SSRI Plus Anticonvulsant May Be Effective for Depression With Dysphoric Mood

Combination may help depression that occurs along with anger or hostility. NEW YORK (Reuters Health) Mar 29 – Findings from a small study suggest that combining a selective serotonin reuptake inhibitor (SSRI) with an anticonvulsant may be an effective treatment for depression with dysphoric mood, such as anger and hostility.

A link between depression and anger was first made decades ago, but only in recent years have studies investigated this association and possible treatments, Dr. Massimo Pasquini, from University “La Sapienza” of Rome, and colleagues note in Clinical Practice and Epidemiology in Mental Health, a BioMed Central journal published online February 8th.

In fact, depression and concomitant anger/aggression is almost as common as depression with anxiety, the researchers point out.

The implication of serotonergic pathways in aggressive behaviors has led some researchers to consider SSRIs as the first-line therapy for depression complicated by dysphoric mood. There is also some evidence that anticonvulsants affecting GABAergic and glutamatergic pathways may be useful, but to the authors’ knowledge, no trials have examined this.

The present study involved 35 outpatients with unipolar depressive disorder and “substantial anger, irritability, aggressiveness or hostility.” They were treated with an SSRI plus an anticonvulsant (usually valproate) for 12 weeks.

A variety of tests, including the Hamilton Depression Rating Scale, were used to gauge depression and dysphoric mood severity before, during, and after treatment. Follow-up data through weeks 4 and 12 of treatment were available for 32 and 23 patients, respectively.

Treatment with the two-drug regimen was associated with a significant improvement in depressive symptoms (p < 0.001). In addition, marked improvements in anger/irritability and anxiety were noted. Eighty-two percent of patients were rated as improved or much improved on the Clinical Global Improvement scale, the authors state.

“Future studies with more robust methodology are needed to corroborate our findings,” the investigators conclude. Confirmation of these findings would support the use of a “dimensional rather than a strictly categorical approach to psychopathological assessment and treatment of psychiatric conditions.”

Clin Pract Epidemiol Mental Health 2007;3.

  2007 Reuters Ltd.

Reviewed by Lindsay 03-15-02

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