SPECIFIC USE OF ANTIDEPRESSANTS OF DIFFERENT CHEMICAL GROUPS IN PATIENTS WITH CHRONIC RENAL FAILURE AND SYNDROMES OF ITCHING AND PAIN RECEIVING CHRONIC HEMODIALYSIS

THE AIM of the investigation was to comparatively assess effectiveness of antidepressants of different chemical groups used in patients with syndrome of itching receiving chronic hemodialysis (CH). PATIENTS AND METHODS. 100 patients with chronic renal failure (CRF) receiving CH were examined, 57 of them (35 men and 22 women) had syndrome of itching. Fifty seven patients having similar demographic and clinical characteristics were given antidepressants of different pharmacological groups: mianserin (tetracyclic antidepressant, tianeptin (tricycli antidepressant), cytalopram (selective serotonin reuptake inhibitor). The group of patients given mianserin consisted of 17 patients, 20 patients received tianeptin and 20 received cytalopram. The doses used in all the patients were not higher than the average daily doses: mianserin - 30 mg, tianeptin - 37.5 mg, cytalopram - 20 mg. The total duration of treatment was 6 weeks. The control group consisted of 20 patients with chronic renal failure on CH having chronic itching but not receiving antidepressants. RESULTS. In CRF patients receiving CH the antidepressants were found to be effective not only in respect to depression, anxiety and pain, but also to itching. In addition, gender differences were revealed in the effectiveness of antidepressants. So, in men the effectiveness of antidepressants was higher than that in women including the correction of itching syndrome. In men mianserin was more effective, next was tianeptin and of little effectiveness was cytalopram. In women the correction of syndromes of pain and itching was slower and in less degree than in men. In women of greater effects was tianeptin, mianserin and cytalopram being less effective, CONCLUSION. The investigation of effectiveness of antidepressants (mianserin, tianeptin, cytalopram) have established that in CRF patients they are able to correct not only affective disorders, but the syndrome of chronic pain and itching. Gender differences were revealed in effectiveness of antidepressants.

1. MacKie D Psychological aspects of skin disease The Practitioner 1991, 235 356-360

2. Koo JYM The use of psychotropic medications in clinical dermatology Dermatologie clinics 1992 10 (3) 641-645

3. Gupta MA, Gupa AK, Schork N J, Ellis CN Depression modulates pruritis perception a study of Pruritis in Psoriasis, atopic dermatitis, and chronic idiopathic urticaria Psychosomatic Medicine 1994, 56 36-40

4. Ede M Psychogenic aspects of dermatology a clinical trial of Norpramin Psychosomatics 1965, 6 376-381

5. Friedman S, Kantor I, Sobel S et al. A follow-up study on the chemotherapy of neurodermatitis with a monoamine oxidase inhibitor J Nerv Ment Dis 1978, 166 349-357

6. Morley WH Nortriptylin in the treatment of chronic urticaria Br J Chn Pract 1969, 23 305-306

7. Greene SL, Reed CE, Schroeter AL Double-blind crossover study comparing doxepin with disphenhydramine for the treatment of chronic urticaria J Am Acad Dermatol 1985, 12 669-675

8. Harto A, Sendagorta E, Ledo A Doxepimnthetreatment of chronic urticaria Dermatologica 1985, 170 90-93

9. Gupta MA, Gupta AK Fluoxetine is an effective treatment for neurotic excoriations Casereport Cutis 1993, 51 386-387

10. Neittaanmaki H, Myohanen T, Fraki J Comparison of cinnarizine, cyproheptadine, doxepin, and hydroxyzine in treatment of idiopathic cold urticaria Usefulness of doxepin J Am Acad Dermatol 1984, 11 483-489