In patient VI

At the 6-day administration of the drug there was a sudden reversal of affect with the development of "frenzied mania, followed by impulsive acts of aggression, depersonalization, visual and verbal autoskopicheskimi mandatory deception of perception, fragmentary delusions of witchcraft and sverhvozmozhnostey. This state has demanded the abolition of Paxil and the appointment of neuroleptics sedative spectrum. Actually timoleptichesky effect by the fifth day of treatment paksilom was negligible (reducing the amount of points on the rating scales menee15%). However, there was a reduction of suicidal behavior in 86% (3 item HAMD) and 100% for dynamic assessment of suicide risk (Table 2). B. The patient in monotherapy paksilom in soft capacity doses, subsequent administration of the drug at the highest dose (60 mg. - 2 weeks), isolated timoleptichesky effect was small - 10%. Assessed by the reduction of the amount of evidence scale HAMD. Some signs remained virtually unchanged: assessment of depressive background (1 point) decreased by 2.3%, ideas of guilt dezaktualizirovalis by 5,7% (2 points), continued psycho-motor retardation (item 8). Antisuitsidalnoe action is shown in the weakening of thoughts about the inferiority of life, no suicidal plans and intentions for a second week of admission (Table 3, HAMD - reduction of symptoms by 79% to 3 points). In the third week of therapy at a dose of 60 mg. In the night became noticeable side effects as dry mouth, orthostatic hypotension (dizziness, weakness, collapse), which demanded the abolition of Paxil. Throughout the course of therapy paksilom classic melancholic depression (21 days), the condition of the patient's VA remained without significant dynamics in all respects, except reducing suicidal risk (1 point before treatment, after 1 week -0 points). Depression in patients remained resistant to paksilu to the same extent as before and after its application to other antidepressants.

      In all cases we observed the effect of Paxil antisuitsidalny clearly appeared to a greater or lesser extent, on the first week of admission. Suicidal symptoms were reduced by 75 - 100% of initial values ??Thus, we suggest a powerful "disinhibiting" effect of Paxil in the deep apathy-adynamic depression. However, most strikingly its activating effect is manifested in the case of mixed affective disorder, indicating phase inversion in history. Observed a direct correlation between the rate of increasing doses and severity of the incentive effect: more rapidly than the planned increase in dose, the stronger the "disinhibition," which allows the use of Paxil with that purpose in addition to antipsychotic without causing extrapyramidal disorders. Antisuitsidalnaya activity Paxil caused by a common antidepressant effect, however, the degree of a reducing effect on autoaggressive symptoms and timing of its implementation are inferior actually timilepticheskomu effect. If the latter is closely associated with features of clinical and pathological structure of depression is antisuitsPrimenenie Paxil in the treatment of panic disorder.