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Maprotiline treatment was applied to 21 in-patients with a mean age of 21.8 far 22 days and 8 patients who coludn’t improve according to the Hamilton Depression Scale score received a further treatment with Fluoxethine for 15 more days. Hamilton Depression Scale scores, 08:00 am and 24:00 pm cortizol levels and 24-hour 5 H IM values of all patients were determined before treatment and at the 15 th day of Fluoxethine treatment. In all groups 08:00 A.M. levels of cortizol were found to be higher than 24:00 pm levels. Hamilton Depression Scale scores of the group resistant both to Maprotiline and Fluoxethine treatments were found to be higher than all other groups. In cases in which we couldn’t get a satisfactory result to antidepressants acting by way of cathecolamine metabolism, an alternative antidepressant acting by way of indolamine metabolism should be preferred. As a result of this study, our assumption which was based on out-patient experiences that Maprotiline was effective on serotonergic regulated, Fluoxethine was effective on serotonergic dysregulated; or rather Maprotiline was effective on cases with no tendency of suicide, Fluoxethine was effective on cases with a strong tendency of suicide had to be reconstructed and not the thought content and tendency but the solid attempt and results of suicidal acts should have to be taken into consideration as the main basis.
Major depresyonda tedaviye cevabın biyokimyasal parametrelerle önceden görülmesi ve maprotilin-fuoksetin uygulamaları
Yaş ortalaması 21,8 olan major depresyonlu 21 hastaya 22 gün süre ile maprotilin tedavisi uygulanmış ve IIDS skoruna göre tedaviden yarar görmedikleri belirlenen 8 hasta 15 günlük şuoksetin tedavisine alınmıştır. Hastaların tedavi öncesinde maprotilin tedavisinin 10. ve 22. günlerinde şuoksetin tedavisinin 15. gününde IIDS skorları saat 08 ve 24 kortizol değerleri ve 24 saatlik 5-IIIAA düzeyleri saptanmıştır. Tüm hasta gruplarında kortizolün 08 değerleri saat 24 değerlerine göre yüksek bulunmuştur. Hem maprotilin hem de şuoksetin tedavisine dirençli grubun IIDS skorları tüm diğer gruplara oranla yüksek bulunmuştur. Katekolamin metabolizması üzerinden etkili bir antidepresana olumlu yanıt alatnadığımız olgularda indolamiıı metabolizması üzerinden etki gösteren diğer bir antidepresana geçmek uygun olacaktır.