RU2249453C1 - Method for carrying out combined reduction of depressive syndromes of subpsychotic level and endogenous genesis in day care hospital - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves administering typical tricyclic antidepressants combined with selective reverse serotonin capture inhibitors. Anxious version of subpsychotic level depressive syndrome of endogenous genesis being treated, intravenous drop-by-drop infusion of 2.-4.0 ml of 1% amitriptiline solution per 200 ml of physiologic saline is applied in 12-14 procedures combined with selective reverse serotonin capture inhibitor given per os, Zoloft is per os administered as the inhibitor at a dose of 50-100 mg. Then, supporting Zoloft therapy is applied at a dose of 100 mg during 3 months. Atypic version of depressive syndrome of subpsychotic level and endogenous genesis is treated with intravenous drop-by-drop infusion of 1.25% Melipramine solution at a dose of 2.0-4.0 ml per 200 ml of power supply source in 12-14 infusions combined with a reverse serotonin capture inhibitor. Paxyl is taken at a peroral dose of 40-60 mg as the inhibitor. Then, supporting Paxyl therapy is applied at a dose of 40-60 mg during 3 months.

EFFECT: enhanced effectiveness of treatment; reduced risk of complications; accelerated depressive syndrome relief.

Description

The invention relates to medicine, namely to border psychiatry.

There are ways to relieve depressive syndromes of a subpsychotic level of endogenous genesis: the initial dose of amitriptyline or melipramine should be at least 75 mg, the rate of dose increase should be 25-50 mg per day, the average therapeutic dose of amitriptyline is 250-300 mg per day, oral administration of amitriptyline is recommended or melipramine (G.Ya. Avrutsky. Treatment of the mentally ill, 1981, p. 343).

However, the method of treatment of G. Ya. Avrutsky uses, firstly, oral administration of antidepressants, which helps to prolong the course of the depressive phase, leads to the formation of therapeutic resistance, and secondly, large doses are used, which leads to severe side effects, reducing “Quality of life" of patients.

The closest in technical essence method of treating depressive syndromes of subpsychotic level of endogenous genesis was proposed by Yu.L. Nuller. For moderate and severe depression of endogenous origin, treatment is carried out starting with iv drip of large doses of tricyclic antidepressants (75-100 mg), increasing the dose over 3-4 days to 200-250 mg. In some cases, the daily dose of tricyclic antidepressants can be increased to 400-450 mg (Yu.L. Nuller. Affective psychoses, 1988, pp. 103-104).

However, the treatment method of Yu.L. Nuller also uses large subtoxic doses of tricyclic antidepressants, which leads to a large number of side effects in patients, reducing the patient’s “quality of life”. In addition, the treatment method of Yu.L. Nuller is designed only for an inpatient patient, which limits the possibility of using psychopharmacotherapy, increasing the risk of developing “hospitalism” of patients.

The task is to quickly stop the depressive syndromes of the subpsychotic level of endogenous genesis in a day hospital, eliminating side effects.

The essence of the method is in / in the drip of tricyclic antidepressants, combined with the oral administration of selective serotonin reuptake inhibitors, in / in the drip of 2.0-4.0 ml of a 1% solution of amitriptyline per 200.0 ml of saline No. 12-14 combined with oral administration of zoloft (sertraline) at a dose of 50-100 mg for the anxious variant of depressive syndrome of subpsychotic level of endogenous origin (according to ICD-10: recurrent depressive disorder, current episode of severe degree), and administration for 3 me yatsev Zoloft (sertraline) at a dose of 100 mg at strategic supporting pathogenetic therapy; and iv drip of 2.0-4.0 ml of 1, 25% melipramine solution per 200.0 ml of physiological saline No. 12-14 with the apathetic variant of the depressive syndrome of subpsychotic level of endogenous origin, combined with oral administration of paxil (paroxetine) in a dose of 40-60 mg with paxil (paroxetine) in a dose of 40 mg for 3 months for strategic supportive pathogenetic therapy.

The method is as follows.

Treatment is carried out in a day hospital or intensive care unit in a clinic. The patient lies on the bed and is given an intravenous drip infusion of a monopharmacological composition. In an alarming version of the depressive syndrome of a subpsychotic level of endogenous genesis, intravenous administration of 2.0 ml of 1% amitriptyline solution per 200.0 ml of physiological saline is carried out, which is combined with oral administration of zoloft (sertraline) at a dose of 50-100 mg. Depending on the severity of the condition, after 2-3 days of therapy, the dose of amitriptyline increases to 4.0 ml. In total, 12-14 intravenous infusions are performed. For strategic supportive pathogenetic therapy, zoloft (sertraline) is prescribed at a dose of 100 mg for 3 months. With the apathetic version of the depressive syndrome of a subpsychotic level of endogenous genesis, intravenous drip of 2.0 ml of 1.25% solution of melipramine per 200.0 ml of physiological solution is carried out, which is combined with oral administration of paxil (paroxetine) at a dose of 40-60 mg. Depending on the severity of the condition, after 2-3 days of therapy, the dose of melipramine increases to 4.0 ml. In total, 12-14 intravenous infusions are performed. For strategic supportive pathogenetic therapy, paxil (paroxetine) is prescribed at a dose of 40 mg for 3 months. The duration of intravenous infusions is 1.5-2 hours, every 30 minutes, blood pressure and pulse are monitored. After infusions, rest is recommended for 30-40 minutes.

Examples:

1. Patient N. 38 years. Delivered for treatment by relatives with complaints of severe anxiety (especially in the morning), sleep disturbances (pre-, intra-, post-somnical disorders), lack of appetite (she lost 8 kg in 2 months), violation of the monthly cycle in the form of delay, lowered mood , lack of strength, desire to do something, thoughts of guilt before relatives, self-incrimination for “nonexistent” sins, a partial critical attitude to his condition is noted. Based on complaints, medical history, psychopathological and pathopsychological examination, a diagnosis was made in accordance with ICD-10 and the traditions of domestic clinical psychiatry: depressive syndrome of subpsychotic level of endogenous genesis, an alarming option (according to ICD-10: recurrent depressive disorder, current episode of severe degree). An intravenous drip of 4.0 ml of a 1% solution of amitriptyline was used in combination with oral administration of zoloft (sertraline) at a dose of 100 mg, in a course of 14 procedures. For 3-4 days, anxiety decreased, mood improved, at the end of the course of treatment anxiety completely stopped, vital functions normalized, mood improved, depressive experiences deactivated, a critical attitude to his illness appeared. After the course, the patient was transferred to a strategic supporting pathogenetic therapy with zoloft at a dose of 100 mg, a course of 3 months.

2. Patient S. 49 years. Delivered for treatment at the insistence of relatives, as he believes that “nothing will help him” and categorically refuses hospitalization in a psychiatric hospital. Upon receipt of a complaint of depression, apathy, “lack of strength, desire to do something”, low mood, sleep disturbances, appetite (lost 1.5 months by 12 kg), thoughts of “hopelessness of life”, “guilt”, recurring suicidal thoughts. On the basis of complaints, anamnesis, psychopathological and pathopsychological examination, the diagnosis was made: depressive syndrome of subpsychotic level of endogenous genesis, apathetic variant. An intravenous drip of 4.0 ml of a 1.25% solution of melipramine was used in combination with the oral administration of paxil (paroxetine) at a dose of 40 mg in a course of 14 procedures. On 3-4 days, the mood increased, by 10-12 days there was a surge of strength and energy, a desire appeared to live, work, vital functions normalized, mood improved, depressive experiences deactivated, a critical attitude to his illness appeared. After the course, the patient was transferred to a strategic supportive pathogenetic therapy with paxil at a dose of 40 mg, a course of 3 months.

3. Patient D. 36. Delivered for treatment with complaints of anxiety (especially in the morning), decreased mood, sleep disturbances (pre-intra-somnic disorders), appetite, lack of strength, desires, fatigue. In the eyes of tears, pantomime is suppressed, dreary. According to relatives, most of the time at home he does nothing, spends in bed, does not communicate with anyone, refuses treatment in a psychiatric hospital. On the basis of complaints, medical history, psychopathological and pathopsychological examination, the diagnosis was made: depressive syndrome of subpsychotic level of endogenous genesis, an alarming option. The treatment was carried out according to the method of Yu.L. Nuller: intravenous administration of large doses of tricyclic antidepressants (75-100 mg) was carried out, the dose was increased within 3-4 days to 200-250 mg. A dose of 300 mg was recommended for maintenance therapy. After the treatment, the condition improved: vital functions normalized, mood improved; anxiety stopped, however, during the entire course of treatment and with the further administration of amitriptyline maintenance therapy at a dose of 300 mg, the patient presented numerous complaints of dry mouth, asthenia and muscle relaxation, constipation, visual impairment, and difficulty urinating. After discharge from the hospital, the patient could not perform the usual work, was drowsy, inhibited, complained of sexual problems. When using this method, side effects occur that are characteristic of tricyclic antidepressants, which affects the patient’s “quality of life” and this method is adequate only for stationary conditions.

Thus, the use of the proposed method contributes to the rapid relief of depressive syndromes of subpsychotic level of endogenous genesis in a day hospital; the combination of tricyclic antidepressants with selective serotonin reuptake inhibitors leads to minimal side effects, which significantly increases the quality of life of patients with the further use of selective serotonin reuptake inhibitors as a strategic supportive pathogenetic therapy.

Claims (1)

A method for the combined relief of depressive syndromes of a subpsychotic level of endogenous genesis in an inpatient setting, including intravenous drip of tricyclic antidepressants, characterized in that the administration of tricyclic antidepressants is combined with oral administration of selective serotonin reuptake inhibitors, while treating an anxiety-related depressive syndrome of depressive syndrome 2.0-4.0 ml of a 1% solution of amitriptyline n is administered intravenously 200 ml of saline infusions number 12-14 in combination with oral administration of a serotonin reuptake inhibitor as Zoloft is orally administered at a dose of 50-100 mg, followed by maintenance therapy of Zoloft 100 mg for three months; and in the atypical variant of depressive syndrome of a subpsychotic level of endogenous genesis, 2.0-4.0 ml of 1.25% melipramine solution per 200 ml of physiological solution of 12-14 infusions is administered intravenously in combination with an oral administration of a serotonin reuptake inhibitor, in which 40-60 mg of paxil is orally administered, followed by 40 mg maintenance therapy of paxil for three months.