Video Rating Analysis of Effect of Maprotiline in Patients with Dementia and Depression

Fuchs, Ângela; Hehnke, Uwe; Erhart, C.; Schell, Ch.; Pramshohler, B.; Danninger, B.; Schautzer, F.

doi:10.1055/s-2007-1014339

Cited by 39 publications

(16 citation statements)

References 3 publications

(3 reference statements)

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“…Of the 13 potentially relevant RCTs retrieved in the literature searches, 8 were excluded for the following reasons: medication not available in North America 35 ; study population did not have depression 36 ; only a portion of the study population had dementia and were not explicitly identified in the study 38,39 ; or study data were only presented as P values. 40 Raw study data were requested from several studies' authors and sites and (or) drug manufacturers [38][39][40] ; however, this information was not received.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Antidepressants for Treatment of Depression in Alzheimer's Disease: A Metaanalysis

Thompson¹,

et al. 2007

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Objective: Depression in patients with Alzheimer's disease (AD) is common (15% to 63%) and is associated with significant morbidity and increased mortality. Our objective was to quantitatively summarize the data on the efficacy and safety of antidepressant treatment for depression complicating AD. Method:We performed a metaanalysis of randomized, double-blind, placebo-controlled trials of antidepressants with a database search of the English literature (up to 2006) and a manual search of references in the retrieved articles. We extracted the proportion of subjects who responded and remitted, experienced adverse events (AEs), discontinued treatment due to AEs, or discontinued treatment for any reason. Cognition scores were also extracted. Results:We included 5 studies, which involved 82 subjects treated with antidepressants and 83 subjects who received placebo treatment. Antidepressants were superior to placebo for both treatment response (odds ratio [OR] 2.32; 95% confidence interval [CI], 1.04 to 5.16) and remission of depression (OR 2.75; 95%CI, 1.13 to 6.65). There were no significant differences between the 2 groups for change in cognition (weighted mean difference -0.71, 95%CI, -3.20 to 1.79), overall dropouts (OR 0.70; 95%CI, 0.29 to 1.66) or dropout due to AEs (OR 1.41; 95%CI 0.36 to 5.54). The numbers needed to treat for one additional AD patient to respond to antidepressant treatment were 5 (95%CI, 3 to 59) and 5 (95%CI, 2 to 24) for remission of depression. Conclusions:Antidepressant treatment for depression in AD is efficacious, with rates of discontinuation that are comparable to placebo. Nonetheless, clinicians must be vigilant regarding the potential side effects of antidepressants in this population. Clinical Implications· Antidepressants are efficacious in the treatment of depression in AD. · Tolerability of antidepressants in AD appears to be similar to placebo. · TCAs may be associated with a decline in cognition. Limitations· Antidepressant classes were not compared because of the limited number of published trials in AD. · Individual AEs could not be analyzed. · Individual trials were limited by small sample sizes, low medication dosages, differing outcomes of interest, and varying outcomes measures.

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Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Antidepressants for Treatment of Depression in Alzheimer's Disease: A Metaanalysis

Thompson¹,

et al. 2007

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“…100 Another study suggested that maprotiline may have beneficial effects on depression, but the study results are compromised by a high rate lost to follow-up. 101 A few small studies suggested that the use of serotonergic reuptake blockers such as fluvoxamine, 74 fluoxetine, 102 citalopram, 97 and paroxetine 103 may offer some benefit in treating depression in patients with AD. One study compared fluoxetine to amitriptyline and showed improved depression scores for both groups, but there were more dropouts because of side effects in the amitriptyline group.…”

Section: Ischemic Vascular Dementiamentioning

confidence: 99%

Practice parameter: Management of dementia (an evidence-based review) [RETIRED]

et al. 2001

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Article abstract-Objective: To define and investigate key issues in the management of dementia and to make literaturebased treatment recommendations. Methods: The authors searched the literature for four clinical questions: 1) Does pharmacotherapy for cognitive symptoms improve outcomes in patients with dementia? 2) Does pharmacotherapy for noncognitive symptoms improve outcomes in patients with dementia? 3) Do educational interventions improve outcomes in patients and/or caregivers? 4) Do other nonpharmacologic interventions improve outcomes in patients and/or caregivers? Results: Cholinesterase inhibitors benefit patients with AD (Standard), although the average benefit appears small; vitamin E likely delays the time to clinical worsening (Guideline); selegiline, other antioxidants, antiinflammatories, and estrogen require further study. Antipsychotics are effective for agitation or psychosis in patients with dementia where environmental manipulation fails (Standard), and antidepressants are effective in depressed patients with dementia (Guideline). Educational programs should be offered to family caregivers to improve caregiver satisfaction and to delay the time to nursing home placement (Guideline). Staff of long-term care facilities should also be educated about AD to minimize the unnecessary use of antipsychotic medications (Guideline). Behavior modification, scheduled toileting, and prompted voiding reduce urinary incontinence (Standard). Functional independence can be increased by graded assistance, skills practice, and positive reinforcement (Guideline).

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“…Há relatos de uso bem sucedido de tricíclicos no tratamento antidepressivo de pacientes demenciados, 63 mas poucos estudos placebo-controlados. 45,50 A maprotilina, antidepressivo tetacíclico com perfil noradrenérgico, foi utilizada em alguns estudos controlaTabela 3 -Esquema posológico das drogas mais utilizadas no tratamento da depressão em pacientes com DA 49 com resultados satisfatórios. A mianserina, outro tetracíclico que inibe a recaptação de noradrenalina, tem ação anticolinérgica praticamente nula e poucos efeitos sobre a pressão arterial, mas é capaz de produzir sedação importante, discrasias sanguíneas e redução do limiar convulsivo.…”

Section: Antidepressivos Cíclicosunclassified

Transtornos depressivos na doença de Alzheimer: diagnóstico e tratamento

Forlenza

2000

Rev. Bras. Psiquiatr.

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revisão Transtornos do humor afetam uma porcentagem considerável de indivíduos com doença de Alzheimer, em algum ponto da evolução da síndrome demencial. Pode ser uma condição difícil de se detectar, dependendo da gravidade do acometimento cognitivo. Na presença de manifestações depressivas leves ou atípicas, a observação da evolução, associada ou não ao emprego de técnicas não-farmacológicas, é a abordagem inicial mais recomendá-vel; na vigência de depressão moderada a grave, o emprego de psicofármacos pode fazer-se necessário. Embora haja evidências dos benefícios advindos do tratamento da depressão em pacientes com demência, avaliações formais da sua eficácia nesses pacientes são limitadas. A escolha do antidepressivo depende muito mais do seu perfil de tolerabilidade, das condições clínicas associadas e das características individuais do paciente. Os inibidores seletivos da recaptação de serotonina são usualmente as drogas de primeira opção, pelo perfil mais adequado de segurança, tolerabilidade e facilidade posológica. Em situações especiais, devem ser considerados os potenciais terapêuticos das novas drogas ou mesmo dos medicamentos tradicionais. O artigo revê a literatura dos últimos dez anos, enfocando particularidades do diagnóstico da depressão em pacientes com doença de Alzheimer, bem como diretrizes para uma prescrição segura. Demência. Doença de Alzheimer. Depressão. Diagnóstico. Tratamento.Depressive symptoms frequently arise in the course of dementia, imposing additional limitations to both cognitive performance and quality of life. Diagnosing depression in these cases can be difficult, especially in patients with moderate and severe Alzheimer's disease. In general, non-pharmacological approaches are the first-line treatment for mild depressive symptoms, but medication is clearly indicated for moderate and severe cases. However, ageand disease-related changes make the pharmacological management of such patients particularly complex and hazardous. In spite of their documented therapeutic value, antidepressant medications are widely underused in this population. Electroconvulsive therapy is also valuable in the management of refractory or severe depression. This is a review of the literature regarding the association of depression and Alzheimer's disease, and a summary of the guidelines for safe prescription of antidepressant treatment.Dementia. Alzheimer's disease. Depression. Diagnosis. Treatment.Recebido em 13/7/1999. Aceito em 11/1/2000. Fonte de financiamento inexistente. Conflito de interesses inexistente. Resumo Descritores Abstract Keywords IntroduçãoO presente artigo de revisão aborda a associação entre depressão e demência na doença de Alzheimer (DA). À luz de evidências obtidas na literatura, o autor procurou oferecer ao leitor, de forma compreensiva, algumas diretrizes clínicas para o diagnóstico e o tratamento biológico dos transtornos depressivos em pacientes com demência. Não é objetivo deste trabalho a discussão das técnicas psicológicas para o tratamento de pacientes com demência. O...

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Video Rating Analysis of Effect of Maprotiline in Patients with Dementia and Depression

Cited by 39 publications

References 3 publications

Efficacy and Safety of Antidepressants for Treatment of Depression in Alzheimer's Disease: A Metaanalysis

Efficacy and Safety of Antidepressants for Treatment of Depression in Alzheimer's Disease: A Metaanalysis

Practice parameter: Management of dementia (an evidence-based review) [RETIRED]

Transtornos depressivos na doença de Alzheimer: diagnóstico e tratamento

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