Depressions with eating disorders: clinical manifestations and therapy

Depression is a common comorbid diagnosis in patients with eating disorders (EDs). The development of pathogenetic therapy for depression with EDs is far from being completed.

The objective of the psychopharmacotherapeutic study was to evaluate the efficacy and tolerability of melatonergic monotherapy with the antidepressant agomelatine (25–50 mg/day at night) for depressions with two ED variants: hyperphagic (n=32) and hypo- and aphagic (n=31) EDs.

Patients and methods. The investigation enrolled patients of both sexes, aged 18 to 65 years. The investigators performed clinical psychopathological and experimental psychological studies, as well as psychometric examination using the 21-item Hamilton Depression Rating Scale (HDRS-21), the Clinical Global Impression (CGI), the Supplemental Hospital Offset Payment Program (SHOPP), the Dutch Eating Behavior Questionnaire (DEBQ), and statistical data processing.

Results and discussion. There was a significant pronounced antidepressant effect of 6-week agomelatine therapy for depressions occurring with different ED variants both in the pattern of the depressive symptom complex and in that of concurrent with and preceding the latter. At the same time, the efficacy of the drug did not depend on the clinical presentations of the leading hypothymic syndrome, the variants of EDs, and the duration of actual depression. However, by the end of the study period, a larger effect was achieved in the therapy for depressions with the hyperphagic variant of EDs, as well as in patients with EDs manifesting in the pattern of depressive symptom complex. Agomelatine has a favorable tolerance profile. BMI tends to become normal in patients with different variants of EDs during the therapy. The adverse events are transient and/or unclear; they do not require therapy discontinuation.

Conclusion. Agomelatine is an effective and relatively safe drug that can be recommended to treat depressions concurrent with EDs in therapeutic dosages for at least 6 weeks.

[Efficacy and tolerability of contemporary antidepressants: results of network meta-analyses and Russian experience]

The objective of this review is to compare results of network metaanalyses of the efficacy and tolerability of different antidepressants for treatment of unipolar depression in adults. An analysis of different criteria of antidepressant efficacy and tolerability showed the benefits of agomelatine. Results of using this drug in national clinical practice and multicenter studies of depression of different nosology with heterogeneous psychopathological symptoms support this notion.