P.2.
a Affective disorders and antidepressants – Affective disorders (clinical)
criteria for major depressive disorder and were required to have a
17-item Hamilton Rating Scale for Depression (HAMD17) total
score > or equal 17 and McGill Pain Questionnaire (MPQ) with
pain detection (intensity > or equal 1 and pain localizated with
Visual Analog Scales VAS) to be eligible for the study. This
population received duloxetine (60–120 mg/d depending on clin-
ical response). Efficacy measures included HAMD17, MPQ and
VAS. Concomitant medical illnesses that can explain primary pain
such as arthritis, fibromyalgia, migraine headache and specific
analgesic ordinary treatments, were not allowed. The efficacy
measures was the averages items at each month visits (maximum
four visits). Response (> or equal 50% reduction in HAMD17 or
> or equal 1 in MPQ/VAS total score from baseline) and remission
(HAMD17 < or equal 7 or MPQ/VAS equal 0) were estimated
Results: In depression measures, the estimated probabil-
ity of response was 68% for duloxetine treated patients (60–
120 mg/day). In pain measures, the estimated probability of re-
sponse was 55% for duloxetine treated patients (60–120 mg/day).
Duloxetine was generally safe and well-tolerated.
Conclusion: There is a high prevalence of pain symptoms
among patients with major depressive disorders. In this study,
duloxetine (60–120 mg/day) was shown to be an effective treat-
ment for the painful physical symptoms which are frequently
associated with depression. Improvements in pain severity oc-
curred independently of changes in depressive symptom severity.
These results support duloxetine’s efficacy in the treatment of pain
and depression. Further studies will be required to more fully
understand the treatment of major depressive disorder in patients
with substantial coexisting pain symptoms.
References
[1] McCleane, G., 2008, Antidepressants as analgesics. CNS Drugs 22(2),
139−56.
[2] Brecht, S., Courtecuisse, C., Debieuvre, C. et al., 2007, Efficacy and
safety of duloxetine 60 mg once daily in the treatment of pain in
patients with major depressive disorder. J Clin Psychiatry Nov;68 (11),
1707−16.
[3] Brannan, SK., Mallinckrodt, CH., Brown, EB, et al., 2005, Duloxetine
60 mg once-daily in the treatment of painful physical symptoms in
patients with major depressive disorder. Journal of Psychiatric Research
39, 43−53.
P.2.a.012 A diagnosis of depression is associated with
increased hypnotic use in primary care
J. Donoghue1 ° , M. Lader2 , D. Stahl2 . 1 John Moores University,
School of Pharmacy & Chemistry, Liverpool, United Kingdom;
2 Kings College, Institute of Psychiatry, London, United Kingdom
Aims: UK prescribing guidelines for the use of benzodiazepines
state that they should be used to treat insomnia only when it is
severe and for a maximum period of 4 weeks [1]. However, these
recommendations do not take into account the need to manage
disturbed sleep in depression, which may persist after clinical
remission [2]. This study investigated the impact of a diagnosis
of depression on hypnotic prescribing in primary care in the UK.
Method: Data for 10 years (1996–2005) were obtained from
the DIN-Link database (over 750,000 patients closely matching
the socio-demographic profile of the UK). Patients (>18 years)
who received a new prescription for a hypnotic (no prescriptions
for any benzodiazepine in the previous year) were included and
followed for 1 year. Data were obtained on gender, age, diagnosis
of depression and length of treatment. Patients were divided into
two groups: those who had received a primary care diagnosis of
S299
depression either at the same time as the first prescribing of a
hypnotic or subsequently, (depressed group) and those without
such a diagnosis (non-depressed).
Results: The proportion of patients who received a diagnosis of
depression increased from 11.1% in 1996 to 17.4% in 2005. Pre-
scribing was dominated by two hypnotic medicines: temazepam
and zopiclone, which accounted for between 82.0% – 87.5% of
patients in the depressed group, and 81.6−89.3% in the non-
depressed group depending on year.
Throughout the period of the study, irrespective of age or
gender, the average length of continuous hypnotic treatment was
longer in patients in the depressed group (p = 0.005). For example,
in 2005 the average length of continuous hypnotic treatment in the
depressed group was 80 days, nearly three times longer than the
maximum recommended in national guidelines, and 30% higher
than in the non-depressed group. The greater average length of
continuous hypnotic treatment in the depressed group was seen
regardless of whether patients were prescribed temazepam or
zopiclone.
Similarly, consistently across the study decade, higher propor-
tions of patients in the depressed group continued treatment for
more than 3 months or for more than 1 year than non-depressed
patients (>3 months: p = 0.005; >1 year: p = 0.007). These findings
were replicated irrespective of age.
Conclusions: In patients newly prescribed a hypnotic, a diag-
nosis of depression is associated with significant increases in the
length of hypnotic treatment. This finding holds true irrespective
of gender, age, or hypnotic prescribed. Disturbed sleep in depres-
sion may be intractable and prescribing guidelines on the use of
hypnotics do not meet the needs of depressed patients.
References
[1] British Medical Association and the Royal Pharmaceutical Society of
Great Britain. British National Formulary No. 55. http://www.bnf.org/
bnf/bnf/55/3139.htm accessed 19.3.2008.
[2] American Psychiatric Association. Diagnostic & Statistical Manual of
Mental Disorders, Fourth Edition (DSM-IV). 1994. American Psychi-
atric Association, Washington DC.
P.2.a.013 Outcome situations of patients, after
admission at the emergency room, with
suicidal attempt
P. Minner1 ° , D. Lorge1 , H. Cornet1 , D. Neu1 , I. Pelc1 ,
P. Verbanck1 . 1 Univ. Libre Brussels-Hop. Univ. Brugmann,
Psychiatry, Brussels, Belgium
Introduction: It is generally established that close follow-up and
medical treatment are required after a suicidal attempt (SA).
Nevertheless this kind of follow-up is not installed systematically
and depends on health care providing offers and the patient’s
demand [1,2]. High recurrence rates of SA and presentation at a
psychiatric emergency room are well known for certain diagnostic
groups and clinical subtypes [1]. Prediction parameters of those
recurrences have been made [3] but efficient prevention in terms of
SA remains difficult. Although most follow-up attitudes and after-
care plans need the patients’ active collaboration and compliance,
the latter remain controversial regarding objective predictors of SA
recurrence and the patients’ potential refusal of those treatment
proposals.
Purpose: We followed the clinical outcome of 290 patients
after their admission to the emergency room for SA. The study’s
objectives were to determine clinical after-care attitudes and to