Combining an SSRI with an anticonvulsant in depressed patients with dysphoric mood: an open study

BACKGROUND: Several patients with unipolar depression present with prominent dysphoric mood. We aimed at examining the effectiveness of the combination of an SSRI with an anticonvulsant in such patients. METHODS: Thirty-five newly admitted outpatients with substantial anger, irritability, aggressiveness or hostility who were diagnosed a DSM-IV unipolar depressive disorder were rated on the Hamilton Depression Rating Scale (HDRS), the Clinical Global Improvement (CGI) scale, and a scale for the rapid dimensional assessment (SVARAD), were prescribed an SSRI and an anticonvulsant (usually valproate), and were followed up for 12 weeks. Repeated measures analysis of variance was used to test for within-subject changes in scale scores over time. RESULTS: Thirty-two and 23 patients attended the follow-up visits 4 and 12 weeks later, respectively. Significant decreases (p < .001) were observed in HDRS total score, HDRS and SVARAD anxiety factors, HDRS and SVARAD core depression factors, and SVARAD anger/irritability factor. Adjusting for age or gender did not change the results. Most patients (82%) were rated as improved or much improved on the CGI. CONCLUSION: Although our study has several limitations, we observed a remarkable improvement in most unipolar depressed outpatients with dysphoric mood treated with an SSRI and an anticonvulsant. The effectiveness of anticonvulsants might be linked to their action on symptoms of aggression and behavioural activation

Hormonal background of physiological aggressiveness in psychologically healthy women

The aim of this study was to see whether or not physiological hormonal fluctuations during the menstrual cycle modulate normal aggressiveness in psychophysically healthy women. In 15 probands estrogens (E), progesterone (PROG) and free testosterone (FT) plasma levels were measured by immunochemiluminescence and levels of global aggressiveness and its subitems "verbal aggressiveness", "suspiciousness" and "resentments" were measured by the Buss-Durkee Rating Scale in the early follicular, midluteal and premenstrual phases of the cycle. E and PROG levels varied significantly along the menstrual cycle, while those of FT, of global aggressiveness (GA) and of its subitems did not change. Values of global aggressiveness did not correlate with any of the hormonal parameters studied. However, E values correlated positively with "verbal aggression" scores in the follicular phase and positively with "resentment" in the premenstruum, while PROG levels correlated negatively with "suspiciousness" and "resentment" in the premenstrual phase of the cycle. Hormonal and psychological changes from one phase to the next (Δ) revealed that Δ E in the second half of the cycle correlated negatively with "verbal aggressiveness", while Δ PROG from follicular to luteal and from luteal to premenstrual phases correlated negatively with "resentment". Thus, although aggressiveness did not seem to vary along the menstrual cycle, nor to correlate with hormonal changes, hormone secretions and fluctuations might possibly modulate some of the physiological aspects of the behavioral parameter. © 2009 Elsevier B.V