Depression with dysphoria may need two drug types

Findings from a small study suggest that combining an antidepressant with an anticonvulsive drug, a type of drug normally used to treat epilepsy, may be an effective treatment for patients with depression plus dysphoric mood, such as anger or hostility.

A link between depression and anger was first made decades ago, but only in recent years have studies investigated this association and possible treatments, Dr. Massimo Pasquini, from University "La Sapienza" of Rome, and colleagues note in Clinical Practice and Epidemiology in Mental Health, a BioMed Central journal.

In fact, depression plus anger or aggression is almost as common as depression with anxiety, the researchers point out.

The implication of serotonergic pathways in aggressive behaviors has led some researchers to consider a selective serotonin reuptake inhibitor (SSRI) as the first-line therapy for depression complicated by dysphoric mood.

There is also some evidence that anticonvulsants affecting GABAergic and glutamatergic pathways may be useful, but to the authors' knowledge, no trials have examined this.

The present study involved 35 outpatients with a depressive disorder, along with "substantial anger, irritability, aggressiveness or hostility." The subjects were treated with an SSRI plus an anticonvulsant (usually valproate) for 12 weeks.

A variety of tests, including the Hamilton Depression Rating Scale, were used to gauge the severity of depression and dysphoric mood before, during, and after treatment. Follow-up data through week 4 and 12 of treatment were available for 32 and 23 patients, respectively.

Treatment with the two-drug regimen was associated with a significant improvement in depressive symptoms. In addition, marked improvements in anger or irritability and anxiety were noted. Eighty-two percent of patients were rated as improved or much improved on the Clinical Global Improvement scale, the authors state.

"Future studies with more robust methodology are needed to corroborate our findings," the investigators conclude. Confirmation of these findings would support the use of a "dimensional rather than a strictly categorical approach to psychopathological assessment and treatment of psychiatric conditions."

SOURCE: Clinical Practice and Epidemiology in Mental Health, February 8, 2007.