Citalopram versus mianserin. A controlled, double-blind trial in depressed patients

In a double-blind trial, comprising 60 endogenously depressed patients, citalopram was compared with mianserin. Fifty-eight patients completed the 6-week trial period with ratings and side effect recordings at weeks 0, 1, 2, 4, and 6. Both drugs were administered as a single evening dose, 20-80 mg (most frequently 40 mg) for citalopram and 60-120 mg (most frequently 90 mg) for mianserin. CPRS (Subscale for Depression) total scores showed a highly significant reduction in both groups with a significant difference in favour of citalopram after 1 and 2 weeks. Based on the Global Evaluation of the Severity of Illness there were 18 complete and three partial responders on citalopram and 13 complete and four partial responders on mianserin. Six patients on citalopram and one patient on mianserin showed mild or moderate side effects, but no cardiovascular side effects were recorded. The authors conclude that citalopram is a safe antidepressant drug, presumably better than mianserin.

Clinical trials of fluvoxamine vs chlorimipramine with single and three times daily dosing

1 Two double-blind, randomised studies were performed to compare the efficacy of fluvoxamine and chlorimipramine in depressed patients. In the first study the effects of a single daily dosage of between 100 and 300 mg of fluvoxamine were compared with those of chlorimipramine at a dosage of 50-150 mg daily in 43 out-patients with endogenous depression. 2 In a second study using three times daily dosing with a daily dosage of 150-300 mg for both fluvoxamine and chlorimipramine, 30 in-patients with unipolar depression were assessed. 3 Four weeks of treatment with single daily dosing resulted in a mean improvement of 61.4% (+/- s.d. 31.7) on the Hamilton Rating Scale for Depression (HAMD) for fluvoxamine and of 65.3% (+/- s.d. 25.8) for chlorimipramine. In the study with three times daily dosing the mean results were 72.9% (+/- s.d. 22.3) improvement for fluvoxamine and 62.1% (+/- s.d. 28.5) for chlorimipramine. 4 At similar dosages, fluvoxamine had significantly less untoward effects on blood pressure than chlorimipramine. Anticholinergic effects were also fewer in the fluvoxamine group, as were nervous system symptoms, with the latter difference reaching statistical significance (P = 0.02). 5 We conclude that fluvoxamine, given in a single daily dose of 150-250 mg, provides antidepressant efficacy similar to chlorimipramine. At this dosage it may be expected to produce less anticholinergic effects and have less influence on blood pressure than chlorimipramine.

[Temporal evolution of fibrinogen and platelets in reaction to various stressors in coronary and non-coronary subjects (author's transl)]

Twenty-one postmyocardial infarction patients are compared with twenty-one matching non-coronary subjects. Fibrinogen level as well as whole blood platelet count were measured six times for each subject in a timespan of 2 hours, during which two stress situations are induced. Throughout the experiment, non-coronary subjects show significantly lower levels of fibrinogen and higher blood platelet count. These two variables follow a specific temporal evolution. Stressfull situations are directly related with a significant decrease in the whole blood platelet count. Films inducing a directional anxiety match a lower blood platelet count, as compared to films inducing a diffuse anxiety. A link may be hypothesized between the stress-induced decrease in blood platelet count and the relative thrombopenia of coronary patients.

[Temporal evolution of lipids in reaction to various stressors in coronary and non-coronary subjects (author's transl)]

In order to assess the impact of coronary disease on sequential physiological reactions to stress, this study compares 21 post myocardial infarction patients with 21 matching non-coronary subjects. In each group, levels of phospholipids, triglycerides, cholesterol, FFA, alpha-, beta, pre-beta-lipoproteins and the ratio cholesterol/triglycerides are assessed, six times consecutively in a timespan of 2 hours. Concomitantly, two stressful situations are induced: the first stress is catheterization, the second is a film implementing either a focused-or diffused anxiety. Phospholipids react essentially to catheterization stress. While the ratio cholesterol/triglycerides turns out to be sensitive to psychological stress, neither cholesterol nor triglycerides alter individually when psychological stress is present. Throughout the experiment, levels of beta-lipoproteins very significantly in time and with respect to the theme of the film attended; coronary patients do not show the same sequential variations as normal subjects do. Variations in alpha-lipoproteins differentiate coronary from normal subjects. Levels of FFA vary according to the nature of the film attended and differ in normal and coronary subjects: extreme values are observed in normal subjects rather than coronary patients. Hyperlipidemia, as a reaction to stress, is a process interlinked with many factors, each increasing the liability of coronary disease.

[Temporal evolution of blood pressure and heart rate reaction to various stressors in coronary and non-coronary subjects (author's transl)]

The temporal evolution of systolic and diastolic blood pressure and heart rate in reaction to several stresses is measured in a group of 21 post myocardial infarction and 21 non coronary subjects. Heart rate modifications depend essentially upon the nature of stress: catheterization induces tachycardia while a stressing film induces bradycardia. These observations can be connected to environmental intake or rejection. During catheterization stress, the systolic blood pressure is high in both groups but returns to its normal values as soon as the intervention ends. In response to anxiety films, it persists higher in coronary patients than in normal subjects, who do not seem to react to this kind of stress. These results arise the question of either a longer recuperation, or a different reactivity to symbolic stressors (films).

[Temporal evolution of neuro-endocrine secretions in reaction to various stressors in coronary and non-coronary subjects (author's transl)]

The purpose of this study is a comparison of sequential physiolocical reactions to different stressors in 21 post-myocardial infarction and 21 non-coronary subjects. Two stressful situations are induced in a timespan of 2 hours; the first stress is catheterization, the second is a film implementing either a focused or a diffuse anxiety. Throughout the experiment, the following physiological parameters are assessed six times consecutively: levels of catecholamines, cortisol, TSH, insulin and the ratios: adrenalin/fnor-adrenalin and adrenalin/cortisol. Results indicate that levels of adrenalin and cortisol show specific variations with time and are most sensitive to catheterization. Levels of nor-adrenalin very differently with time among coronary patients, as well as they do in normal subjects. Individuals submitted to focused anxiety show increased levels of catecholamines and cotisol, as well as a lower level of insulin than subjects submitted to diffuse anxiety. The sequential evolution of cortisol differs in coronary patients and normal subjects and in function of the type of film attended. Physiological reactions to stress and far more specific and interdependent than prior studies stated in the past. They vary with the degree and the nature of stress. It is our belief that there is no standardised response to stress.

[Psychological links and coronary diseases. II. Psychological correlations of certain physiological variables (author's transl)]

In this study, correlations were tabulated between physiological and psychological measurements drawn from a group of 21 infarct patients and a matching group of 21 normal subjects. The physiological variables taken under consideration are the number of platelets, the beta-lipoproteines and the systolic blood pressure; all these variables were tested under stress and at rest. On the top, fibrinogene at rest, cortisol under stress and heart rate under conditions of "intake" and "rejection" were also measured. The psychological assessment was achieved by the MMPI. Several psychological traits link with physiological parameters to be considered as cardiovascular risks. However, these links are mostly specific; moreover, they vary under different experimental conditions. In other words, different neuro-behavioral patterns seem to operate at rest and under stress. The links between psychological and physiological variables vary also between normal subjects and infarct patients. Normal subjects as well as infarct patients show a relationship between neurotic traits and genuine physiological reactions. However, among the formers, these neurotic traits are in closer relationship with inhibitions as among heart patients. Psychological risk factors in cardiovascular disorders appear to be related with a genuine expression of conflictual affects leading to inadequate physiological responses; when these reactions are repeated in time, functional disorders may induce organic lesions.

[Psychological links and coronary diseases. I. Physiological correlations of certain psychological variables (author's transl)]

Twenty-one infarct patients were compared with 21 normal subjects regarding several hemodynamic, lipidic and neuroendocrine variables, in various stress situations and at rest. Correlations were tabulated between those bioclinical measurements and various personality patterns drawn from the MMPI. This study shows that the physiological reactions to stress vary in subjects with psychological cardiovascular risk factors as compared to subjects without psychological risk factors. The bearers of psychological risk factors show a higher systolic and diastolic blood pressure, a specific lipids pattern and a lower rate of platelets. In summary, psychological risk factors link with physiological reactions to stress which appear to be by themselves cardiovascular risk factors.

[Homogeneity of defence mechanisms in a group of infarct patients and impact of these defences on the expression of their emotions (author's transl)]

This study made use of the EMO-Questionnaire of Baehr and Baehr and the DMI of gleser and Ihilevich. The first purpose of this study is to evaluate the homogeneity of a group of infarct patients as to what the defence mechanisms are concerned. The wards statistical procedure showed the group was composed of two subgroups amounting respectively 66% (group I) and 34% (group II) of the subjects. The discriminant function analysis reveals how much the two groups are differentiated but coherent. The subjects of group I use predominately intellectualization and denegation; they use moderately turning against self and projection; they use rarely turning against object. The subjects of group II make moderately use of all these defence mechanisms. The second purpose is to precise in which measure the way of expression of affects is related to the defence mechanisms. The U-test of Mann Whitney reveals lower scores among the subjects of group I as compared to those of group II, in aggressiveness, anxiety, inferiority feelings, somatisation, fantasy productions and withdrawal.

[Validation of a psychological questionnaire to differentiate subjects with propensities for hypertension, tachycardia or angor from normal subjects (author's transl)]

The present work allows us to draw a psychological profile of patients suffering from hypertension, tachycardia and angina pectoris. It confirms the fact that patients affected by cardiovascular symptoms are not relevant to one and the same structure of personality. It lays stress on the necessity to differentiate the studied symptoms and to homogenize the cardiovascular samples.

[Subjective importance and affective organization of body concepts after myocardial infarction (author's transl)]

Subjective importance and affective organization of fifty body concepts have been evaluated in sixty myocardial patients and sixty healthy subjects. Myocardial patients attribute more importance to their articulations and perceive their bodies as an instrument for action rather than as a locus of emotion and pleasure. This observation is discussed in relation with the hypothesis of "pensée opératoire".

[Approach to the personality of the coronary patients with a new modifyed MMPI scale (author's transl)]

In order to set up an instrument for psychologically differentiate normal from coronary subjects, the analysis of 550 items of the MMPI in 40 normal and 40 coronary subjects has been performed. This has allowed to elaborate a questionnaire of 69 items, the Polyvar, and two new MMPI scales, which try to focus on the way conflictual affects are being expressed by coronary patients. Applied to new populations, these two instruments permit to significantly differentiate normal from coronary subjects. The last are characterized by a trouble in the existence and a rigid denial of any weakness. They look like individuals who can not satisfy their fundamental pulsions without risking to confront other requests, and through this, they generate anxiety and guilt.

[Subjective misconcepts of social status and coronary troubles (author's transl)]

The study of various social parameters as risk factors for coronary diseases gives contradictory results. The inadequacy of social status and the consequent subjective misconcept could reconcile these apparent oppositions. The present research seems to confirm the fact that misconcepts induced by inadequacity of social status are more frequent and more intensive in patients with coronary troubles.

[Anxiety self-rating and myocardial infarction (author's transl)]

This study addresses to critical issues related to the role of anxiety in myocardial infarct. Is the predictive value of the Anxiety Scale Questionnaire (ASQ) to be found in content of items and its self-rating by the subject or in response style to the questionnaire? Would anxiety play in certain circumstances a positive role in that it drives the individual to seek early medical treatment? Differences in anxiety scores, response style indices and factorial structures of the ASQ items reveal : 1. myocardial infarction subjects have higher, but not significantly higher, anxiety scores relative to healthy volunteers to an atherosclerosis screening test and healthy control individuals matched for age, sex and socio-economic status, 2. healthy volunteers are characterized by extreme response style that could reveal their involvement in the testing situation; 3. control individuals show a tendency to intermediate response; 4. the lack of invariance of factorial structure across the three groups suggests that each of them has a specific organization of anxiety. Scale-checking style, though strongly associated with the content of items, could have a predictive value since, anxiety levels being equal, subjects may be differently involved in their answers. The assumption is supported by the specific organization of anxiety evidenced in each group considered. A relation between such organization and preventive behaviour is not infirmed by the present data and ought to be further analyzed.

[Comparison of carotid pulse in normal subjects and coronary patients]

A comparison of the values of R-R, S1S2, QS1, QS2, LVET, PEP, and ICT recorded from the carotid pulse of 40 coronary patients and 40 normal subjects has shown that the coronary group, when compared with the normals, show: --A significant lengthening of the QS2, PEP and ICT values, and a tendency towards lengthening of the S1S2 interval. --A tendency towards shortening of the LVET period. The ratio of PEP/LVET is a particularly good discriminant factor between the two groups. Because of these differences, assessment of the carotid pulse, which is an easy and non-invasive investigation, has become a good means of diagnosing coronary arterial disease. The results of this study have been compared with those from previous studies, and the clinical significance of the different findings has been analysed.

[Premonitory psychiatric signs of cardiovascular complaints]

The present study attempts to find out whether 19 behaviors, identified in 1952 and considered as revealing of a psychoneurotic state, appear more often among subjects who complain, 16 years later (in 1968), of a cardiovascular problem than among the subjects who remain free of any cardiovascular complaint during this period. The sample analysed comes from an epidemiological survey, realized by Leighton and known by the name Stirling County Study. That study includes 654 subjects free of any cardiovascular complaint in 1952. These subjects were divided into five independent categories in terms of the presence or absence of certain cardiovascular complaints expressed in 1968. The five categories of cardiovascular complaints were compared as to the frequency and nature of the psychiatric characteristics which differentiate them. Three conclusions appear from this study. 1. The psychiatric characteristics (identified in 1952) are more numerous among the subjects who manifest, 16 years later, a cardiovascular complaint (identified in 1968), when one compares them to the psychiatric characteristics of those who do not develop any cardiovascular complaint during this period. 2. The patterns of psychiatric characteristics which differentiate the subjects who develop a cardiovascular complaint vary with sex. These patterns are much more broad, coherent, and differentiating among women. 3. The accumulation of psychiatric characteristics possesses, among women, a differentiating value greater than any characteristic taken alone.