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Acetyl-L-carnitine for dysthymia in the elderly.

Eighty elderly patients (mean age, 72 years) with dysthymic disorder were randomly assigned to receive, in double-blind fashion, acetyl-L-carnitine at a dose of 1 g 3 times per day or 20 mg per day of fluoxetine (a selective serotonin-reuptake inhibitor) for 6 weeks. Significant improvements were seen in both groups on the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, and the Beck Depression Inventory. The degree of improvement in the 2 groups was similar.

Comment: Dysthymic disorder (also called dysthymia) is characterized by a depressed mood that does not fit the diagnostic criteria for major or minor depression. Criteria for diagnosing dysthymic disorder include the presence of a depressed mood for most of the day, for more than 50% of days, for at least 2 years. In children and adolescents, the mood can be irritable and the duration must be at least 1 year. At least 2 of the following symptoms are also present: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, difficulty concentrating or making decisions, and feelings of hopelessness. There is considerable overlap between dysthymic disorder and major and minor depression. The cause of dysthymic disorder is not clear, but it appears to involve abnormalities of serotonergic and noradrenergic systems. The results of the present study indicate that acetyl-L-carnitine is as effective as fluoxetine in the treatment of dysthymic disorder in elderly patients. Although its mechanism of action is not fully understood, acetyl-L-carnitine is known to function as a neurotransmitter.

Bersani G et al. L-Acetylcarnitine in dysthymic disorder in elderly patients: a double-blind, multicenter, controlled randomized study vs. fluoxetine. Eur Neuropsychopharmacol. 2013;23:1219-1225.

by Alan R. Gaby, MD

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Title Annotation:Literature Review & Commentary
Author:Gaby, Alan R.
Publication:Townsend Letter
Article Type:Brief article
Date:Oct 1, 2015
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