Effect of amitriptyline on the thyrotropin response to thyrotropin-releasing hormone in endogenous depression.

Patients with endogenous depression whose depressive episodes were clinically resolved after electroconvulsive therapy were divided into two groups: one in which patients remained well (n = 16) and another in which patients relapsed within 6 months (n = 11). Treatment with amitriptyline for 3 weeks did not affect the median thyrotropin (thyroid-stimulating hormone; TSH) response to thyrotropin-releasing hormone (TRH) in recovered patients, whereas that in relapsed patients was significantly enhanced. The data suggest that amitriptyline affects the TSH response to TRH differently in stably recovered and relapsed patients. If this effect is maintained beyond the 3-week period studied, treatment with amitriptyline will invalidate the predictive value of the TRH test.

Prediction of relapse with the TRH test and prophylactic amitriptyline in 39 patients with endogenous depression.

The authors conducted a double-blind prospective study of 39 patients with unipolar endogenous depression who recovered after ECT. Thyrotropin (TSH)-releasing hormone (TRH) tests were performed before and after ECT. Patients were divided into three groups on the basis of their altered TSH response: Persistent remission was predicted for patients in group 1 (N = 15) and relapse was predicted for groups 2A (N = 13) and 2B (N = 11). Patients in groups 1 and 2A received placebo and those in group 2B received amitriptyline for 6 months. Fewer relapses occurred in groups 1 and 2B than in group 2A (p less than .05), showing that relapse can be predicted by the TRH test and prevented by amitriptyline.

Dexamethasone suppression test and TRH test in endogenous depression.

Dexamethasone suppression test (DST) and thyrotropin releasing hormone (TRH) stimulation test were performed in 34 patients with endogenous depression. Compared with 33 psychiatric controls (limit of discrimination for serum cortisol of 275 nmol/l = 10 micrograms/100 ml) the specificity of the DST was 91% and the sensitivity was 65%. Compared with 24 healthy subjects the sensitivity of the TRH test was 24%, and the combined sensitivity for the DST and the TRH test was 76%. In contrast to the TRH test the DST showed a significant relationship (r = 0.54, P less than 0.01) to the Hamilton Rating Score. Repeating the tests after clinical recovery parallel changes of the two tests were found in 14 of 19 patients with abnormal DST in the depressed phase. In the remaining five patients the DST normalized, while the TRH test remained unchanged. It is suggested that both the apparent higher diagnostic sensitivity and the higher rate of normalization after clinical recovery of the DST is due to the dependency of the severity of depression.

Epidemic of chancroid in Greenland 1977-78.

In Greenland there has been a rapid increase in the incidence of gonorrhoea and syphilis during past decades. In 1977 there was an epidemic of chancroid along the west coast of Greenland, with 975 cases reported from some 32,500 adults. The number of reported cases increased until October, 1977, and subsequently decreased. 186 patients were studied. Many of these had previously had gonorrhoea and syphilis. Male patients were both Eskimoan and Danish but female patients were solely Eskimoan. The sex ratio (M/F) was 1.6/1. The incubation period was 4 days in men and 13 days in women. Symptom-free female carriers did not seem to be an important reservoir of infection. 15% of the patients were admitted to hospital with buboes or extensive lesions. The clinical course was uncomplicated in most cases. Ulcers healed within a week of treatment with sulphonamide. Chancroid can be expected to disappear in Greenland within a short time.