

Diretrizes da Associação Brasileira de Estudos do Álcool e outras Drogas (ABEAD) para o diagnóstico e tratamento de comorbidades psiquiátricas e dependência de álcool e outras substâncias

Recently, several studies have focused on comorbity psychiatric disorders with alcohol and other substance dependence. The Brazilian Association of Studies on Alcohol and Other Drugs proposed the Brazilian Guidelines project. This study review diagnostic and therapeutic criteria to the most prevalent psychiatric comorbidities. Randomized clinical trials, epidemiological, animal studies and other forms of research are reviewed. The main psychiatric comorbidities are studied based on guidelines adopted by other countries and the literature data resumed. Epidemiological aspects, diagnoses, integrated treatment and service organization, as well as specific psychotherapic and pharmacological treatment are discussed. The Brazilian Association of Studies on Alcohol and Other Drugs Guidelines reassures the importance of adequate diagnoses and treatment regarding alcoholic and drug dependent patients suffering of comorbid psychiatric disorders.

Anticonvulsivantes e antipsicóticos no tratamento do transtorno bipolar

Abstract Bipolar disorder is a complex medical condition, and up to the date there is no single treatment with proven efficacy in the controlof all aspects of the illness. The available literature on the use of anticonvulsants (valproate, carbamazepine, oxcarbazepine,lamotrigine, gabapentin, topiramate, clonazepam) and atypical antipsychotics (clozapine, risperidone, olanzapine, quetiapine,ziprasidone, and aripiprazole) for acute and prophylactic treatment of bipolar disorder was reviewed. There is a large amount ofevidence that lithium is efficacious in the prophylaxis of episodes and better for acute mania than for depressive episodes. Otherdata show that carbamazepine and valproate are effective in acute manic episodes. Lamotrigine has been shown to reduce cyclingand effective in depressive episodes. Based on the available data, olanzapine was found to be the most appropriate atypicalantipsychotic agent for the treatment of manic bipolar patients, although there are also studies suggesting the efficacy ofrisperidone, aripiprazole and clozapine. The preliminary data evaluating the efficacy of quetiapine and ziprasidone in bipolardisorder are still very limited. There is no consistent information supporting the prophylactic use of newer antipsychotics.Keywords: Keywords: Bipolar disorder/drug therapy; Antipsychotic agents/therapeutic use; Anticonvulsivants/therapeutic use

Psychodramatic psychotherapy combined with pharmacotherapy in major depressive disorder: an open and naturalistic study

OBJECTIVE Recent literature has highlighted the role of psychotherapy in the treatment of major depressive disorder. Combined therapies comprising both psychotherapy and pharmacotherapy have presented the best results. Although several kinds of psychotherapies have been studied in the treatment of depressive disorders, there remains a lack of data on psychodramatic psychotherapy in the treatment of major depressive disorder. The objective of this study was to evaluate the impact of psychodramatic psychotherapy (in a sample of major depressive disorder patients. METHOD This is an open, naturalistic, controlled, non-randomized study. Twenty major depressive disorder patients (according to the DSM-IV criteria), under pharmacological treatment for depression, with Hamilton Depression Scale total scores between 7 and 20 (mild to moderate depression), were divided into two groups. Patients in the psychotherapeutic group took part in 4 individual and 24 structured psychodramatic group sessions, whilst subjects in the control group did not participate in this psychodramatic psychotherapy. Both groups were evaluated with the Social Adjustment Scale-Self Report and the Hamilton Depression Scale. RESULTS Psychotherapeutic group patients showed a significant improvement according to the Social Adjustment Scale-Self Report and the Hamilton Depression Scale scores at endpoint, compared to those of the control group. CONCLUSIONS Results suggest that individual and group psychodramatic psychotherapy, associated to pharmacological treatment, provides good clinical benefits in the treatment of major depressive disorder.

Electroconvulsive therapy in treatment-resistant mania: case reports

UNLABELLED Electroconvulsive therapy is known to be effective in the treatment of mood disorders, more specifically for depression and mania. Although a large body of evidence confirms the efficacy of electroconvulsive therapy in the treatment of mania, few prospective studies have been done to assess its effectiveness in treatment-resistant manic episodes. These case reports describe the initial results of a study that is being conducted to evaluate the efficacy of Electroconvulsive therapy among treatment-resistant bipolar patients. METHODS Three manic patients (according to DSM-IV criteria) who were considered treatment-resistant underwent a series of 12 bilateral Electroconvulsive therapy sessions. Before the treatment and then weekly, they were evaluated with the following rating scales: Young Mania Rating Scale, Hamilton Rating Scale for Depression, Brief Psychiatric Rating Scale, and Clinical Global Impressions-Bipolar Version. RESULTS The 3 patients showed a satisfactory response to Electroconvulsive therapy, although some differences in the course of response were observed. CONCLUSION These case reports suggest that Electroconvulsive therapy needs further evaluation for the treatment of resistant bipolar patients.

Guidelines of the Brazilian Association of Studies on Alcohol and Other Drugs (ABEAD) for diagnosis and treatment of psychiatric comorbidity with alcohol and other substance and dependence

Abstract In recent years, several studies have been focused on the comorbidity of psychiatric disorders with alcohol and other substance dependence. In this context, the Brazilian Association of Studies on Alcohol and Other Drugs initiated a project to establish Brazilian Guidelines. The aim of this study was to review diagnostic and therapeutic criteria for the most prevalent psychiatric comorbidities. Randomized clinical trials, epidemiological studies, animal testing and other forms of research are reviewed herein. The main psychiatric comorbidities are investigated and data published in the literature are reviewed, based on guidelines adopted by other countries. Epidemiological aspects, diagnostic criteria, integrated treatment and the organization of specialized service, as well as details regarding psychotherapy and pharmacological treatment are discussed. The guidelines of the Brazilian Association of Studies on Alcohol and Other Drugs reinforce the importance of adequate diagnosis and treatment regarding alcoholic and drug dependent patients suffering of comorbid psychiatric disorders.