Responders to antidepressant drug treatment: a study comparing nefazodone, imipramine, and placebo in patients with major depression.

BACKGROUND: Nefazodone hydrochloride, an antidepressant that acts as a 5-HT2 antagonist and serotonin (5-HT) and norepinephrine uptake inhibitor, was evaluated in a double-blind, imipramine- and placebo-controlled study involving 128 patients with major depression. METHOD: Eligible patients were randomly assigned to receive placebo (2 to 6 capsules/day), imipramine (100 to 300 mg/day), or nefazodone (200 to 600 mg/day) for 8 weeks. The principal efficacy outcome measure assessed was the number of patients who experienced an adequate response during treatment. RESULTS: Based on global improvement (Clinical Global Impressions-Improvement), 67% of nefazodone-treated patients (p < or = .01) and 63% of imipramine-treated patients (p < or = .05) responded during 8 weeks of treatment, compared with 36% of placebo controls. Sixty-two percent of nefazodone-treated, 53% of imipramine-treated, and 26% of placebo-treated patients had 17-item Hamilton Rating Scale for Depression (HAM-D-17) scores < or = 10 on completion of acute treatment. Nefazodone-treated patients had a lower incidence of premature treatment discontinuation and fewer dropouts for adverse events than the imipramine group. CONCLUSION: In a three arm comparison with imipramine and placebo, nefazodone had the greatest number of patients with major depression who responded to therapy. Nefazodone, a new antidepressant with novel pharmacology, is a well-tolerated, efficacious antidepressant.

Two combined, multicenter double-blind studies of paroxetine and doxepin in geriatric patients with major depression.

Depressive illness among the elderly is an important public health concern. However, treatment of the elderly may be complicated by age-related changes in physiology, general medical status, and susceptibility to side effects. There is therefore a need for improved treatment modalities for depressed elderly patients. Paroxetine is an antidepressant that acts through selective inhibition of serotonin reuptake. It lacks the anticholinergic and cardiovascular side effects of most first- and second-generation antidepressants. The authors present the combined data from two similarly designed comparisons of paroxetine and doxepin in outpatients over 60 years of age with major depression. The results show that paroxetine was an effective as doxepin in alleviating depression as measured on the Hamilton Rating Scale for Depression (HAM-D) total score, the Montgomery and Asberg Depression Rating Scale (MADRS), and the Hopkins Symptom Checklist (SCL) depression factor score. Paroxetine was significantly superior to doxepin on the Clinical Global Impressions (CGI) scale for severity of illness, the HAM-D retardation factor, and the HAM-D depressed mood item. Doxepin produced significantly more anticholinergic effects, sedation, and confusion. Paroxetine was associated with more reports of nausea and headache. These results suggest that paroxetine may be a valuable tool for the treatment of major depression in the elderly.

Antidepressant efficacy of sertraline: a double-blind, placebo- and amitriptyline-controlled, multicenter comparison study in outpatients with major depression.

A double-blind, placebo- and amitriptyline-controlled comparison study was performed to evaluate the antidepressant efficacy of sertraline, a specific serotonin uptake inhibitor. Patients with DSM-III-defined major depression randomly received either sertraline (N = 149), amitriptyline (N = 149), or placebo (N = 150) once daily for the 8-week study period. The mean final daily medication dose for the all-patients group was 145 mg and 104 mg for the sertraline- and amitriptyline-treatment groups, respectively. As measured by the Hamilton Rating Scale for Depression and the Clinical Global Impressions Scale, both the sertraline and amitriptyline treatment groups showed a significantly greater improvement from baseline (p less than or equal to .001) than the placebo group. The sertraline group had a higher proportion of gastrointestinal complaints and male sexual dysfunction than either the amitriptyline or the placebo group. The amitriptyline group showed a higher proportion of anticholinergic and sedative side effects and dizziness compared with patients who received either sertraline or placebo.

Double-blind, multicenter comparison of sertraline and amitriptyline in elderly depressed patients.

Two hundred forty-one elderly depressed patients entered the 8-week, double-blind phase of this parallel-group, multicenter study; 161 patients were randomized to receive sertraline (50-200 mg/day) and 80 were randomized to receive amitriptyline (50-150 mg/day). Among evaluable patients, there were no statistically significant differences between treatments in any of the primary efficacy variables: change in total Hamilton Rating Scale for Depression (HAM-D) score (17 items), percentage change in HAM-D score, change in HAM-D Item 1, change in Clinical Global Impressions (CGI) Severity score, change in the Depression Factor of the 56-item Hopkins Symptom Checklist, and the CGI Improvement score at the last visit. Similar results were obtained using data from all patients (intention-to-treat analysis), except that amitriptyline was superior in HAM-D Total score (p = .044). The two drugs produced a similar degree of response: on the basis of the HAM-D criterion, 69.4% of sertraline patients and 62.5% of amitriptyline patients responded, and, on the basis of CGI criterion, 79.5% of sertraline and 73.4% of amitriptyline patients responded. Twenty-eight percent of the sertraline patients withdrew from the study because of a treatment-related side effect and 2.5% (4) because of a laboratory abnormality. In comparison, 35% of the amitriptyline patients withdrew because of treatment-related side effects. Sertraline was associated with a statistically lower frequency of somnolence, dry mouth, constipation, ataxia, and pain and a higher frequency of nausea, anorexia, diarrhea/loose stools, and insomnia; thus, anticholinergic effects were less common and gastrointestinal effects were more common with sertraline than with amitriptyline.(ABSTRACT TRUNCATED AT 250 WORDS)

MMPI results: a comparison of trauma victims, psychogenic pain, and patients with organic disease.

Made comparison using MMPI T scores on three private psychiatric sub-populations: Post-trauma patients, patients with organically based illness, and patients with psychogenic pain (complaints functional in origin) (N = 78). The standard 3 validity and 10 clinical scales were used to evaluate possible differences among the groups. Differences were presented among the groups on scales 3 (Hy), 9 (Ma), and (F). Individual profiles also were assessed. In patients with a 1-3/3-1 profile, the psychogenic group had significantly higher elevation over the post-trauma and organic groups. In patients with 8 (Sc) or 9 (Ma) high both with and without 1-3/3-1 high, differences were found; the post-trauma and organic groups showed marked elevation over those in the psychogenic group. Results indicate the MMPI to be a viable aid in distinguishing between patients with post-trauma stress disorder vs. those with functional disorders. The data suggest that MMPI profiles of patients with post-trauma stress disorder more closely resemble the MMPI profiles of patients who have organic disease with pain caused by organic pathology than the profiles of patients with psychogenic pain and/or hypochondriasis.

MMPI code types and DSM-III diagnoses.

Examined the relationship of the MMPI high-point codes and the diagnostic system of the Diagnostic Statistical Manual III of the American Psychiatric Association. Five psychiatrists reanalyzed the patients' records and rendered a DSM-III diagnosis. In all, 24 code types were identified from the private psychiatric clinic sample (N = 261). The resulting clusters of diagnostic classification are presented, and, additionally, a narrative summation for each code type is given.

Post head trauma syndrome in an adolescent treated with lithium carbonate--case report.

A twelve year old black male sustained closed head trauma, following which he developed agitated hypomanic behavior. After failure to respond to several treatment modalities, he was begun on lithium carbonate for six months, at which time the medication was discontinued without recurrence of pathological behavior.

Capgras' syndrome presenting as postpartum psychosis.

A 25-year-old white woman was hospitalized with a postpartum psychosis presenting as an affective disorder with the delusion of Capgras. She was treated with electroconvulsive therapy with resolution of her affective and delusional states.

A case of blood-illness-injury phobia treated behaviorally.

A patient with a 24-year history of blood-illness-injury phobia associated with bradycardia and syncope was treated behaviorally. He was taught to prevent bradycardia and resulting syncope occurring in the presence of phobic stimuli by provoking anger in himself using appropriate imagery. Within a few weeks, the patient was able to use the procedure successfully to prevent syncope in everyday situations. At 6 months follow-up he remained comfortable in the presence of previously phobic stimuli and he no longer needed to use self-induced anger to prevent syncopal episodes.

Histamine: effect on self-stimulation.

When injected discretely into the lateral hypothalamus of rats, histamine inhibited electrical self-stimulation at the injection site without affecting self-stimulation in the contralateral lateral hypothalamus. This effect was blocked by prior treatment with antihistaminics. Histidine, the amino acid precursor of histamine, produced a similar effect after a delay of 6 to 10 minutes.