Extreme Creatine Phosphokinase Elevation in a 20-Year-Old Man Participating in a Clinical Trail of Major Depressive Disorder

Abstract

Sir: The article "Googling Suicide: Surfing for Suicide Information on the Internet" by Recupero et al. 1 demonstrates that while most suicide-related Internet "hits" are either suicideneutral or anti-suicide, the Internet allows individuals to easily access not only Web sites that furnish detailed instructions on maximizing self-harm but also sites that provide forums for encouragement and support in furtherance of such acts. These findings lead the authors to conclude that "mental health professionals should ask patients about their Internet use." 1(p878) I would agree that clinicians should talk to patients about their lives. They should speak to patients about their relationships, their interests, even their leisure time activities. In short, they should get to know their patients. The last thing contemporary clinicians need, however, is another item added to the "what should be asked about" list-in this case, patients' Internet usage patterns. Laundry list approaches in both assessment and treatment settings do not result in the establishment of an optimal therapeutic relationship between clinician and patient and at times may even serve to further alienate patients. (This alienation may in fact be what many patients searching the Internet are already feeling.) The best approach remains getting to know your patients-which requires not only asking patients questions but taking the time to listen to their answers.

Global metabolic profiling for the study of Rhizoma Paridis saponins‐induced hepatotoxicity in rats

“…As self‐protection, this reaction could inhibit DNA adducts formation to protect body against the cytotoxicity and carcinogenicity of RPS (Yen et al, ). In addition, creatine, as an important protector of mitochondrial energy metabolism (Kolling et al, ), plays a pivotal role in brain energy homeostasis which is involved in the pathophysiology of depression (Shiovitz et al, ). RPS treatment significantly increased the level of creatine, which may be related to its sedative‐hypnotic activity (Liu et al, ).…”

Agomelatine and Transient Elevation of Creatine Phosphokinase

“…After this, we re-initiated antidepressant treatment with Mirtazapine (15 mg/d), which was well tolerated. To the best of our knowledge there is just one case report in the literature on a patient with CK level elevations receiving agomelatine [5]. Even though in this case the detected CK levels were excessively high, they were later attributed to physical activity, namely heavy physical workouts.…”

“…To the best of our knowledge, only one case of CK elevation under agomelatine treatment had been reported so far. However, these findings were attributed to other plausible causes than the pharmacological treatment [5]. In the first case, a 32-year-old man was admitted to our day clinic with the diagnosis of a moderate depressive episode, posttraumatic stress disorder and attention deficit hyperactivity disorder.…”