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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two patients with severe Parkinson's disease were treated with electroconvulsive therapy for a supervening depression. Not only did the symptoms of depression clear up after only four treatments, but the parkinsonian signs also showed striking and sustained improvement. This may be related to ECT-induced changes in dopamine and norepinephrine metabolism. Parkinsonism does not appear to be a contraindication to ECT. On the contrary, ECT may be the treatment of choice for certain patients with Parkinson's disease, whether nor not it is complicated by intractable depression.
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PMID:Improvement of Parkinsonism in depressed patients treated with ECT. 111 72

Electroconvuslive therapy alleviated the symptoms of four out of six patients suffering from chronic pain and from depression as measured by the Hamiliton Depression Rating Scale. All of the patients had been unsuccessfully treated with tricyclic antidepressant medication. The author suggests that ECT may be the treatment of choice for some patients with this combination of symptoms.
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PMID:Electroconvulsive therapy for chronic pain associated with depression. 112 7

Twenty-four patients receiving unilateral electroconvulsive therapy for depression were given the first treatment with electrodes on the left or right side of the head and the second treatment with electrodes on the opposite side. They were tested with the Word Associate Learning subtest of the Wechsler Memory Scale when fully responsive after the first ECT and after the same time interval following the second ECT. Twelve were left-handed and 12 were right-handed writers. In both groups, better scores were usually obtained after right-sided treatment. Redistribution of patients into sinistral, mixed, and dextral groups showed that this difference between the effects of left and right-sided ECT was significant only in dextrals. Only two right-handed writers had scores indicating right-sided dominance for speech; both were 'shifted sinistrals'. Left hemisphere dominance was indicated in 67% of all non-dextrals. Eight of nine patients in whom testing was repeated after a second pair of treatments on alternate sides obtained scores favouring the same side in both pairs of testing. Findings indicate the need for closer inquiry into handedness than is often made before unilateral ECT is prescribed. Further development of unilateral ECT for establishing cerebral dominance in individuals is supported by the results.
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PMID:Investigation of cerebral dominance in 'left-handers' and 'right-handers' using unilateral electroconvulsive therapy. 115 21

Forty depressed in-patients for whom electro-convulsive therapy had been prescribed were rated before treatment on depression and anxiety scales. Side effects, post-operative agitation and retrograde memory impairment were assessed in each patient after each of several treatments. Results were compared when no tranquillizer was given and when either diazepam or haloperidol was administered intravenously immediately before the anaesthetic. It was found than when ECT was given without tranquillization, the incidence and severity of post-operative agitation and of side effects were significantly greater in those patients with a high level of anxiety before treatment. Both diazepam and haloperidol were found to be effective in subduing agitation and side effects in anxious, depressed patients, but with diazepam recovery time was longer.
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PMID:Intravenous tranquillization with ECT. 120 56

Tricyclic antidepressants are extremely valuable drugs when they are used in suitable patients, principally those suffering from endogenous depressions. Diagnosis of depression is of major importance in determining the nature of treatment to be used. Differences between most tricyclics are minor for the most part, involving different degrees of sedative or anticholinergic properties. With the exception of doxepin, they are about equally effective in blocking the amine pump mechanism, which is believed to be the pharmacologic action most pertinent to their antidepressant action. A wide range of dose must be explored if patients are to be treated properly. For the most part, doses are defined empirically, either by alleviation of depression or by intolerable side effects. Dosage schedules should be flexible initially but during therapeutic and maintenance periods, single daily doses are possible. Maintenance doses should be reduced to the lowest consistent with continued relief. Treatment should be brief if the episode of depression is the first and is not severe, but may be prolonged for years in patients with a history of frequent and severe recurrences of depression. Other drugs may sometimes be required, and psychological approaches to treatment are always required. ECT should be available for selected instances of severe depression. The hazards of tricyclics are well known and generally are extensions of known pharmacologic effects. Careful prescribing of these drugs can minimize the consequences of suicidal or accidental overdose.
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PMID:Clinical use of tricyclic antidepressants. 125 67

While psychotherapy is the treatment of choice in neurotic situational depressions of older patients, it is not effective enough in endogenous bipolar or monopolar depression of elderly. These respond better to somatic therapy, mainly pharmacotherapy, or, if necessary, ECT. Experience shows the aged endogenous depressions respond favorably to tricyclic antidepressants as well as to mono-amino oxidase inhibitors, although the dosage may have to be kept lower than with younger patients. ECT, if necessary, is well tolerated and effective in aged patients. However, proper precautions have to be taken before this treatment is commenced. Patients with a history or signs of recent coronary thrombosis or decompensated heart failure should be excluded. Also, the number of treatments should be kept at a minimum. The individual treatments should be spaced farther apart and so-called "intensive treatment" avoided. If an endogenous depression lasts for more than 2 years and does not respond to any other kind of treatment, psychosurgery may have to be considered. Experience has shown that long-lasting, deep depressions of the aged can be helped by this method without any important personality change.
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PMID:Somatic therapies in older depressed patients. 127 Jul 65

Eight cases of resistant recurrent depression were treated with a combination of nortriptyline and a new serotonin reuptake inhibitor, with or without concurrent lithium therapy. Significant improvement was seen in all patients where other drug regimes and ECT had been ineffective. No adverse reactions occurred in any of our patients, seven of whom were elderly. The combination treatment was more effective than individual therapies alone.
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PMID:Combination treatment with noradrenalin and serotonin reuptake inhibitors in resistant depression. 848 7

Many people with well defined borderline and schizotypal personality disorders may benefit considerably from small doses of neuroleptics. Depression that occurs with personality disorders, which is frequent, responds poorly to tricyclics but may respond better to neuroleptics, while the response to ECT is usually short lived. Selected borderline subjects may respond to MAOIs, particularly where there is a history of childhood hyperactivity. Carbamazepine and lithium may help some individuals with episodic behavioural dyscontrol and aggression, even in the absence of epileptic, affective or organic features. Drug treatments can be combined with psychotherapy, but further placebo-controlled trials are needed to clarify which drugs are most useful, and whether there are any useful clinical predictors of drug responsiveness.
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PMID:Drug treatment of the personality disorders. 842 26

ECT-induced cortisol release was distinctly seen, and fell along a course of ECT in each of 12 inpatient male melancholics (p = 0.00024, binomial), with dexamethasone given to diminish the elevated baseline cortisol levels typically seen in depression. Cortisol release dropped on average by 55% (p = 0.015), from 16.6 +/- 6.8 micrograms/dl (p = 0.000002) with the first ECT to 8.0 +/- 7.7 micrograms/dl (p = 0.000003) after 6 or more ECTs. The fall along the course was larger with unilateral ECT than bilateral ECT (p = 0.042), although significant regardless of electrode placement, suggesting that unilateral ECT tends to lose therapeutic impact along a course in comparison to bilateral ECT.
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PMID:Electroconvulsive therapy-induced cortisol release after dexamethasone in depression. 140 78

In order to test the effects of various biological treatments on serotonergic function in depression, twenty-one patients with a diagnosis of major depression underwent neuroendocrine challenge tests before and after treatment with either ECT, fluoxetine or amitriptyline. The serotonin (5-HT) releasing agent d-fenfluramine was used as a challenge drug and cortisol (CORT) and prolactin (PRL) plasma levels were monitored over a 5-h period. Overall PRL responses were significantly enhanced following pharmacotherapy irrespective of therapeutic outcome. Effective treatment in each case lowered baseline CORT levels but CORT response to d-fenfluramine remained blunted. Hypercortisolaemia may be involved in the impaired pretreatment PRL response as a strong inverse relationship was established, for the combined studies, between basal CORT plasma concentrations and PRL responses.
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PMID:D-fenfluramine-induced prolactin and cortisol release in major depression: response to treatment. 146 Jan 63


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