Experience of using fluoxetine in the treatment of borderline conditions. The text of a scientific article on the specialty Medicine and Health Care “
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Text of the scientific work on the theme “Experience of using fluoxetine in the treatment of borderline states”
EXPERIENCE OF FLUOXETHINE APPLICATION IN THE TREATMENT OF FRONTIER
Grodno State Medical University, Department of Medical Psychology and Psychotherapy
Clinical studies and achievements of psychopharmacology in the last 10 to 15 years have significantly expanded our understanding of the therapeutic possibilities of antidepressants, which are increasingly used to treat not only depression, but also other mental and behavioral disorders, as well as psychosomatic diseases.
The role of this class of psychotropic drugs has especially increased in connection with the active introduction of new antidepressants, selective serotonin reuptake inhibitors (SSRIs), into clinical practice [1, 2]. One of the representatives of this group is fluoxetine. Despite the fact that these drugs are widely used in the West, in our country they are being introduced slowly. This can be explained by the fact that doctors do not have the skill to use fluoxetine and it is little known to patients.
A study of the effects of fluoxetine was carried out in the neurosis department, located at the district hospital in Grodno. We used the drug Fluoxar manufactured by Pharmacare Ltd (Israel). Each Fluoxicar tablet contains 20 mg of fluoxetine hydrochloride. The indications for using fluoxetine are:
• typical mild to moderate depression;
• Organic Emotional – Labile Disorder with Cerebro – Asthenic Syndrome.
According to literature data, indications for prescribing fluoxetine are also:
• Obsessive – compulsive disorder;
• negative symptoms in schizophrenia;
• premenstrual tension syndrome.
Contraindications to the appointment of fluoxikar:
(fewer than tricyclic antidepressants)
• liver or kidney failure;
• hypersensitivity to fluoxetine;
The drug is used 1 time per day in medium doses of 20 to 40 mg in the morning with food. The standard dose is 20 mg / day with a slight risk of side effects. Elderly patients sometimes need 5 to 10 mg / day. The drug can be given in a single dose early in the morning or in the morning and afternoon. In some countries, fluoxetine is prescribed at a dose of 90 mg once a week.
The first signs of a clinical effect develop by the end of the 1st week of treatment, but the full effect appears only after 2–3 weeks of therapy and gradually increases within a few more weeks (up to 2–3 months of treatment).
The purpose of this study was to determine the effectiveness of small and medium doses of fluoxetine in patients with borderline disorders.
The study included 40 people aged 20 to 50 years. The fluoxetin treatment group included patients with the Hamilton scale of depression (ILM – B)  7–16 points and 16–24 points, which corresponds to a minor depressive episode and moderate. Patients with a depression level of more than 24 on the Hamilton scale were not included in the study group, since they are not a contingent of patients of the neurosis department and, on the other hand, the goal of the study was to study the average doses (40 mg / day) of fluoxetine, but not the maximum. Hamilton’s patients were assessed at the start of treatment and after 2 weeks of treatment. During the study, the use of other drugs with an antidepressant effect was excluded.
Thus, the selection criteria for the fluoxetine treatment group were:
• the level of depression on the Hamilton scale;
• The informed consent of the patient to participate in the study.
The existing clinical disorders met the diagnostic criteria established by the International Classification of Mental and Behavioral Disorders of the 10th revision  and by di
Diagnosis Number of Patients
1. Recurrent depressive disorder
a) the current mild episode N = 4
b) moderate degree N = 3
2. Light depressive episode N = 4
3. Mixed anxiety and depressive disorder N = 3
4. Adaptation disorder with anxious – depressive reaction N = 3
5. Somatoform disorders N = 12
6. Panic disorder N = 3
7. Organic emotional – labile disorder N = 8
Agnosams surveyed were distributed as follows (Table 1).
After 2 weeks of fluoxetine intake, 30 out of 40 patients showed a significant improvement in their state of health (according to the G Amilton scale, the decrease in symptomsand 50%), in 8 patients there was a slight improvement in health (on the Hamilton scale, the symptoms were reduced by 25%) and only 2 patients showed practically no changes (these 2 patients were treated with a diagnosis of “hypochondriacal disorder”).
A significant improvement in well-being was observed in 30 patients, in whom the clinic was dominated by a decrease in mood with ideas of low value and self-abasement. In this case, the greatest effect was found in apathetic depressions (16 patients). Also significant improvement was noted in patients in whom depression was somatized, i.e. somatic complaints prevailed in the clinic (9 patients).
A somewhat smaller effect of fluoxetine was found in patients with anxiety depressions (2 patients). However, with a mildly severe anxious depression of a neurotic level, fluoxetine had a distinct tranquilizing effect (3 patients).
Of particular note is the positive effect of fluoxetine in patients with panic disorders and chronic pain disorders (8 patients). In the clinic of these patients, anxiety was not the leading symptom. The high effect of fluoxe – ting was probably determined by improving mood, increasing efficiency, increasing self-confidence, reducing vegetative manifestations, enhancing self-control.
The pronounced effect of fluoxetine in patients with organic emotionally labile disorder was caused by a decrease in the vegetative component, a lengthening of the period of effective performance, removal of asthenic symptomatic – plex, a decrease in irritability, and an increase in overall tone.
The safety assessment of the drug was carried out at least 2 times a week on the basis of subjective complaints of patients and routine physical examination. At the dosage of 40 mg / day of fluoxetine and the duration of le –
2 weeks the following side effects were identified:
• increased anxiety in patients with a dominant symptom of anxiety (2 patients);
• Sleep disorders at the beginning of treatment (4 patients), but later the sleep was getting better.
No other side effects have been identified.
Thus, the main clinical effects of fluoxetine were:
Comparison of side effects of fluoxetine and antidepressants of other groups.
Fluoxetine (Fluoxycar) does not have anticholinergic effects, it is safe in patients with impaired cardiac conduction and does not impair cognitive functions. Fluoxetine also does not cause weight gain. With the abolition of the drug does not occur withdrawal syndrome. The drug does not cause psychophysical dependence.
Thus, judging by the results of our study, fluoxetine (Fluoxycar) is:
• highly effective antidepressant new generation;
• it is simple and easy to use;
• does not cause withdrawal syndrome;
• does not lead to the formation of psychophysical dependence;
• safe in overdose;
• does not violate the patient’s quality of life.
When using a daily dose of 40 mg, the reduction of symptoms occurs fairly quickly and further dose increase is not required. Therefore, fluoxetine (Fluoxar) can be recommended for use in somatic outpatient practice.
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