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The recent clinical studies on hypericum extract support the present indications for its use in mild to moderate depression and depressive episodes. The effectiveness is superior to placebo and comparable with synthetic antidepressive drugs. The rate of unwanted events is explicitly lower and their severity in general only mild. A further indication for hypericum could be somatoform disorders, but further clinical studies are recommended. The main compound responsible for interactions is presumably hyperforin, but further ingredients could contribute according to the specific composition of the particular extract.

We report on a case of a patient with migraine and depression treated with citalopram and sumatriptan. The drug evaluation is presented using the actual summaries of product characteristics (SPC, "Fachinformationen"). Particular the individual perioperative anaesthesiological risk assessment regarding the pharmacodynamic and pharmacointeractions is discussed.

Obsessive-compulsive disorder (OCD) is characterized by obsessions, compulsions, or both, which cause significant personal distress or social dysfunction. OCD is a common psychiatric illness with a prevalence of 1-2%. Because most people have regular contact with primary health care services, the patient with OCD is likely to see their general practitioner even though psychological problems may not be the main reason for consultation. Early recognition of the disorder facilitates early intervention. This reduces distress, disability and burden of illness. Pharmacological treatment with serotonin reuptake inhibitors (SRI) and cognitive-behavioral therapy have both been proven to be effective and are evidence based.

Objectives: In common, depressive disorders are treated with various antidepressants, the number of which is enormously increasing. Nevertheless, in some cases therapy resistance is observed. In these cases, neuroleptics are used as an alternative. Recently, Tianeptin (Stablon) has also been used for the treatment of depressive disorders., Method: We report a 32-year old "therapy resistant" depressive female. Monotherapy with antidepressants and Tianeptin (Stablon) was ineffective., Results: Finally, a combination of antidepressants and Tianeptin (Stablon) was effective and lowered the HAMD-Score significantly., Discussion: A combination of antidepressants and Tianeptin (Stablon) seems to be an effective new Option for the treatment of "therapy resistant" major depressions.

Injections with botulinum toxin type A (BTX) are considered the first-line treatment for spasmodic torticollis (ST), blepharospasm (BL) and hemifacial spasm (HFS). Because BTX brings only temporary and partial relief, patients frequently try other additional therapies to minimize their symptoms. The subjective rating of all therapies ever tried by patients with ST, BL and HFS was evaluated by using a simple questionnaire. Two hundred questionnaires were considered (112 TS, 54 BL, 34 HFS). BTX was rated subjectively the best therapy in all three diagnostic groups (median: 2 = good effect). Despite Citalopram and physiotherapy (median: 3 = average effect), all other therapies were rated with a median of > or = 4 (= minimal effect). Patients with ST tried 7.7, patients with BL 2.4 and patients with HFS 2.6 different types of therapy. In conclusion, BTX is the most effective treatment for patients with ST, BL and HFS, as rated subjectively. Further evaluation of therapies additional to BTX injections is recommended.

Behavioral disturbances are a common complication in dementia. The underlying cause of this condition is mainly a disturbance of serotonin neurotransmission. In this paper the effect of citalopram on behavioral disturbances was studied in 20 patients with dementia. After 3 weeks of treatment improvement of the symptoms confusion and restlessness of the Gottfries-Brane-Steen Geriatric Scale was found (p < 0.05). These findings underline the effect of citalopram as emotional "stabilizer" in demented patients, as already described in earlier studies.