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Phenylpiracetam (PP) is a nootropic drug with additional pharmacological effects, including anxiolytic, antiasthenic, antidepressant, anti-inflammatory and anticonvulsant effects. The paper presents the results of an analysis of experimental and clinical studies, which indicate the prospects for the use of PP in cerebral ischemia, neurodegenerative pathologies, epilepsy, asthenia, and mental disorders. The adaptogenic properties and mitochondrial protective effect of PP are considered, assessments of the possible effect of PP on neurotransmitter systems, regulation of carbohydrate and fat metabolism with the prospects for the use of PP in patients with metabolic syndrome.

The article presents an analytical review of the data on the effectiveness of agomelatine as an augmentation of antipsychotics in the treatment of post-schizophrenic depression (PSD). The results of 5 published studies with a total sample size of 137 patients, the duration of therapy from 28 to 180 days with the appointment of agomelatin in combination with antipsychotics, including cases of additional use of drugs of other classes (normotimics, antidepressants, anxiolytics, anticholinergic correctors) were used. As a result, a pronounced effect was established in the indicators of respondents and patients in remission, combined with a favorable tolerability and safety profile, determining the prospects for the use of agomelatin in the therapy of PSD. Certain limitations in the methodology, including open and uncontrolled research design and small sample sizes, determine the relevance of systematic controlled trials to confirm the results obtained.

The choice of antidepressants for depression or neurotic disorder is analyzed in the article. Drugs of the group of selective serotonin reuptake inhibitors are used for various mental disorders more often than other antidepressants according to clinical recommendations. Drugs of other groups (selective serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, tetracyclic antidepressants, monoamine oxidase inhibitors) are used when the effectiveness of selective serotonin reuptake inhibitors is insufficient or the severity of the mental disorder is significant. The duration of therapy, if well tolerated, can range from several months to many years. Antidepressants from Canonpharma Production are successfully used in clinical practice: Sertraline Canon, Fluoxetine Canon, Escitalopram Canon, Duloxetine Canon, Mirtazapine Canon, Agomelatine Canon. These drugs have different mechanisms of action. They are used for various depression and other mental disorders. All antidepressants from Canonpharma Production have been tested for bioequivalence to the original drugs. This fact increases confidence in these medicines. Some features of the use of these antidepressants based on clinical recommendations and personal experience are discussed in the article.

The efficacy and safety of psychopharmacotherapy with antidepressants is of great medical importance. The search for clinical and biological predictors for choosing the optimal psychopharmacotherapy with antidepressants is actively underway all over the world. Research is mainly devoted to searching for associations of polymorphic gene variants with the efficacy and safety of therapy. However, information about a patient's genetic polymorphism is often insufficient to predict the efficacy and safety of a drug. Modern research on the personalization of pharmacotherapy should include, in addition to genetic, phenotypic biomarkers. This is important because genotyping, for example, cannot accurately predict the actual metabolic activity of an isoenzyme. To personalize therapy, a combination of methods is required to obtain the most complete profile of the efficacy and safety of the drug. Successful treatment of depression remains a challenge, and inter-individual differences in response to antidepressants are common. About half of patients with depressive disorders do not respond to the first attempt at antidepressant therapy. Serious side-effects of antidepressant pharmacotherapy and discontinuation of treatment due to their intolerance are associated with ineffective therapy. This review presents the results of the latest studies of «omics» biomarkers of the efficacy and safety of antidepressants.

The article reflects the results of a number of studies that demonstrate the therapeutic effectiveness of Recognan (citicoline) in anxiety-depressive and asthenic disorders against the background of somatic and neurological diseases, in the correction of post-stroke depression. Recent experimental animal studies prove the effect of citicoline on anxiety and depression. In the complex effect, Recognan potentiates the main pharmacological effect of antidepressants and anxiolytics. In some studies, a dose-dependent change in animal behavior has been observed in response to the analgesic and antidepressant effects of citicoline. The effectiveness of citicoline in combination with transcranial direct current stimulation in the treatment of depression has been shown. The analysis of these research materials allows us to recommend Recognan in the complex therapy of asthenic and anxiety-depressive disorders in response to such pathological conditions as anxiety, asthenia, depression.

Epidemiological studies indicate that about 35% of the world's population periodically suffer from insomnia. Many authors in their studies note sleep disturbances in the clinic of both somatic and mental disorders, often considering sleep disturbances as one of the predictors of these diseases. In psychiatric practice, sleep disorders are most often described in the clinic of depression, which is determined by the general pathophysiological mechanisms of their development due to disruption of the activity of the main neurotransmitter systems of the brain. The results of clinical studies show that the drug of choice in the treatment of sleep disorders in the depression clinic is the antidepressant Mirtazapine, which has a unique profile of pharmacological activity. According to international recommendations, Mirtazapine is a first-line drug in the treatment of anxiety and depressive disorders with sleep disorders and sexual dysfunction caused by taking other antidepressants.

Depression is a leading cause of disability and reduced work capacity worldwide. The monoamine theory of the pathogenesis of depression has remained dominant for many decades, however, drugs developed on its basis have limited efficacy. Exploring alternative mechanisms underlying this pathology could illuminate new avenues for pharmacological intervention. Targeting glutamatergic pathways in the CNS, particularly through modulation of NMDA and AMPA receptors, demonstrates promising results. This review presents some existing drugs with glutamatergic activity and novel developments based on it to enhance the efficacy of pharmacotherapy for depressive disorders.

To analyze the stages of development of the problem, identify the evolution of views and the main directions of current research in the field of bipolar affective disorder, which occurs with psychopharmacotherapy-induced manic phases, the search for publications by keywords «pharmaco-induced mania»", «bipolar affective disorder» was carried out in the PubMed/MEDLINE, Russian Citation index and other sources from the mid-19 th century to the present. The issue of adequate treatment of bipolar depression became relevant back in the 20 th century; numerous observations indicated the presence of associated risks when using antidepressants in patients with bipolar affective disorder, namely, the likelihood of affect inversion and aggravation of the course of the disease (accelerated cyclicity, continuum). In recent years, due to the expansion of research capabilities and the introduction of biological psychiatry, works have appeared that consider this problem from both clinical and pharmacodynamic, genetic and neurophysiological aspects, which opens up the prospect of developing advanced methods of personalized medicine for the diagnosis and treatment of bipolar disorder, taking into account the need to minimize iatrogenic effects.

Objective: Evaluation of the safety of psychopharmacotherapy (PFT) of mental disorders in modern protocols for the treatment of patients with blood disorders., Material and Methods: The data of medical records of 552 patients with blood disorders who received PFT during treatment at the clinic of the National Medical Research Center for Hematology were analyzed. Any adverse events recorded while taking PFT were taken into account. Statistical analysis included descriptive statistics, frequency analysis, and assessment (Student's t-test) of changes in blood parameters (before and after taking psychotropic drugs)., Results: Signs of hematotoxicity were found only in 7.1% ( n =37) patients, in all cases while taking benzodiazepines ( n =12) in combination with hematotoxic drugs for the treatment of blood disorders. Other significant adverse events (which caused premature discontinuation or dose reduction) were detected in 4.8% ( n =25) cases, of which 9 were associated with the appointment of anxiolytics (hydroxyzine, zopiclone), 11 with antidepressants (clomipramine, amitriptyline, duloxetine, trazodone, ademethionine) and 5 with antipsychotics (risperidone, alimemazine, haloperidol)., Conclusion: Most psychotropic drugs are effective in relation to psychopathological disorders that develop in hematological patients and are safe when used at minimum/average therapeutic doses within the daily dosage ranges established by the official instructions for use.

The purpose of this narrative review is to relate current data on the molecular mechanisms of action of trazodone with its clinical effects and applicability in mental disorders caused or triggered by somatic and neurological disease, according to available publications. In the article, the prospects for the use of the multimodal antidepressant trazodone are discussed in accordance with therapeutic targets. The latter are discussed in accordance with the typology of the mentioned above psychosomatic disorders. Trazodone is an antidepressant acting primarily due to the blockade of postsynaptic serotonin 5H2A- and 5H2C-receptors, as well as the blockade of serotonin reuptake, but also has affinity for a number of additional receptors. The drug has a favorable safety profile and a wide range of beneficial effects: antidepressive, somnolent, anxiolytic, anti-dysphoric and somatotropic. This makes it possible to influence a wide range of therapeutic targets in the structure of mental disorders caused or triggered by somatic and neurological diseases, carrying out safe and effective psychopharmacotherapy.

Objective: To investigate the therapeutic efficacy and tolerability of Mexicor as an adjuvant in the treatment of depression with SSRI antidepressants., Material and Methods: The study included 100 patients, aged 18-50 years, with verified depression of mild ( n =32) or moderate ( n =68) severity. Patients ( n =50) of the main group, along with basic antidepressant therapy with SSRIs, received Mexicor at a dose of 600 mg/day, in the comparison group ( n =50) - only SSRIs. Clinical-psychopathological, psychometric, using the HDRS-21 scale, CGI, HADS, fluency test of speech responses and the Stroop test, statistical research methods were used., Results: The reduction of depressive symptoms on the HDRS-21 scale, starting from the fourth week, was statistically significantly superior to that in the comparison group ( p <0.001), the reduction in the severity of the condition on the CGI scale in the main group was also significantly greater than in the comparison group (17.3% and 9.6% respectively, p <0.05). A significant improvement in speech fluency was found in the main group ( p <0.05). Adverse events in the main group were significantly less common ( p <0.001)., Conclusion: Administration of Mexicor together with SSRIs leads to improved efficacy and tolerability of antidepressant therapy, and in the future, Mexicor may be recommended as an adjuvant in SSRI therapy for depression.

Objective: To identify the frequency of administration of fluvoxamine, to determine the main targets of the drug and the expediency of its use in depression of various genesis in children and adolescents., Material and Methods: To assess the frequency of prescribing fluvoxamine, 195 medical histories of patients who were inpatients in the children's department of the Mental Health Research Center in 2023 were analyzed. To assess the dynamics of depression during treatment with fluvoxamine, a clinical group was formed of 12 patients aged 10 to 15 years (age 13.1±3.6 years) who received fluvoxamine for the treatment of depression with comorbid obsessive-compulsive and anxiety-phobic disorders. Clinical and psychopathological, psychometric (Hamilton Depression Rating Scale - HDRS) and statistical research methods were used., Results: In total, in 2023, fluvoxamine was received by 20% ( n =37) of all inpatient patients of child age (from 7 to 16 years). All patients received combination therapy. The therapeutic targets were comorbid depressive, obsessive-compulsive and anxiety symptoms developing in the structure of nosologically heterogeneous states, with the dominance of schizophrenic spectrum disorders. Against the background of the use of the drug fluvoxamine for 4 weeks in the clinical group, there was a significant reduction in depressive symptoms on the HDRS. Adverse events during complex therapy were observed in 20% of patients, but were not severe, did not require discontinuation of therapy and were unreliably associated with the use of fluvoxamine., Conclusion: The use of the fluvoxamine provides reduction of depressive symptoms within the framework of various nosologies, and is characterized by sufficient safety. The variety of therapeutic targets of the fluvoxamine, including antidepressant, anti-anxiety, cognitive effects, is certainly a significant advantage of the studied fluvoxamine for use in childhood.

Objective: To conduct a comparative analysis of psychopharmacotherapy effectiveness in hypochondriac disorders of late age and to identify the optimal combinations of drugs depending on the thymopathic (hypothymic and/or anxiety) components accompanying the main hypochondriac manifestation., Material and Methods: One hundred and eight female inpatients, aged from 50 to 88 years, with leading hypochondriac symptoms of non-delusional level were enrolled in the study. All patients were examined clinically and psychopathologically using psychometric scales: the Montgomery-Asberg Depression Rating Scale, the Hamilton Anxiety Rating Scale, the hypochondria rating scale and the UKU side-effect rating scale., Results: Based on the psychometric assessment, the patients were divided into the following groups: group 1 - subjects with hypochondriac symptoms without accented thymopathic component ( n =18); group 2 - subjects with a high level of hypothymia ( n =49); group 3 - subjects with a high level of anxiety ( n =22); group 4 - subjects with a high level of both anxiety and depression ( n =19). Hypochondriac disorder without a thymopathic component was treated with monotherapy with antipsychotic drugs in low therapeutic dosages or with a combination of antipsychotic drugs in low therapeutic dosages with tricyclic antidepressants in low and medium dosages. Hypothymic hypochondriac disorders were treated with antidepressants of mainly SSRIs group and of tricyclic structure in combination with typical and atypical antipsychotic drugs in low therapeutic dosages. In these patients monotherapy with antidepressants or a combination of different antidepressants was effective in rare cases only. Hypochondriac disorder with an anxiety component was significantly more often treated by complex therapy with the addition of anxiolytic drugs, as well as a combination of antidepressants with antiptychotic drugs. Mixed hypochondriac states were treated with a combination of antidepressants and antipsychotic drugs or complex therapy with the addition of an anxiolytic drug., Conclusion: Hypochondriac disorders of late age in most cases are accompanied by depressive and/or anxiety symptoms, which must be taken into account for improvement of diagnostic effectiveness and relevant selection of therapy.

Objecive: To analyze the literature data on the relationship between antidepressant therapy and suicide risk and the ways to prevent suicidal behavior in patients on antidepressant therapy., Material and Methods: A non-systematic review of publications was conducted using keywords in the following databases: ELibrary.ru, PubMed, Cochrane Database of Systematic Reviews. Inclusion criteria were meta-analyses, Cochrane reviews, epidemiological and original studies., Results: Data from original studies are inconsistent, but more evidence-based epidemiologic studies support the preventive role of antidepressant therapy with regard to suicide. An increased risk of suicide with antidepressant therapy is seen in younger patients, especially in the first 2 weeks of treatment, in the absence of a therapeutic response. The initial dosage of antidepressants, possibly the type of antidepressant, is of some importance. The group at risk of committing suicide is those who have received psychotropic therapy in the previous year., Conclusion: There is no generally accepted model of prevention, but it is recommended that patients be observed during the first 4 weeks of treatment for depression, as well as during the period of antidepressant dose modification.

Objective: To analyze main aspects of the treatment of patients with youth depression with attenuated schizophrenic symptoms (ASS)., Material and Methods: Two hundred and nineteen young in-patients (median age 19.6±2.4) with the first depressive episode (F32.1, F32.2, F32.38, F32.8.) and ASS were examined. The comparison group included 52 patients with depression without ASS with similar socio-demographic and age characteristics (average age 19.8±2.7 years). The efficacy of the therapy was assessed by the reduction of HDRS, SOPS and SANS scores. The Drug Compliance Scale was used to assess the compliance of patients., Results: The average duration of in-patient treatment did not differ between groups (56.3 days in the main group and 54.2 days in the comparison group). The most effective therapy was found in the depression reduction on HDRS (67.9% and 76.6% respectively), the ASS reduction was 46.1% on the SOPS and 31.2% on the SANS. The combination of antidepressants (46.0±28.9 mg/day for fluoxetine equivalents) and antipsychotics (385.4±210.7 mg/day for chlorpromazine equivalents) were required to achieve this efficacy. The average duration of continued treatment was 7.4±9.6 months that was significantly lower ( p< 0.05) than in the comparison group (11.7±9.0 months), which was determined by the low compliance of such patients., Conclusion: The results show that a combination treatment and the implementation of measures, increasing the degree of compliance are required to increase the efficacy of treatment in patients with youth depression and ASS.

Depressive disorder is the most common mental illness, which is also one of the leading causes of disability worldwide. In addition, most suicides are associated with depression. Despite all modern achievements in the treatment of depressive disorders, up to 60% of patients did not adequately respond to psychopharmacotherapy (non-responders). Current guidelines and studies characterize non-responders as patients who have an inadequate response to taking two or more antidepressants from different classes within 4 weeks. However, in some cases, such a long wait for a therapeutic response can lead to adverse consequences. Thus, there is a need to develop prognostic methods of therapeutic resistance in patients with depressive disorders. The purpose of this review is to summarize current methods used to predict therapeutic response in patients with depressive disorders. A literature search was conducted using the search terms «depression», «antidepressant», «outcome», «predictor», «(bio) marker», «treatment-resistant depression» and «chronic depression». The search was conducted in the PubMed, Scopus, and Google Scholar databases for the time period from 2005 to 2020.

The review is devoted to the consideration of the effectiveness of treatment of depression, the ratio of symptomatic and functional remission, factors associated with the achievement of high-quality remission and recovery of patients. Currently, between 29 and 66% of patients do not fully recover from antidepressant therapy and have residual symptoms of depression. Persistent depressive symptoms, neurocognitive deficits predict increased risk of relapse, social disability, impair interpersonal relationships, and represent a barrier to functional recovery. The results of a comparative analysis of antidepressants in terms of their effect on the restoration of the functioning of patients with depression are presented. It has been established that the positive impact on the social functioning of patients should be an important criterion when choosing an antidepressant for supporting therapy. Effective therapeutic approaches that maintain symptomatic remission increase the potential for functional recovery.

Aim: To assess the influence of psychopharmacotherapy (PPT) of anxiety and depressive disorders on fatigue severity in patients with rheumatoid arthritis (RA)., Materials and Methods: 128 RA-patients were included. Severity of fatigue was measured with fatigue severity scale (FSS), clinically important fatigue was diagnosed in patients with FSS4. Anxiety and depressive disorders (ADD) were diagnosed by a licensed psychiatrist in 123 (96.1%) of RA-patients in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with MontgomeryAsberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A). RA-patients with ADD were divided into the following treatment groups: 1 сDMARDs (n=39), 2 сDMARDs+PPT (sertraline or mianserine), n=43, 3 сDMARDs+bDMARDs (n=32), 4 сDMARDs+bDMARDs+PPT (sertraline or mianserine), n=9. Biologics treatment duration varied from 1 to 5 years, antidepressants from 6 to 96 weeks. 83 (67.5%) RA patients were assessed at five-years follow-up. Multinominal logistic regression analysis was conducted to determine factors associated with clinically important fatigue., Results: Multinominal logistic regression analysis showed clinically important fatigue at baseline to be positively associated (OR 13.57; 95% CI 3.04460.486; p=0.01) and remission of ADD negatively associated (OR 0.162; 95% CI 0.0320.809; p=0.027), with clinically important fatigue at 5 years follow-up (R2=0.385, p0.0001)., Conclusion: Due to significant relationship between mental health status, antidepressants treatment and clinically important fatigue in RA-patients, all patients reporting clinically important fatigue should be recommended mental health counselling by a licensed psychiatrist.

A combination of depression and alcohol use disorder (AUD) is a typical and most common example of a dual diagnosis at the intersection of general psychiatry and addiction psychiatry. A comorbidity of depression and AUD is more common than it can be brought about by mere coincidence, which might be explained to some extent by the synergetic effect of both diseases, with each of them complicating the course and worsening the prognosis of the other. Treatment protocols for patients with depression and comorbid AUD include antidepressants, specific medications for alcohol dependence, and psychotherapy. The first-line antidepressants in the treatment of patients with a comorbid combination of depression and alcohol use disorder, as in other clinical situations implying use of antidepressants, are selective serotonin reuptake inhibitors (SSRIs). Fluvoxamine has certain advantages over the other SSRIs in the treatment of patients with a depression and comorbid AUD.

Self-poisoning is a common method of suicide, for which various medications are used, including antidepressants. A non-systematic review of Russian-language and English-language publications, by keywords, in the databases: ELibrary.ru, PubMed, Cochrane Database of Systematic Reviews. The purpose of the review was to analyze the literature on new risk factors and methods of their reduction in suicides with self-poisoning with antidepressants. Every fifth (20%) self-poisoning performed with antidepressants. In self-poisoning attempts, one drug used in 55% of cases, and more than one drug was used in 45% of cases. Impulsive suicides account for up to half of all suicide cases. Risk factors for impulsive suicides include the presence of impulsive character traits, female gender, young age, and the use of psychostimulants. The WHO Regional Office for Europe's mhGAP-IG guidelines recommend limiting access to a patient at risk of suicide to a weekly dose of an antidepressant. Preferably, the use of antidepressants from the group of SSRIs in small forms of release.

Based on a clinical case, the authors consider the problem of the optimal choice of an antidepressant, taking into account not only the psychopathological structure of depression, the severity and characteristics of its triad, but also the presence of somatic symptoms. This determines the need for a comprehensive analysis of the pharmacological profile of prescribed antidepressants, their psychotropic and somatotropic effects. The switch of the patient to brintellix, which has polymodal neuroreceptor activity, at a dose of 20 mg per day, made it possible to achieve remission and reduce adverse reactions caused by SSRIs.

Objective: To compare the changes in thrombodynamics indices in two groups of patients with endogenous mental disorders before and after combined treatment with antipsychotics and antidepressants (AD + group) and those who did not receive antidepressants (AD-group)., Material and Methods: The study included 110 patients, aged from 16 to 60 years (median age [Q1; Q3] 29 years [22; 35]), admitted for inpatient treatment at the clinic of Mental Health Research Center with the following mental disorders: schizophrenia with attack-like/attack-progressive/continuous type of course (F20.00-2), schizotypal disorder with affective fluctuations (F21.3-4), affective disorder (F 31.1-5; F 32.0-3; F 33.0-3). The thrombodynamics test (TD) was carried out on a T-2 thrombodynamics device according to the manufacturer's instructions (Hemacore LLC, Moscow, Russia)., Results: In patients with endogenous mental disorders after combined therapy with antidepressants and antipsychotics, a statistically significant decrease in the procoagulant activity of plasma and procoagulant spontaneous clots is observed, which indicates a decrease in the severity of systemic, immune inflammation. In patients with endogenous mental disorders after antipsychotic therapy without the addition of antidepressants, for most thrombodynamic parameters, there is no statistically significant decrease in procoagulant plasma activity and spontaneous clots formation. It indicates the persistence of acute systemic, immune inflammation in this group., Conclusion: The statistically significant positive change in plasma and platelet hemostasis may testify that combined treatment with antipsychotics and antidepressants in patients with endogenous mental disorders may be a biological, pathogenetic link that promotes augmentation (extended action) of antipsychotic therapy.

Objective: To identify differences in executive functions in patients with depressive disorders depending on their sensitivity to antidepressants., Material and Methods: The study included 70 patients with depressive disorder. All patients received syndrome-induced psychopharmacotherapy, which included antidepressants and normotimics. The severity of depressive disorder was assessed using the Hamilton Depression Rating Scale (HDRS). The criterion for the effectiveness of therapy (sensitivity) was an improvement in clinical symptoms by 50% or more, as measured with HDRS. The study was performed in two stages (points): at the first point, patients were examined upon admission to the Department before taking medications, and the second point was performed after a 4-week treatment of patients in the hospital. The assessment of executive functions was performed using computer tests Go/Nogo, Corsi and Stroop., Results and Conclusion: Patients with depressive disorders who were not sensitive to therapy were characterized by low performance in executive functions compared to patients with a positive therapeutic response. Based on the data obtained, a multiple linear regression equation was constructed to predict the therapeutic response based on individual differences in the results of cognitive tests, regardless of potential clinical and demographic factors.

The review briefly summarizes experimental and preclinical data of the role of pro-inflammatory cytokines in triggering pathophysiological changes associated with depression, primarily major depressive disorder (MDD), as well as the possibility of using anti-inflammatory drugs as antidepressants.

The article presents the literature data that determine the place of antidepressants in the relief and maintenance therapy for recurrent depression (RD) and depression in the framework of bipolar affective disorder (BPAD) and provides a justification for their use in the presence of residual depressive symptoms during remission. There are several ways to achieve complete remission: determination of the nature of residual symptoms; identification of adverse side-effects that have occurred as a result of the therapy; the establishment of those symptoms that are subjectively perceived by the patient as interfering with his/her full life. The data on the effective use of agomelatin for maintenance therapy, both as monotherapy and in combination with other antidepressants, anticonvulsants and neuroleptics, in RD and BPAD are presented. The authors have analyzed the case histories of 29 outpatients with depressions of various origins (RDD, BPAD, prolonged psychogenic depression, organic affective disorder), who received agomelatin as part of complex and monotherapy for a long time (1 to 13 years), and justified the predictors of its efficacy.

Objective: To investigate the effect of therapy with various classes of antidepressants on the quality of remission and adherence to therapy in patients with schizoaffective disorder (SAD) in remission., Material and Methods: We examined 87 outpatients, including 29 men (33.33%), 58 women (66.67%) diagnosed with SAD according to ICD-10 criteria (item F25), in whom 341 cases of remission were studied. The average age of the patients was 41.40±12.56 years. Cases of remission in patients receiving therapy with nonselective monoamine reuptake inhibitors (NSMRIs) were included in group 1 ( n =228), cases of remission formed on therapy with selective neuronal reuptake inhibitors (SNRI) were included in group 2 ( n =113). Clinical follow-up and statistical methods were used., Results: In both groups, mood disorders in remission were represented by subdepression. Delusional disorders at the stage of remission were almost 7 times more common in group 1 (12.28%), compared with group 2 (1.77%). The duration of the interictal period in patients treated with NSMRIs was higher (504.0±60.67 days) compared with patients receiving SNRI (176.46±17.88 days). In group 2, residual affective-delusional symptoms in remission were significantly less common. Cases of refusal from therapy in group 2 were 12 times less frequent, which indicates a greater adherence to therapy in patients receiving SNRI., Conclusion: It is possible to recommend treatment with NSMRIs for patients with depressive affect in the structure of SAD to increase the duration of the interictal period. At the same time, for patients with SAD in the presence of delusional and affective-delusional symptoms, it is preferable to prescribe SNRI.

Objective: Comparative evaluation of the effectiveness and safety of antidepressant monotherapy and combined antidepressant therapy with the inclusion of neuroprotectors in the treatment of depression in old and very old patients in a psychiatric hospital., Materials and Methods: The study included 2 groups of patients from the cohort of patients hospitalized in the gerontopsychiatric unit with mild and moderate depression (according to the ICD-10 classification) aged 60 years and older. The groups are comparable in their main demographic and clinical characteristics. Both groups received antidepressant monotherapy with venlafaxine (21 people) or combined therapy with the same antidepressant, but in combination with cerebrolysin or carnicetine (40 people) for 8 weeks. The efficacy of antidepressant therapy was evaluated with HAMD-17 and HARS; the effect of treatment on the level of cognitive activity of patients with MMSE and the 10-word memory test., Results: In the group of patients receiving combined antidepressant therapy, a significantly faster and more pronounced therapeutic response was observed compared to the group of patients treated with antidepressant monotherapy. In the group of combined therapy, an earlier (by 4 weeks) and significant ( p <0.001) reduction of depressive and anxiety symptoms was established by the end of treatment, this group had a significantly higher number of respondents, as well as a better quality of therapeutic remission and a significant improvement in the cognitive functioning of patients compared to the monotherapy group. When comparing the effectiveness of different neuroprotectors (cerebrolysin or carnicetine), significant differences in the reduction of depressive and anxiety disorders in favor of carnicetine were established only at the end of the therapeutic course., Conclusion: Combined antidepressant therapy with a combination of treatment with an antidepressant and a drug with neuroprotective properties can increase the effectiveness of antidepressant therapy in old and very old patients. Both cerebrolysin and carnicetine can be recommended for use in a psychiatric hospital to improve the quality of the therapeutic response and reduce the time of hospitalization.

Aim: Comparative evaluation of the efficacy and safety of antidepressant monotherapy and complex antidepressant therapy in combination with carnicetine in the treatment of depression in elderly patients in a psychiatric hospital., Material and Methods: Two groups of hospitalized patients, aged from 60 to 79 years, with mild or moderate depression (according to ICD-10), comparable in basic demographic and clinical characteristics, received mono- or complex (in combination with carnicetine) antidepressant therapy for 8 weeks. Treatment efficacy was assessed with HAM-D, HARS, CGI-S and CGI-I; the level of cognitive activity was assessed with MMSE, the 10-word memory test and clock drawing test., Results: It has been established that the use of complex antidepressants therapy with the inclusion of carnicetine allows to achieve a more rapid and pronounced therapeutic response compared to antidepressant monotherapy. This is confirmed by the earlier (by the 4th week) and significant reduction of depressive and anxiety symptoms (p<0.01), a greater number of responders and better quality of depressive outcomes to the end of treatment and a more rapid improvement in cognitive functioning., Conclusion: The results allow us to recommend the inclusion of carnicetine for the augmentation of antidepressant therapy in elderly patients of the psychiatric hospital to achieve a more rapid and complete therapeutic response and reduce the duration of hospitalization.

Depression often complicates the course of the post-stroke period, adversely affecting the functional recovery and quality of life of patients, and is associated with an increased risk of mortality. Over the recent years, the role of inflammatory processes, genetics, white matter damage, cerebrovascular reactivity disorders, changes in the level of monoamines and cortisol, impaired neuroplasticity and glutamate neurotransmission in the pathophysiological mechanisms of post-stroke depression (PSD) is increasingly discussed. Randomized clinical trials (RCTs) have shown that antidepressants are highly effective in the treatment and prevention of PSD. The action of antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs), can be directed to the main pathophysiological processes of post-stroke depression. Treatment of PSD with antidepressants not only reduces the severity of depression, but also improves the functional state, rehabilitation and quality of life of patients.

This paper presents a case report of a patient with neurotic depression. The features of personal predisposition and clinical characteristics of the disease are considered. The authors note the advantages of an integrated approach to the treatment of neurotic depression with antidepressants and psychotherapy (cognitive behavioral therapy).

Agomelatine is an antidepressant agent with an innovative unique pharmacodynamic profile, including melatonergic receptor agonism (MT1 / MT2) and antagonistic effects on serotonergic 5-HT2C receptors. According to the results of meta-analyzes of clinical studies of the acute phase of a major depressive disorder, the antidepressant effect of agomelatine itself is significantly higher than that of placebo, but somewhat inferior to a number of other antidepressants (especially SSRIs and venlafaxine). To date, there is some uncertainty regarding the efficacy of agomelatine for the prevention of recurrence of MDD and its hepatotoxicity profile. In this regard, agomelatine is not considered as a drug of first choice in treatment of MDD. However, the heterogeneous clinical manifestations of MDD and the unique mechanism of action of agomelatine with the ability of the drug to have a modulating effect on sleep, make it possible to effective use it for treating such disorders. In addition, agomelatine has a more favorable safety profile, which allows considering it as a drug of choice in patients who have contraindications to other antidepressants or in the absence of therapeutic response to another antidepressant therapy.

The authors discuss the relationship between depression and cognitive impairment in the aspect of mechanisms of their development, variants of comorbidity and recommendations on differentiated therapy in elderly. The diagnostic differentiation between depression and dementia at different stages of dementia as well as in younger and older ages, a role of depression as a risk factor for dementia, a role of other factors, in particular age, as well as treatment approaches on the example of antidepressants and cerebrolysin are considered.

Aim: To assess the plasma level of N-acetylaspartate (NAA) before and after combined therapy with antidepressants and actovegin in a group of elderly patients diagnosed with depression., Material and Methods: Nineteen patients, 7 men and 12 women, mean age 70.5±5.8 years, were studied using clinical examination and psychometric scales as well as computed tomography (CT). NAA plasma levels were determined. The duration of treatment with antidepressants (venlafaxine, fluvoxamine) and actovegin was 28 days, patients were examined at baseline and on the 28 th day of treatment., Results and Conclusion: The NAA plasma level was reduced in patients compared to healthy volunteers. The increase of this indicator after treatment reflected a significant improvement on clinical and psychometric measures. The dynamics of NAA changes (increase or decrease) showed heterogeneity in the group of patients, which was not related to the efficacy of treatment but was correlated with comorbid diseases, in particular vascular diseases, and CT changes (leukoaraiosis). The authors consider the results of this study as preliminary.

Aim: To study the influence of depression on the quality of remission in patients with schizoaffective disorder (SAD) and develop recommendations for anti-relapse therapy., Material and Methods: Eighty-nine outpatients with the diagnosis of SAD were examined, in whom 348 remission cases were studied. In accordance with the characteristics of the episodes, the patients were divided into 2 main groups: patients with only depressive manifestations (group 1) and patients with affective disorders of both poles (group 2). Clinical-psychopathological, clinical-anamnestic, clinical-follow-up and statistical methods were used., Results and Conclusion: The type of SAD did not have a significant effect on the duration of remission and the duration of subsequent hospitalization. Patients of group 2 had residual symptoms in remission almost 2 times less often and the level of affective-delusional disorders in this group was higher compared to group 1. In both groups, affective symptoms are represented by subdepression. Patients without residual symptoms had a longer remission compared to patients with subdepression. Subdepressive disorders are associated with lower treatment adherence. Prescribing anti-relapse treatment of SAD, one should consider not only the current state and features of the last episode, but also the features of previous episodes. Patients with depressive episodes are characterized by subdepressive residual symptoms in remission. For patients with different variants of affective disorders in SAD, emotional disorders in remission are as specific as elements of affective-delusional disorders. Anti-relapse therapy should include neuroleptics and normothymics. In case of residual depressive symptoms, the authors recommend the addition of antidepressants.

Aim: Increasing the effectiveness of treatment of elderly depressed patients in the conditions of the gerontopsychiatric hospital by augmentation of actovegin to antidepressants of new generations (fluvoxamine, venlafaxine or agomelatine)., Material and Methods: The efficacy of the therapy was compared in two groups of 21 patients aged 60 to 79 years with mild to moderate depression in ICD-10 receiving 8-week antidepressant mono- or combined therapy with actovegin. The effectiveness criteria were changes in the mean total scores on the HAMD-17, HARS, CGI scales, as well as the proportion of respondents and the quality of getting out of depression. Cognitive activity was assessed using MMSE, 10 word memory tests and drawing of clock., Results: It has been established that the use of complex antidepressants therapy with the inclusion of actovegin allows for a more rapid and pronounced therapeutic effect compared to monotherapy with antidepressants. This is confirmed earlier (by the 4th week) and significant reduction of depressive and anxious symptoms (p<0.01), a greater number of responders and better quality of depressive outcomes by the end of treatment. In patients with complex therapy, there was also a faster improvement in cognitive functioning., Conclusion: Obtained results allow us to recommend the inclusion of actovegin in the antidepressant therapy regimen of elderly in-patients with the aim of achieving a faster and fuller therapeutic response and shortening hospitalization.

Theanine is an analog of glutamate and the major aminoacid in green tea. It has received growing attention in recent years because of its beneficial effects on the central nervous system. Theanine was shown to increase levels of brain-derived neurotrophic factor and to stimulate neurogenesis. Anti-stress and calming effects of theanine are the most apparent and well-studied. A number of studies showed neuroprotective effects of theanine after an ischemic cerebral injury or the exposure to toxic chemicals. It also improved cognitive function including attention, memory and learning. Recent studies demonstrated a promising role of theanine in augmentation therapy for major depressive disorder and schizophrenia. Theoretical grounds for using theanine in treatment of bipolar disorder, anxiety disorder and some neurodegenerative disorders are discussed.

Aim: To study the efficacy of nooclerin (deanoli aceglumas) in alcohol withdrawal syndrome assessed by clinical and biochemical characteristics., Material and Methods: A multicenter, open, randomized, comparative study of nooclerin in the complex treatment of alcohol withdrawal syndrome included 90 patients. The patients were randomized into nooclerin group (n=55) and control group (n=35)., Results and Conclusion: Nooclerin reduced alcohol withdrawal symptoms more significantly throughout the whole study period. There were significant between-group differences on the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) and the Multidimensional Fatigue Inventory (МFI-20). However, patients exhibited no excessive activity. No adverse side-effects were observed.

The aim of the study was to evaluate the efficiency of photoneuromodulation in the complex treatment of patients with the burning mouth syndrome (BMS). Supervised were 120 patients with BMS at the age of 37-79 years (mean age 47.5±5.35 years), which were divided into two groups - the main group and the comparison group (n=60). All patients with BMS underwent complex treatment that included professional oral hygiene, training in rational oral hygiene and tongue, oral sanitation, rational prosthetics, consultation, treatment and follow-up with a neurologist, general treatment with the appointment of anti-anxiety drugs or antidepressants , vitamins of B group and vascular preparations. In the main group, after the drug treatment, a photoneuromodulation was performed - the effect of transcranial broadband red light, in the cervical collar zone and in the projection of the pain points of the tongue, the course of treatment was 20 days. In the comparison group, only medication was prescribed. The control group consisted of 30 relatively healthy persons at the age of 36±4.7 years without concomitant somatic diseases. Comparison of the results of the analysis of the level of pain, anxiety and depression, free radical oxidation and the activity of the serum antioxidant system after treatment in the main group and the comparison group indicates that after the complex treatment with the inclusion of the course of photoneuromodulation, the best result was obtained for reducing the level of pain, anxiety and depression, intensity of oxidative processes and increase of activity of the general antioxidant system of protection of blood serum in patients with the burning mouth syndrome.

The objective of this review is to compare results of network metaanalyses of the efficacy and tolerability of different antidepressants for treatment of unipolar depression in adults. An analysis of different criteria of antidepressant efficacy and tolerability showed the benefits of agomelatine. Results of using this drug in national clinical practice and multicenter studies of depression of different nosology with heterogeneous psychopathological symptoms support this notion.

Panic disorder is a common mental disease with high psychiatric comorbidity. It is considered that a combination of genetic predisposition and a special psychic vulnerability plays a key role in the occurrence of panic disorder. Clinically proven efficacy in the treatment of panic disorder have benzodiazepines, tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors and selective serotonin and norepinephrine reuptake inhibitors; antidepressants from other pharmaceutical groups are also used. Selective serotonin reuptake inhibitors are the first line medicines in the treatment of panic disorder. Atypical antipsychotics may be used for the therapy augmentation in addition to first line drugs. Psychotherapy is used along with medications, and a combination of pharmacotherapy and cognitive behavioral therapy is the best method of treatment.

Aim: To study the association between polymorphisms of PIP5K2A and HTR2C genes and response to antidepressant therapy in patients with a current depressive episode., Material and Methods: The study included 222 patients (168 women and 54 men) with a current depressive episode. The assessment of the severity of the current depressive episode and the efficacy of treatment was performed using the Hamilton depression scale (HDRS-17) and the Clinical global impression scale (CGI-S, CGI-I). The association of treatment efficacy with PIP5K2A polymorphisms rs10430590, rs10828317 and HTR2C polymorphisms rs6318, rs569959, rs3813929, rs12858300 was studied., Results and Conclusion: Polymorphisms rs10828317 and rs10430590 in the PIP5K2A gene were associated with the CGI-S total score at day 28 of therapy. Polymorphism rs6318 in the HTR2C gene was associated with response to antidepressant therapy followed by clinical improvement of patients with current depressive episode on the 28th day of antidepressant therapy.

Aim: To evaluate the effects of mexidolum on physical performance using acute and subchronic administration in experimental animals., Material and Methods: The investigation was carried out using 123 male white outbred mice. The forced swim test was used to assess the effects of the drugs on the physical performance of mice., Results and Conclusion: A single intraperitoneal administration of 50 and 100 mg/kg mexidolum and subchronic intraperitoneal administration of 100 mg/kg mexidolum significantly enhances the physical performance of animals in the forced swim test. Subchronic intraperitoneal administration of 100 mg/kg of the comparison drug mildronatum enhances the physical performance of animals, while intraperitoneal administration at a lower dose (50 mg/kg) has no effect. The effect of mexidolum at a dose of 50 and 100 mg/kg is comparable with the effect of mildronatum in a dose of 100 mg/kg.

The analytical paper summarized the results of recent studies of an association of depression, anxiety, and stress with coronary heart disease (CHD). Mental disorders are shown to be associated with increased risk of CHD and to worsen the course of coronary disease. Antidepressants and psychotherapy improve the control of mental disorders, quality of life, and, in some cases, have a positive impact on the course of coronary disease.

Aim: To evaluate the efficacy of different treatment regimens of depression complicated by abuse and dependence on alcohol and to identify the most effective tactics of treatment., Material and Methods: One hundred patients with depression were studied. Examination of patients was conducted using clinical-psychopathological method, the MADRS (at admission, on the 1st, 2nd, 4th and 6th week of treatment) and CGI scale (in the beginning of treatment and on 6th week). Data analysis using standard statistical indicators was performed. In accordance with the therapeutic tactics, patients were stratified into three groups: patients, treated with a combination of antidepressants, antipsychotics and mood stabilizers (group 1); antidepressants and antipsychotics (group 2); antidepressants and mood stabilizers (group 3)., Results: In group 1, a reduction in MADRS scores was significantly higher compared to other groups (8.53 points, p≤0.01). On the 6th week, 50% of the patients showed complete or almost complete remission, and the state of 44.7% patients was classified as 'mild disorders'. In group 3, serious condition remained in 16.7% of patients by the end of the 6th week. By the 6th week of treatment, 39.5% of patients of group 1 had 'very significant improvement'. The least treatment efficacy was noted in group 3., Conclusion: The use of the combination of antidepressants, antipsychotics and mood stabilizers demonstrates the greatest efficacy in terms of reduction of depressive symptoms.

Parkinson's disease as an extrapyramidal pathology is accompanied by some non-motor symptoms (depression, cognitive disorders, and sleep disturbance), which are based on disturbances of nigrostriatal dopaminergic neurotransmission supplemented by disorganization of other neuromediator systems. Traditional antiparkinsonian drugs with different cellular mechanism of action are capable of restricting these symptoms in patients and on animal models, while exhibiting their own psychotropic activity. This circumstance should be taken into account in assessing the pharmacological activity profiles of drugs.

In the formation of a common age-associated pathological process in patients with Parkinson's disease along with movement disorders so-called «non-motorized» clinical symptoms (including anxiety and depression) play an important role. These pathological manifestations can reduce the quality of life of the patient and require specific therapeutic measures. The picker is the use of drugs - antidepressants. The article discusses the opportunity for the effective and safe use of such drug - sertraline combined with basic therapy, which is widely used in Parkinson's disease. Distinct positive results were obtained in the process of using the proposed scheme of treatment in 35 patients at the age of 62,3±3,6 years and with disease duration of 3,9±2,6 years. We observed decrease depressive symptoms, improve sleep, decrease anxiety levels while improving the quality of life of patients. No unwanted side effects of the treatment were observed. The possibility to use of sertraline for the relief of anxiety and depressive disorders in the elderly suffering from Parkinson's disease was shown.

Aim: To perform a comparative study of anxiolytic and antidepressant effects of derivatives of 3-oxypyridine and succinic acid (emoxipine, reamberin and mexidol) in experimental diabetes mellitus., Material and Methods: An effect of emoxipine, reamberin and mexidol on manifestations of anxiety in 'elevated plus maze' (EPM) and duration of 'desperate behavior' (DB) in Porsolt test in rats with alloxan diabetes during medication course was studied. Alpha-lipoic (thioctic) acid (α-LA) was used as a reference drug. In additional experimental series, an effect of emoxipine, reamberin, mexidol and α-LA on the intensity of hyperglycemia in experimental DM was investigated., Results and Conclusion: All studied medications used in doses equivalent to therapeutic range in humans and administered for 14 days significantly reduced manifestations of anxiety and depression in rats with alloxan diabetes. The most pronounced anxiolytic potential was demonstrated for emoxipine that emerged as the only medication in the study that reduced manifestations of anxiety not only in comparison with 'alloxan diabetes-control' groups but also in comparison to 'intact control'. The intensity of tranquilizing activity of derivatives of 3-oxypyridine and succinic acid was similar to that of α-LA while the thymoanaleptic activity, when the drugs were administered in maximal doses to rats with experimental DM, was higher. Both emoxipine and mexidol as well as α-LA in all studied doses significantly decreased hyperglycemia in alloxan diabetes. Reamberin demonstrated only insignificant tendencies of the same trend.

The existing literature in the field demonstrates that in the majority of cases depressive disorder has a recurrent course that resulted in negative consequences: an increase in a number of chronic and marked episodes, a higher risk of suicide and stable cognitive deficit. An analysis of predictors promoting the formation of recurrent depressive disorder allows an identification of a constellation of biological, psychological, therapeutic, social factors which should be taken into account in the choice of methods of prevention of the next episode of depression. Currently, the prolonged supporting psychopharmacotherapy, including antidepressant therapy, is a main tactics in the prevention of recurrent dynamics of depressive disorder though its efficacy is understudied.

As clinical practice and experimental studies show, symptoms of depression and anxiety often accompany each other. It is well known that combination of anxiety and depression in patients is treated more slowly, requires large doses of drugs, increases the likelihood of suicide and often leads to relapse. Furthermore, antidepressants and anxiolytics exert its therapeutic effect in limited cases even in monopolar anxiety or depression state. In this review of literature and our own data the relationship of anxiety and depression is analyzed. It has been shown with using the model of mixed anxiety/depression disorder caused by chronic social defeat stress, that the anxiety and depression are changed under the influence of psychotropic drugs independently.

GABA is the major inhibitory neurotransmitter in the central nervous system determining the efficacy of neuronal interaction. GABA-receptors play a key role in different aspects of fear memory--acquisition and consolidation, retention, reconsolidation and extinction. Extinction is an important behavioural phenomenon which allows organism to adapt its behavior to a changing environment. Extinction of fear memory is a form of new inhibitory learning which interferes with expression of the initial acquired fear conditioning. Resistance to extinction is symptom of depression and posttraumatic stress disorder. The aim of the present review was to summarize own and literary data about GABAergic modulation of fear extinction and pharmacological correction of extinction impairment at influences on GABA(A)- and GABA(B)- receptors.