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1.
Acta Psychiatr Scand ; 110(6): 452-8, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15521830

ABSTRACT

OBJECTIVE: To compare the rates of suicidal behaviour during vs. after discontinuation of treatment with antidepressants, and to determine the comparative rates of suicidal behaviour for patients maintained on tricyclic (TCA) vs. selective serotonin reuptake inhibitor (SSRI) antidepressants. METHOD: Charts were reviewed for 521 patients with major depressive disorder and/or dysthymic disorder. Periods of active treatment or discontinuation with SSRIs or TCAs were determined. Rates of completed suicide, suicide attempts, and hospitalization for suicidality were analyzed. RESULTS: There was greater than a five-fold increase in risk for suicidal behaviour after discontinuation of antidepressant treatment (P < 0.0001). The rates of suicidal behavior during treatment with SSRIs or TCAs were similar. CONCLUSION: Suicidal behaviour in unipolar depressed patients treated with antidepressants increases substantially after medication discontinuation. This effect occurred in both patients who were maintained on SSRIs and TCAs. The findings support a possible protective effect on suicidal behaviour for both SSRIs and TCAs.


Subject(s)
Antidepressive Agents, Tricyclic/therapeutic use , Depressive Disorder/drug therapy , Selective Serotonin Reuptake Inhibitors/therapeutic use , Suicide, Attempted , Adult , Antidepressive Agents, Tricyclic/adverse effects , Depressive Disorder/epidemiology , Drug Monitoring , Female , Humans , Male , Retrospective Studies , Selective Serotonin Reuptake Inhibitors/adverse effects , Substance Withdrawal Syndrome/etiology , Suicide, Attempted/statistics & numerical data , United States/epidemiology
2.
J Affect Disord ; 67(1-3): 167-73, 2001 Dec.
Article in English | MEDLINE | ID: mdl-11869764

ABSTRACT

BACKGROUND: Previous research has identified a high rate of anxiety disorders comorbidity in patients with a primary mood disorder diagnosis. Discrepancies between studies in the comorbidity prevalence of specific anxiety disorders in mood disorders, and of anxiety disorders comorbidity between unipolar depression and bipolar mood disorder are in part due to differences in sampling and diagnostic assessment methodology. METHOD: The authors reviewed the charts of 138 patients who received the SCID-P for DSM-III on enrollment in a Mood Disorders Clinic during the period 1982 through 1988. The comorbidity of specific DSM-III Anxiety Disorders with specific mood disorders was determined and comparatively examined using non-parametric statistics. RESULTS: There was high overall comorbidity of anxiety disorders that did not differ between bipolar and unipolar subjects. There were no differences in the comorbidity of individual anxiety disorder diagnoses in the unipolar vs. bipolar groups. However, in unipolar patients with, compared to those without an additional diagnosis of dysthymia, there was greater overall anxiety disorders comorbidity, with a particularly high prevalence of generalized anxiety disorder. LIMITATION: The subgroup of patients with bipolar I disorder was relatively small (N=8). CONCLUSION: Mood and anxiety disorders comorbidity is complex and presents a continuing challenge for both clinicians and researchers.


Subject(s)
Anxiety Disorders/psychology , Mood Disorders/psychology , Adult , Anxiety Disorders/epidemiology , Comorbidity , Female , Humans , Male , Middle Aged , Mood Disorders/epidemiology , Prevalence , Psychometrics , Retrospective Studies
3.
J Affect Disord ; 53(2): 109-22, 1999 May.
Article in English | MEDLINE | ID: mdl-10360405

ABSTRACT

BACKGROUND: previous research has been inconclusive about the nature of hemispheric asymmetry in emotional processing. METHOD: 13 patients with DSM-IV bipolar disorder received repeated QEEGs over 2 years in different mood states. Z-score measures of asymmetry were assessed. RESULTS: asymmetry in frontotemporal slow-wave activity appeared to be in opposite directions in depression compared to mania/hypomania. CONCLUSIONS: mood change in bipolar disorder is associated with change in QEEG asymmetry. LIMITATIONS: study of larger numbers of more homogenous patients under similar conditions is needed. CLINICAL RELEVANCE: study of mood state-dependent asymmetry changes in bipolar disorder may lead to better understanding of hemispheric processing of emotion.


Subject(s)
Bipolar Disorder/complications , Bipolar Disorder/diagnosis , Brain/physiology , Depressive Disorder/complications , Depressive Disorder/diagnosis , Electroencephalography , Functional Laterality/physiology , Adult , Female , Humans , Longitudinal Studies , Male , Middle Aged , Psychiatric Status Rating Scales , Severity of Illness Index
5.
Psychiatry Res ; 29(1): 29-35, 1989 Jul.
Article in English | MEDLINE | ID: mdl-2672062

ABSTRACT

Eleven females and five males with fall/winter seasonal affective disorder were randomly assigned to 7-day treatment regimens from 8 p.m. to 10 p.m. using identical light at 2000 or 300 lux. A modified Hamilton Rating Scale for Depression and a Beck Depression Inventory were administered before treatment, after treatment # 7, and 2 weeks after phototherapy was terminated. Analysis of variance with repeated measures revealed a significant interaction between sex of the patient, intensity of the lights, and day of rating for scores on both the modified Hamilton Rating Scale for Depression and the Beck Depression Inventory. For both measures, the interaction occurred because all groups showed a decrease in depression ratings during the phototherapy exposure period, but only females at the higher intensity continued to have low depression scores 2 weeks after light treatment had stopped. These data indicate that bright light at both high (2000 lux) and low (300 lux) intensities is able to reduce depression in patients with seasonal affective disorder. The data also indicate that both sex of the patient and intensity of the light may interact to determine the latency to relapse.


Subject(s)
Depressive Disorder/therapy , Phototherapy/methods , Seasons , Adult , Clinical Trials as Topic , Depressive Disorder/psychology , Female , Humans , Male , Psychiatric Status Rating Scales , Random Allocation
7.
Psychiatry Res ; 18(4): 355-64, 1986 Aug.
Article in English | MEDLINE | ID: mdl-3749392

ABSTRACT

Previous research has indicated that exposure to bright fluorescent light can benefit clinically depressed individuals. The present study, a 1- to 2-week open trial of bright (greater than or equal to 2,000 lux) incandescent light with seasonal (fall/winter) and nonseasonal depressives, produced a therapeutic effect on seasonal depression, as measured by three criteria for recovery: final score on the Hamilton Rating Scale for Depression (HRSD) less than 10; final HRSD score less than or equal to 50% of pretreatment HRSD score; no longer meets DSM-III criteria for major depressive disorder. Phototherapy was not effective in the nonseasonal patients, whose functioning was more impaired than that of the seasonal subjects even before the trial. No adverse effects were observed in any patient.


Subject(s)
Depressive Disorder/psychology , Lighting , Seasons , Adult , Depressive Disorder/therapy , Female , Humans , Male , Psychiatric Status Rating Scales
9.
Psychiatry Res ; 14(3): 209-13, 1985 Mar.
Article in English | MEDLINE | ID: mdl-3858893

ABSTRACT

Four weekly repetitions of the overnight dexamethasone suppression test (DST) in each of 10 healthy volunteers yielded plasma cortisol levels that were consistently suppressed. These results suggest that unlike some dynamic tests of hypothalamic-pituitary functioning, the DST does not produce false-positive results due to weekly repetition. This finding is of interest because previous research has demonstrated that a subgroup of melancholic initial nonsuppressors continue to resist cortisol suppression despite apparent clinical improvement. The present findings do not support the hypothesis that continued nonsuppression in clinically improved patients is an artifact of serial testing.


Subject(s)
Dexamethasone , Hydrocortisone/blood , Adult , Circadian Rhythm , Female , Humans , Kinetics , Male , Radioimmunoassay , Reference Values
10.
Am J Psychiatry ; 142(2): 192-8, 1985 Feb.
Article in English | MEDLINE | ID: mdl-3970243

ABSTRACT

The REM latencies of 24 nonschizotypal borderline outpatients--who were not in the midst of a major depressive episode--were in the range of those of 30 patients with primary major depression but were significantly shorter than those of 16 patients with nonborderline personality disorders and 14 nonpsychiatric controls. Also, more of the borderline subjects had lifetime diagnoses of affective disorder, such as dysthymic, cyclothymic, and bipolar II disorder, and of a spectrum of anxiety and somatization disorders. The authors conclude that contemporary operational criteria for borderline disorder identify a wide net of temperamental disorders with strong affective coloring rather than a unitary nosologic entity.


Subject(s)
Borderline Personality Disorder/classification , Personality Disorders/classification , Sleep, REM , Adult , Ambulatory Care , Borderline Personality Disorder/diagnosis , Borderline Personality Disorder/physiopathology , Depressive Disorder/classification , Depressive Disorder/diagnosis , Depressive Disorder/physiopathology , Diagnosis, Differential , Female , Humans , Male , Manuals as Topic , Middle Aged , Mood Disorders/classification , Mood Disorders/diagnosis , Mood Disorders/physiopathology , Personality Disorders/diagnosis , Personality Disorders/physiopathology , Psychiatric Status Rating Scales
11.
Am J Psychiatry ; 141(9): 1101-2, 1984 Sep.
Article in English | MEDLINE | ID: mdl-6147104

ABSTRACT

A 52-year-old woman with bipolar disorder, rapid-cycling type, developed delirium while taking therapeutic doses of carbamazepine and neuroleptics. Her cognitive changes were attributed to a drug interaction at the CNS level.


Subject(s)
Antipsychotic Agents/adverse effects , Bipolar Disorder/drug therapy , Carbamazepine/adverse effects , Delirium/chemically induced , Drug Interactions , Female , Haloperidol/adverse effects , Humans , Imipramine/adverse effects , Middle Aged , Thioridazine/adverse effects
12.
J Clin Psychiatry ; 45(7): 315-6, 1984 Jul.
Article in English | MEDLINE | ID: mdl-6735991

ABSTRACT

A case of thrombocytopenia associated with carbamazepine use is reported, and previous reports of adverse hematologic effects in patients taking carbamazepine are discussed. With increasing use of carbamazepine in the treatment of affective disorders, psychiatrists will need to be aware of the drug's hematologic side effects, and institute appropriate monitoring procedures.


Subject(s)
Carbamazepine/adverse effects , Thrombocytopenia/chemically induced , Aged , Blood Cell Count , Carbamazepine/therapeutic use , Depressive Disorder/drug therapy , Female , Humans , Mood Disorders/blood , Mood Disorders/drug therapy
13.
Psychiatry Res ; 12(2): 155-60, 1984 Jun.
Article in English | MEDLINE | ID: mdl-6591220

ABSTRACT

To evaluate the influence of weight loss on the dexamethasone suppression test (DST), we studied 61 patients with major depressive disorder as defined by the Research Diagnostic Criteria, 59 healthy normal volunteers, and 16 volunteers who lost weight by dieting. Nonsuppression on the DST was not correlated to weight loss in the depressed patients. Of the healthy volunteers, 12.5% converted to nonsuppression status. This conversion rate is not significantly different from nonsuppression rates in the normal population. Implications of these findings are discussed.


Subject(s)
Body Weight , Depressive Disorder/physiopathology , Dexamethasone , Hydrocortisone/blood , Humans , Hypothalamo-Hypophyseal System/physiopathology , Personality Inventory , Pituitary-Adrenal System/physiopathology , Retrospective Studies
15.
Am J Psychiatry ; 141(1): 116-8, 1984 Jan.
Article in English | MEDLINE | ID: mdl-6691427

ABSTRACT

Twenty patients with major depressive disorder defined by the Research Diagnostic Criteria were given a range of neuropsychological tests and evaluated with the dexamethasone suppression test (DST). No correlation was found between results on the DST and cognitive impairment.


Subject(s)
Depressive Disorder/diagnosis , Dexamethasone , Psychological Tests , Adult , Cognition , Depressive Disorder/blood , Depressive Disorder/psychology , Female , Humans , Hydrocortisone/blood , Male
16.
Psychiatry Res ; 10(3): 175-81, 1983 Nov.
Article in English | MEDLINE | ID: mdl-6320245

ABSTRACT

Sixteen patients with major depressive disorder who were nonsuppressors on the dexamethasone suppression test (DST) on hospital admission were studied for plasma levels of adrenocorticotropic hormone (ACTH). Eight patients reverted to normal suppression with clinical recovery, while eight remained nonsuppressors. There was a significant reduction of ACTH levels in those who normalized on their DST, while ACTH levels remained high in the group that continued to be nonsuppressors. The results favored the hypothesis that dexamethasone nonsuppression in depression is mediated by high ACTH levels.


Subject(s)
Adrenocorticotropic Hormone/blood , Depressive Disorder/diagnosis , Dexamethasone , Depressive Disorder/blood , Humans , Hydrocortisone/blood , Radioimmunoassay
17.
J Affect Disord ; 5(3): 191-7, 1983 Aug.
Article in English | MEDLINE | ID: mdl-6224831

ABSTRACT

Fourteen patients with RDC diagnosis of primary, endogenous, major depressive disorder were studied in an inpatient setting. All were non-suppressors on the Dexamethasone Suppression Test on admission to hospital and were retested at discharge. Over 70% of patients continued to be non-suppressors at discharge, when in clinical remission. Four out of 14 patients converted to normal suppression. All 10 of the non-normalizers did poorly on follow-up: 3 patients committed suicide. All normalizers did well. Non-normalization of the DST at discharge from hospitalization may be more common than previously suspected and predicts poor clinical outcome.


Subject(s)
Depressive Disorder/diagnosis , Dexamethasone , Adult , Aged , Female , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Patient Discharge , Prognosis , Prospective Studies
18.
Arch Gen Psychiatry ; 40(7): 801-10, 1983 Jul.
Article in English | MEDLINE | ID: mdl-6344834

ABSTRACT

Although characterologic constellations such as obsessionalism, dependency, introversion, restricted social skills, and maladaptive self-attributions are popularly linked to the pathogenesis of depressive disorders, the evidence in support of this relationship remains modest. Indeed, many of these attributes may reflect state characteristics woven into the postdepressive personality. Current evidence is strongest for introversion as a possible premorbid trait in primary nonbipolar depressions. By contrast, driven, work-oriented obsessoid, extroverted, cyclothymic, and related dysthymic temperaments appear to be the precursors of bipolar disorders. Other personalities, while not necessarily pathogenic in affective disorders, nevertheless may modify the clinical expression of affective disorders and their prognosis.


Subject(s)
Mood Disorders/psychology , Personality , Character , Cyclothymic Disorder/psychology , Dependency, Psychological , Depressive Disorder/psychology , Extraversion, Psychological , Humans , Introversion, Psychological , Mood Disorders/diagnosis , Prognosis , Self Concept , Social Adjustment
19.
Psychiatry Res ; 9(1): 45-51, 1983 May.
Article in English | MEDLINE | ID: mdl-6310664

ABSTRACT

The failure of adequate cortisol suppression after 1 mg dexamethasone in 50% of patients with endogenous depression has been attributed to abnormal hypothalamic-pituitary-adrenal axis regulation, resulting in high levels of adrenocorticotropic hormone (ACTH). Because studies of plasma ACTH have been conflicting, we studied plasma ACTH levels during the 24-hour dexamethasone suppression test in a homogeneous group of 29 hospitalized patients with primary endogenous depression and 19 normal volunteers. No differences were found in ACTH levels among normal volunteers, depressed cortisol suppressors, and depressed cortisol nonsuppressors at either 4 p.m. or 11 p.m.


Subject(s)
Adrenocorticotropic Hormone/blood , Depressive Disorder/diagnosis , Dexamethasone , Adult , Depressive Disorder/blood , Female , Humans , Hydrocortisone/blood , Male
20.
Psychiatry Res ; 5(3): 267-76, 1981 Dec.
Article in English | MEDLINE | ID: mdl-6948309

ABSTRACT

The discriminatory power of rapid eye movement (REM) density in 61 outpatients with medical, neurologic, and psychiatric disorders and 8 noncase controls was assessed. REM density was significantly lower in a group of patients with medical-neurologic disease as compared with psychiatric and control subjects without evidence for such disease. Furthermore, low scores discriminated depressions occurring in the context of somatic disease when compared with those in the absence of such disease. The differences between groups were not accounted for by age or sex. The cutoff REM density score of 12.56, based on the 99% lower confidence limit of the noncase controls, provided the highest sensitivity (0.82) without loss of specificity (0.80). It was concluded that REM density may have merit as a general measure of diffuse central nervous system pathology, whether primary or secondary to widespread systemic disease. The findings of Kupfer's group are upheld and extended to a broader medical and neuropsychiatric population than in the original Pittsburgh study.


Subject(s)
Electroencephalography/methods , Mental Disorders/diagnosis , Nervous System Diseases/diagnosis , Sleep, REM , Adult , Agoraphobia/diagnosis , Anxiety Disorders/diagnosis , Bipolar Disorder/diagnosis , Depressive Disorder/diagnosis , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Obsessive-Compulsive Disorder/diagnosis , Personality Disorders/diagnosis , Sex Factors , Somatoform Disorders/diagnosis
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