SYMPOSIA

Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org
Poster Presentations
[PP-088] Ref. No: 217
Venlafaxine-mirtazapine combination in the treatment of post traumatic stress disorder
Abdullah Bolu, Süleyman Akarsu, Cemil Çelik, Barbaros Özdemir, Kamil Nahit Özmenler
Department of Psychiatry, Gulhane Military Medical Faculty, Ankara, Turkey
E-mail: abdullah_bolu@yahoo.com
Introduction: Posttraumatic stress disorder (PTSD) is an incapacitating clinical syndrome characterized by intrusive recollections,
emotional numbing and withdrawal, cue-related responses, and psychological and physiological hyperarousal. In the treatment of PTSD
pharmacotherapy must be supported with psychotherapy to increase the success of treatment. In this study we aimed to evaluate the
effect of venlafaxine-mirtazapine combination in the PTSD patients, who did not respond to antidepressant treatment at
adequate dose for an adequate duration.
Material and Methods: The hospital records of the patients who were diagnosed with PTSD according to DSM-IV diagnostic criteria and
did not respond to adequate doses of an antidepressant treatment for adequate duration were examined retrospectively. Data of the
patients (n=28), whose treatment were venlafaxine- mirtazapine combination, were obtained. These data were IES-R, Hamilton Anxiety
scale and Hamilton Depression Scale scores.
Results: IES-R score, Hamilton Anxiety, Hamilton depression scores of 28 patients who were diagnosed with PTSD were evaluated. A
significant decrease in IES-R total, IES-R avoidance, Hamilton Anxiety and Hamilton depression scores (p> 0.05) with adequate dose and
duration of venlafaxine-mirtazapine treatment were detected. The same change was not accompanied in IES-R hyperarousal and IES-R
intrusive test scores.
Conclusion: Post-traumatic stress disorder treatment takes longer and sometimes becomes chronic. According to the results of this study,
venlafaxine- mirtazapine combination can be used in the treatment of PTSD patients who did not respond to antidepressant treatment
at adequate doses for an adequate duration.
Key words: Mirtazapine, posttraumatic stress disorder, PTSD, venlafaxine
References:
1. McDougall SJ, Widdop RE, Lawrence AJ (2004) Medial prefrontal cortical integration of psychological stress in rats. Eur J Neurosci; 20: 2430-2440.
2. Radley JJ, Rocher AB, Janssen WG, Hof PR, McEwen BS, Morrison JH (2005) Reversibility of apical dendritic retraction in the rat medial prefrontal cortex following
repeated stress. Exp Neurol; [Epub ahead of print].
3. Kılıçoğlu A. Stress and effects of brain: A review. New Symposium Journal; July 2007, Volume 45, İssue 3
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S175
[PP-089] Ref. No: 221
Efficacy and 3-month follow-up of repetitive transcranial magnetic stimulation
(rTMS) in treatment resistant depression: Three cases
Onur Durmaz, Mehmet Alpay Ateş, Mesut Çetin, Servet Ebrinç, Cengiz Başoğlu, Ayhan Algül
Department of Psychiatry, GATA Haydarpasa Training Hospital, Istanbul, Turkey
E-mail: drodurmaz@gmail.com
Introduction: rTMS(Repetitive Transcranial Magnetic Stimulation) is an effective non-invasive cortical stimulation method that is being used
in the treatment of drug resistant major depressive disorder. The underlying mechanism of effect of rTMS has not been fully understood
yet. Neuromodulation, neuroplasticity, and cortical excitability are the most accepted theories (1). Even though the post-treatment effect of
rTMS in depression is well known, little is known about its lasting effect (2).Therefore in this report we investigated the effect of add-on rTMS
treatment with 3 month follow-up after treatment in 3 outpatient cases diagnosed with drug resistant unipolar major depression.
Case 1: A 33 year-old female patient was diagnosed with major depressive disorder and received venlafaxine 300 mg/day for two years.
An add-on 15 sessions of DLPFC rTMS (20 Hz, 110% MT, 1000p/d) was applied due to insufficient medication response. The MADRS and
HAM-A scales were assessed before and the day following treatment and then 1 and 3 months after treatment. The MADRS scores were
found to be 37, 11, 2 and 4, while the HAM-A scores were found to be 35, 9, 5 and 6, respectively.
Case 2: A 35 year-old male patient was diagnosed with major depressive disorder since age 12 and received escitalopram 20 mg/day for
three months. An add-on 15 sessions of DLPFC rTMS (20 Hz,110% MT,1000p/d) was applied due to insufficient medication response. The
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