Salih Saygin Eker

Oxidation of apolipoprotein B-containing lipoproteins and serum paraoxonase/arylesterase activities in major depressive disorder

Major depressive disorder (MDD) is blaimed to play a role in the onset of coronary artery disease (CAD). The aim of the present study was to investigate serum paraoxonase/arylesterase activities and oxidation of apolipoprotein B-containing lipoproteins in patients with MDD. Oxidation of lipoproteins plays an important role in atherogenesis and the enzyme paraoxonase, has been shown to prevent lipoprotein oxidation. Furthermore, low paraoxonase activity was suggested to predict CAD. Eighty-six patients who fully met the fourth Diagnostic and Statistical Manual of Mental Disorders criteria for MDD and 36 healthy control subjects were included in the study. Serum paraoxonase and arylesterase activities were determined spectrophotometrically. Malondialdehyde (MDA) levels of apolipoprotein B-containing lipoproteins were determined before (basal) and after incubation with copper-sulphate, that yielded basal- and Delta-MDA values, respectively. Serum paraoxonase/arylesterase activities were significantly reduced in the post-treatment group compared with the pre-treatment group. Basal-MDA (MDA) level was significantly higher in the MDD group compared with the control group. Delta-MDA level of the severe MDD group was significantly higher than that of the control group. There was a positive correlation between the oxidizability of apolipoprotein B-containing lipoproteins and the severity of the disease. Total cholesterol, HDL-cholesterol, LDL-cholesterol, apolipoprotein B levels were significantly higher and apolipoprotein AI levels were significantly lower in the MDD group compared with those of the control group. The findings of the present study suggest that: 1) antidepressant treatment might reduce serum paraoxonase activity/mass; 2) oxidation and oxidizability of apolipoprotein B-containing lipoproteins seem to be increased in MDD.

Effects of various antidepressants on serum thyroid hormone levels in patients with major depressive disorder

A total of 62 patients with major depressive disorder were analyzed in the study. Patients were evaluated for 11 weeks in an open label design to investigate the differential effects of reboxetine, sertraline and venlafaxine on thyroid hormones. Serum thyrotrophin (TSH), thyroxine (T4) and free (f)T4 levels were measured before and after treatment. All groups showed significant improvement in HAM-D scores. TSH level significantly reduced and T4 level significantly increased in the reboxetine group, however TSH level significantly increased and T4 level significantly reduced in the sertraline group. Percent changes of TSH (p=0.007) and T4 (p=0.001) were significantly different between the reboxetine and sertraline groups. In the sertraline group, baseline TSH levels were correlated with response to treatment as determined by the change in HAM-D scores (p=0.03, r=0.648). There was a significant association between the percent changes in TSH values and the reduction in HAM-D scores in the reboxetine group (p=0.03, r=-0.434). In the whole study group, female patients had lower values of basal T4 compared with men (p=0.043), however percent changes of T4 did not differ between genders. In the treatment-responders significant increase in the reboxetine group and significant decrease in the sertraline group regarding the T4 values were found. We observed that various antidepressants had different effects on thyroid hormone levels and this could be attributed to the different mechanisms of actions of these antidepressants.

First-episode psychosis is associated with oxidative stress: Effects of short-term antipsychotic treatment

In the present study, our aim was to investigate the oxidative–antioxidative systems in unmedicated first‐episode psychosis (FEP) patients at the beginning and after short‐term treatment.

Can BDNF and IL-2 be indicators for the diagnosis in schizophrenic patients with depressive symptoms?

Objective The aim of the current study is to determine whether serum levels of brain-derived neurotrophic factor (BDNF) and interleukin-2 (IL-2) can be biological indicators for the diagnosis of schizophrenia in patients with depressive symptoms. Method Forty-seven patients (11 patients diagnosed with schizophrenia, 16 patients diagnosed with schizophrenia and comorbid depression and 20 patients diagnosed with major depressive disorder) and 20 healthy subjects were enrolled. The Positive and Negative Symptoms Scale, the Calgary Depression Scale for Schizophrenia and the Hamilton Depression Rating Scale were used for assessment. The serum BDNF and IL-2 levels of all the subjects were studied. Results Decreased levels of serum BDNF and increased levels of serum IL-2 were found in the patients diagnosed with either schizophrenia, schizophrenia with depression, or major depressive disorder (p = 0.049, p = 0.010; p = 0.001 and p = 0.044; p = 0.027, p = 0.003; respectively) compared with control group. There were no significant differences between the patient groups in their serum BDNF and IL-2 levels. Conclusions The present study suggests that neurotrophic factors and immune system changes are involved in the pathogenesis of schizophrenia with or without depressive symptomatology. However, the data do not clarify whether depressive symptoms in schizophrenia occur as a dimension of schizophrenia or as symptoms of major depression that is comorbid with schizophrenia.

Are there differences between serotonergic, noradrenergic and dual acting antidepressants in the treatment of depressed women?

Background. This study aims to investigate if there is a differential outcome of serotonergic and noradrenergic antidepressant treatment and if menopausal status has an impact on antidepressant response in depressed women. Methods. Data of the 111 depressed women who were included and completed the previous four open-label studies where patients were evaluated six times during a 10-week period, were pooled in the current study. Each of the reboxetine, sertraline and venlafaxine groups consisted of 37 depressed women. Patients were also divided into two subgroups of age, determining the 44 years as the cut-off point representing the menopausal status. Results. No significant difference was observed in the percent change of Hamilton Depression Rating Scale-17 (HDRS) and remission rates among treatment groups. Percent changes in Clinical Global Impression-Severity of Illness scale (CGI-S) and response rates were in favour of venlafaxine group at week 10. Individual HDRS items 2, 3, 4, 5 and 6 demonstrated significant improvement in the sertraline group, whereas HDRS item 7 demonstrated significant improvement in the venlafaxine group. An early reduction in anxiety subscale was observed in the venlafaxine group. Menopausal status had no impact on the outcome measures. Conclusions. These results suggest that noradrenergic and serotonergic activity do not differ from each other in treating depressed women. However, serotonergic activity appears to be more prominent in some particular symptoms such as feelings of guilt, suicidal ideation and sleep. Also, menopause does not appear to affect antidepressants’ benefit in depressed women.

Reversible escitalopram-induced hypothyroidism

Some drugs can cause alterations in the concentration of thyroid hormones in blood even without clinical signs of dysfunction or pathology of the thyroid gland. Apart from the well-known relationship between depression and hypothalamic-pituitary-thyroid (HPT) axis, and the impact of selective serotonin reuptake inhibitors (SSRIs) on thyroid indices, hypothyroidism is a very rare adverse effect of SSRI treatment. However, the case presented here demonstrates that escitalopram may have the potential to induce hypothyroidism without any significant clinical signs and symptoms. Therefore, the possibility of SSRI-induced asymptomatic hypothyroidism presented here may help clinicians in this regard.

The effects of reboxetine and venlafaxine on ECG variables in depressed patients / Depresyon hastalarında reboksetin ve venlafaksinin EKG değişkenleri üzerine etkisi

Antidepressants exert distinct effects on cardiac autonomic nervous system function depending on their receptor profile; thus, different groups of antidepressants are expected to insuence cardiac parameters in varying degrees. This study compares the effects of venlafaxine, a serotonin and noradrenaline reuptake inhibitor and reboxetine, a selective noradrenaline reuptake inhibitor, on ECG parameters and vital signs. Methods: The cardiac parameters and vital signs of 44 depressed patients were evaluated. The initial dose of venlafaxine XR was 75 mg/day and the dose was increased to 150 mg/day at the end of the 2nd week. Reboxetine was started at 4 mg/day and increased to 8 mg/day at the end of the 2nd week of the study. Electrocardiography (ECG) was performed and the PR, QRS, QT, and QTc intervals were measured both at the beginning and at the end of the trial, as were the vital signs. Results: The heart rate was significantly increased in the reboxetine group (Wilcoxon z=-3.510, p

Comparison of the efficacy and safety of sertraline, reboxetine, and venlafaxine in patients with major depressive disorder: a pooled analysis of four randomized, open-label trials

ABSTRACTObjective: This paper aims to compare the efficacy and safety of three widely used antidepressants, sertraline, reboxetine, a sertraline-reboxetine combination and venlafaxine, in the treatment of MDD and their effect on depressive symptoms in MDD patients.Methods: A total of 206 patients were included in reboxetine, venlafaxine, sertraline, and sertraline-reboxetine combination groups; however 37 cases dropped out during the study period. The remaining 169 patients were distributed to groups as follows: reboxetine: 43, venlafaxine: 43, sertraline 42, sertraline-reboxetine combination group: 41. The data from patients, who were included and completed the previous four open-label studies, were pooled in the current study.Results: Treatment groups did not differ in terms of depression-related and sociodemographic features. There were no significant differences among treatment groups in terms of efficacy, safety, and remission. The reductions in HDRS scores as percentages were higher in venlafaxine g...

Can serum BDNF levels predict the distinction between bipolar disorder depressive episode and unipolar depressive episode

Objective: This is study aimed to determine if serum levels of brain derived neurotrophic factor (BDNF) can be used as a biological marker to make a distinction between the depressive episodes of bipolar disorder (BD) and recurrent major depressive disorder (UD). Methods: Patients between 18-65 years of age and diagnosed with BD and UD according to DSM-IV-TR diagnostic criteria, who were admitted to the outpatient clinic of psychiatry department were enrolled to the patient arm of the study. Volunteers between 18-65 years of age, who had no physical morbidity and clinical psychopathology according to DSM-IV-TR diagnostic criteria, were enrolled to the control arm of the study. There were 24 patients (11 BD and 13 UD) and 18 healthy volunteers. Patients were required to be drug naive for the past four weeks prior to the study enrollment. Hamilton Depression Rating Scale (HDRS) were applied to all patients. The serum levels of BDNF of all the subjects were studied. Results: There were no differences between groups in terms of sociodemographic variables. Total number depressive episodes were higher in BD group compared to UD group. There were no differences between BD and UD groups in terms of serum levels of BDNF. However, in patient group serum BDNF values were lower than the control group. Serum BDNF levels did not correlate with age, body mass index or gender in each group. Serum BDNF levels did not correlate with mean scores of HDRS or number of depressive episodes. Discussion: Considering the outcomes of the present study, serum BDNF levels did not demonstrate any significant difference between patient groups. However, serum BDNF levels were lower in patient groups compared to controls. For the time being there is no valid biological diagnostic marker for psychiatric disorders. The data of the present study is far from generating a biological marker for the distinction of depressive episodes of UD and BD.