Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Effective drugs for mental disorders have been found by serendipitous findings not supported by knowledge of psychopharmacology. Drug are assigned labels, such as "antidepressant" without knowledge that such a label delimits the utility of such agents. Many double-blind controlled studies have shown that imipramine effectively ameliorates panic attacks and agoraphobia. Epidemiological data show a relationship between Panic Disorder and Depression. Relatives of probands with Major Depression plus an Anxiety Disorder were at greater risk for both Major Depression and for an Anxiety Disorder. Panic Disorder, as a subcategory of Anxiety Disorder was associated with the greatest increased risk. Intravenous sodium lactate reliably produces anxiety attacks clinically indistinguishable from those occurring in Panic Disorder, in subjects with that disorder. Panic Disorder is characterized by response to imipramine, an epidemiological link to Affective Disorder, and is similar to panic induced by infusion of sodium lactate.
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PMID:Panic disorder: response to sodium lactate and treatment with antidepressants. 388 90

An algorithm for transcribing Research Diagnostic Criteria diagnoses for depressive disorders to similar categories in the DSM-III was applied to 103 depressed outpatients previously diagnosed by Research Diagnostic Criteria. All had Hamilton Depression Rating Scale scores of 18 or less. Among 64 patients completing a six-week, double-blind study comparing desipramine hydrochloride with placebo, desipramine was significantly more effective than placebo in patients with DSM-III major depression but not in those with dysthymic disorder. Among patients with major depression, a significant drug-placebo response difference was demonstrated even in those without melancholia. These findings support the clinical usefulness of the DSM-III in the treatment of depressed outpatients. Independent of DSM-III diagnosis, however, evidence of panic attacks seemed to identify patients who benefited from desipramine therapy. This suggests that the DSM-III hierarchy, which excludes consideration of panic in patients with major depression, may require revision.
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PMID:Treatment outcome validation of DSM-III depressive subtypes. Clinical usefulness in outpatients with mild to moderate depression. 390 79

The authors present a review of existing literature along with new data regarding the phenomenology, differential diagnosis, course and treatment of panic disorder and agoraphobia. Panic attacks are viewed as central to the development of these disorders, and individual cognitive frameworks contribute to the manner in which a patient's symptoms evolve. An apparent though unclear relation to depressive states is described. Substance abuse may also be a consequence of recurrent panic attacks. A scheme towards differential diagnosis of panic disorder from other psychiatric and medical disorders is proposed. Personality characteristics of these patients vary considerably, but certain factors, such as dependency, are common. Family relations are often strained and assume importance in treatment. Data on the longitudinal course of illness is presented implying a relationship of panic disorder to both depression and stressful life events in many patients. Treatments that thus far seem most effective are pharmacological and behavioural approaches. Imipramine, MAO inhibitors, and alprazolam currently appear to be the most useful medications employed, although other agents may at times be useful alternatives. Dietary interventions, family therapy, and group and individual psychotherapy are also reviewed and discussed as adjunctive therapies in the treatment of panic disorder.
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PMID:Differential diagnosis and treatment of panic disorder: a medical model perspective. 391 78

Forty-three patients with panic disorder or agoraphobia with panic attacks and 20 control subjects received 0.5 M racemic sodium lactate intravenous infusions, single-blind as to duration and sequence. During the procedure, pulse; blood pressure; blood L-lactate and pyruvate; plasma ionized calcium, phosphate, prolactin, epinephrine, norepinephrine, and cortisol levels; and venous PCO2, pH, and bicarbonate were measured in an attempt to clarify the mechanism of lactate-induced panic attacks. During the infusion, 72% of the patients but none of the control subjects had panic attacks. The laboratory findings suggest that peripheral catecholamine surge is not the mechanism by which lactate causes panic, although elevated epinephrine may be a predisposing factor. Heightened central noradrenergic activity was present in many but not all of the attacks. Contrary to previous hypotheses, neither depression of ionized calcium nor induction of metabolic alkalosis appears sufficient to cause panic during lactate infusion.
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PMID:Possible mechanisms for lactate's induction of panic. 395 91

Intravenous sodium lactate was given to seven patients with primary depression and secondary panic attacks and 26 patients with panic disorder or agoraphobia with panic attacks. The two groups had similar rates of panic response. These results challenge the diagnostic specificity of lactate-induced panic.
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PMID:Lactate-induced panic in primary affective disorder. 396 56

Patients diagnosed as having agoraphobia with panic attacks by DSM-III criteria were evaluated with the dexamethasone suppression test (DST). Depressive symptoms were assessed using the Beck Depression Inventory, the Depression Scale of the Minnesota Multiphasic Personality Inventory, and the Hamilton Rating Scale for Depression. Of 97 patients tested, 12.4% had a positive DST. These findings are consistent with earlier reports that found an incidence of abnormal DSTs between 11% and 15% in agoraphobic patients. Abnormal DSTs did not correlate with levels of depression on any of the depression measures.
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PMID:The dexamethasone suppression test in agoraphobia. 398 66

The longitudinal course of panic disorder and its associated symptoms were investigated in thirty-eight patients. The temporal relationships among panic attacks, generalized anxiety, agoraphobia and depression are described. Similar and different biological alterations in the tricyclic-responsive disorders of primary depression and panic disorder are reviewed and discussed.
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PMID:Longitudinal course of panic disorder: clinical and biological considerations. 399 12

The authors administered the dexamethasone suppression test (DST) to outpatients, who were free from psychoactive drugs for at least 10 days before the test, with primary affective disorder (N = 60), generalized anxiety disorder (N = 26), panic disorder (N = 22), and agoraphobia with panic attacks (N = 13). With a cortisol value of 5 micrograms/dl considered nonsuppression, there were no significant differences in dexamethasone nonsuppression rates among the diagnostic groups. Scores on the Hamilton Rating Scale for Depression and a melancholia subscale were significantly higher in the depressed group than in the anxiety disorder group. The findings raise questions concerning the specificity of the DST for primary affective disorder in relationship to anxiety disorders.
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PMID:The DST in psychiatric outpatients with generalized anxiety disorder, panic disorder, or primary affective disorder. 401 7

Depression is not only a common disorder, but also one that is readily treatable. Antidepressant drugs play a major role in treatment, although concurrent use of electroconvulsive therapy or psychotherapy may be indicated for some patients. Antidepressant drugs have been most specifically beneficial for patients with 'endogenous' depressions, but they should be used whenever this type of depression cannot be definitely ruled out. Besides the older tricyclic antidepressants and monoamine oxidase inhibitors, a new 'second generation' group of drugs is now available. Although these drugs offer no great therapeutic advantages over the older ones, they may prove to have a more acceptable profile of side effects, may act more quickly, and may show less cardiotoxicity with overdoses. Whether one can classify depression pathogenetically according to various biological markers, such as urinary excretion of the norepinephrine metabolite, 3-methoxy-4-hydroxy phenylglycol, is still uncertain. At present, the choice of antidepressant drug for an individual patient is largely empirical. Besides being useful for treating depression, antidepressants may be used for treating enuresis, chronically painful states, obsessive-compulsive-phobic states, acute panic attacks and cataplectic attacks in narcoleptics. Many studies have tried to define a therapeutic range of plasma concentrations of these drugs, so as to afford a better basis for dosing, but routine monitoring of drug plasma concentrations is seldom needed; the primary indication for doing so would be in the patient who has received what should be an adequate dose but who is still unresponsive. The value of maintenance treatment with antidepressants has been clearly established; the pattern it takes is best determined by the natural history of the disorder in individual patients. Most drug interactions with antidepressants are pharmacodynamic in nature and can be managed by adjusting doses. Pharmacokinetic interactions with various sympatholytic antihypertensive drugs, such as guanethidine, methyldopa and clonidine, are rare but may be serious. Patients with depression may be spared a considerable amount of discomfort, morbidity, and possibly mortality, by judicious use of antidepressant drugs and the other treatments currently available.
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PMID:Current antidepressant drugs: their clinical use. 611 51

New uses are still being discovered for a number of psychotropic agents that have been available for some time. Among the more important recent discoveries are the efficacy of the tricyclic antidepressants for panic disorder and agoraphobia with panic attacks; the use of the monoamine oxidase inhibitors for the above disorders and for atypical depression and hysteroid dysphoria; the use of propranolol for anxiety disorders and for uncontrollable violent outbursts; the antianxiety and antipanic effects of clonidine; and the usefulness of lithium in treating schizophrenia and schizoaffective disorder and for emotionally unstable character disorders. In addition to strengthening the therapeutic armamentarium, the author says, the discovery of new drug response patterns helps generate or strengthen hypotheses about the pathophysiology of various psychiatric disorders.
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PMID:Newer uses for older psychotropic medications. 612 38


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