Early onset and accumulation of REM sleep in depression: a study of the phase-advance hypothesis.

Twenty-two depressed subjects who met criteria for major depressive disorder were grouped according to their initial REM latency. Subjects with short (less than or equal to 60 min) initial REM latency were separated from those with normal (greater than 60 min) initial REM latency. Subjects with short initial REM latency were found to have earlier onsets to at least two subsequent REM periods. The number of minutes of REM sleep accumulated were also plotted against elapsed time after sleep onset. The short-latency group accumulated REM sleep earlier than, but at about the same rate as, the normal latency group. These data support the phase-advance hypothesis of REM sleep in depression.

The dexamethasone suppression test in normal control subjects: comparison of two assays and effect of age.

he authors used competitive protein binding assay and radioimmunoassay to measure cortisol levels in 38 normal control subjects three times before and three times after administration of 1 mg of dexamethasone. They found significant interassay differences at 11:00 p.m. before dexamethasone and at all three postdexamethasone times. Analysis of variance revealed significant overall positive relationships between age and cortisol levels measured by both techniques. Age correlated significantly with postdexamethasone cortisol levels measured by radioimmunoassay but not when measured by competitive protein binding assay. Clinicians should obtain data from their laboratories as to appropriate cutoffs for cortisol suppression on the specific assay used.

Toward a biochemical classification of depressive disorders, VII: urinary free cortisol and urinary MHPG in depressions.

The authors measured urinary free cortisol and urinary 3-methoxy-4-hydroxyphenylglycol (MHPG) levels in 24 severely depressed patients and 22 normal control subjects. Urinary free cortisol levels were significantly higher in the depressed patients than in the control subjects, but mean urinary MHPG levels were not significantly different in these two groups. A very high positive correlation between urinary MHPG levels and urinary free cortisol levels was found in the depressed patients but not in the control subjects.

The dexamethasone suppression test: identification of subtypes of depression.

In this study mean 4 p.m. cortisol levels were significantly higher in patients with major depression than in control subjects or in patients with bipolar depression or dysthymic-related disorders. Moreover, the distribution of values differed significantly among groups. Eighteen of 45 patients with major depression had cortisol levels of 10 micrograms/dl or more, compared with 2 of 20 bipolar depressed patients and 0 of 31 controls. Patients with very high cortisol levels (15 micrograms/dl or more) tended to fulfill criteria for major depression with mood-congruent psychosis. The distribution of values in the major depression group also suggested the existence of three major subgroups. The authors discuss the implications of these data.

The dexamethasone suppression test as a discriminator among subtypes of psychotic patients.

Plasma cortisol levels examined at 16.00 hours after dexamethasone in 31 controls and in 34 psychotic patients with various diagnoses, suggests that the ranges of such levels may help to discriminate among subtypes of psychotic patients. They were significantly higher in the unipolar depressed psychotic group than in control subjects or in psychotic patients with bipolar depression or schizophrenia. Moreover, the distribution of values differed between groups. Whereas 8 of 14 psychotic patients with unipolar depressive illness had post-dexamethasone cortisol values greater than or equal to 14 micrograms/dl, none of the remaining psychotic patients had similarly high values. Implications of these data are discussed.

Stabilization of high blood pressure with tricyclic antidepressants and lithium combinations in hypertensive patients.

Combinations of tricyclic antidepressant drugs and lithium have been used for certain types of depression. This combination of drugs has a tendency to stabilize or decrease high blood pressure among patients with hypertension, and we have observed such a phenomenon among five patients. In four patients, difficulty was encountered in withdrawing the tricyclic agent because of exacerbation of hypertension. The time required to stabilize blood pressure varied from a few days to a few weeks. Withdrawal of antihypertensive medication was possible after initiation of combination therapy with lithium and tricyclic agents in three patients. A hypothesis for the mechanism of this interesting observation is offered.

Toward a biochemical classification of depressive disorders, V: Heterogeneity of unipolar depressions.

The authors found that the mean urinary level of 3-methoxy-4-hydroxyphenylglycol (MHPG) was significantly lower in 20 patients with bipolar manic-depressive or schizoaffective depressions than in either 50 patients with unipolar depressions or 26 age- and sex-matched control subjects. In contrast, the mean MHPG levels in the total group of patients with unipolar depressions and in any subgroup defined by Research Diagnostic Criteria (RDC) were not significantly different from control values. However, examination of the distribution of urinary MHPG levels in patients with unipolar depressions in relation to other recent findings by the authors' collaborative research group suggested the existence of at least three biochemical subtypes of unipolar depressions that may, in part, be differentiated on the basis of urinary MHPG levels.

Prolactin secretion in alcoholics. / Prolactin secretion in alcoholic patients

Se determinaron los niveles de prolactina circulante en condiciones basales y la respuesta de la misma a estimulacion con tiroliberina, en un grupo de 22 pacientes alcoholicos y un grupo de sujetos sanos con caracteristicas demograficas similares El objetivo fue establecer los efectos del consumo cronico y excesivo de alcohol sobre la secrecion de prolactina por la hipofisis. Los pacientes fueron estudiados tres semana despues de haber cesado su ingestion de alcohol. Los resultados sugieren, que el consumo exagerado de alcohol por si mismo no tiene efectos permanentes en la secrecion de prolactina ni en la respuesta a tiroliberina, aun cuando en algunos pacientes se encontraron valores ligeramente menores que en sus controles.Los autores discuten la importancia que tienen las alteraciones hepaticas de causas diversas en la secrecion de prolactina asi como las diferencias y similitudes de los datos aqui descritos con otros reportados en la literatura

Prolactin in psychiatry.

Prolactin is a protein hormone synthesized and secreted by the anterior pituitary gland. Because the monoamines dopamine and serotonin are important in the control of its secretion, prolactin has been the subject of much psychoendocrine research in recent years. The authors review some of the implications of the main findings of such research as they relate to schizophrenia, affective disorders, premenstrual syndrome, and alcoholism and discuss its possible usefulness to clinicians. As a research strategy, prolactin studies have a good potential for identifying specific neurotransmitters involved in discrete psychopathologic entities.

Toward a biochemical classification of depressive disorders. III: Pretreatment urinary MHPG levels as predictors of response to treatment with maprotiline.

Pretreatment urinary MHPG levels were examined in 28 depressed patients as a possible predictor of response to treatment with maprotiline, a tetracyclic antidepressant that exerts potent effects on norepinephrine uptake, but has little effect on serotonin uptake. Maprotiline was administered in doses up to 150 mg/day during the first 2 weeks after which time the dose could be increased incrementally up to 300 mg/day if indicated clinically. At 2 weeks, patients with low pretreatment urinary MHPG levels responded more favorably to treatment than did patients with high MHPG levels. At 4 weeks, patients with low MHPG levels continued to show more favorable responses; however, differences between the two groups were less clear-cut than at 2 weeks. The findings suggest the patients with low pretreatment urinary MHPG levels are more sensitive to, and respond more rapidly to, treatment with maprotiline than patients with high pretreatment urinary MHPG levels.

Catecholamine measures for diagnosis and treatment of patients with depressive disorders.

Measurement of the catecholamine's, norepinephrine, epinephrine, metanephrine, normetanephrine, vanilmandelic acid, and 3-methoxy-4-hydroxyphenyl-glycol (MHPG) show certain statistical correlations with three clinical diagnoses. These conditions are as follows: 1) bipolar and schizo-affective depression, 2) unipolar nonendogenous depressions, and 3) schizophrenia related depressions. More specifically MHPG acts to predict which patients will require higher doses of medication, higher plasma levels, and longer treatment periods to respond to treatment.

MHPG as a predictor of antidepressant response to imipramine and maprotiline.

To explore the hypothesis that depressed patients with low pretreatment levels of urinary 3-methoxy-4-hydroxyphenylglycol (MHPG) respond more favorably to antidepressant drugs which act on noradrenergic neuronal systems than do patients with high MHPG levels, the authors administered 150--200 mg/day of imipramine or maprotiline to 13 depressed patients. All of the 5 patients with low pretreatment MHPG levels responded to treatment compared with 1 of the 14 patients with high MHPG levels; 4 patients dropped out of the study.