RU2129864C1 - Method of secondary prophylaxis of depressive syndromes of endogenous genesis nonpsychotic level under conditions of daytime hospital - Google Patents

Abstract

FIELD: medicine; boundary psychiatry. SUBSTANCE: method includes introduction of antidepressants in physiological solution in dose of 40-50 mg. Time of infusion is 1.5-2.0 h. Treatment is performed twice a year February-March and September-October. Course of treatment includes 10-12 days. Method makes it possible to prevent season relapses of depressive phase occurrence. EFFECT: reduced terms of depressive phase, accelerated onset of quick and stable remission.

Description

 The invention relates to medicine, namely to border psychiatry.

 The following methods of treating depressive syndrome of endogenous genesis are as follows: oral administration of antidepressants with a gradual increase in dose from 75 mg per day to 250 mg per day (depending on the severity of the phase). If increasing the dose for 2-3 weeks does not give an effect, then a part of the dose of the antidepressant is injected in / m or in / drip. In the absence of a clear regression of symptoms after 1.5 - 2 months, the method of simultaneous drug withdrawal is used, and if several withdrawals are ineffective, it is necessary to switch to ECT (electroconvulsive therapy) (G. Avrutsky, Treatment of mental patients, 1988).

 However, in the method of treatment Avrutsky G.Ya. predominantly oral administration of antidepressants is used for 1.5 to 2 months, which does not lead to a rapid phase failure, but delays it for several months.

 The closest in technical essence method of treatment of endogenous depressive syndrome Mosolov S.V. (Clinical use of modern antidepressants. 1995), which uses oral administration of 25 - 50 mg of antidepressants with increasing doses up to 300 - 350 mg per day. The effect occurs in 10 to 12 days. In severe (subpsychotic) forms of endogenous depression, iv infusion of antidepressants up to 150-200 mg per duck N 10-12 is used. In the period between phases, lithium salts and antidepressants (50-100 mg) are used throughout the year.

 With the method of treatment Mosolova S.N. the seasonal rhythm of the onset and development of depressive phases is not taken into account, and intravenous drip of antidepressants is used only at the time of onset of symptoms.

 The task is to reduce the depressive phase and the onset of a faster and more stable remission, to prevent seasonal relapses in the occurrence of depressive phases.

 The essence of the method is to use iv drip of antidepressants 2 times a year (February - March, September - October) N 10 - 12 for the purpose of stopping seasonal relapses of depressive disorders, based on the principles of chronobiology (since in the spring - autumn period the number of exacerbations of endogenous depression increases). After four courses of secondary prevention (February - March, September - October for 2 years), endogenous depressive episodes are blocked, seasonal relapses of nonpsychotic depressive manifestations are prevented, the dose (50 mg) does not change and therapeutic resistance does not occur, and psychotherapy is easier to overcome resistance to the disorders that have occurred.

 Description of the method: treatment is carried out on an inpatient basis, i.e. the patient is in the hospital for about 3 hours. Used in / in infusion infusions of antidepressants in a dose of 40 - 50 mg per physical. solution (200.0 ml) N 10 - 12. The number of infusions depends on the severity of the clinical picture. The duration of the drip infusion is 1.5 to 2 hours. Every 20 minutes, blood pressure and pulse are monitored. After infusion, rest of 30 to 40 minutes is recommended. Treatment is carried out 2 times a year (in February - March, September - October, a course of 12 days).

 Examples: Patient M., 35 years old. I turned for treatment with complaints of reduced mood, melancholy, lack of strength, desires, sleep disturbances, appetite, distraction, decreased performance. Before admission, he was repeatedly treated (within 9 years) by a psychiatrist, but remissions were unstable, and repeated depressive phases occurred after 4 - 5 months. Based on complaints, anamnesis and a psychological examination, a diagnosis was made - depressive syndrome of endogenous origin. It was used iv infusion of amitriptyline at a dose of 50 mg per day per 200.0 ml of physical. solution N 12, the treatment was carried out in a day hospital. After the treatment, the condition has improved significantly: vital functions have recovered, mood has improved, a surge of strength and increased efficiency have been noted. Subsequently, for 2 years, 4 courses of secondary prevention were carried out (in March and October), after which the patient has not consulted a psychiatrist for 3 years.

 Patient S., 42 years old. She complained of aching pains in the stomach, intestines, periodically disappearing and re-arising, worrying for 2 years, aggravating in the morning and weakening in the evening, the use of analgesics did not improve the condition. She underwent a full course of examination by a therapist, surgeon, but no pathology was detected. On the basis of the history and psychological examination, a diagnosis was made - masked depression, an allergic variant. Treatment was carried out according to the above method, then for 2 years - 4 courses of secondary prevention (spring, autumn). After the treatment, the pain stopped and did not resume in the future.

 Patient E. 36 years. She complained of anxiety, low mood, loss of interest in life, sleep disturbances and appetite. This condition lasts for 7 months, but did not contact a psychiatrist. Based on complaints, anamnesis, psychological examination, a diagnosis was made - depressive syndrome of endogenous origin. The treatment was carried out according to the method of Mosolov S.V., i.e. used oral administration of amitriptyline in an initial dose of 50 mg per day, with a gradual increase in dose to 150 mg per day. After 18 to 20 days, the condition improved: mood improved, vital functions returned to normal. For 4 months he took maintenance therapy at a dose of 75 mg per day. 5 months after treatment, he again addressed the above complaints, i.e., during treatment using this method (oral administration of antidepressants, lack of secondary prevention), the duration of remission was shorter and the next phase of endogenous depression arose earlier than when using systematic chronobiological effects.

 Thus, the use of the proposed method allows to reduce the depressive phase, promotes the onset of fast and persistent remission, prevents seasonal relapses in the occurrence of depressive phases, the patient continues to work, i.e. located in a natural family production environment.

Claims (1)

 A method for the secondary prevention of depressive syndromes of non-psychotic level of endogenous genesis in a day hospital, including intravenous drip of antidepressants, characterized in that the antidepressants are administered at a dose of 40-50 mg in saline with an infusion duration of 1.5 to 2.0 hours, treatment is carried out twice per year: February-March, September-October, course 10 - 12 days.