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Dr. Vassilis Martiadis

Utente Avanzato

Posts: 656

Activity points: 1.968

Data di registrazione: martedì, 29 giugno 2010

Lavoro: Specialista in Psichiatria - Psicoterapeuta Cognitivo-Comportamentale

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16

sabato, 15 gennaio 2011, 20:14

Purtroppo per il momento e' così.
Dott. Vassilis Martiadis

Specialista in Psichiatria


www.psichiatranapoli.it

redeirulez

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Posts: 1

Activity points: 3

Data di registrazione: giovedì, 20 gennaio 2011

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17

giovedì, 20 gennaio 2011, 22:38

Salve, stavo cercando in rete informazioni sull'agomelatina quando ho notato su "Progress in Neuro-Psychopharmacology and Biological Psychiatry" una lettera pubblicata il 7 ottobre 2010 del Prof. Michele Fornaro che riporta un caso di trattamento del disturbo da attacchi di panico con l'agomelatina:

"Panic disorder (PD) is a common and often chronic psychiatric condition associated not only with negative outcomes from both emotional and physical standpoints but also with significant disruptions in several areas of an individual's life (While SSRIs are particularly effective in the treatment of PD, the need for 5-HT2A agonists has been considered, and drugs with opposing mechanisms of 5-HT2A modulation (e.g., trazodone and tianeptine) have been reported to be as effective as SSRIs (In one case, the PD patient initially responded to paroxetine (10 mg/day), which was up-titrated to 20 mg/day within the first 6 months of therapy, but withdrew from use of the drug due to iatrogenic sexual dysfunctions and refractory insomnia caused by benzodiazepine (i.e., clonazepam 2 mg/day) augmentation. Specifically, C.D., a 24-year-old man, had sought medical assistance following repetitive panic attacks, which had initially occurred at the age of 19 years. The patient's past medical and pharmacological histories were negative. His relevant neurovegetative symptoms included palpitations, tremors, muscle tension and massive sweating of the hands, and they may have contributed to progressive social withdrawal and academic failure. The patient met the DSM-IV criteria for PD with agoraphobia using the clinical version of the Structured Clinical Interview for DSM-IV (SCID-I).
When prescribed paroxetine (15 mg/day) and clonazepam (2 mg/day) in conjunction with 40 mg/day propranolol for sweating at the age of 21 years, C.D. obtained substantial remission but refused to continue maintenance treatment due to loss of libido and ejaculation delay, which he feared would jeopardize his romantic relationship. At that point, the patient's compliance was low, and his attitude toward the medications was irrational. He refused a dosage reduction, known as a “drug holiday” (i.e., drug consumption on alternate days), psychotherapeutic support, and alternative classes of antidepressants. Afterward, he did not return for consultation. After a three-year-long absence, however, he returned to the same outpatient facility because of recurrent panic attacks.
Although he still refused psychotherapy because he considered it to be “too time consuming”, the patient decided to start a trial treatment with agomelatine (25 mg/day). Two months after beginning the new therapy, his fear of having panic attacks disappeared due to successful therapeutic effects and the absence of reoccurring panic attacks leading up to the last evaluation, which was carried out ten months later. Remarkably, the patient reported no significant side effects during the 5-month trial of agomelatine (25 mg/day), which was taken in the absence of other medications.
In this case, agomelatine (25 mg/day) appeared to be an effective therapy for PD. However, this was a preliminary report due to the lack of appropriate rating instrumentation and longer-term follow-up, and it requires confirmation by a randomized controlled trial to assess the efficacy of agomelatine in treating PD. Furthermore, its efficiency should also be evaluated in patients who are tolerant of SSRIs"


Siccome stimo molto il Dr. Vassilis Martiadis volevo sapere cosa ne pensava a riguardo, grazie.

Dr. Vassilis Martiadis

Utente Avanzato

Posts: 656

Activity points: 1.968

Data di registrazione: martedì, 29 giugno 2010

Lavoro: Specialista in Psichiatria - Psicoterapeuta Cognitivo-Comportamentale

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18

sabato, 22 gennaio 2011, 20:49

Può essere uno spunto interessante per iniziare a progettare trials clinici che valutino l efficacia Dell agomelatina anche nei disturbi d ansia. Al momento questi report vanno presi con le molle poiché pochi casi non possono giustificare un allargamento Dell indicazione, che al momento resta approvata solo per la depressione.
Cordiali saluti
Dott. Vassilis Martiadis

Specialista in Psichiatria


www.psichiatranapoli.it