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No. 4 (2022)

ТЕРАПИЯ ПСИХИЧЕСКИХ РАССТРОЙСТВ В ПОЗДНЕМ ВОЗРАСТЕ

A Differentiated Approach to the Choice of a Neuroprotective Drugs During Complex Antidepressant Therapy of Elderly Depressive Patients in a Hospital Setting

https://doi.org/10.21265/PSYPH.2022.56.11.005

Published 2022-12-31

  • O.B. Yakovleva
    • ,
  • T.P. Safarova
    • ,
  • S.I. Gavrilova

O.B. Yakovleva
Federal State Budgetary Scientific Institution “Mental Health Research Centre”

T.P. Safarova
Federal State Budgetary Scientific Institution “Mental Health Research Centre”

S.I. Gavrilova
Federal State Budgetary Scientific Institution “Mental Health Research Centre”

Abstract

Purpose of the study. Development of a differentiated approach to the choice of types of neuroprotective drugs in the course of complex antidepressant therapy in depressive elderly patients.
Material and methods. We studied groups of hospitalized patients aged – 60 years with mild, moderate and severe depression (according to ICD-10) who received antidepressant monotherapy for 28 days (43 people) or complex antidepressant therapy in combination with carnicetin (20), cerebrolysin (20), citicoline (20), ethylmethylhydroxypyridine succinate (EMHPS) (25) and actovegin (25). Complaints about memory impairment, living alone, and the presence of leukoarosis on brain CT were considered predictors of low therapeutic response (LTRP). Efficacy of therapy (change in total HAMD 17 scores in %) was compared in subgroups with neuroprotectors and in the comparison group in patients with 2 or more LTRPs, as well as in patients with complex (anxious, senesto hypochondriacal) and prolonged (≥ 6 months) depressions.
Results. By the 28th day of treatment, all patients with LTRPs in the subgroups with the addition of neuroprotectors were responders (≥ 50 % change) with a significantly higher efficacy of therapy than in the monotherapy group (36.0 %, p < 0.05). The efficacy of therapy was significantly higher in the subgroup with the addition of actovegin than in the subgroups with cerebrolysin and citicoline (73.7 % versus 55.6 and 52.0 %, respectively, p < 0.05). In complex depression, the effectiveness of therapy in the subgroup with cerebrolysin did not statistically differ from the comparison group. In chronic depression, no statistically significant difference in efficacy was found between the citicoline-supplemented subgroup and the monotherapy group. The highest efficacy in the treatment of complex and prolonged depression was observed in subgroups with the addition of actovegin and EMHPS, which significantly differed from the group with monotherapy (p < 0.01).
Conclusion. If there are indications for prescribing complex antidepressant therapy (2 or more LTRPs) in depressive patients of late age, all studied neuroprotective drugs demonstrated high efficiency compared to monotherapy. In complex depressions, the combination of antidepressants with cerebrolysin turned out to be less effective, in protracted depressions – with citicoline. Neuroprotectors actovegin and EMHPS can be considered universal drugs of choice for complex therapy of the most difficult categories of elderly depressive patients in a hospital setting.

Keywords

depression of late age, antidepressants, neuroprotective drugs, predictors of low therapeutic response

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