Antidepressant therapy in complex treatment of painful diabetic polyneuropathy

Abstract

Aims. Comparative efficiency and safety analysis of antidepressant agents from different pharmacological classes (pipofezine and venlafaxine) in combination with carbamazepine for treatment of neuropathic pain (NP) in patients with diabetic polyneuropathy (DP). Materials and methods. We examined 21 male and 27 female patients with painful DP (mean age 54.3±14.2 years; mean duration of diabetes mellitus (DM) 8.9±5.1 years; mean duration of DP - 3.8±2.1 years). DP was diagnosed clinically and by electromyography method. Pain syndrome was assessed with DN4 questionnaire, visual analogue scale (VAS) and McGill Pain Questionnaire. Psycho-vegetative status was evaluated by Spielberger test with reactive and personal anxiety (RA and PA) assessment and Beck depression inventory. All patients received symptomatic pharmacotherapy with anticonvulsant and antidepressant agent. First group (DP-1) included 23 patients on carbamazepin and pipofezine. Second group (DP-2) included 25 patients on carbamazepin and venlafaxine. Results. Following treatment, pain syndrome was completely compensated in 8.7% of patients from DP-1 group and 12.5% from DP-2. Decrease in pain intensity >50% from initial level was achieved in 73.9% (DP-1) and 75% (DP-2) of cases. Mean pain intensity according to VAS reduced from 5.2±2.1 points to 2.3±1.4 points (DP-1) and from 5.8±2.3 points (DP-2) with equal statistical significance (p < 0.001). Moreover, both groups were characterized by significant decrease in all indexes of McGill Pain Questionnaire. Patients from both groups showed improvement in autonomic disorders, depression, RA and PA. DP-1 reported lower rate of side effects from the treatment. Predictors of positive treatment outcome (complete compensation or pain intensity reduction ≥50%) were found to be experience of DM < 9.1 years, DP < 3.8 years, depression score < 25 points and pain intensity (VAS) < 5.6 points. Conclusion. Our study suggests that complex treatment with venlafaxine or pipofezine may be a highly effective therapy for chronic NP and concomitant psychovegetative disorders (autonomous dysfunction, anxiety-depressive disorder), though pipofezine has a more favourable safety profile. Optimal regime for complex treatment is pipofezine 75 mg/day (in three doses) or venlafaxine 800 mg/day in four doses.