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Heres S, Cordes J, Feyerabend S, Schmidt-Kraepelin C, Musil R, Riedel M, Spellmann I, Langguth B, Landgrebe M, Fran E, Petcu C C, Hahn E, Ta TMT, Matei V, Dehelean L, Papava I, Leweke FM, van der List T, Tamasan SC, Lang FU, Naber D, Ruhrmann S, Wolff-Menzler C, Juckel G, Ladea M, Stefanescu C, Lautenschlager M, Bauer M, Zamora D, Horowitz M, Davis JM, Leucht S. Changing the Antipsychotic in Early Nonimprovers to Amisulpride or Olanzapine: Randomized, Double-Blind Trial in Patients With Schizophrenia. Schizophr Bull 2022; 48:1273-1283. [PMID: 35857811 PMCID: PMC9673269 DOI: 10.1093/schbul/sbac068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND HYPOTHESIS Meta-analyses have shown that the majority of patients with schizophrenia who have not improved after 2 weeks of treatment with an antipsychotic drug are unlikely to fully respond later. We hypothesized that switching to another antipsychotic with a different receptor binding profile is an effective strategy in such a situation. STUDY DESIGN In total, 327 inpatients with an acute exacerbation of schizophrenia were randomized to double-blind treatment with either olanzapine (5-20 mg/day) or amisulpride (200-800 mg/day). Those patients who had not reached at least 25% Positive-and-Negative-Syndrome-Scale (PANSS) total score reduction from baseline after 2 weeks (the "non-improvers") were rerandomized double-blind to either staying on the same compound ("stayers") or to switching to the other antipsychotic ("switchers") for another 6 weeks. The primary outcome was the difference in the number of patients in symptomatic remission between the combined "switchers" and the "stayers" after 8 weeks of treatment, analyzed by logistic regression. STUDY RESULTS A total of 142 nonimprovers were rerandomized at week two. 25 (45.5 %) of the 'stayers' compared to 41 (68.3 %) of the "switchers" reached remission at endpoint (p = .006). Differences in secondary efficacy outcomes were not significant, except for the PANSS negative subscore and the Clinical-Global-Impression-Scale. "Switchers" and "stayers" did not differ in safety outcomes. CONCLUSIONS Switching "non-improvers" from amisulpride to olanzapine or vice-versa increased remission rates and was safe. The superiority in the primary outcome was, however, not paralleled by significant differences in most secondary efficacy outcomes and the effect was only apparent at the last visit making replications of longer duration necessary.
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Affiliation(s)
- Stephan Heres
- To whom correspondence should be addressed; Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine Kbo-Klinik für Psychiatrie und Psychotherapie Nord, Schwabing, kbo-Tagesklinik und Institutsambulanz Nord des Isar-Amper-Klinikums München Ost Kölner Platz 1, Haus 7 80804 Munich, Germany, tel: 49 (0) 89 412 006 158, fax: 49 (0) 89 412 006 172, e-mail:
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, LVR-Clinic Düsseldorf, Medical Faculty, Heinrich-Heine-University, Duesseldorf NW, Germany,Department of Psychiatry and Psychotherapy, Kaiserswerther Diakonie, Florence Nightingale Hospital, Düsseldorf NW, Germany
| | - Sandra Feyerabend
- Department of Psychiatry and Psychotherapy, LVR-Clinic Düsseldorf, Medical Faculty, Heinrich-Heine-University, Duesseldorf NW, Germany,Department of Psychiatry and Psychotherapy, Kaiserswerther Diakonie, Florence Nightingale Hospital, Düsseldorf NW, Germany
| | - Christian Schmidt-Kraepelin
- Department of Psychiatry and Psychotherapy, LVR-Clinic Düsseldorf, Medical Faculty, Heinrich-Heine-University, Duesseldorf NW, Germany,Department of Psychiatry and Psychotherapy, Kaiserswerther Diakonie, Florence Nightingale Hospital, Düsseldorf NW, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University of Munich, Munich, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University of Munich, Munich, Germany,Marion von Tessin Memory-Zentrum GmbH, Munich BY, Germany
| | - Ilja Spellmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University of Munich, Munich, Germany,Klinikum Stuttgart, Zentrum für Seelische Gesundheit, Stuttgart BW, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg BY, Germany
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg BY, Germany,Department of Psychiatry and Psychotherapy, kbo Lech-Mangfall-Hospital Agatharied, St.-Agatha-Str. 1a, 83734 Hausham BY, Germany
| | - Elmar Fran
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg BY, Germany
| | - Camelia Petcu C
- Psychiatry Department, University of Medicine and Pharmacy ”Carol Davila” Bucharest, ”Prof. Dr. Alexandru Obregia” Psychiatric Hospital, Berceni Str 10-12, Bucharest, Romania
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Tam M T Ta
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Valentin Matei
- Psychiatry Department, University of Medicine and Pharmacy ”Carol Davila” Bucharest, ”Prof. Dr. Alexandru Obregia” Psychiatric Hospital, Berceni Str 10-12, Bucharest, Romania
| | - Liana Dehelean
- Department of Neurosciences-Psychiatry, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania,Centre for Cognitive Research in Neuropsychiatric Pathology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania,Center for Translational Research, and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania,Center for Studies in Preventive Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania
| | - Ion Papava
- Department of Neurosciences-Psychiatry, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania,Centre for Cognitive Research in Neuropsychiatric Pathology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania
| | - F Markus Leweke
- Brain and Mind Centre, The University of Sydney, 94 Mallet St, Camperdown NSW 2050, Sydney, Australia,Central Institute of Mental Health, Heidelberg University I5, 68159 Mannheim BW, Germany
| | - Till van der List
- Central Institute of Mental Health, Heidelberg University I5, 68159 Mannheim BW, Germany,Practise for Psychiatry and Psychotherapie Nowackanlage 15, 76137 Karlsruhe BW, Germany
| | - Simona C Tamasan
- Liaison Psychiatry, “Pius Branzeu” County Emergency Hospital, Timisoara TS, Romania
| | - Fabian U Lang
- Department of Psychiatry II, Ulm University, Ulm BW, Germany
| | - Dieter Naber
- Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne NW, Germany
| | - Claus Wolff-Menzler
- Klinik für Psychiatrie und Psychotherapie Universitätsmedizin Göttingen, Göttingen, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL University Hospital, Psychotherapy and Preventive Medicine Ruhr University, Bochum, Germany
| | - Maria Ladea
- DMU IMPACT (Departement Medico-Universitaire de Psychiatrie et d'Addictologie) Groupe Hospitalier Henri MONDOR, Créteil, France
| | | | - Marion Lautenschlager
- ZfP Südwürttemberg, Bad Schussenried, Germany,Charité University Medicine, Campus Mitte, Berlin BE, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany
| | - Daisy Zamora
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany,Department of Psychiatry, UNC School of Medicine, 321 S Columbia St, Chapel Hill, NC 27599, USA
| | - Mark Horowitz
- Department of Psychiatry, University of Illinois, Chicago, IL, USA
| | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, IL, USA
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
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Bumb JM, Enning F, Mueller JK, van der List T, Rohleder C, Findeisen P, Noelte I, Schwarz E, Leweke FM. Differential melatonin alterations in cerebrospinal fluid and serum of patients with major depressive disorder and bipolar disorder. Compr Psychiatry 2016; 68:34-9. [PMID: 27234180 DOI: 10.1016/j.comppsych.2016.03.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/19/2016] [Accepted: 03/24/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Melatonin, which plays an important role for regulation of circadian rhythms and the sleep/wake cycle has been linked to the pathophysiology of major depressive and bipolar disorder. Here we investigated melatonin levels in cerebrospinal fluid (CSF) and serum of depression and bipolar patients to elucidate potential differences and commonalities in melatonin alterations across the two disorders. METHODS Using enzyme-linked immunosorbent assays, CSF and serum melatonin levels were measured in 108 subjects (27 healthy volunteers, 44 depressed and 37 bipolar patients). Covariate adjusted multiple regression analysis was used to investigate group differences in melatonin levels. RESULTS In CSF, melatonin levels were significantly decreased in bipolar (P<0.001), but not major depressive disorder. In serum, we observed a significant melatonin decrease in major depressive (P=0.003), but not bipolar disorder. No associations were found between serum and CSF melatonin levels or between melatonin and measures of symptom severity or sleep disruptions in either condition. CONCLUSION This study suggests the presence of differential, body fluid specific alterations of melatonin levels in bipolar and major depressive disorder. Further, longitudinal studies are required to explore the disease phase dependency of melatonin alterations and to mechanistically explore the causes and consequences of site-specific alterations.
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Affiliation(s)
- J M Bumb
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - F Enning
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - J K Mueller
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Till van der List
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Rohleder
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - P Findeisen
- Institute for Clinical Chemistry, Medical Faculty Mannheim, Heidelberg University, Germany
| | - I Noelte
- Department of Neuroradiology, University Hospital Mannheim, Mannheim, Germany
| | - E Schwarz
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - F M Leweke
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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