[The link of platelet cytochrome C-oxidase activity with some clinical parameters of depression in elderly patients]

OBJECTIVE

To search for correlations between platelet cytochrome c-oxidase (COX) activity and the quality of therapeutic outcomes and other clinical parameters of depression in elderly patients.

MATERIAL AND METHODS

Twenty elderly women, aged 55-78 years, with depressive episodes in recurrent depressive disorder (RDD) or bipolar affective disorder (BD) were studied. COX activity and severity of depression were evaluated twice: before the beginning of antidepressant treatment and at the 28-th day of the therapy, using the Hamilton Depression Rating Scale (HAMD-17) and the Hamilton Anxiety Rating Scale (HAM-A).

RESULTS

Significant correlations were revealed between platelet COX activity and some clinical parameters of the disease and the severity of depression in patients after treatment. The baseline level of the platelet COX activity was correlated with the age of disease onset (R= -0.63, p=0.003) and its duration (R=0.55, p=0.010). Significant negative correlations were also found between the baseline level of COX activity and depression severity (HAMD-17 total score) (R= -0.48, p=0.032) and the severity of anxiety (HARSHAM-A total score) (R= -0.54, p=0.010) after 28-day treatment.

CONCLUSION

This pilot study has revealed a link between platelet COX activity and the severity of depression and anxiety after a 28-day antidepressant therapy. The results indicate the prospects for further study of COX as a biomarker of therapeutic outcomes in elderly patients with depression.

The Effect of Chronic Mild Stress and Venlafaxine on the Expression and Methylation Levels of Genes Involved in the Tryptophan Catabolites Pathway in the Blood and Brain Structures of Rats

A growing body of evidence suggests that depression may be associated with impairment of the tryptophan catabolites (TRYCATs) pathway. The present study investigated the effects of the chronic administration of venlafaxine on the expression and methylation status of Katl, Tph1/2, Ido1, Kmo and Kynu in the brain and blood of rats exposed to the CMS model of depression. The rats were subjected to the CMS procedure for 2 or 7 weeks and administered venlafaxine (10 mg/kg/day, IP) for 5 weeks. mRNA and protein expression and the methylation status of gene promoters in PBMCs and six brain structures were evaluated and analysed using the TaqMan Gene Expression Assay and Western blotting, and methylation-sensitive high-resolution melting (MS-HRM), respectively. We found that the CMS procedure increased KatI expression in the midbrain and KatII expression in the midbrain and the amygdala, while venlafaxine administration decreased KatII expression in the hypothalamus and the cerebral cortex. The methylation status of the Tph1 and Kmo promoters in peripheral blood mononuclear cells (PBMCs) was significantly increased in the stressed group after antidepressant therapy. The protein levels of Tph1 and Ido1 were decreased following venlafaxine administration. Our results confirmed that CMS and venlafaxine modulate the expression levels and methylation status of genes involved in the TRYCATs pathway.

Scientific Papers and Patents on Substances with Unproven Effects

It is evident from reviewing scientific literature that the quality of argumentation in some areas of medical research has deteriorated during the last decades. Publication of a series of questionable reliability has continued without making references to the published criticism; examples are discussed in this review. Another tendency is that drugs without proven efficiency are advertised, corresponding products patented and marketed as evidence-based medications. Professional publications are required to register drugs and dietary supplements to obtain permissions for the practical use; and such papers appeared, sometimes being of questionable reliability. Several examples are discussed in this review when substances without proven effects were patented and introduced into practice being supported by publications of questionable reliability. Some of the topics are not entirely clear; and the arguments provided here can induce a constructive discussion.

[Personalized approach to the treatment of depression in the elderly]

AIM

To develop a personalized approach to the appointment of a complex antidepressant therapy in combination with drugs of neuroprotective and neurotrophic action in depressed elderly patients based on the selection of predictors of low therapeutic response (LTR).

MATERIAL AND METHODS

The study included 152 hospitalized patients, aged 60 years and older, with moderate and mild depression (ICD-10) who received monotherapy (44 people) with antidepressants of the new generation and complex therapy (108 people) with the same antidepressants in combination with neuroprotective drugs. In the monotherapy group, correlations between treatment efficacy (change in average total HAMD-17 scores) and a set of parameters, including socio-demographic data, results of psychopathological, somatic, standardized assessment and neuroimaging (CT) of the brain were analyzed. The validity of the established correlations as predictors of LTR was estimated based on a comparison of their frequency among the responders (≥50% reduction) and non-responders (<50% reduction). Comparison of the efficacy of therapy in groups of patients with mono - and complex therapy was carried out depending on the presence or absence of predictors of LTR.

RESULTS

LTR predictors are living alone, complaints about memory loss and signs of pronounced diffuse lesions of the subcortical white matter of the brain, which are significantly more frequently observed in non-responders (p<0.05). The increase in the number of predictors (2 and more) correlates with a significant decrease in therapeutic efficacy (p<0.001). Patients with complex in structure and protracted depressions tend to decrease in efficiency, and in most of them (more than 87% of cases) LTR predictors are detected. In patients with LTR predictors, the complex therapy is significantly more effective than monotherapy, allowing in all cases to achieve 50% reduction of depressive symptoms by the 4th week of treatment.

CONCLUSION

Personalized indications for the appointment of complex antidepressant therapy in combination with neuroprotective drugs in depressed elderly patients are formulated.

[Augmentation with carnicetine for late depression]

AIM

Comparative evaluation of the efficacy and safety of antidepressant monotherapy and complex antidepressant therapy in combination with carnicetine in the treatment of depression in elderly patients in a psychiatric hospital.

MATERIAL AND METHODS

Two groups of hospitalized patients, aged from 60 to 79 years, with mild or moderate depression (according to ICD-10), comparable in basic demographic and clinical characteristics, received mono- or complex (in combination with carnicetine) antidepressant therapy for 8 weeks. Treatment efficacy was assessed with HAM-D, HARS, CGI-S and CGI-I; the level of cognitive activity was assessed with MMSE, the 10-word memory test and clock drawing test.

RESULTS

It has been established that the use of complex antidepressants therapy with the inclusion of carnicetine allows to achieve a more rapid and pronounced therapeutic response compared to antidepressant monotherapy. This is confirmed by the earlier (by the 4th week) and significant reduction of depressive and anxiety symptoms (p<0.01), a greater number of responders and better quality of depressive outcomes to the end of treatment and a more rapid improvement in cognitive functioning.

CONCLUSION

The results allow us to recommend the inclusion of carnicetine for the augmentation of antidepressant therapy in elderly patients of the psychiatric hospital to achieve a more rapid and complete therapeutic response and reduce the duration of hospitalization.