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No. 1 (2023)

PSYCHOPHARMACOTHERAPY

Comparative efficacy and tolerability of two-year relapse prevention therapy with carbamazepine, lithium carbonate, fluoxetine and paroxetine in patients with recurrent depressive disorder

https://doi.org/10.21265/PSYPH.2023.38.56.004

Published 2023-03-30

  • E.G. Kostyukova
    • ,
  • P.V. Alfimov
    • ,
  • A.A. Shafarenko
    • ,
  • S.N. Mosolov

E.G. Kostyukova
Moscow Research Institute of Psychiatry – branch of the FSBI “V.P. Serbsky National Medical Research Center of Psychiatry and Narcology” of the Ministry of Health of the Russian Federation

P.V. Alfimov
Clinic “MHS Mental Health Service”

A.A. Shafarenko
State Budgetary Healthcare Institution of the City of Moscow “Psychiatric Clinical Hospital No. 1 named after N.A. Alekseev of the Moscow Department of Health”

S.N. Mosolov
Moscow Research Institute of Psychiatry – branch of the FSBI “V.P. Serbsky National Medical Research Center of Psychiatry and Narcology” of the Ministry of Health of the Russian Federation; Russian Medical Academy of Continuing Professional Education of the Ministry of Health of Russia

Abstract

Relevance. The high risk of recurrence in recurrent depressive disorder (RD) determines the need for maintenance therapy. Before the introduction of a new generation of antidepressants (AD), mood stabilizers (MS) were used. Comparative studies of lithii carbonate (LI) or carbamazepine (CRB) and new generation of AD have not been found. Objective: Comparative study of the features of the clinical action of MS (CRB, Li) and AD (paroxetine (PAR) and fluoxetine (FLU)). Design: open, prospective, comparative. Duration - 2 years. Material and methods: 89 patients (40 men and 49 women), diagnosed with RD (F33 ICD-10); at least 3 depressive episodes in the last 2 years; no preventive therapy in the anamnesis. The average age is 43.32 ± 2.4 years. The groups (Li, CRB, PAR, FLU) were comparable in patients number and clinical and demographic indicators. The effectiveness was determined by comparing the indicators of the dynamics of the disease course for 2 years before and after the start of therapy. Results: Positive effect of CRB therapy (90.9 % of patients) > PAR (90.5 %) >Li (73.9 %) >FLU (60.7 %). Partial responders revalenced in MS-group , full responders – in AD-group. AD were superior to MS in tolerability. In the CRB group, the average number of adverse events per patient was higher (p < 0.001) compared to PAR and FL and lower compared to Li (p < 0.05). Conclusions: first-choice drugs are a new generation of AD. CRB can be used with insufficient efficacy, intolerance of AD (selective serotonin reaptake inhiditors) and in patients with a high risk of phase inversion. If it is impossible to treat AD or CRB, a Li can be used with careful clinical control to exclude prolonged subdepressions.

Keywords

recurrent depressive disorder, secondary preventive therapy, lithium carbonate, carbamazepine, paroxetine, fluoxetine, mood stabilizers, new generation antidepressants

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