2 results
Silexan for treatment of psychiatric manifestations in the context of COVID-19: a case series
- L. Bartova, M. Dold, G. Fugger, A. Weidenauer, D. Rujescu-Balcu, S. Kasper
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S798-S799
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Introduction
Silexan manufactured from Lavandula angustifolia showed favorable safety and efficacy in subthreshold and generalized anxiety disorder (GAD), mixed anxiety and depressive disorder (MADD), and further, especially subsyndromal psychiatric manifestations including depression, sleep disturbances, restlessness, fatigue and pain.
ObjectivesSince the abovementioned clinical phenotypes were repeatedly observed in the course of the so-called post coronavirus-19 disease (COVID-19) syndrome, which were, importantly, of subsyndromal severity in the most cases, we were confident that Silexan will be efficacious also in this indication.
MethodsWe report on three adult outpatients treated with Silexan due to psychiatric conditions that occurred in the context of a mild and short-lasting COVID-19 infection.
ResultsA 38-years old female experienced fatigue, brain fog, inner tension, restlessness and sad mood with weepiness after recovery of her respiratory COVID-19 infection. Since she did not remit under ongoing psychotherapy (PT), Silexan 80 mg p.o.q.d. was additionally employed and very well tolerated. She achieved full remission of her subthreshold symptoms within one month. A 27-years old male developed GAD including anxiety, inner tension, restlessness, irritability, muscle aches, difficulties in concentrating and in controlling feelings of worry after he recovered from respiratory COVID-19. Following his preference, PT and Silexan 80 mg p.o.q.d. were initiated and very well tolerated. Because of partial response, Silexan was increased to 80 mg twice daily after three weeks. After additional two weeks, he was able to enjoy everyday activities and to comply with working demands without relevant difficulties. A 38-years old female developed a post COVID-19 syndrome with fatigue, anxiety, depression, inner tension, tachycardia, hopelessness and rumination. Due to the current MADD Bupropion 150 mg and subsequently 300 mg p.o.q.d. and Hydroxyzine 25 mg on demand were administered. Although clinical improvement was achieved, the patient discontinued the treatment due to subjective exacerbation of tachycardia and refused any further treatment optimization. Once she agreed to phyto-psychopharmacotherapy, Silexan 80 mg p.o.q.d. was employed and, while well tolerated, increased to 80 mg twice daily after two weeks. The patient was increasingly able to participate at her working and social activities again and stayed stable for four months.
ConclusionsTo our knowledge, this is the first report on administering Silexan in subsyndromal and full-blown anxiety and depression with cognitive and psychosomatic symptoms that occurred in the context of COVID-19. While substantial clinical improvements were achieved, no relevant adverse effects occurred.
Disclosure of InterestNone Declared
Alternating intravenous racemic ketamine and electroconvulsive therapy in treatment resistant depression: A case report
- L. Bartova, A. Weidenauer, M. Dold, A. Naderi-Heiden, S. Kasper, M. Willeit, N. Praschak-Rieder
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S522
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Introduction
Treatment resistant depression (TRD) affecting approximately 10–30% of all depressed patients often remains misdiagnosed and undertreated, leading to a higher risk of relapse and suicide. Electroconvulsive therapy (ECT) and sub-anesthetic ketamine have repeatedly shown to be effective in the TRD population. Administering ketamine as an anesthetic component to augment antidepressant efficacy of ECT has been proven inconclusive, while a combination of alternating ECT and ketamine has not been investigated yet.
Case reportWe present a severely depressed and chronically suicidal female inpatient who failed multiple antidepressant treatment attempts, requiring frequent psychiatric admissions. Since available conventional as well as non-conventional antidepressant treatment strategies were nearly exhausted, we employed a combination of ECT (bilateral stimulation up to 150%) 2–3 times/week, while intravenous racemic ketamine (up to 75 mg per infusion) was administered on ECT free days 2–3 times/week. Consequently, robust anti-suicidal and antidepressant effects could be observed already during the first treatment week. The temporarily occurring subjective forgetfulness disappeared after the last ECT. Summarizing, we employed 9 ECT treatments and 7 ketamine infusions leading to a stable psychopathological state even after discharge from psychiatric inpatient care. In order to prevent relapse a maintenance-therapy comprising ECT once monthly and 2 ketamine infusions (up to 100 mg per infusion) administered on the day before and after ECT was established.
ConclusionsIn our patient alternating ECT and intravenous racemic ketamine were proven safe and long-term effective after numerous failed antidepressant trials including ECT and ketamine alone. We may hence encourage clinicians to widen their therapeutic armamentarium in severe TRD.
Disclosure of interestThe authors have not supplied their declaration of competing interest.