Does the role of serotonin differ
O. Vinar
in OCD and depressive disorder?Inst. Organic Chemistry and Biochemistry,
Acad. Sci., Prague (emeritus)Serotoninergic antidepressants are used in the treatment of depressive disorders and in OCD. Their dosage has to be higher in OCD and their therapeutic effects appear after a longer latency than in depression.
A case report is presented where serious OCD symptoms appeared in a depressed patient when the treatment with a serotonin reuptake enhancer (tianeptine) was begun.
The 26 years old mother of a daughter (6 years) suffered from a severe major depressive disorder with mood-congruent psychotic features. Her depression responded to a seven weeks of fluoxetine treatment with a moderate decrease of the HAMD total score from 25 to 18. She became critical to her illness and had a good insight. Because her mother had responded to tranylcypromine 41 years ago, fluoxetine was stopped with the intention to begin the treatment with moclobemide after five weeks. Depression at the second week worsened and tianeptine as an antidepressant where the interaction with fluoxetine should not be a risk was started. Her anxiety subsided in the first days, but she became preoccupied with the fear that she would lose her child because she was mentally ill. She knew that her fears were not substantiated but she could not help herself to stop to think so. She wished her mother to sit with her and to listen again and again to her complaints. On the fifth day on tianeptine, she was found by her mother masturbating. During the next days, she felt an irresistible compulsion to play with her sex organs and she apologized that she could not stop it although she knew that she should not do it. It was not connected with any pleasure. Tianeptine was stopped on the ninth day. Already after six hours after the last tablet, the patient could control better her behavior. Three days later, her compulsive behavior disappeared altogether. She remained depressed and moclobemide was introduced. First signs of an antidepressant effect appeared after five days and depression subsided gradually during next two weeks.
This observation is far from bringing any scientific evidence that tianeptine worsens OCD without losing its antidepressant effects. Nevertheless, we might speculate about different role of changes in the concentration of serotonin in the synaptic cleft (increased after SSRIs and decreased after tianeptine) in OCD and in depression.
Several lines of evidence are in agreement with the view that the improvement in depression is related to neoneurogenesis in hippocampus, whereas in OCD, a reduction in the volume of the left amygdala seems to be necessary. These morphological changes occur only after long-term antidepressant treatment. The concentration of serotonin increases already in minutes after a single dose of an SSRI. Our case report might help to stimulate research which could explain how the changes on the synapse translate into the changes in the morphology of the brain.
References:
1. Mocaer, E., Rewttori, M. C., Kamoun, A.: Clin. Neuropharmacology (1988) 11 suppl.2, 32–42
2. Szeszko, P. R., MacMillan, S., Mc.Menimam, M. et al. Neuropsychopharmacology (2004) 29.826
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